Abstract | Cilj istraživanja
Specijalistički rad detaljno opisuje topikalne pripravke koji se koriste u prevenciji i liječenju
dermatoloških nuspojava povezanih s primjenom konvencionalne i biološke terapije kod onkoloških
pacijenata. U radu su opisane glavne karakteristike najučestalijih dermatoloških nuspojava, njihova
klinička slika, inicidencija te mogući mehanizmi nastanka. Također su opisani topikalni pripravci i
fizikalne metode te opće potporne mjere koji su obuhvaćeni literaturom prevencije i liječenja
dermatoloških nuspojava. Nuspojave obuhvaćene radom odnose se na sindrom šaka-stopalo,
papulopustularni osip, promjene na noktima, pruritus, kserozu, promjene u rastu dlake, fotoosjetljivost,
oralni mukozitis, pigmentacijske promjene, lihenoidni dermatitis, Raynaudov fenomen, flagelatni
dermatitis i ekstravazacijske ozljede. Spomenuti su i teški oblici kožnih reakcija koji zahtijevaju hitnu
hospitalizaciju.
Cilj ovog specijalističkog rada je sustavnim pregledom dostupnih topikalnih pripravaka i
fizikalnih metoda za ublažavanje dermatoloških nuspojava antitumorskih lijekova potaknuti izradu
smjernica za njihovo liječenje te osvijestiti pacijente i zdravstvene djelatnike o mogućnostima i važnosti
njege kože prije, tijekom i nakon procesa liječenja.
Materijal i metode
Materijal za izradu ovog specijalističkog rada sastoji se od relevantnih stručnih i znanstvenih
članaka koji obrađuju problematiku dermatoloških nuspojava povezanih s primjenom antitumorske
terapije i topikalne pripravke koji se koriste za njihovo ublažavanje. Osim stručnih članaka korišteni su i
podaci službenih web-stranica relevantnih za temu rada.
Literatura je pretraživana prema temi istraživanja, predmetu istraživanja, autorima i časopisu.
Pri proučavanju relevantnih članaka izdvojeni su najvažniji rezultati, rasprave i zaključci. Na
temelju proučavanih članaka izvedena su vlastita razmatranja proučavane problematike koja su
sastavni dio rasprave ovog specijalističkog rada.
Literatura je pretraživana putem baza podataka PubMed, Google Scholar i Cochrane Library
korištenjem sljedećih ključnih riječi: anticancer agents, cutaneous adverse reactions, management,
targeted therapies, topical preparations, vehicles.
Rezultati
Unatoč brojnim studijama koje se bave problematikom dermatoloških nuspojava nastalih uslijed
primjene antitumorskih lijekova, još uvijek za većinu njih nisu razvijene jasne smjernice i protokoli
liječenja. Nedostatak kliničkih studija najčešće je premali broj ispitanika i prekratko vrijeme njihova
provođenja. Pacijenti često ne prijavljuju dermatološke nuspojave, osobito kada se javljaju izvan
bolničkih uvjeta, te ih ne povezuju s terapijom.
Kod onkoloških pacijenata topikalni oblici liječenja imaju prednost pred sistemskom terapijom
zbog politerapije. Većina topikalnih lijekova koji su u receptnom režimu koristi se off-label, tj. izvan
odobrene indikacije, temeljem iskustva kliničara i brojnih studija u liječenju dermatoloških nuspojava,
kao što su topikalni kortikosteroidi, inhibitori kalcineurina, analozi vitamina D i retinoidi. Brojni kozmetički
i medicinski proizvodi, primjerice ovlaživači, keratolitici, fotozaštitna i antimikrobna sredstva, široko su
dostupni pacijentima u slobodnoj prodaji uz preporuku prethodnog savjetovanja s ljekarnikom ili drugim
zdravstvenim djelatnikom koji ga izdaje, u svrhu njihove racionalne i odgovorne primjene.
Nanotehnologija je omogućila razvoj suvremenih podloga i formulacija poboljšanih svojstava,
prije svega bioraspoloživosti, koje su prihvatljivije pacijentu i olakšavaju mu primjenu, što u konačnici
dovodi do terapijskog cilja.
Iako su mogućnosti prevencije i liječenja dermatoloških nuspojava antitumorskih lijekova doista
raznolike, još uvijek je zabilježena njihova relativno visoka incidencija.
Zaključak
Pravilnim odabirom topikalnog pripravka čiji je sastav prikladan oboljelom području kože uz
uvažavanje afiniteta pacijenta moguće je utjecati na pojavnost i tijek brojnih dermatoloških nuspojava
bez potrebe za prekidom ili prilagodbom osnovnih terapijskih postupaka.
S obzirom na konstantni porast broja onkoloških pacijenata, a time i primjene biološke terapije
koja je praćena većom incidencijom dermatoloških nuspojava, potrebno je na temelju što većeg broja
provedenih studija razviti opće smjernice za njihovu prevenciju i liječenje. |
Abstract (english) | Objectives
This expert thesis describes in detail the topical formulations used for prevention and treatment
of dermatological side effects associated with the application of conventional and biological treatment
with oncology patients. The paper describes the main characteristics of the most frequent dermatological
side effects, their clinical picture, incidence and possible mechanisms of occurrence. The topical
formulations and physical methods, as well as general support measures are also described, which are
encompassed with the literature for prevention and treatment of dermatological side effects. The side
effects included in this paper refer to the hand-foot syndrome, papulopustular rash, changes on the
fingernails, pruritus, xerosis, changes in hair growth, photosensitivity, oral mucositis, altered
pigmentation, lichenoid dermatitis, Raynaud's phenomenon, flagellate dermatitis, and extravasation
injuries. Severe forms of skin reactions which require urgent hospitalization are also mentioned.
The goal of this expert thesis is to, by systematic overview of available topical formulations and
physical methods for relieving dermatological side effects of anticancer medications, encourage the
development of guidelines for their treatment and to make patients and healthcare workers aware of the
possibilities and importance of skin care prior to, during, and after the treatment process.
Material and methods
The material for drafting this expert thesis is comprised of relevant expert and scientific articles
which address the issue of dermatological side effects associated with the application of anticancer
therapy and topical formulations which are used for their alleviation. Besides expert articles the data
from official websites relevant for the topic of the paper were used.
Literature was searched pursuant to the research topic, research subject, authors, and journal.
When studying relevant articles, the most important results, discussions, and conclusions were
extracted. Based on the studied articles, own considerations of the studied problematic were derived
which are an integral part of the discussion of this expert thesis.
Literature was searched through PubMed, Google Scholar, and Cochrane Library databases,
by using the following keywords: anticancer agents, cutaneous adverse reactions, management,
targeted therapies, topical preparations, vehicles.
Results
Despite numerous studies dealing with the issue of dermatological side effects caused by the
application of anticancer medications, for most of them clear treatment guidelines and protocols have
not yet been developed. The flaws of clinical studies are most often too few respondents and too short
time of their conduction. The patients often don't report dermatological side effects, especially when they
occur outside of hospital settings, and they don't link them with the treatment.
In oncology patients, topical forms of treatment have an advantage to systemic therapy due to
polytherapy. Most of topical medication which are in the prescription regime are used off-label, i.e.
beyond the approved indication, based on the experience of clinicians and numerous studies in treating
dermatological side effects, such as topical corticosteroids, calcineurin inhibitors, vitamin D analogues,
and retinoids.
Numerous cosmetic and medical products, for example moisturizers, keratolytics,
photoprotective and antimicrobial agents are widely available to patients in free sale with the
recommendation of previous consultation with a pharmacist or other healthcare professional who issues
it, for the purpose of their rational and responsible application.
Nanotechnology has enabled the development of modern foundations and formulations with
improved properties, primarily bioavailability, which are more acceptable to the patient and facilitate him
the application, which ultimately leads to the therapeutic goal.
Although the possibilities of prevention and treatment of dermatological side effects of
anticancer medications are truly diverse, their relatively high incidence is still recorded.
Conclusion
By choosing the right topical formulations whose composition is suitable for the affected area of
skin with respect to the affinity of the patient it is possible to influence the incidence and course of
numerous dermatological side effects without the need to interrupt or adjust basic therapeutic
procedures.
Given the constant increase in the number of oncology patients, and thus the application of
biological therapy accompanied by a higher incidence of dermatological side effects, it is necessary to
develop general guidelines for their prevention and treatment based on as many studies as possible. |