I-Javascript ivaliwe esipheqululini sakho okwamanje.Uma i-javascript ivaliwe, eminye imisebenzi yale webhusayithi ngeke isebenze.
Bhalisa imininingwane yakho ethile kanye nezidakamizwa ozithakaselayo, futhi sizofanisa ulwazi olunikezayo nama-athikili kusizindalwazi sethu esibanzi futhi sikuthumelele ikhophi ye-PDF nge-imeyili ngesikhathi esifanele.
I-Piyu Parth Naik Dermatology, Izibhedlela Nemitholampilo YaseSaudi German, Dubai, United Arab Emirates Ezokuxhumana: I-Piyu Parth Naik Dermatology, Izibhedlela Nemitholampilo yaseSaudi German, Burj Al Arab, Dubai, United Arab Emirates Ucingo oluphikisanayo +971 503725616 i-imeyili [i-imeyili itholiwe Ukuvikelwa] Abstract : Ubuthi be-botulinum (BoNT) i-neurotoxin ekhiqizwa amagciwane e-Clostridium botulinum.Inokusebenza ngempumelelo nokuphepha okwaziwayo ekwelapheni i-focal idiopathic hyperhidrosis.I-BoNT iqukethe ama-neurotoxin ayisikhombisa ahlukene;Nokho, ubuthi A no-B kuphela asetshenziswa emtholampilo.I-BoNT isanda kusetshenziselwa ukwelashwa ngaphandle kwelebula yezifo ezihlukahlukene zesikhumba.Ukuvimbela isibazi, i-hyperhidrosis, imibimbi, amavukuzane amancane okujuluka, ukuqothuka kwezinwele, i-psoriasis, isifo sika-Darier, isifo se-bullous skin, i-herpes yokujuluka kanye ne-Raynaud's phenomenon ezinye zezinkomba ezintsha ze-BoNT ezimonyoni, ikakhulukazi ku-dermatology Ezicini ezingezona izimonyo.Ukuze sisebenzise i-BoNT ngendlela efanele ekusebenzeni komtholampilo, kufanele siqonde kahle i-anatomy esebenzayo yemisipha elingisiwe.Ukusesha kwezincwadi okujulile kwenziwa ukuze kubuyekezwe zonke izivivinyo ezigxile ku-dermatological nezivivinyo zomtholampilo ezicini ze-BoNT ukuze kunikezwe umbono ojwayelekile wokusetshenziswa kwe-BoNT ku-dermatology.Lokhu kubuyekezwa kuhlose ukuhlaziya indima ye-botulinum toxin ku-dermatology kanye ne-cosmetology.Amagama angukhiye: i-botulinum toxin, i-botulinum toxin, i-botulinum, i-dermatology, i-cosmetology, i-neurotoxin
I-Botulinum neurotoxin (BoNT) ikhiqizwa ngokwemvelo yi-Clostridium botulinum, okuyi-anaerobic, i-gram-positive, i-spore-producing bacterium.1 Kuze kube manje, ama-serotypes e-BoNT ayisikhombisa (A kuya ku-G) atholakele, futhi izinhlobo A no-B kuphela ezingasetshenziswa ekusetshenzisweni kokwelapha.I-BoNT A (i-Oculinum) yagunyazwa yi-US Food and Drug Administration (FDA) ngo-1989 ukuze kwelashwe i-blepharospasm kanye ne-strabismus.Inani lokwelapha le-BoNT A lanqunywa okokuqala ngqa.Kwaze kwafika ngo-April 2002 lapho i-FDA igunyaza ukusetshenziswa kwe-BoNT A ukwelapha imigqa ye-glabellar.I-FDA igunyaze i-BoNT A yokwelashwa komugqa ongaphambili kanye nolayini ongaseceleni wecanthal ngo-Okthoba 2017 noSepthemba 2013, ngokulandelanayo.Kusukela lapho, ukwakhiwa kwe-BoNT okuningana kwethulwe emakethe.2 Selokhu yathengiswa, i-BoNT iye yasetshenziselwa ukwelapha amajaqamba, ukucindezeleka, i-hyperhidrosis, i-migraine, nokuguga kwentamo, ubuso, namahlombe emkhakheni wezokwelapha nezimonyo.3,4
I-Clostridium botulinum ikhiqiza inhlanganisela yamaprotheni amathathu ehlanganisa ubuthi obuyi-150 kDa, amaprotheni angenabuthi, angenayo i-hemagglutinin, kanye nephrotheni ye-hemagglutinin engenabuthi.Ama-bacterium proteases adiliza ubuthi abe umkhiqizo osebenzayo onemicu ephindwe kabili eneketanga "elikhanyayo" elingu-50 kDa kanye neketango "elisindayo" elingu-100 kDa.Ngemva kokuhanjiswa ku-presynaptic nerve terminal, iketango elisindayo le-toxin esebenzayo libophezela ku-synaptic vesicle glycoprotein 2, lithuthukise i-endocytosis ye-toxin-glycoprotein complex, futhi likhiphele iketango lokukhanya lobuthi endaweni ye-synaptic.I-toxin light chain cleavage vesicle-associated membrane membrane protein/synaptoxin (BoNT-B, D, F, G) noma iprotein 25 ehlotshaniswa ne-synaptosome (BoNT-A, C, E) ukuvimbela ukukhishwa kwe-peripheral motor neuron axon I-Acetylcholine nayo idala isikhashana. ukuwohloka kwamakhemikhali nokukhubazeka kwemisipha.2 E-United States, kunamalungiselelo amane e-BoNT-A atholakala ngokwentengiso agunyazwe i-FDA: i-incobotulinumtoxinA (Frankfurt, Germany), onabotulinumtoxinA (California, US), prabotulinumtoxinA-xvfs (California, US), kanye ne-abobotulinumtoxinA (Arizona, US) ;kanye Nohlobo olulodwa lwe-BoNT-B: rimabotulinumtoxinB (California, USA).5 Umhlahlandlela et al.6 iphawule ngeqhaza le-BoNT emkhakheni we-dermatology.Kodwa-ke, akukaze kube nokubuyekezwa kwakamuva mayelana nokusetshenziswa kwe-BoNT emkhakheni we-dermatology nobuhle.Ngakho-ke, lokhu kubuyekezwa kuhlose ukuhlaziya indima ye-BoNT ku-dermatology kanye ne-cosmetology.
Amagama angukhiye aqondile ahlanganisa ubuthi be-botulinum, isikhumba esinamafutha, i-rosacea, ukuguquguquka kobuso, izibazi, imibimbi, ukulahlekelwa izinwele, i-psoriasis, isifo sesikhumba se-bullous, isifo sika-Darier, ama-exocrine moles, i-sweat herpes, i-Raynaud's phenomenon, i-hyperhidrosis Ekuphenduleni, i-dermatology, nobuhle, ukusesha izihloko. ziqhutshwa kusizindalwazi esilandelayo: I-Google Scholar, i-PubMed, i-MEDLINE, i-Scopus, ne-Cochrane.Umbhali ikakhulukazi ufuna izindatshana mayelana neqhaza le-BoNT ku-dermatology kanye ne-cosmetology.Ukusesha kwezincwadi kokuqala kwembula izindatshana ze-3112.Izindatshana ezishicilelwe phakathi kukaJanuwari 1990 noJulayi 2021 ezichaza i-BoNT ku-dermatology ne-cosmetology, izindatshana ezishicilelwe ngesiNgisi, nayo yonke imiklamo yocwaningo ifakiwe kulokhu kubuyekezwa.
I-Canada yagunyaza ukusetshenziswa kwe-BoNT ekwelapheni okuyizimonyo kwemisipha yasendaweni kanye nokushwabana kwamashiya ngo-2000. I-FDA yase-US yagunyaza ukusetshenziswa kwe-BoNT ngezinjongo zezimonyo ngomhla ka-April 15, 2002. Izinkomba ze-BoNT-A ezisanda kusetshenziswa ekusetshenzisweni kwezimonyo zifaka phakathi imigqa eshwabene phakathi. amashiya, izinyawo zegwababa, imigqa yonogwaja, imigqa yasebunzini evundlile, imigqa ye-perioral, ukugoqa kwengqondo nokucindezelwa kwezilevu, amabhande e-platysma, ukushwabana komlomo, nemigqa yentamo evundlile.7 Izinkomba zohlobo lwe-botulinum A olugunyazwe yi-US FDA ziphakathi nendawo kuya kweqinile imigqa eshwabene ehlotshaniswa nomsebenzi oweqile wemisipha yangaphambili kanye/noma eshwabene phakathi kwamashiya, kanye nemigqa emaphakathi kuya kokuqina ehlangothini yecanthal ehambisana nomsebenzi oweqile wemisipha ye-orbicularis.Futhi umugqa wasebunzini ovundlile omaphakathi ukuya kobukhali ohlotshaniswa nomsebenzi omsipha wangaphambili owedlulele.8
I-Sebum isiza ukuhlinzeka ngama-antioxidants ancibilikayo ngamafutha ebusweni besikhumba futhi inezindawo zokulwa namagciwane;ngakho-ke, isebenza njengesithiyo sesikhumba.I-sebum eningi ingavala izimbotshana, izale amagciwane futhi ingase ibangele ukuvuvukala kwesikhumba (isibonelo, i-seborrheic dermatitis, induna).Ngaphambilini, ulwazi olufanele mayelana nemiphumela ye-BoNT ku-sebum seludaluliwe.I-9,10 Rose kanye ne-Goldberg10 ihlole ukusebenza nokuphepha kwe-BoNT kubantu abangu-25 abanesikhumba esinamafutha.I-BoNT (abo-BNT, umthamo ophelele we-30-45 IU) ijova amaphuzu angu-10 ebunzini, okuthuthukisa kakhulu ukwaneliseka kwesiguli futhi kunciphisa ukukhiqizwa kwe-sebum.Min et al.kwabelwa ngokungahleliwe izifundo ezingu-42 ezinemibimbi yasebunzini ukuze zithole amayunithi angu-10 noma angu-20 e-BoNT ezindaweni ezinhlanu ezihlukene zokujova.Womabili amaqembu athole ukwelashwa kwe-BoNT, okuholele ekuncipheni okukhulu kwe-sebum endaweni yomjovo kanye ne-sebum gradient endaweni yomjovo.Ngesonto le-16, ukukhiqizwa kwe-sebum kwamaqembu amabili okwelapha kubuyele emazingeni ajwayelekile, futhi ngokwanda komthamo womjovo, umphumela wokwelapha awuzange ube ngcono kakhulu.
Indlela umjovo we-intradermal we-toxin ye-botulinum oholela ngayo ekunciphiseni ukukhishwa kwe-sebum ayiqondi ngokugcwele, ngoba imiphumela yesimiso sezinzwa kanye ne-acetylcholine ezindlala ze-sebaceous ayikachazwa ngokugcwele.Imiphumela ye-neuromodulatory ye-BoNT cishe iqondise ama-receptors endawo e-muscarinic ku-erector pili muscle nezindlala ze-sebaceous.Ku-vivo, i-nicotinic acetylcholine receptor 7 (nAchR7) ivezwa ezindlala ze-sebaceous zomuntu, futhi ukusayina kwe-acetylcholine kukhulisa ukwakheka kwe-lipid ngendlela encike kumthamo ku-vitro.11 Ucwaningo olwengeziwe luyadingeka ukuze kutholwe ukuthi ubani obaluleke kakhulu kanye nenqubo yomjovo kanye nemithamo engcono kakhulu (Umfanekiso 1A no-B).
Umfanekiso 1 Isithombe esingenhla (A) sesiguli esinesikhumba esinamafutha asobala, kuyilapho kwesinye isigxobo, isithombe esingezansi (B) sesiguli esifanayo ngemva kokwelashwa kwe-BoNT okubili sibonisa ukuthuthuka okuphawulekayo.(Ubuchwepheshe: amayunithi angu-100, u-2.5 ml we-intradermal BoNT-A wajovwa kanye ebunzini. Ingqikithi yokwelashwa okufanayo okubili kwenziwa ngokuhlukana kwezinsuku ezingu-30. Ukusabela okuhle komtholampilo kwathatha izinyanga ezingu-6).
I-Rosacea yisifo esivamile sesikhumba esivuthayo esibonakala ngokuguquguquka kobuso, i-telangiectasia, ama-papules, ama-pustules, ne-erythema.Imithi yomlomo, i-laser therapy, kanye nemithi yokwelapha ngokuvamile isetshenziselwa ukwelapha ukuguquguquka kobuso, nakuba kungasebenzi ngaso sonke isikhathi.Olunye uphawu olungemnandi lokunqamuka kokuya esikhathini ukuguquguquka kobuso.Ucwaningo oluningana lubonise ukuthi i-BoNT ingasiza ekwelapheni ukushisa kwe-menopausal kanye ne-rosacea.12-14 Umthelela we-BoNT ku-Dermatological Quality of Life Index (DLQI) yeziguli ezinokuguquguquka kobuso uzophenywa ocwaningweni lokuhlola oluzayo.15 I-BoNT ijovwe esihlathini kanye, kuze kufike kumthamo ophelele wamayunithi angama-30, okuholele ekwehleni okukhulu kwe-DLQI ezinyangeni ezimbili.Ngokuka-Odo et al., i-BoNT yehlise kakhulu isilinganiso senani lokukhanya okushisayo kokuya esikhathini ngosuku lwama-60.12 Umphumela we-abo-BoNT nawo wacwaningwa ezigulini eziyi-15 ezine-rosacea.Ezinyangeni ezintathu kamuva, i-15-45 IU ye-BoNT yajovwa ebusweni, okwaholela ekuthuthukisweni okuphawulekayo kwezibalo ze-erythema.13 Ocwaningweni, ukusabela okubi akuvamile ukuba kukhulunywe ngakho.
Ukwanda kokuguquguquka kwe-BoNT kungesinye sezizathu ezingaba yisizathu sokuvinjwa kwayo okuqinile kokukhululwa kwe-acetylcholine kuma-peripheral autonomic neurons ohlelweni lwe-vasodilation yesikhumba.16,17 Kwaziwa kahle ukuthi abalamuli abavuvukalayo njenge-calcitonin peptide ehlobene nofuzo (CGRP) kanye ne-substance P (SP) nabo bavinjelwa yi-BoNT.18 Uma ukuvuvukala kwesikhumba sendawo kuncipha futhi kulawulwa, i-erythema ingase iphele.Ukuze uhlole indima ye-BoNT ku-rosacea, kudingeka izifundo ezibanzi, ezilawulwayo, ezingahleliwe.Imijovo ye-BoNT yokuguquguquka kobuso inezinzuzo ezengeziwe ngoba inganciphisa ubunzima kwizicindezeli zobuso, ngaleyo ndlela ithuthukise imigqa emihle nemibimbi.
Abantu abaningi manje bayakubona ukubaluleka kokugwema ngenkuthalo izibazi ekwelapheni izibazi zangemva kokuhlinzwa.Ukushuba kwesilonda onqenqemeni lwesilonda phakathi nenqubo yokuphola kuyisici esibalulekile ekunqumeni ukubukeka kokugcina kwesibazi sokuhlinzwa.I-19,20 BoNT ivimbela ukukhululwa kwe-acetylcholine neurotransmitter, cishe iqede ngokuphelele ukuqina kwemisipha eshukumisayo esilondeni esipholayo esivela kumthambo we-peripheral.Izici zokudambisa ukushuba kwe-BoNT, kanye nokuvimbela kwayo okuqondile kwe-fibroblast kanye nenkulumo ye-TGF-1, kubonisa ukuthi ingasetshenziswa ukugwema izibazi zokuhlinzwa.I-21-23 Umphumela wokulwa nokuvuvukala we-BoNT kanye nomthelela wawo esikhumbeni se-vasculature kunganciphisa isigaba senqubo yokuphulukisa isilonda esivuvukalayo (kusuka ezinsukwini ezimbili kuya kwezingu-5), okungasiza ekuvimbeleni ukwakheka kwezibazi.
Ezifundweni ezihlukahlukene, i-BoNT ingasetshenziswa ukuvimbela izibazi.24-27 Ku-RCT, ukuphepha nokusebenza komjovo we-BoNT wangaphambi kokuhlinzwa ezigulini ze-15 ezinezibazi ezivela ku-thyroidectomy zahlolwa.24 Izibazi ezintsha (zingakapheli izinsuku ezingu-10 ze-thyroidectomy) zanikezwa i-BoNT (20-65 IU) noma u-0.9% we-saline evamile (ukulawula) kanye.Ingxenye yokwelashwa kwe-BoNT ibonise umphumela ongcono kakhulu wezibazi kanye nokwaneliseka kwesiguli kunokwelashwa okujwayelekile ngosawoti omningi .U-Gassner et al.25 baphenye ukuthi ingabe ukujova kwe-BoNT ebusweni ngemva kokubhodlozwa kwesiphongo nokukhishwa kabusha kungaphola yini izibazi zobuso.Uma kuqhathaniswa nomjovo we-placebo (usawoti ovamile), i-BoNT (15-45 IU) yajovwa esibazini sangemva kokuhlinzwa ngemva kokuvalwa kwenxeba phakathi namahora angu-24 ukuze kuthuthukiswe umphumela wezimonyo nokuphola kwesilonda.
Imibimbi enamandla futhi emile yenziwa izicubu zemisipha ezisebenza kakhulu, ukulimala okuncane nokuguga, futhi iziguli zikholelwa ukuthi zibenza babukeke bekhathele noma bethukuthele.Ingaphatha imibimbi yobuso futhi inikeze abantu ukubukeka okukhululekile nokuqabulayo.I-FDA njengamanje inokugunyazwa okukhethekile kwe-BoNT yokwelapha ulayini we-periorbital kanye no-interbrow.I-BoNT isetshenziselwa ukwelapha i-masseter hypertrophy, ukumamatheka kwe-gingival, ibhendi ye-platysma, imajibula ye-mandibular, ukudangala kwesilevu, umugqa wesiphongo ovundlile, ukumamatheka okugobile, umugqa weperioral, umugqa wamakhala ovundlile namashiya axegayo.Umphumela womtholampilo uhlala cishe izinyanga ezintathu.28,29 (Umfanekiso 2A no-B).
Umfanekiso 2 Isithombe esiphezulu (A) ngaphambi komjovo we-Botox wekesi sibonisa ukuthi umugqa wesiphongo ovundlile kanye nomugqa weglabe kwenza isihloko sibukeke sithukuthele.Ngakolunye uhlangothi, isithombe esiphansi secala elifanayo (B) ngemva kwenyama emibili Ngemva komjovo we-toxin, le migqa isuswa ngokunethezeka.(Ubuchwepheshe: amayunithi angama-36, u-0.9 mL we-intradermal BoNT-A wajovwa esiphongweni ngesikhathi. Indawo yomjovo yayiphawulwe ngepensela yesikhumba ngaphambi kokwelashwa. Isamba sokwelashwa okubili okufanayo kwenziwa, ngokwehlukana kwezinsuku ezingama-30).
I-BoNT ingathuthukisa ukuzethemba kwesiguli ngokomzwelo nokucatshangwayo lapho isetshenziswa ngokunciphisa isigqi.Ukuthuthuka kumphumela we-FACE-Q kubonwe ngemva kokwelashwa kwemigqa ye-glabellar emaphakathi kuya kokuqina.Ngisho nangemva kwezinsuku eziyi-120, lapho imiphumela yomtholampilo ye-BoNT kufanele ngabe isinciphile, iziguli zabika ukuthuthuka kwezempilo yengqondo kanye nokubukeka okuthuthukile kobuso.
Ngokungafani nokujovwa kabusha okuzenzakalelayo kwe-BoNT njalo ngemva kwezinyanga ezintathu ukuze kutholwe impendulo engcono kakhulu yomtholampilo neyengqondo, udokotela kufanele axoxisane nesiguli lapho kudingekile ukuhlehla.I-30,31 Ngaphezu kwalokho, i-BoNT isetshenziswe ngempumelelo ukuvimbela nokwelapha i-migraine ku-neurology, ukuthuthukisa izinga lempilo nokuphila kahle kweziguli32 (Umfanekiso 3A no-B).
Umfanekiso 3 Isithombe esingaphezulu (A) sesihloko sibonisa ukuthi imigqa engemuva ye-periorbital inikeza umuzwa wokuguga nokukhathala.Ngakolunye uhlangothi, isithombe esiphansi (B) secala elifanayo siqeda le migqa futhi siyiphakamisa ngemva komjovo we-Botox Amashiya aseceleni abonakala ngokucacile.Ngemva kokuhlala phansi ngalesi sikhathi, le ndikimba iphinde iveze ingcebo yempilo engokomzwelo.(Ubuchwepheshe: amayunithi angu-16, i-0.4 ml ye-intradermal BoNT-A ijovwa kanye, kanye endaweni ngayinye esemaceleni e-periorbital. Kube kanye kuphela okugcine kunempendulo ebalulekile ethatha izinyanga ezi-4.)
I-Alopecia areata, i-androgenetic alopecia, i-alopecia yekhanda elibuhlungu kanye ne-radiation-indued alopecia kwelashwe nge-BoNT-A.Nakuba indlela eqondile i-BoNT esiza ngayo izinwele zivuseleleke ingaqinisekile, kucatshangelwa ukuthi ngokuphumuza imisipha ukuze kuncishiswe umfutho we-microvascular, ingathuthukisa ukutholakala komoya-mpilo ezinhlakeni zezinwele.Ezifundweni ezingu-1-12, i-30-150 U ijojowe ku-lobe yangaphambili, i-periauricular, temporal kanye nemisipha ye-occipital (Umfanekiso 4A no-B).
Umfanekiso 4 Uhhafu wesokunxele (A) wesithombe somtholampilo ubonisa uhlobo lwesi-6 lwempandla yowesilisa wendoda eneminyaka engu-34 ubudala ngokwesigaba esamukelwayo saseNorwood-Hamilton.Ngokuphambene, isiguli esifanayo sabonisa ukwehliswa kohlobo lwe-3V ngemva kwemijovo ye-botulinum engu-12 (B).(Ubuchwepheshe: amayunithi angu-100, u-2.5 mL we-intradermal BoNT-A wajovwa endaweni ephezulu yekhanda kanye. Isamba sokwelashwa okufanayo okuyi-12 esihlukaniswe izinsuku eziyi-15 siholele ekuphenduleni komtholampilo okwamukelekayo, okuthathe izinyanga ezi-4).
Nakuba ucwaningo oluningi lubonisa ukuthuthukiswa komtholampilo ekumineni kwezinwele noma ukukhula kanye nokwaneliseka okuphezulu kwesiguli, amanye ama-RCT ayadingeka ukuze kunqunywe umthelela wangempela we-BoNT ekukhuleni kwezinwele.33-35 Ngakolunye uhlangothi, imijovo eminingi ye-BoNT yemibimbi yasebunzini iqinisekisiwe ukuthi ihlobene nokuqothuka kwezinwele zangaphambili.36
Ucwaningo oluningana lubonise ukuthi isimiso sezinzwa sidlala indima ku-psoriasis.Ukugcwala kwemicu yezinzwa esikhumbeni se-psoriasis kuphezulu, futhi amazinga e-CGRP ne-SP atholakala ezinzwa ezinzwa aphezulu.Ngakho-ke, ubufakazi bomtholampilo obubonisa ukuxolelwa kwe-psoriasis ngemva kokulahlekelwa i-innervation kuyanda, futhi ukulimala kwesimiso sezinzwa noma ukusebenza kwezinzwa kusekela le mbono.I-37 BoNT-A yehlisa ukukhululwa kwe-CGRP ne-SP ye-neurogenic, okungachaza ukubonwa komtholampilo okuzimele kwesifo.38 Emagundaneni amadala e-KC-Tie2, umjovo we-intradermal we-BoNT-A unganciphisa kakhulu ama-lymphocyte esikhumba uma kuqhathaniswa ne-placebo Infiltrate futhi uthuthukise kakhulu i-acanthosis.37 Nokho, mincane kakhulu imibiko yomtholampilo eshicilelwe kanye nezifundo zokuqaphela, futhi ayikho kuzo elawulwa yi-placebo.Phakathi kweziguli ze-15 ezine-psoriasis ephambene, i-Zanchi et al.38 ibike impendulo enhle yokwelashwa kwe-BoNT-A;kodwa-ke, imiphumela yokuhlolwa kwesiguli kanye nokuhlolwa kwezithombe zokungena nokungena kanye nokuhlolwa kwe-erythema kwasetshenziswa.Ngakho-ke, u-Chroni et al39 baveze ukukhathazeka okuhlukahlukene mayelana nocwaningo, kuhlanganise nokuntuleka kwezinkomba zokulinganisa ukuthuthukiswa (njengamaphuzu e-PA).Umbhali ucabange ukuthi i-BoNT-A inomphumela omuhle ekwehliseni ukujuluka kwendawo ekugoqeni, njengesifo i-Hailey-Hailey, lapho umphumela we-BoNT-A ubangelwa ukuncipha kokujuluka.I-40-42 Ikhono le-BoNT-A lokuvimbela i-hyperalgesia Nokho, ukukhululwa kwe-neuropeptides kuholela ebuhlungu obuncane kanye nokuluma ezigulini.43
I-Off-lebel, i-BoNT isetshenziselwe ukwelapha izifo ezihlukahlukene zesikhumba eziyinkunzi, njenge-linear IgA bullous disease disease, isifo se-Weber-Cockayne nesifo sika-Hailey-Hailey.Imijovo ye-BoNT-A, i-tacrolimus yomlomo, i-yttrium aluminium garnet ablation laser, kanye ne-BoNT-A equkethe i-erbium iye yasetshenziswa ukwelapha isifo i-Hailey-Hailey endaweni engaphansi kwebele, i-axillary, inguinal kanye ne-intergluteal cleft.Ngemuva kokwelashwa, izimpawu zomtholampilo ziba ngcono, futhi ububanzi bethamo bungama-25 kuya ku-200 U njalo ezinyangeni ezi-3 kuya kwezi-6.42,44 Ecaleni elibikiwe, owesifazane oneminyaka ephakathi ne-epidermolysis bullosa wesifunda wajova u-50 U ikhwapha ngalinye onyaweni lwakhe, kwathi u-100 U wajovwa esigulini nge-linear IgA bullosa Foot yesiguli esincane esinesifo sesikhumba.45,46
Ngo-2007, u-Kontochristopoulos et al47 uphathe ngempumelelo indawo engaphansi kwesiguli esineminyaka engu-59 ubudala, esebenzisa i-BoNT-A njengokwelashwa kwe-adjuvant yesifo sika-Darier okokuqala ngqa.Kwesinye isimo ngo-2008, ingane encane enokubandakanyeka okunzima kwe-anogenital yayinenzuzo ekunciphiseni ukujuluka endaweni ephukile.48 Ukutheleleka kwakhe okuhambisana nakho welashwa nge-acitretin engu-10 mg kanye nama-antibiotics kanye nemithi elwa namagciwane ngosuku, kodwa izinga lakhe lempilo laliphansi futhi ukungakhululeki kwakhe kwaqhubeka.Emasontweni amathathu ngemva kokujova ubuthi be-botulinum, izimpawu zakhe nezilonda zasemtholampilo zaba ngcono kakhulu.
I-Eccrine nevus i-hamartoma yesikhumba engavamile ebonakala ngokunyuka kwenani lezindlala ze-eccrine kodwa akukho ukuthuthukiswa kwemithambo yegazi.Ngenxa yesici sokugcina, i-eccrine nevus ihlukile kwezinye izifo ezifana ne-angiomatous eccrine hamartoma.49 Iimvukuzane ezincane zokujuluka zivame kakhulu ezimpahleni, zinezinkinga ezimbalwa zesikhumba, kodwa kunezindawo zasendaweni ze-hyperhidrosis.50 Ukuhlinza ngokuhlinzwa noma imithi ye-topical yizindlela zokwelapha ezidume kakhulu, kuye ngosayizi wekhava kanye nebhizinisi le-hyperhidrosis.U-Honeyman et al51 babhale ngengane eneminyaka engu-12 ubudala ene-sweat nevi encane azalwe nayo esihlakaleni esingakwesokudla eyayikwazi ukumelana nama-antiperspirants.Ngenxa yobukhulu be-tumor kanye nendawo yaso ye-anatomical, ukukhishwa kokuhlinzwa akuzange kufakwe.I-Hyperhidrosis yenza ukubamba iqhaza emisebenzini yezenhlalo neyengqondo kube inselele.Abacwaningi bakhethe ukujova i-5 U ye-BoNT-A ngezikhathi ze-0.5-1 cm.Ababhali abazange bacacise ukuthi impendulo yokuqala yokwelashwa kwe-BoNT-A yenzeke nini, kodwa bathi ngemva konyaka, baqaphela ukuthi isibalo sokujuluka sehle kakhulu saba kanye ngenyanga, nezinga lempilo yesiguli liyathuthuka.U-Lera et al49 uphathe isiguli esinezinga eliphansi lempilo kanye nenani le-HDSS elingu-3 engalweni enomjuluko omncane we-naevi (HDSS) (onzima).I-BoNT-A (100 IU) iphinde yahlanganiswa ngengxube ye-saline oyinyumba engu-2.5 mL equkethe u-0.9% we-sodium chloride futhi yajova endaweni yokuhlola i-iodine yokulandela umkhondo.Ngemva kwamahora angu-48, isiguli sabona ukujuluka okuncishisiwe, okube nemiphumela emihle kakhulu ngesonto lesithathu.Isikolo se-HDDS sehla siye ku-1. Ngenxa yokuphinda ukujuluka, ukwelashwa kwe-BoNT-A kwaphindwa ngemva kwezinyanga eziyisishiyagalolunye.Ekwelapheni i-exocrine hemangioma hamartoma, ukwelashwa komjovo we-BoNT-A kuyasiza.52 Nakuba lesi simo siyivelakancane, kulula ukubona ukuthi kubaluleke kangakanani ukuthi laba bantu babe nezinketho zokwelashwa ezisebenzayo.
I-Hidradenitis suppurativa (HS) yisifo sesikhumba esingamahlalakhona esibonakala ngobuhlungu, izibazi, izona, ama-fistula, amaqhuqhuva avuvukele, futhi sivela ezindlaleni ze-apocrine ekupheleni kwezigaba.53 I-pathophysiology yalesi sifo ayicacile, futhi imibono eyamukelwa ngaphambilini mayelana nokuthuthukiswa kwe-HS manje ibekela inselele.Ukuvaleka kwe-follicle yezinwele kubalulekile ezimpawu ze-HS, nakuba indlela ebangela ukuvala ingacacile.Njengomphumela wokuvuvukala okulandelayo kanye nenhlanganisela yokungasebenzi kahle kwamasosha omzimba kokuzalwa nokuguquguqukayo, i-HS ingadala ukulimala kwesikhumba.54 Ucwaningo olwenziwa ngu-Feito-Rodriguez et al.55 lubike ukuthi i-BoNT-A yelaphe ngempumelelo i-prepubertal HS emantombazaneni aneminyaka engu-6 ubudala.Umbiko wecala lika-Shi et al.56 uphawule ukuthi i-BoNT-A yelashwe ngempumelelo esigabeni se--3 HS sowesifazane oneminyaka engu-41 ubudala.Ucwaningo lwakamuva olwenziwa ngu-Grimstad et al.57 luhlole ukuthi ingabe umjovo we-intradermal we-BoNT-B uyasebenza yini ku-HS ezigulini ezingu-20.I-DLQI yeqembu le-BoNT-B inyuke isuka ku-median ye-17 ekuqaleni yaya ku-8 ezinyangeni ezi-3, kuyilapho i-DLQI yeqembu le-placebo yehla isuka ku-13.5 yaya ku-11.
I-Notalgia paresthetica (NP) i-neuropathy eqhubekayo ethinta indawo ephakathi nendawo, ikakhulukazi i-T2-T6 dermatome, enokuluma engenhla nezimpawu zesikhumba ezihlobene nokungqubuzana nokuklwebheka.I-BoNT-A ingasiza ekwelapheni ukulunywa kwendawo ngokuvimba ukukhululwa kwento engu-P, izinhlungu nokulunywa komlamuli.58 Umbiko wecala lika-Weinfeld59 uhlole ukusebenza kwe-BoNT-A ezimweni ezimbili.Bobabili belashwe ngempumelelo nge-BoNT-A.Ucwaningo olwenziwa nguPerez-Perez et al.58 luhlole ukusebenza kwe-BoNT-A ezigulini ze-5 ezitholwe zine-NP.Ngemuva komjovo we-intradermal we-BoNT, imiphumela eminingi yabonwa.Akukho ukulunywa komuntu okwakhululeka ngokuphelele.Isivivinyo esilawulwa ngokungahleliwe (RCT) sika-Maari et al60 sihlole ukusebenza kahle nokuphepha kwe-BoNT-A ezigulini ezine-NP e-Canadian Dermatology Research Clinic kusukela ngoJulayi 2010 kuya kuNovemba 2011. Ucwaningo lwehlulekile ukuqinisekisa imiphumela enenzuzo ye-BoNT-A.Umjovo we-Intradermal ngethamo elifika ku-200 U ukunciphisa ukulunywa ezigulini ezine-NP.
I-Pompholyx, ebizwa nangokuthi i-hyperhidrosis eczema, isifo se-vesicular bullous esihlasela izintende nezinyawo zezinyawo.Nakuba i-pathophysiology yalesi simo ingacacile, manje isithathwa njengophawu lwe-atopic dermatitis.61 Ukusebenza okumanzi, ukujuluka, kanye nokuphazamiseka yizici ezivame kakhulu eziholela phambili.62 Ukugqoka amagilavu noma izicathulo kungabangela ubuhlungu, ukuvutha, ukulunywa, kanye nokungaphatheki kahle ezigulini;izifo ezibangelwa amagciwane zivamile.U-Swartling et al61 uthole ukuthi iziguli ezine-palm hyperhidrosis zelashwa nge-BoNT-A ethuthukisiwe ye-eczema yesandla.Ngo-2002, bashicilela imiphumela yocwaningo olubandakanya iziguli eziyishumi ezine-bilateral vesicular hand dermatitis;isandla esisodwa sathola umjovo we-BoNT-A, kanti esinye isandla sasebenza njengokulawula ngesikhathi sokulandelela.Ukwelashwa kube nemiphumela emihle noma emihle kakhulu ezigulini eziyi-7 kweziyi-10.Ezigulini eziyisi-6, u-Wollina no-Karamfilov63 basebenzisa i-topical corticosteroids ezandleni zombili futhi bajova i-100 U ye-BoNT-A ngokungena entracutaneously ezandleni ezithinteke kakhulu.Ekwelashweni kwesandla kokwelashwa okuhlangene, ababhali bathola ukuthi ukulunywa namabhamuza kwehla ngokushesha.Bathi ukusebenza kahle kwe-BoNT-A ku-impetigo ngenxa yomphumela wayo wokungajuluki kanye nokuvinjwa kwe-SP.
I-finger vasospasm, eyaziwa nangokuthi i-Raynaud's syndrome, inselele ukuyelapha futhi ngokuvamile ayizweli emithini yomugqa wokuqala njenge-bosentan, iloprost, i-phosphodiesterase inhibitors, i-nitrate, kanye ne-calcium channel blockers.Izinqubo zokuhlinza ezibandakanya ukululama nokuvalwa, njenge-sympathectomy, ziyahlasela.Isimo sikaRaynaud esihlotshaniswa ne-primary and sclerosis selashwe ngempumelelo ngomjovo we-BoNT.Abaphenyi be-64,65 baqaphele ukuthi iziguli ze-13 zithole ukukhululeka kobuhlungu ngokushesha, futhi izilonda ezingapheli zelashwa zingakapheli izinsuku ezingu-60 ngemuva kokuthola i-50-100 U ye-BoNT.Imijovo yanikezwa iziguli eziyi-19 ezinesimo sikaRaynaud.66 Ngemva kwamasonto ayisithupha, izinga lokushisa lomunwe weminwe elashwe nge-BoNT lenyuke kakhulu uma liqhathaniswa nomjovo we-saline evamile, okubonisa ukuthi i-BoNT inenzuzo ekwelapheni i-vasospasm ehlobene ne-Raynaud.67 Njengamanje, zikhona izindlela ezijwayelekile zokujova ezisetshenziswayo;ngokusho kocwaningo oluthile, imijovo eminwe, ezihlakaleni, noma emathanjeni e-metacarpal distal ayizange iholele emiphumeleni yomtholampilo ehluke kakhulu, nakuba iphumelela ekwelapheni i-vasospasm ehlobene ne-Raynaud.68
I-50-100 U ye-BoNT-A ngekhwapha ngalinye, elawulwa nge-intradermally kumklamo ofana negridi, ingasetshenziswa ukwelapha i-primary axillary hyperhidrosis.Imiphumela yomtholampilo ibonakala phakathi nesonto futhi ihlala izinyanga ezi-3 kuye kweziyi-10.Iziguli eziningi zanelisekile ngokwelashwa kwazo.Iziguli kufanele zaziswe ukuthi kuze kufike ku-5% wamacala azothola ukujuluka kwesimanje okunxephezela.I-69,70 BoNT ingakwazi futhi ukwelapha ngempumelelo i-palm and plantar hyperhidrosis (Umfanekiso 5A no-B).
Umfanekiso wesi-5 Isithombe somtholampilo sezinga eliphezulu (A) sibonisa umfundi osemusha wasekolishi one-diffuse palm hyperhidrosis okhathazekile ngalesi sifo futhi ongaphenduli emithini.Iziguli ezifanayo ezathola ukwelashwa kobuthi be-botulinum zabonisa ukulungiswa okuphelele kwe-hyperhidrosis (B).(Ubuchwepheshe: Ngemva kokuqinisekiswa ngokuhlolwa kwe-iodine yesitashi; amayunithi angu-100, i-2.5 mL ye-intradermal BoNT-A yajovwa kanye ngesandla. Isamba sezifundo ezimbili ezifanayo zezinsuku eziyi-15 ngokuhlukana zikhiqize impendulo ebalulekile ethatha izinyanga eziyi-6).
Umunwe ngamunye unendawo yomjovo we-2-3, futhi imijovo kufanele ihlelwe kugridi enebanga elingu-1 cm.I-BoNT-A inganikezwa esandleni ngasinye ebangeni lamayunithi angama-75-100 kanye nonyawo ngalunye ebangeni lamayunithi ayi-100-200.Imiphumela yomtholampilo ingase ithathe isonto ukuze ibonakale, futhi ingase ihlale izinyanga ezintathu kuya kweziyisithupha.Ngaphambi kokuqala ukwelashwa, iziguli kufanele zaziswe ngemiphumela engemihle engaba khona yomjovo we-BoNT ezintendeni zezandla nasezinyaweni.Ngemuva komjovo wesundu, isiguli singase sibike ubuthakathaka.Ngakolunye uhlangothi, imijovo ye-plantar ingase yenze ukuhamba kube nzima, ikakhulukazi uma ama-nerve blocks enziwa ngaphambi kokwelashwa kwe-BoNT.71,72 Ngeshwa, u-20% weziguli ze-plantar hyperhidrosis aziphenduli ekwelashweni ngemva kokuthola imijovo ye-BoNT.72
Ocwaningweni lwakamuva, i-BoNT isetshenziselwe ukwelapha i-hyperhidrosis ngendlela entsha.Kwesinye isimo, isiguli sesilisa esinesilonda sokucindezela sathola imijovo engu-100 ye-BoNT-A ku-gluteal cleft njalo ezinyangeni ezingu-6-8 ukuze kuncishiswe ukukhiqizwa komjuluko nokuhambisana ne-maceration yesilonda;ubuqotho besikhumba kwagcinwa Iminyaka engaphezu kwemibili, akubanga khona ukuwohloka komtholampilo kokulimala kwengcindezi.73 Olunye ucwaningo lwasebenzisa i-2250 U ye-BoNT-B ukuze ijovwe esikhumbeni se-occipital, isikhumba sekhanda le-parietal, isikhumba sasebunzini nasebunzini, kanye nezindawo ze-perioral kanye ne-peri-eye kuphethini ye-strip ukwelapha i-postmenopausal craniofacial hyperhidrosis.I-DLQI yeziguli ezithola i-BoNT-B ibe ngcono ngo-91% phakathi namasonto amathathu ngemva kokwelashwa, kuyilapho izinga lempilo leziguli ezithola i-placebo lehle ngo-18%.74 Umjovo we-BoNT uyasebenza ekwelapheni amathe kanye nesifo se-Frey.Izazi ze-Otolaryngologists zivame ukwenza ukwelashwa ngenxa yendawo ye-anatomical yomjovo.75,76
Izithukuthuku ezinombala zingaba yisimo esiphazamisa ngokusobala esigulini.Nakuba lesi sifo singavamile kakhulu;ukubandakanyeka kobuso namakhwapha kungase kubhebhethekise inkinga yesiguli.Imibiko eminingi yamacala kanye nokushicilelwa kubonisa ukuthi i-BoNT-A iyasebenza ngemva kokujovwa ezinsukwini ezingu-7 nje.77-79
Iphunga elingathandeki elivela ku-armpit hyperhidrosis kanye nephunga lomzimba lingase libe namahloni noma linyanye.Lokhu kungase kube nomthelela omubi endaweni yengqondo yesiguli kanye nokuzethemba.Muva nje, uWu et al.ibike ukuthi ngemva komjovo we-intradermal we-BoNT-A, iphunga elibi emakhwapheni lacishe laqedwa ngokuphelele.80 Kolunye ucwaningo lwesikhathi esizayo;Kwaqashwa intsha engu-62 enokuxilongwa kwesikhumba kwephunga eliyinhloko lekhwapha.Ama-82.25% eziguli abe nomuzwa wokuthi ukunuka kwehle kakhulu ngemva kokuba i-BoNT-A ijovwe endaweni ye-axillary.81
I-Meh ikhonjwa ngezilonda ze-benign cystic eyodwa noma eziningi kwabesifazane abaneminyaka ephakathi nendawo, ikakhulukazi endaweni yobuso emaphakathi, enenkambo ende yesifo kanye nokushintshashintsha kwesizini.I-Meh ngokuvamile ivela ezimweni ezinelanga futhi ihlotshaniswa ne-hyperhidrosis.Abacwaningi abaningi babone imiphumela engavamile kulezi zimo ngemva kokujova i-BoNT-A.82 eduze kwesilonda.
I-post-herpetic neuralgia (PHN) iyinkinga evamile yezinzwa yokutheleleka nge-herpes zoster, evame kakhulu kubantu abangaphezu kweminyaka engama-60 ubudala.I-BoNT-A ikhiqiza ngokuqondile imiphumela evimbela i-pan-inhibitory eziphethweni zemizwa yendawo futhi ilawula i-microglia-astrocytic-neuronal crosstalk.Ucwaningo oluningi luye lwaqaphela ukuthi ngemva kokuthola ukwelashwa kwe-BoNT-A, iziguli ezinobuhlungu obuncishisiwe okungenani ngama-30% kuya ku-50% ziye zanciphisa kakhulu amaphuzu okulala kanye nekhwalithi yokuphila.83
I-lichen elula engapheli ichazwa ngokuthi i-focal pruritus ngokweqile ngaphandle kwesizathu esicacile.Lokhu kungasithena amandla kakhulu isiguli.Ukuhlolwa komtholampilo kwe-dermatological kwembula ama-erythema plaque ahlukanisiwe, ukwanda kwezimpawu zesikhumba kanye nokukhishwa kwe-epidermal.Ucwaningo lwakamuva oluyingqophamlando oluvela e-Egypt lubonisa ukuthi i-BoNT-A ingakwazi ukwelapha ngokuphepha nangempumelelo i-lichen simplex engapheli, i-hypertrophic lichen planus, i-lichen planus, ukusha, i-reverse psoriasis, nokungalawuleki kwendawo kwe-post-herpetic neuralgia Pruritus.84
I-Keloids yizibazi zezicubu ezingavamile ezenzeka ngemva kokulimala.Ama-Keloid ahlobene nezakhi zofuzo, futhi izindlela eziningi zokwelapha zizanyiwe, kodwa umphumela unomkhawulo.Nokho, akekho kubo owelapheka ngokuphelele.Nakuba i-intralesional corticosteroids iseyindlela yokwelapha eyinhloko, umjovo we-intralesional we-BoNT-A usuphenduke enye indlela enhle kakhulu ezinsukwini zakamuva.I-BoNT-A inganciphisa amazinga e-TGF-β1 ne-CTGF, futhi ekugcineni yenze buthaka ukuhlukaniswa kwama-fibroblasts.Ucwaningo oluningi luye lwafakazela impumelelo ye-BoNT-A ekwelapheni ama-keloids.Eqinisweni, uchungechunge lwecala lweziguli ezimbili ze-keloid lwaze lwabika impendulo ye-100%, futhi iziguli zanelisekile kakhulu ngokusetshenziswa komjovo we-intralesional BoNT-A.85
I-Congenital thick onychomycosis yisifo esingavamile sofuzo esihambisana ne-plantar hyperkeratosis, i-nail hypertrophy kanye ne-hyperhidrosis.Bambalwa abacwaningi abaye baphetha ngokuthi umjovo we-BoNT-A awukwazi nje ukuthuthukisa i-hyperhidrosis, kodwa futhi unciphise ubuhlungu nokungakhululeki.86,87
I-keratosis ethwala amanzi yisifo esingajwayelekile.Lapho isiguli sihlangana namanzi, amatshe amhlophe ajiyile ematheni nasezintendeni zezandla kanye nokulunywa.Imibiko yamacala amaningana ezincwadini ikhombisa ukwelashwa okuyimpumelelo kanye nokuba ngcono ngemuva kokwelashwa kwe-BoNT-A, ngisho nasezimeni ezingazweli.88
Ukopha, ukuqunjelwa, i-erythema kanye nobuhlungu endaweni yomjovo kungase kube yimiphumela engemihle ye-BoNT.89 Le miphumela engemihle ingavinjelwa ngokusebenzisa inaliti ezacile kanye nokuhlambulula i-BoNT ngosawoti.Imijovo ye-BoNT ingabangela ubuhlungu bekhanda;Nokho, ngokuvamile anyamalala ngemva kwamasonto angu-2-4.Ama-analgesics esistimu angasetshenziswa ukubhekana nalo mphumela ohlangothini.90,91 Isicanucanu, ukudangala, izimpawu ezinjengomkhuhlane kanye ne-ptosis eminye imiphumela emibi erekhodiwe.I-89 Ptosis iyindawo yomphumela ongaseceleni wokusetshenziswa kwe-BoNT ukwelapha amashiya.Kubangelwa ukusabalalisa kwe-BoNT yendawo.Lokhu kusakazwa kungase kuthathe amasonto ambalwa, kodwa kungaxazululwa ngamaconsi eso e-alpha-adrenergic agonist.Uma i-BoNT ijova kwijwabu leso elingezansi, ingabangela i-ectropion ngenxa yenqubo yendawo yokusabalalisa.Ukwengeza, iziguli ezithola imijovo ye-BoNT yokwelapha izinyawo zegwababa noma amaphethini onogwaja (i-periorbital) zingase zibe ne-strabismus ngenxa yomjovo we-BoNT ongaqondile kanye nokusabalala kwe-BoNT kwasendaweni.89,92 Noma kunjalo, njengoba umphumela wokukhubazeka wobuthi unyamalala kancane kancane, yonke le miphumela emibi izonyamalala kancane kancane.93,94
Ingozi yezinkinga ezivela emijovweni yezimonyo ye-BoNT iphansi.I-Ecchymosis kanye ne-purpura yimiphumela evame kakhulu futhi ingancishiswa ngokufaka ukucindezela okubandayo endaweni yomjovo ngaphambi nangemuva komjovo we-BoNT.I-90,91 BoNT kufanele ijovwe ngethamo eliphansi, okungenani isentimitha elingu-1 ukusuka onqenqemeni lwethambo le-orbital elingaphansi, eliphakeme noma elingemuva, ngomthamo ofanelekile.Isiguli akufanele sisebenzise indawo yomjovo phakathi kwamahora angu-2-3 ngemva kokwelashwa, futhi sihlale noma sime siqonde phakathi namahora angu-3-4 ngemva kokwelashwa.95
I-BoNT-A ekwenziweni okusha okuhlukahlukene okwamanje iyahlolwa ukuze iphathe imigqa ye-glabellar nemigqa yamehlo.I-daxibotulinumtoxinA yesihloko kanye nomjovo ihlolisisiwe, kodwa ukwakheka kwezihloko kuboniswe kungasebenzi.Umjovo we-DAXI ungene esivivinyweni sesigaba sesi-III se-FDA, okufakazela ukuthi ukusebenza kahle nemiphumela yomtholampilo ekwelapheni imigqa ye-glabellar ingase ibe amaviki ama-5 ubude kune-onabotulinumtoxinA.96 I-LetibotulinumtoxinA manje isisemakethe e-Asia futhi igunyazwe yi-FDA yokwelapha imibimbi ye-periorbital.97 Uma kuqhathaniswa ne-incobotulinumtoxinA, i-LetibotulinumtoxinA inenani eliphakeme leprotheyini ye-neurotoxic ngeyunithi ngayinye, kodwa inani le-neurotoxin engasebenzi nalo liphezulu, okwandisa ingozi yokusabela komzimba.98
Ngaphezu kokwakhiwa okusha kwe-BoNT-A, i-BoNT-E ewuketshezi iyacwaningwa ngoba kuthiwa iqala ngokushesha ukwenza kanye nesikhathi esifushane semiphumela yomtholampilo (izinsuku eziyi-14-30).I-EB-001 itholwe iphephile futhi isebenza ngempumelelo ekwehliseni ukubukeka kwemigqa eshwabene futhi ithuthukise ukubukeka kwezibazi zasebunzini ngemva kwe-Mohs microsurgery.99 Odokotela besikhumba bangavunyelwa ukusebenzisa lezi zincwadi.Ngaphezu kwezinhloso zamanje zobuhle, izinkampani ezenza imithi zifuna amalungiselelo e-BoNT-A okwelashwa ngaphandle kwelebuli yezimo zezokwelapha zezifo zesikhumba.
I-BoNT iwumuthi omjovo okwazi ukuzivumelanisa nezimo ongasetshenziswa ukwelapha izifo zesikhumba ezihlukahlukene, okuhlanganisa i-hidradenitis suppurativa, i-psoriasis, isifo sesikhumba se-bullous, izibazi ezingavamile, ukuqothuka kwezinwele, i-hyperhidrosis, nama-keloids.Kuzinhlelo zokusebenza zezimonyo, i-BoNT kukholakala ukuthi iphephile futhi iyasebenza ekwehliseni imibimbi yobuso, ikakhulukazi ingxenye yesithathu ephezulu yokushwabana kobuso.I-BoNT A yaziwa ngokusetshenziswa kwayo ekwehliseni imibimbi emkhakheni wezimonyo.Nakuba i-BoNT ngokuvamile iphephile, kubalulekile ngaso sonke isikhathi ukuqonda indawo yomjovo ngoba ubuthi bungasakazeka futhi buthinte kabi izindawo okungafanele zelashwe.Odokotela kufanele baqaphele izinkinga ezindaweni ezithile lapho bejova i-BoNT ezinyaweni, ezandleni, noma entanyeni.Odokotela besikhumba badinga ukujwayela ukusetshenziswa kwe-BoNT ekulebula nangaphandle kwelebula ukuze banikeze iziguli izindlela zokwelapha ezifanele futhi banciphise ukugula okuhlobene.Ukusebenza komtholampilo kwe-BoNT kumasethingi angekho ngelebula nanoma yiziphi izinkinga ezingaba khona zokuphepha zesikhathi eside kufanele zihlolwe ngokuhlolwa komtholampilo okuklanywe kahle.
Ukwabelana ngedatha akusebenzi kulesi sihloko ngoba awekho amasethi edatha akhiqizwe noma ahlaziywa phakathi nesikhathi samanje socwaningo.
Ukuhlolwa kweziguli kwenziwa ngokuhambisana nemigomo yeSimemezelo saseHelsinki.Umbhali uqinisekisa ukuthi uthole wonke amafomu emvume yesiguli afanelekile lapho isiguli sivuma ukufaka izithombe nolunye ulwazi lomtholampilo kujenali.Iziguli ziyaqonda ukuthi amagama azo nama-initials ngeke zenziwe obala, futhi zizozama ukufihla ukuthi zingobani.
UDkt. Piyu Parth Naik ufake isandla kuphela ekubhalweni kombhalo wesandla.Umbhali wenze igalelo elibalulekile kumqondo nokuklama, ukutholwa kwedatha kanye nokuchazwa kwedatha;iqhaza ekubhaleni izindatshana noma okuqukethwe kolwazi olubalulekile olubuyekezwe ngokujulile;wavuma ukuthumela kujenali yamanje;ekugcineni ivume inguqulo ukuthi ishicilelwe;futhi bavumelane nomsebenzi Obhekele zonke izici.
Isikhathi sokuthumela: Oct-18-2021