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Yi rijista takamaiman bayananku da takamaiman magungunan sha'awa, kuma za mu dace da bayanan da kuka bayar tare da labarai a cikin babban ma'ajin mu kuma mu aika muku da kwafin PDF ta imel a kan kari.
Piyu Parth Naik Dermatology, Saudi German Hospitals and Clinics, Dubai, United Arab Emirates Communications: Piyu Parth Naik Dermatology, Saudi German Hospitals and Clinics, Burj Al Arab, Dubai, Hadaddiyar Daular Larabawa ta waya +971 503725616 imel [email samu Kariya] Abstract : Botulinum toxin (BoNT) wani neurotoxin ne wanda kwayoyin Clostridium botulinum ke samarwa.Yana da sanannen inganci da aminci a cikin maganin hyperhidrosis na idiopathic mai mahimmanci.BoNT ya ƙunshi nau'ikan neurotoxins guda bakwai;duk da haka, kawai gubar A da B ana amfani da su a asibiti.An yi amfani da BoNT kwanan nan don maganin kashe-kashe na cututtukan fata daban-daban.Rigakafin tabo, hyperhidrosis, wrinkles, ƙananan gumi moles, asarar gashi, psoriasis, cututtukan Darier, cututtukan fata, ciwon gumi da kuma abin da ya faru na Raynaud wasu sababbin alamun BoNT ne a cikin kayan shafawa, musamman a cikin dermatology Abubuwan da ba na kwaskwarima ba.Domin yin amfani da BoNT daidai a aikin asibiti, dole ne mu fahimci aikin jiki na tsokoki na simulated.An gudanar da bincike mai zurfi na wallafe-wallafen don sabunta duk gwaje-gwajen da suka dace da dermatological da gwaje-gwaje na asibiti a kan abubuwan BoNT don ba da cikakken bayani game da amfani da BoNT a cikin dermatology.Wannan bita na nufin nazarin rawar botulinum toxin a cikin dermatology da cosmetology.Mahimman kalmomi: toxin botulinum, toxin botulinum, botulinum, dermatology, cosmetology, neurotoxin
Botulinum neurotoxin (BoNT) ta dabi'a ce ta Clostridium botulinum, wanda shine anaerobic, gram-tabbatacce, ƙwayoyin cuta masu haifar da spore.1 Ya zuwa yau, an gano nau'ikan nau'ikan nau'ikan BoNT guda bakwai (A zuwa G), kuma nau'ikan A da B ne kawai za'a iya amfani dasu don amfanin warkewa.Cibiyar Abinci da Magunguna ta Amurka (FDA) ta amince da BoNT A (Oculinum) a cikin 1989 don maganin blepharospasm da strabismus.An ƙaddara ƙimar warkewar BoNT A a karon farko.Sai Afrilu 2002 FDA ta amince da amfani da BoNT A don magance layukan glabellar.FDA ta amince da BoNT A don maganin layin gaba da layin canthal na gefe a cikin Oktoba 2017 da Satumba 2013, bi da bi.Tun daga wannan lokacin, an gabatar da tsarin BoNT da yawa zuwa kasuwa.2 Tun lokacin da aka sayar da shi, BoNT an yi amfani da shi don magance ciwon ciki, damuwa, hyperhidrosis, migraine, da tsufa na wuyansa, fuska, da kafadu a cikin wuraren kiwon lafiya da na kwaskwarima.3,4
Clostridium botulinum yana ɓoye hadaddun furotin guda uku wanda ya haɗa da 150 kDa toxin, mara guba, furotin ba hemagglutinin, da furotin na hemagglutinin mara guba.Proteases na ƙwayoyin cuta suna rushe toxin a cikin samfur mai aiki mai nau'i biyu tare da sarkar "haske" 50 kDa da sarkar "nauyi" 100 kDa.Bayan an kai shi zuwa tashar jijiyar presynaptic, nauyin nauyin nauyin guba mai aiki yana ɗaure zuwa synaptic vesicle glycoprotein 2, yana inganta endocytosis na toxin-glycoprotein hadaddun, da kuma sakin sarkar haske mai guba a cikin sararin samaniya.Toxin haske sarkar cleavage vesicle-hade membrane protein / synaptoxin (BoNT-B, D, F, G) ko synaptosome-hade protein 25 (BoNT-A, C, E) don hana saki na gefe motor neuron axon acetylcholine kuma yana haifar da wucin gadi. raunin sinadarai da gurguwar tsoka.2 A cikin Amurka, akwai shirye-shiryen BoNT-A guda huɗu na kasuwanci da FDA ta amince da su: incobotulinumtoxinA (Frankfurt, Jamus), onabotulinumtoxinA (California, US), prabotulinumtoxinA-xvfs (California, US), da abobotulinumtoxinA (Arizona, Amurka) ;da BoNT-B guda ɗaya: rimabotulinumtoxinB (California, Amurka).5 Guida et al.6 yayi sharhi game da rawar da BoNT ke takawa a fagen dermatology.Duk da haka, ba a yi wani bita na baya-bayan nan game da aikace-aikacen BoNT a fagen ilimin fata da kyau ba.Sabili da haka, wannan bita yana nufin nazarin rawar BoNT a cikin dermatology da cosmetology.
Specific keywords sun haɗa da toxin botulinum, fata mai laushi, rosacea, goge fuska, scars, wrinkles, asarar gashi, psoriasis, cututtukan fata, cututtukan Darier, moles exocrine, cututtukan gumi, sabon abu na Raynaud, hyperhidrosis A cikin martani, dermatology, da kyakkyawa, binciken labarin. Ana gudanar da su a cikin bayanan bayanai masu zuwa: Google Scholar, PubMed, MEDLINE, Scopus, da Cochrane.Marubucin ya fi neman labarai game da rawar da BoNT ke takawa a fannin ilimin fata da kwaskwarima.Binciken adabi na farko ya nuna labarai 3112.Labaran da aka buga tsakanin Janairu 1990 da Yuli 2021 suna kwatanta BoNT a cikin ilimin fata da kayan kwalliya, labaran da aka buga cikin Ingilishi, kuma duk ƙirar bincike an haɗa su cikin wannan bita.
Kanada ta amince da yin amfani da BoNT a cikin maganin kwaskwarima na ƙwayar tsoka na gida da gashin gira a cikin 2000. FDA ta Amurka ta amince da amfani da BoNT don dalilai na kwaskwarima a ranar 15 ga Afrilu, 2002. Alamomin BoNT-A kwanan nan da aka yi amfani da su a aikace-aikacen kwaskwarima sun haɗa da layi mai laushi tsakanin gira, ƙafafun hankaka, layukan zomo, layin goshi a kwance, layukan gefe, folds na hankali da ɓacin rai, makada platysma, murƙushe baki, da layukan wuya a kwance.7 Alamu don nau'in botulinum A da FDA ta Amurka ta amince da su suna da matsakaicin matsakaicin layi mai tsanani da ke hade da yawan aiki na prefrontal da / ko tsokoki na tsokoki tsakanin gira, da kuma matsakaicin matsakaicin layi na canthal mai tsanani da ke hade da wuce kima na tsokar orbicularis.Kuma layin goshi a kwance mai matsakaici-zuwa mai tsanani wanda ke da alaƙa da wuce gona da iri na tsokar gaba.8
Sebum yana taimakawa samar da antioxidants mai narkewa mai narkewa zuwa saman fata kuma yana da kaddarorin antibacterial;saboda haka, yana aiki azaman shingen fata.Yawan sebum zai iya toshe pores, haifar da kwayoyin cuta kuma yana iya haifar da kumburin fata (misali, seborrheic dermatitis, kuraje).A baya can, an bayyana ilimin da ya dace game da tasirin BoNT akan sebum.9,10 Rose da Goldberg10 sun gwada tasiri da aminci na BoNT akan mutane 25 da fata mai laushi.BoNT (abo-BNT, jimlar kashi na 30-45 IU) an allura a cikin maki 10 na goshin goshi, wanda ya inganta ingantaccen haƙuri kuma yana rage yawan samar da sebum.Min et al.da bazuwar da aka sanya wa batutuwa 42 masu kurɓaren goshi don karɓar raka'a 10 ko 20 na BoNT a wuraren allura daban-daban guda biyar.Dukansu ƙungiyoyin sun sami maganin BoNT, wanda ya haifar da raguwa mai yawa a cikin sebum a wurin allurar da kuma ƙwayar ƙwayar ƙwayar cuta a kusa da wurin allurar.A cikin mako na 16th, samar da sebum na kungiyoyin jiyya guda biyu sun koma matakan al'ada, kuma tare da karuwa a cikin alluran allura, maganin warkewa bai inganta sosai ba.
Hanyar da alluran intradermal na toxin botulinum ke haifar da raguwar siginar sebum ba a fahimta sosai ba, saboda ba a yi cikakken bayanin tasirin tsarin jijiya da acetylcholine akan glandan sebaceous ba.Abubuwan da ke haifar da neuromodulatory na BoNT da alama sun yi niyya ga masu karɓa na muscarin na gida a cikin tsokar pili mai kafa da glandan sebaceous.A cikin vivo, mai karɓa na nicotinic acetylcholine 7 (nAchR7) an bayyana shi a cikin glandon sebaceous na ɗan adam, kuma siginar acetylcholine yana haɓaka haɓakar lipid a cikin hanyar dogaro da kashi a cikin vitro.11 Ana buƙatar ƙarin bincike don sanin wanene ɗan takara mafi mahimmanci kuma mafi kyawun hanyar allura da sashi (Hoto 1A da B).
Hoto 1 Hoto na sama (A) na majiyyaci tare da fata mai laushi, yayin da a wani sandar, ƙananan hoto (B) na majiyyaci guda ɗaya bayan jiyya na BoNT guda biyu yana nuna ci gaba mai mahimmanci.(Fasaha: 100 raka'a, 2.5 ml na intradermal BoNT-A an allura sau ɗaya a cikin goshi. An yi jiyya guda biyu iri ɗaya a cikin kwanaki 30 tsakanin su. Kyakkyawan amsawar asibiti ya kasance tsawon watanni 6).
Rosacea cuta ce ta fata mai kumburi ta gama gari wacce ke da firgita fuska, telangiectasia, papules, pustules, da erythema.Ana amfani da magungunan baka, maganin laser, da magungunan da ake amfani da su don magance zubar da fuska, kodayake ba koyaushe suke da tasiri ba.Wani alamar rashin jin daɗi na menopause shine zubar da fuska.Yawancin karatu sun nuna cewa BoNT na iya taimakawa wajen magance zafi mai zafi na menopause da rosacea.12-14 tasirin bont a kan ingancin rayuwar rayuwa (DLQI) na marasa lafiya da za a bincika fuska a cikin binciken matukan jirgi na gaba.An yi allurar 15 BoNT a cikin kunci sau ɗaya, har zuwa jimlar adadin raka'a 30, wanda ya haifar da raguwa mai mahimmanci a cikin DLQI a cikin watanni biyu.A cewar Odo et al., BoNT ya rage yawan adadin zafi mai zafi na menopause a ranar 60th.12 An kuma yi nazarin tasirin abo-BoNT a cikin marasa lafiya 15 tare da rosacea.Bayan watanni uku, an yi allurar 15-45 IU na BoNT a fuska, wanda ya haifar da ci gaba mai mahimmanci a cikin erythema.13 A cikin bincike, ba a cika yin magana ba.
Ƙarfafawa na BoNT yana ɗaya daga cikin dalilan da za a iya hana shi mai karfi na sakin acetylcholine daga ƙananan ƙananan ƙwayoyin cuta na tsarin vasodilation na fata.16,17 An san cewa masu shiga tsakani masu kumburi irin su calcitonin gene-related peptide (CGRP) da abu P (SP) suma BoNT sun hana.18 Idan kumburin fata na gida ya ragu kuma an sarrafa shi, erythema na iya ɓacewa.Don kimanta rawar BoNT a cikin rosacea, ana buƙatar karatu mai yawa, sarrafawa, bazuwar.Alluran BoNT don wanke fuska suna da ƙarin fa'idodi saboda suna iya rage damuwa a kan masu hana fuska, ta yadda za su inganta layi mai kyau da wrinkles.
Mutane da yawa yanzu sun fahimci mahimmancin guje wa tabo a cikin maganin tabon bayan tiyata.Tashin hankali da ke aiki a gefen rauni yayin aikin warkaswa shine mabuɗin mahimmanci don tantance bayyanar ƙarshe na tabo.19,20 BoNT yana hana sakin acetylcholine neurotransmitter, kusan gaba ɗaya kawar da ƙwayar tsoka mai ƙarfi akan raunin warkarwa daga jijiya na gefe.Abubuwan da ke kawar da tashin hankali na BoNT, da kuma hana shi kai tsaye na fibroblast da magana TGF-1, sun nuna cewa za a iya amfani da shi don kauce wa scars na tiyata.21-23 Sakamakon anti-mai kumburi na BoNT da tasirinsa a kan vasculature na fata zai iya rage mataki na tsarin warkar da raunuka (daga 2 zuwa 5 days), wanda zai iya taimakawa wajen hana samuwar tabo.
A cikin nazarin daban-daban, ana iya amfani da BoNT don hana tabo.24-27 A cikin RCT, aminci da tasiri na farkon allurar BoNT na farko a cikin marasa lafiya 15 tare da tabo daga thyroidectomy an kimanta su.24 Fresh scars (a cikin kwanaki 10 na thyroidectomy) an ba su BoNT (20-65 IU) ko 0.9% na al'ada saline (control) sau ɗaya.Rabin jiyya na BoNT ya nuna mahimmanci mafi kyawun tabo da gamsuwar haƙuri fiye da jiyya na saline na al'ada.Gassner et al.25 sun bincika ko allurar BoNT a cikin fuska bayan goshin goshi da raguwa na iya warkar da tabo na fuska.Idan aka kwatanta da allurar placebo (saline na al'ada), an yi wa BoNT (15-45 IU) allura a cikin tabon bayan tiyata bayan raunin rauni a cikin sa'o'i 24 don haɓaka tasirin kwaskwarima da warkar da rauni.
Ƙunƙara mai ƙarfi da a tsaye ana samun su ta hanyar tsokar tsokar tsoka mai ƙarfi, lalacewar haske da tsufa, kuma marasa lafiya sun yi imanin cewa suna sa su gaji ko fushi.Yana iya magance wrinkles na fuska kuma yana ba wa mutane ƙarin annashuwa da annashuwa.A halin yanzu FDA tana da keɓantaccen izini ga BoNT don kula da layi na layi da layi.Ana amfani da BoNT don magance hauhawar jini, murmushin gingival, bandungiyar platysma, gefen mandibular, ɓacin rai, layin goshi a kwance, murmushi mai lanƙwasa, layin gefe, layin hanci a kwance da sagging gira.Sakamakon asibiti yana ɗaukar kimanin watanni uku.28,29 (Hoto na 2A da B).
Hoto na 2 Hoton babba (A) kafin allurar Botox na shari'a ya nuna cewa layin goshi a kwance da layin glabellar suna sa batun yayi fushi.A gefe guda, ƙananan hoto na akwati ɗaya (B) bayan nama biyu Bayan allurar guba, ana cire waɗannan layin cikin kwanciyar hankali.(Fasaha: 36 raka'a, 0.9 ml na intradermal BoNT-A aka allura a cikin goshi lokaci guda. An sanya wurin allurar da fensir fata kafin a yi magani. An yi jiyya guda biyu iri ɗaya, kwana 30 tsakanin su).
BoNT na iya haɓaka tunanin mai haƙuri da fahimtar amincewa lokacin da aka yi amfani da shi tare da raguwar rhythm.An sami ci gaba a makin FACE-Q bayan an yi maganin layukan glabellar matsakaici zuwa mai tsanani.Ko da bayan kwanaki 120, lokacin da tasirin asibiti na BoNT ya kamata ya ragu, marasa lafiya sun ba da rahoton ingantawa a cikin lafiyar hankali da kuma inganta fuska.
Ba kamar sake sakewa ta atomatik na BoNT kowane watanni uku don samun mafi kyawun amsawar asibiti da tunani ba, mai yin aikin ya kamata ya tattauna tare da mai haƙuri lokacin da ja da baya ya zama dole.30,31 Bugu da ƙari, BoNT an samu nasarar amfani da shi don hanawa da kuma magance migraines a cikin jijiyoyi, inganta yanayin rayuwa da jin dadin marasa lafiya32 (Hoto 3A da B).
Hoto na 3 Hoto na sama (A) na batun yana nuna cewa layin gefe na gefe suna ba da jin tsufa da gajiya.A gefe guda kuma, ƙananan hoto (B) na akwati ɗaya yana kawar da waɗannan layi kuma ya ɗaga su bayan allurar Botox.Bayan zama a wannan lokacin, wannan jigon kuma yana nuna wadatar lafiyar tunani.(Fasaha: raka'a 16, 0.4 ml intradermal BoNT-A ana allura sau ɗaya, sau ɗaya a kowane yanki na gefe. Sau ɗaya kawai ya ƙare tare da amsa mai mahimmanci na tsawon watanni 4.)
Alopecia areata, androgenetic alopecia, ciwon kai alopecia da radiation-induced alopecia an bi da su tare da BoNT-A.Ko da yake ainihin hanyar da BoNT ke taimaka wa gashin gashi ba shi da tabbas, an yi la'akari da cewa ta hanyar shakatawa da tsokoki don rage matsa lamba na microvascular, zai iya inganta samar da iskar oxygen zuwa gashin gashi.A cikin darussan 1-12, 30-150 U ana allura a cikin lobe na gaba, periauricular, na wucin gadi da tsokoki na occipital (Hoto 4A da B).
Hoto 4 Rabin hagu (A) na hoton asibiti yana nuna nau'in gashin kansa na namiji mai shekaru 6 na wani mutum mai shekaru 34 bisa ga rarrabuwar Norwood-Hamilton.Sabanin haka, mai haƙuri ɗaya ya nuna raguwa zuwa nau'in 3V bayan 12 botulinum injections (B).(Fasaha: 100 raka'a, 2.5 mL na intradermal BoNT-A aka allura a cikin saman yankin kai sau daya. Jimlar 12 irin wannan jiyya rabu da 15 kwanaki haifar da wani m asibiti amsa, m 4 watanni).
Kodayake yawancin karatun suna nuna haɓakar asibiti a cikin girman gashi ko girma da kuma gamsuwar haƙuri mai girma, ana buƙatar ƙarin RCTs don sanin ainihin tasirin BoNT akan ci gaban gashi.33-35 A gefe guda, an tabbatar da allurar BoNT da yawa don wrinkles na goshi suna da alaƙa da abin da ya faru na asarar gashi na gaba.36
Yawancin karatu sun nuna cewa tsarin juyayi yana taka rawa a psoriasis.Matsakaicin filaye na jijiyoyi a cikin fata na psoriasis yana da yawa, kuma matakan CGRP da SP da aka samu daga jijiyoyi masu hankali suna da yawa.Sabili da haka, shaidar asibiti da ke nuna gafarar psoriasis bayan asarar ciki yana karuwa, kuma lalacewar tsarin jijiya ko aikin jijiya yana goyan bayan wannan hasashe.37 BoNT-A yana rage CGRP neurogenic da sakin SP, wanda zai iya bayyana abubuwan da suka shafi asibiti na cutar.38 A cikin manya KC-Tie2 mice, allurar intradermal na BoNT-A na iya rage yawan lymphocytes na fata idan aka kwatanta da placebo Infiltrate kuma inganta haɓaka acanthosis.37 Duk da haka, akwai kaɗan da aka buga rahotannin asibiti da nazarin lura, kuma babu ɗayansu da ke sarrafa wuribo.Daga cikin marasa lafiya na 15 tare da psoriasis mai juyayi, Zanchi et al.38 sun ruwaito kyakkyawar amsa ga maganin BoNT-A;duk da haka, an yi amfani da sakamakon kima da kai na majiyyaci da ƙima na hoto na kutse da kima erythema.Saboda haka, Chroni et al39 ya nuna damuwa daban-daban game da binciken, ciki har da rashin ƙididdiga masu ƙididdiga don kimanta haɓakawa (kamar maki PA).Marubucin ya yi la'akari da cewa BoNT-A yana da tasiri mai kyau wajen rage gumi na gida a cikin folds, irin su Hailey-Hailey cuta, inda tasirin BoNT-A ya kasance saboda raguwar gumi.40-42 Ikon BoNT-A don hana hyperalgesia Duk da haka, sakin neuropeptides yana haifar da ƙananan ciwo da itching a marasa lafiya.43
Kashe lakabin, BoNT an yi amfani dashi don magance cututtukan fata daban-daban, irin su IgA bullous fata cuta, Weber-Cockayne cuta da Hailey-Hailey cuta.BoNT-A injections, tacrolimus na baka, yttrium aluminum garnet ablation laser, da BoNT-A dauke da erbium an yi amfani da su don magance cutar Hailey-Hailey a cikin ƙananan nono, axillary, inguinal da intergluteal cleft yankunan.Bayan jiyya, alamun asibiti sun inganta, kuma adadin adadin shine 25 zuwa 200 U kowane watanni 3 zuwa 6.42,44 A cikin rahoton da aka ruwaito, wata mace mai tsaka-tsaki tare da yanki na epidermolysis bullosa an yi musu allurar 50 U a kowace kafa a cikin ƙafarta, kuma an yi wa 100 U allura a cikin majiyyaci tare da layin IgA bullosa Kafar matasa masu fama da cutar fata.45,46
A cikin 2007, Kontochristopoulos et al47 yadda ya kamata ya bi da yankin submammary na wani majiyyaci mai shekaru 59, ta amfani da BoNT-A a matsayin maganin adjuvant don cutar Darier a karon farko.A wani yanayin kuma a cikin 2008, ƙaramin yaro mai tsananin saɓanin jima'i yana da fa'ida wajen rage gumi a wurin da aka lalata.48 An yi maganin ciwon da ke tattare da ita tare da acitretin MG 10 da maganin rigakafi da maganin fungal a kowace rana, amma yanayin rayuwarta ya ragu kuma rashin jin daɗi ya ci gaba.Makonni uku bayan allurar botulinum toxin, alamunta da raunuka na asibiti sun inganta sosai.
Eccrine nevus wani hamartoma ne na fata da ba kasafai ake samunsa ba wanda ke da karuwa a yawan glandan eccrine amma babu ci gaban jijiyoyin jini.Saboda siffa ta ƙarshe, eccrine nevus ya bambanta da sauran cututtuka kamar angiomatous eccrine hamartoma.49 Ƙananan ƙwayoyin gumi sun fi zama ruwan dare a kan gabas, tare da ƙananan matsalolin fata, amma akwai wuraren da ke cikin hyperhidrosis.50 Maganin tiyata ko magani na waje sune mafi mashahuri jiyya, dangane da girman ɗaukar hoto da mahallin hyperhidrosis.Honeyman et al51 sun rubuta wani yaro mai shekaru 12 tare da ƙananan gumi nevi a wuyan hannu na dama wanda ke da juriya ga magungunan kashe kwayoyin cuta.Saboda girman ƙwayar ƙwayar cuta da wurin da yake da ita, an cire aikin tiyata.Hyperhidrosis yana sa shiga cikin ayyukan zamantakewa da tunani da kalubale.Masu binciken sun zaɓi yin allurar 5 U na BoNT-A a tazara na 0.5-1 cm.Marubutan ba su bayyana lokacin da aka fara mayar da martani ga magani na BoNT-A ba, amma sun ce bayan shekara guda, sun lura cewa yawan gumi ya ragu sosai zuwa sau ɗaya a wata, kuma yanayin rayuwar mai haƙuri ya inganta.Lera et al49 sun bi da mara lafiya tare da ƙarancin ingancin rayuwa da ƙimar HDSS na 3 akan goshi tare da ƙaramin gumi naevi (HDSS) (mai tsanani).An sake gina BoNT-A (100 IU) a cikin 2.5 mL bakararre saline bayani mai dauke da 0.9% sodium chloride kuma an allura a cikin yankin gwajin aidin.Bayan sa'o'i 48, mai haƙuri ya lura da raguwar gumi, tare da sakamako mafi kyau a cikin mako na uku.Sakamakon HDDS ya ragu zuwa 1. Saboda maimaitawar gumi, an sake maimaita maganin BoNT-A bayan watanni tara.A cikin maganin exocrine hemangioma hamartoma, maganin allurar BoNT-A yana da amfani.52 Ko da yake wannan yanayin ba kasafai ba ne, yana da sauƙi a ga yadda yake da mahimmanci ga waɗannan mutanen su sami zaɓin magani.
Hidradenitis suppurativa (HS) cuta ce ta fata na yau da kullun wacce ke da zafi, tabo, sinuses, fistulas, kumburin nodules, kuma yana bayyana a cikin glandar apocrine na jiki a ƙarshen matakai.53 Ilimin ilimin halittar jiki na cutar ba a sani ba, kuma a baya zato da aka yarda game da ci gaban HS yanzu ana ƙalubalanci.Ƙunƙarar ƙwayar gashin gashi yana da mahimmanci ga alamun HS, kodayake tsarin da ke haifar da ɓoyewar ba a bayyana ba.Sakamakon kumburi na gaba da haɗuwa da ƙwayar cuta na haihuwa da kuma daidaitawa na rigakafi, HS na iya haifar da lalacewar fata.54 Wani binciken da Feito-Rodriguez et al.55 ya bayar ya ruwaito cewa BoNT-A ta yi nasarar magance HS na farko a cikin 'yan mata masu shekaru 6.Rahoton shari'ar Shi et al.56 ya lura cewa an yi nasarar magance BoNT-A a matakin -3 HS na mace mai shekaru 41.Wani binciken da Grimstad et al.57 yayi kwanan nan ya kimanta ko allurar intradermal na BoNT-B yana da tasiri ga HS a cikin marasa lafiya 20.DLQI na ƙungiyar BoNT-B ya ƙaru daga matsakaicin 17 a tushe zuwa 8 a watanni 3, yayin da DLQI na ƙungiyar placebo ya ragu daga 13.5 zuwa 11.
Notalgia paresthetica (NP) wani ciwon neuropathy ne mai ɗorewa wanda ke shafar yanki na interscapular, musamman T2-T6 dermatome, tare da itching na sama da kuma bayyanar cututtuka na fata da ke da alaƙa da gogayya da zazzagewa.BoNT-A na iya taimakawa wajen magance itching na gida ta hanyar toshe sakin abu P, mai matsakanci mai zafi da itching.Rahoton shari'ar 58 na Weinfeld59 ya kimanta ingancin BoNT-A a lokuta biyu.Dukansu an yi nasarar yi musu magani tare da BoNT-A.Nazarin da Perez-Perez et al.58 yayi la'akari da ingancin BoNT-A a cikin marasa lafiya 5 da aka gano tare da NP.Bayan allurar intradermal na BoNT, an lura da tasiri da yawa.Babu wani ciwon kai da aka samu kwata-kwata.Gwajin gwajin da bazuwar (RCT) na Maari et al60 yayi la'akari da inganci da amincin BoNT-A a cikin marasa lafiya tare da NP a Cibiyar Nazarin Dermatology ta Kanada daga Yuli 2010 zuwa Nuwamba 2011. Binciken ya kasa tabbatar da tasiri mai amfani na BoNT-A.Intradermal allura a kashi na har zuwa 200 U don rage itching a marasa lafiya tare da NP.
Pompholyx, wanda kuma ake kira hyperhidrosis eczema, cuta ce ta vesicular bullous mai maimaitawa wacce ke shafar tafin hannu da tafin ƙafafu.Ko da yake ilimin pathophysiology na wannan yanayin ba a sani ba, yanzu ana la'akari da shi alama ce ta atopic dermatitis.61 Aiki jika, gumi, da toshewa sune abubuwan da suka fi haifar da matsala.62 Sanya safar hannu ko takalma na iya haifar da ciwo, konewa, itching, da rashin jin daɗi a cikin marasa lafiya;cututtuka na kwayan cuta suna da yawa.Swartling et al61 ya gano cewa marasa lafiya tare da dabino hyperhidrosis da aka bi da su tare da BoNT-A inganta eczema na hannu.A cikin 2002, sun buga sakamakon binciken da ya shafi marasa lafiya goma tare da dermatitis na vesicular na hannu;hannu ɗaya ya karɓi alluran BoNT-A, ɗayan kuma yana aiki azaman sarrafawa yayin bibiya.Maganin yana da sakamako mai kyau ko mai kyau a cikin 7 cikin 10 marasa lafiya.Daga cikin marasa lafiya 6, Wollina da Karamfilov63 sun yi amfani da corticosteroids na Topical a hannayensu biyu kuma sun yi wa 100 U na BoNT-A allura a cikin hannaye mafi muni.A cikin maganin maganin haɗin gwiwa, marubutan sun gano cewa itching da blisters sun ragu da sauri.Sun danganta tasirin BoNT-A zuwa impetigo saboda tasirin sa mara amfani da hanawa na SP.
Yatsa vasospasm, wanda kuma aka sani da cutar Raynaud, yana da ƙalubalanci don magancewa kuma yawanci yana jure wa magunguna na farko irin su bosentan, iloprost, phosphodiesterase inhibitors, nitrates, da kuma masu hana tashar calcium.Hanyoyin tiyata da suka haɗa da farfadowa da rufewa, irin su tausayi, suna cin zarafi.An sami nasarar magance al'amarin Raynaud da ke da alaƙa da firamare da sclerosis ta hanyar allurar BoNT.Masu bincike na 64,65 sun lura cewa marasa lafiya 13 sun sami saurin jin zafi, kuma cututtuka na yau da kullum sun warke a cikin kwanaki 60 bayan sun karbi 50-100 U na BoNT.An ba da allura ga marasa lafiya 19 tare da sabon abu na Raynaud.66 Bayan makonni shida, zafin yatsan yatsa na yatsan yatsa da aka yi tare da BoNT ya karu sosai idan aka kwatanta da allurar saline na al'ada, yana nuna cewa BoNT yana da amfani ga maganin ƙwayar cuta na Raynaud da ke da alaka da vasospasm.67 A halin yanzu, akwai daidaitattun hanyoyin allura da aka yi amfani da su;A cewar wani binciken, allura a cikin yatsun hannu, wuyan hannu, ko kasusuwa na metacarpal mai nisa ba su haifar da sakamako daban-daban na asibiti ba, kodayake suna da tasiri wajen magance cutar ta Raynaud da ke da alaƙa da vasospasm.68
50-100 U na BoNT-A a kowane ɗaki, ana gudanar da intradermally a cikin tsari mai kama da grid, ana iya amfani dashi don magance hyperhidrosis na farko axillary.Ana iya ganin sakamakon asibiti a cikin mako guda kuma yana ɗaukar watanni 3 zuwa 10.Yawancin marasa lafiya sun gamsu da maganin su.Ya kamata a sanar da marasa lafiya cewa har zuwa kashi 5% na lokuta za su fuskanci gumi na diyya na zamani.69,70 BoNT kuma zai iya magance dabino da hyperhidrosis mai kyau (Hoto 5A da B).
Hoto na 5 Hoton asibiti mai girma (A) yana nuna matashin dalibin kwaleji mai yaduwa ta dabino hyperhidrosis wanda ke cikin damuwa game da wannan cuta kuma baya amsa magani.Irin waɗannan marasa lafiya waɗanda suka karɓi maganin toxin botulinum sun nuna cikakken ƙuduri na hyperhidrosis (B).(Fasaha: Bayan tabbatarwa ta gwajin sitaci aidin; Raka'a 100, 2.5 mL intradermal BoNT-A an yi masa allura sau ɗaya a hannu. Jimlar kwasa-kwasan kwasa-kwasan guda biyu na kwanaki 15 baya haifar da amsa mai mahimmanci na tsawon watanni 6).
Kowane yatsa yana da matsayi na allura 2-3, kuma ya kamata a shirya allurar a cikin grid tare da nisa na 1 cm.Ana iya ba BoNT-A ga kowane hannu a cikin kewayon raka'a 75-100 kuma zuwa kowane ƙafa a cikin kewayon raka'a 100-200.Sakamakon asibiti na iya ɗaukar har zuwa mako guda don bayyana, kuma yana iya ɗaukar watanni uku zuwa shida.Kafin fara jiyya, ya kamata a sanar da marasa lafiya game da illar illar alluran BoNT a cikin tafin hannu da ƙafafu.Bayan allurar dabino, mai haƙuri na iya ba da rahoton rauni.A gefe guda, alluran tsire-tsire na iya sa tafiya da wahala, musamman idan an yi shingen jijiya kafin maganin BoNT.71,72 Abin takaici, 20% na marasa lafiya na hyperhidrosis na shuke-shuke ba su amsa magani ba bayan sun karbi allurar BoNT.72
A cikin binciken kwanan nan, an yi amfani da BoNT don magance hyperhidrosis a wata sabuwar hanya.A cikin wani hali, wani namiji mai haƙuri tare da matsa lamba ya karbi 100 U na BoNT-A injections a cikin gluteal cleft kowane 6-8 watanni don rage gumi samar da rakiyar maceration rauni;An kiyaye mutuncin fata Fiye da shekaru biyu, ba a sami lalacewar asibiti na rauni na matsa lamba ba.73 Wani binciken ya yi amfani da 2250 U na BoNT-B don a yi masa allura a cikin gashin kai na occipital, gashin kai na parietal, gashin goshi da goshi, da kuma wuraren da ke gefen ido da na ido a cikin tsarin tsiri don magance hyperhidrosis na postmenopausal craniofacial.DLQI na marasa lafiya da ke karɓar BoNT-B sun haɓaka da 91% a cikin makonni uku bayan jiyya, yayin da ingancin rayuwar marasa lafiya da ke karɓar placebo ya ragu da 18%.74 BoNT allura yana da tasiri a cikin maganin salivation da Frey syndrome.Likitocin Otolaryngologist sukan yi magani saboda wurin da aka yi allurar.75,76
Gumi masu launi na iya zama yanayin damuwa a fili ga majiyyaci.Ko da yake wannan cuta ba kasafai ba ce;shigar fuska da hannaye na iya kara dagula majinyacin.Yawancin rahotanni da wallafe-wallafe sun nuna cewa BoNT-A yana da tasiri bayan an yi masa allura a cikin kwanaki 7 kawai.77-79
Ƙanshin da ba shi da daɗi daga hammata hyperhidrosis da warin jiki na iya zama abin kunya ko abin ƙyama.Wannan yana iya yin mummunan tasiri a kan sararin tunanin mai haƙuri da amincewa.Kwanan nan, Wu et al.ya ruwaito cewa bayan allurar BoNT-A na intradermal, an kusan kawar da warin da ke cikin armpits.80 A wani nazari mai zuwa na zamani;An dauki matasa 62 da ke da ganewar asali na warin hannu na farko.82.25% na marasa lafiya sun ji cewa an rage warin sosai bayan an yi wa BoNT-A allurar a cikin yankin axillary.81
Meh ana gano shi ta hanyar cututtukan cystic guda ɗaya ko da yawa a cikin mata masu matsakaicin shekaru, galibi suna cikin yankin tsakiyar fuska, tare da dogon lokaci na cuta da canjin yanayi.Meh yakan bayyana a yanayin rana kuma yana da alaƙa da hyperhidrosis.Yawancin masu bincike sun lura da sakamako mara kyau a cikin waɗannan lokuta bayan allurar BoNT-A.82 a kusa da rauni.
Post-herpetic neuralgia (PHN) ita ce mafi yawan rikice-rikicen jijiya na kamuwa da cutar ta herpes zoster, wanda ya fi kowa a cikin mutane fiye da shekaru 60.BoNT-A kai tsaye yana haifar da tasirin pan-inhibitory akan ƙarshen jijiya na gida kuma yana daidaita microglia-astrocytic-neuronal crosstalk.Yawancin karatu sun lura cewa bayan karbar magani na BoNT-A, marasa lafiya waɗanda ciwon ya ragu da akalla 30% zuwa 50% sun rage yawan barci da ingancin rayuwa.83
An siffanta lichen mai sauƙi na yau da kullun a matsayin wuce gona da iri na pruritus ba tare da wani takamaiman dalili ba.Wannan zai iya raunana majiyyaci sosai.Binciken dermatological na asibiti ya nuna keɓantaccen plaques na erythema, ƙarar alamar fata da fitar da epidermal.Wani binciken ƙasa na baya-bayan nan daga Masar ya nuna cewa BoNT-A na iya aminta da inganci don magance lichen simplex na yau da kullun, hypertrophic lichen planus, lichen planus, konewa, baya psoriasis, da rashin ƙarfi na gida na post-herpetic neuralgia Pruritus.84
Keloids sune tabo na nama mara kyau waɗanda ke faruwa bayan rauni.Keloids suna da alaƙa da kwayoyin halitta, kuma an gwada jiyya da yawa, amma tasirin yana da iyaka.Duk da haka, babu ɗayansu da ya warke gaba ɗaya.Kodayake corticosteroids na intralesional har yanzu shine babban hanyar magani, allurar BoNT-A ta ciki ta zama kyakkyawan madadin a cikin 'yan kwanakin nan.BoNT-A na iya rage matakan TGF-β1 da CTGF, kuma a ƙarshe ya raunana bambance-bambancen fibroblasts.Yawancin karatu sun tabbatar da nasarar BoNT-A a cikin maganin keloids.A zahiri, jerin shari'o'in marasa lafiya na keloid guda biyu har ma sun ba da rahoton amsa 100%, kuma marasa lafiya sun gamsu sosai da yin amfani da allurar BoNT-A na intralesional.85
Onychomycosis mai kauri mai kauri cuta ce ta kwayoyin halitta da ba kasafai ke tattare da ita tare da hyperkeratosis na plantar, hauhawar ƙusa da hyperhidrosis.Ƙananan masu bincike sun yanke shawarar cewa allurar BoNT-A ba za ta iya inganta hyperhidrosis kawai ba, amma kuma rage zafi da rashin jin daɗi.86,87
Keratosis da ke haifar da ruwa cuta ce da ba a saba gani ba.Lokacin da majiyyaci ya haɗu da ruwa, ƙaƙƙarfan tsakuwa a tafin hannu da tafin hannu da ƙaiƙayi na iya faruwa.Rahotanni da yawa a cikin wallafe-wallafen sun nuna nasarar magani da ingantawa bayan jiyya na BoNT-A, har ma a lokuta masu tsayayya.88
Zubar da jini, edema, erythema da jin zafi a wurin allurar na iya zama illar BoNT.89 Ana iya hana waɗannan illolin ta hanyar amfani da allura mai sirara da diluting BoNT tare da saline.BoNT injections na iya haifar da ciwon kai;duk da haka, yawanci suna ɓacewa bayan makonni 2-4.Ana iya amfani da maganin analgesics na tsarin don magance wannan sakamako na gefe.90,91 Nausea, rashin jin daɗi, alamun mura da ptosis wasu wasu illolin da aka rubuta.89 Ptosis shine yankin sakamako na gefe na amfani da BoNT don magance gira.Ana haifar da shi ta hanyar yaduwar BoNT na gida.Wannan yaɗuwar na iya ɗaukar makonni da yawa, amma ana iya warware shi tare da faɗuwar ido na alpha-adrenergic agonist.Lokacin da aka allurar BoNT a cikin ƙananan fatar ido, zai iya haifar da ectropion saboda tsarin yadawa na gida.Bugu da ƙari, marasa lafiya waɗanda ke karɓar alluran BoNT don warkar da ƙafafun hankaka ko tsarin zomo (periorbital) na iya haɓaka strabismus saboda allurar BoNT da ba a sani ba da kuma yaduwar BoNT na gida.89,92 Duk da haka, yayin da tasirin gurɓataccen guba na guba ya ɓace a hankali, duk waɗannan illolin za su ɓace a hankali.93,94
Hadarin rikitarwa daga alluran BoNT na kwaskwarima yana da ƙasa.Ecchymosis da purpura sune sakamakon da aka fi sani kuma ana iya rage su ta hanyar amfani da damfara mai sanyi zuwa wurin allurar kafin da bayan allurar BoNT.90,91 BoNT ya kamata a yi masa allura a cikin ƙananan kashi, aƙalla 1 cm daga gefen ƙashin ƙashin ƙugu na orbital, mafi girma ko a gefe, tare da adadin da ya dace.Kada majiyyaci ya yi amfani da wurin allurar a cikin sa'o'i 2-3 bayan jiyya, kuma ya zauna ko ya tsaya a tsaye a cikin sa'o'i 3-4 bayan jiyya.95
BoNT-A a cikin sabon salo daban-daban a halin yanzu ana gwada shi don kula da layin glabellar da layin ido.An yi nazarin daxibotulinumtoxinA na cikin gida da allura, amma an nuna abubuwan da ake amfani da su ba su da tasiri.Allurar DAXI ta shiga gwajin lokaci na FDA na III, yana tabbatar da cewa inganci da sakamakon asibiti a cikin kula da layin glabellar na iya zama har zuwa makonni 5 fiye da onabotulinumtoxinA.96 LetibotulinumtoxinA yanzu yana kan kasuwa a Asiya kuma FDA ta amince da shi don maganin wrinkles na periorbital.97 Idan aka kwatanta da incobotulinumtoxinA, LetibotulinumtoxinA yana da mafi girma na furotin neurotoxic a kowace juzu'in juzu'i, amma adadin neurotoxin mara aiki shima ya fi girma, wanda ke ƙara haɗarin amsawar rigakafi.98
Baya ga sabon tsarin BoNT-A, ana nazarin ruwa BoNT-E saboda an ce yana da saurin fara aiki da ɗan gajeren lokacin sakamakon asibiti (kwanaki 14-30).An gano EB-001 yana da aminci kuma yana da tasiri wajen rage bayyanar layukan murƙushewa da inganta bayyanar goshin goshi bayan Mohs microsurgery.Ana iya ƙyale likitocin fata su yi amfani da waɗannan littattafan.Baya ga dalilai na ado na yanzu, kamfanonin harhada magunguna suna neman shirye-shiryen BoNT-A don kashe-lakabin jiyya na yanayin likita na cututtukan fata.
BoNT magani ne na allura mai daidaitawa wanda za'a iya amfani dashi don magance cututtukan fata iri-iri, ciki har da hidradenitis suppurativa, psoriasis, cututtukan fata mai ban tsoro, tabo mara kyau, asarar gashi, hyperhidrosis, da keloids.A cikin aikace-aikacen kwaskwarima, BoNT an yi imanin cewa yana da aminci kuma yana da tasiri wajen rage wrinkles na fuska, musamman ma na sama na uku na wrinkles na fuska.An san BoNT A don amfani da shi wajen rage wrinkles a fagen kayan shafawa.Ko da yake BoNT yana da lafiya gabaɗaya, yana da mahimmanci koyaushe don fahimtar wurin allurar saboda gubobi na iya yaɗuwa kuma suna cutar da wuraren da bai kamata a bi da su ba.Ya kamata likitocin likitoci su san matsalolin da ke faruwa a wasu wurare na musamman lokacin yin allurar BoNT a cikin ƙafafu, hannaye, ko wuyansa.Likitocin fata suna buƙatar sanin abin da ake amfani da lakabin da kuma kashe-lakabin amfani da BoNT don ba marasa lafiya jiyya masu dacewa da rage cututtukan da ke da alaƙa.Ya kamata a kimanta ingancin asibiti na BoNT a cikin saitunan alamar kashe-kashe da duk wasu batutuwan aminci na dogon lokaci ya kamata a kimanta su ta hanyar ingantaccen gwajin gwaji na asibiti.
Rarraba bayanai baya aiki ga wannan labarin saboda ba a ƙirƙira ko bincikar saitin bayanai ba yayin lokacin bincike na yanzu.
Ana gudanar da gwajin marasa lafiya daidai da ka'idodin sanarwar Helsinki.Marubucin ya ba da tabbacin cewa ta sami duk nau'ikan izinin haƙuri da suka dace wanda mai haƙuri ya yarda ya haɗa da hotuna da sauran bayanan asibiti a cikin jarida.Marasa lafiya sun fahimci cewa ba za a bayyana sunayensu da baƙaƙen sunayensu ba, kuma za su yi ƙoƙarin ɓoye sunayensu.
Dokta Piyu Parth Naik ya ba da gudummawa kawai ga rubuta rubutun.Marubucin ya ba da gudummawa mai mahimmanci a cikin ra'ayi da ƙira, samun bayanai da fassarar bayanai;ya shiga cikin tsara labarai ko ingantaccen abun ciki na ilimi da aka bita;an yarda da mika wuya ga jarida na yanzu;daga karshe ya amince da sigar da za a buga;kuma sun yarda da aikin Mai alhakin kowane bangare.
Lokacin aikawa: Oktoba 18-2021