Melazmalı hastalarda oral traneksamik asit ve trombositten zengin plazma tedavisinin klinik sonuçlarının karşılaştırılması
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2020
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İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Melazma, dünya genelinde en sık tanı konulan dermatolojik hastalıklardan biridir. Kozmetik açıdan hastaların çoğunluğu için sıkıntı yaratan bir durum olan melazma, tedavisinde çok sayıda seçenek olmasına rağmen tedaviye direnç gösteren ve fazlaca tekrarlama olasılığına sahip bir hastalıktır. Patogenezinin henüz tam anlaşılamamış olması tedavide güçlüklere sebep olmaktadır. Geçmişten bugüne kanama diyatezi ve menoraji tedavisinde kullanılan oral Traneksamik Asit (TA), günümüzde melazma tedavisi için başarıyla kullanılmakta olan tedavi yöntemlerinden biridir. Trombositten Zengin Plazma (TZP, Platelet Rich Rlasma: PRP) ise çok sayıda trombositin otolog kanın santrifüjlenmesi ile askıya alındığı az miktarda plazma olarak tanımlanır ve hiperpigmentasyon tedavisindeki potansiyel etkisi güncel çalışmalarda bildirilmiştir. Çalışmamızda melazmalı hastalarda oral TA ve TZP tedavisinin klinik sonuçlarının karşılaştırılması amaçlanmıştır. Materyal ve Metot: Eylül 2017 – Haziran 2019 tarihleri arasında İnönü Üniversitesi Turgut Özal Tıp Merkezi Deri ve Zührevi Hastalıkları Polikliniği'ne başvuran 18 yaş üstü erişkin yaş grubundan oral TA tedavisi uygulanmış 30 melazmalı hasta ve TZP tedavisi uygulanmış 30 melazmalı hastanın klinik sonuçları retrospektif olarak değerlendirildi. Tedavi öncesinde her hasta için yaş, cinsiyet, deri tipi, sigara, alkol kullanımı, melazma süresi, daha önce melazma için kullandığı tedaviler, ek hastalık varlığı, aile öyküsü, güneş koruyucu kullanımı sorgulanarak kayıt altına alınmış olanlar ve her hastanın karşıdan ve sağ-sol olmak üzere her iki yan taraftan fotoğrafları bulunanlar incelemeye alındı. 1.grupta 2x500 mg oral TA tedavisi uygulanan melazma hastaları; 0.,1., 2. ve 3. aylarda modifiye Melazma Yüzey Alanı ve Şiddet İndeksi (modified Melasma Area and Severity Index: mMASI) skoru ve standart koşullarda çekilen fotoğraflarıyla beraber değerlendirildi. Ayrıca 0. ve 3. aylardaki tam kan sayımı, karaciğer ve böbrek fonksiyon testleri ve kanama profiline bakıldı. 2. Grupta 1. 2. ve 3. aylarda yüzlerine intradermal olarak TZP injeksiyonu yapılan melazma hastaları mMASI skoru ve standart koşullarda çekilmiş olan fotoğraflarıyla beraber değerlendirildi. Bulgular: Çalışmamızda hem oral TA'nın, hem de TZP'nin, melazma hastalarında istatistiksel olarak anlamlı düzeyde iyileşme sağladığı saptanmıştır. Oral TA tedavisi uygulanan hasta grubunda, 3. ayda MASI skorunda %75 oranındaki iyileşmenin, TZP tedavisi uygulanan hastalara göre istatistiksel olarak anlamlı şekilde daha fazla olduğu bulunmuştur. Deri tipi, cinsiyet ve melazma süresine göre MASI skoru iyileşme oranlarında her iki grupta da istatistiksel olarak anlamlı fark bulunmamıştır. Sonuç: Oral TA ve TZP'nin her ikisi de melazma tedavisinde başarılı olmakla birlikte, çalışmamızda oral TA'nın daha iyi sonuçlar verdiği gösterilmiştir. Literatürde bu alanda ilk olan çalışmamızı destekleyecek daha fazla çalışmaya ihtiyaç vardır. Anahtar Kelimeler: Melazma, traneksamik asit, trombositten zengin plazma
Aim: Melasma is one of the most commonly diagnosed dermatological diseases worldwide. Although there are many options in the treatment of melasma, which is a cosmetic problem for the majority of patients; it is a disease that is resistant to treatment and has a high probability of recurrence. The pathogenesis is not fully understood yet, which often causes difficulties in treatment. Oral TA, which has been used in the treatment of bleeding diathesis and menorrhagia from the past, is now successfully used for the treatment of melasma. PRP is defined as a small amount of plasma in which a large number of platelets are suspended by centrifugation of autologous blood, and its potential effect in hyperpigmentation treatment has been reported in recent studies. In our study, we aimed to compare the clinical results of oral TA and PRP therapy in patients with melasma. Material and Method: The clinical results of 30 melasma patients over the age of 18 who applied to the İnönü University Turgut Ozal Medical Center Dermatology and Venereal Diseases Outpatient Clinic between September 2017 and June 2019, who were treated with oral TA and 30 patients with melasma who were treated with PRP were retrospectively evaluated. Prior to the treatment; age, gender, skin type, smoking, alcohol use, melasma duration, previous treatments used for melasma, presence of additional disease, family history, sunscreen use were recorded by questioning; and patients whose right and left side photographs were found on both sides were examined. Melasma patients in the 1st group who were started on 2x500 mg oral TA treatment; MASI score at 0, 1, 2 and 3 months was evaluated together with the photographs taken under standard conditions. In addition, complete blood count, liver and kidney function tests and bleeding profile at 0 and 3 months were evaluated. In the second group, patients with melasma who had PRP injection intradermally on their faces at the 1st, 2nd and 3rd months were evaluated together with their MASI score and photographs taken under standard conditions. Results: In our study, it was determined that both oral TA and PRP provide statistically significant improvement in melasma patients. It was found that the 75% improvement in the MASI score was statistically significantly higher in the patient group treated with oral TA compared to the patients treated with PRP. There was no statistically significant difference in MASI score improvement rates in both groups according to skin type, gender and melasma duration. Conclusion: Although oral TA and PRP are both successful in the treatment of melasma, it has been shown in our study that oral TA gives better results. More studies are needed to support our study, which is the first in this field in the literature. Keywords: Melasma, platelet rich plasma, tranexamic acid
Aim: Melasma is one of the most commonly diagnosed dermatological diseases worldwide. Although there are many options in the treatment of melasma, which is a cosmetic problem for the majority of patients; it is a disease that is resistant to treatment and has a high probability of recurrence. The pathogenesis is not fully understood yet, which often causes difficulties in treatment. Oral TA, which has been used in the treatment of bleeding diathesis and menorrhagia from the past, is now successfully used for the treatment of melasma. PRP is defined as a small amount of plasma in which a large number of platelets are suspended by centrifugation of autologous blood, and its potential effect in hyperpigmentation treatment has been reported in recent studies. In our study, we aimed to compare the clinical results of oral TA and PRP therapy in patients with melasma. Material and Method: The clinical results of 30 melasma patients over the age of 18 who applied to the İnönü University Turgut Ozal Medical Center Dermatology and Venereal Diseases Outpatient Clinic between September 2017 and June 2019, who were treated with oral TA and 30 patients with melasma who were treated with PRP were retrospectively evaluated. Prior to the treatment; age, gender, skin type, smoking, alcohol use, melasma duration, previous treatments used for melasma, presence of additional disease, family history, sunscreen use were recorded by questioning; and patients whose right and left side photographs were found on both sides were examined. Melasma patients in the 1st group who were started on 2x500 mg oral TA treatment; MASI score at 0, 1, 2 and 3 months was evaluated together with the photographs taken under standard conditions. In addition, complete blood count, liver and kidney function tests and bleeding profile at 0 and 3 months were evaluated. In the second group, patients with melasma who had PRP injection intradermally on their faces at the 1st, 2nd and 3rd months were evaluated together with their MASI score and photographs taken under standard conditions. Results: In our study, it was determined that both oral TA and PRP provide statistically significant improvement in melasma patients. It was found that the 75% improvement in the MASI score was statistically significantly higher in the patient group treated with oral TA compared to the patients treated with PRP. There was no statistically significant difference in MASI score improvement rates in both groups according to skin type, gender and melasma duration. Conclusion: Although oral TA and PRP are both successful in the treatment of melasma, it has been shown in our study that oral TA gives better results. More studies are needed to support our study, which is the first in this field in the literature. Keywords: Melasma, platelet rich plasma, tranexamic acid
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POLAT, Y.(2020). Melazmalı hastalarda oral traneksamik asit ve trombositten zengin plazma tedavisinin klinik sonuçlarının karşılaştırılması,İnönü Üniversitesi / Tıp Fakültesi / Deri ve Zührevi Hast. Ana Bilim Dalı.
