Title Suvremeni pristup liječenju vitiliga
Title (english) Modern approach to the treatment of vitiligo
Author Tena Matek
Mentor Romana Čeović (mentor)
Committee member Branka Marinović (predsjednik povjerenstva)
Committee member Zrinka Bukvić Mokos (član povjerenstva)
Committee member Romana Čeović (član povjerenstva)
Granter University of Zagreb School of Medicine (Department of Dermatology) Zagreb
Defense date and country 2023-07-13, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Dermatovenerology
Abstract Vitiligo je depigmentacijski poremećaj koji zahvaća kožu. Pretpostavlja se da od vitiliga boluje između 0,5 i 2% populacije. To je bolest kompleksne etiologije u čijem nastanku sudjeluju i genetski i okolišni čimbenici. Danas se vitiligo ubraja među autoimune bolesti, te se smatra da dolazi do autoimune destrukcije melanocita što rezultira pojavom depigmentacijskih makula na zahvaćenoj koži. Postoji nekoliko različitih teorija o tome kako točno dolazi do depigmentacije. Ni jedna teorija sama nije dovoljna za objašnjenje ovog kompleksnog stanja i sve su još uvijek podložne diskusiji. Dijagnoza se najčešće postavlja kliničkim pregledom uz pomoć dermatoskopa. Vitiligo možemo podijeliti u dvije velike skupine: segmentalni i nesegmentalni, koje se dalje mogu podijeliti u podgrupe. Iako se bolest u prošlosti često doživljavala prvenstveno kao kozmetski problem, dokazano je da može imati veliki utjecaj na kvalitetu života pacijenata, te može biti povezana s depresivnim i anksioznim poremećajima. Bolest možemo liječiti lokalnim i sistemskim lijekovima, fototerapijom, fotokemoterapijom, laserom, kirurškim tehnikama, kamuflažnim sredstvima i depigmentacijom okolne zdrave kože. Pacijentima je važno ponuditi i psihološku potporu. Najčešće liječenje započinje lokalnim modalitetima koji uključuju lokalne kortikosteroide i inhibitore kalcineurina. Kod težih oblika bolesti mogu se primijeniti i sistemski kortikosteroidi, ali je potrebno paziti na nepoželjne sistemske pojave liječenja. NB-UVB je najčešće korištena metoda fototerapije, dok se fotokemoterapija (PUVA) rjeđe koristi zbog karcinogenog učinka na kožu, ovisnog o dozi. Može se koristiti i liječenje laserom koje direktno i ciljano djeluje na leziju. Navedene metode liječenja mogu se kombinirati. Stabilne lezije koje ne odgovaraju na prethodno navedene metode liječenja pogodne su za kirurške metode koje dijelimo na tehnike presađivanja tkiva i stanica. Ukoliko je zahvaćena velika površina kože može se provesti i depigmentacija okolne kože. Vidljive lezije mogu se prikriti kamuflažnim tehnikama koje uključuju kozmetiku i sredstva za samotamnjenje. U tijeku su brojna istraživanja novih lijekova za vitiligo koji djeluju na JAK kinazu i proupalne citokine.
Abstract (english) Vitiligo is a depigmentation disorder which affects the skin. It is estimated that it affects between 0.5 and 2% of population. It is a complex disease and both environment and genetics play a role in its development. Today vitiligo is considered to be an autoimmune disease in which there is an autoimmune destruction of melanocytes which results in depigmentation of the affected skin. There are many different theories about the development of depigmented lesions. Any theory alone is not enough to explain this complicated condition and all theories are still being discussed. It can usually be diagnosed during a physical exam with dermoscopy. Vitiligo can be divided into two big groups: segmental and nonsegmental, which can be further divided into smaller subgroups. Although it used to be seen as a merely cometic issue, it is known that it can have an impact on patient's life quality, and it can be the cause of depression and anxiety. Vitiligo can be treated using topical and systemic medications, phototherapy, photochemotherapy, laser, surgical techniques, camouflage techniques and depigmentation of the surrounding skin. All patients should be offered psychological support. The first line of treatment are usually topical medications, which include topical corticosteroids and calcineurin inhibitors. Systemic corticosteroids can be used in more severe vitiligo cases, but we should be careful about systemic side effects which they can cause. The most common phototherapy method is NB-UVB, while photochemotherapy (PUVA) is used less because of its dose dependent carcinogenic effect. Laser treatment, which directly targets the depigmentation, can also be used. Those treatment methods can be combined. Stable vitiligo patches, which did not respond to previously mentioned treatment methods, are suitable for surgical treatment, which can be divided into tissue transplantation and cells transplantation methods. If most of the skin surface is affected, there are methods for depigmentation of the surrounding skin. Lesions can be covered up using camouflage techniques, which include make-up and self-tanning products. Intensive research is being done on medications targeting JAK kinases and proinflammatory cytokines.
Keywords
depigmentacija
fototerapija
kortikosteroidi
kvaliteta života
vitiligo
Keywords (english)
depigmentation
corticosteroids
phototherapy
quality of life
vitiligo
Language croatian
URN:NBN urn:nbn:hr:105:729318
Study programme Title: Medicine Study programme type: university Study level: integrated undergraduate and graduate Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
Type of resource Text
File origin Born digital
Access conditions Open access
Terms of use
Created on 2023-10-26 10:09:51