Alopesi Areata Tanılı Hastalarda İntralezyonel Triamsinolon Asetonid Tedavisi ve Trombositten Zengin Plazma (PRP) Tedavisinin Değerlendirilmesi
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2025
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Giriş ve Amaç: Alopesi areata (AA), genel nüfusun %2'si kadarını etkileyen, saç dökülmesine yol açan skar bırakmayan yaygın kronik bir otoimmün hastalıktır. Alopesi areata hastalığında çeşitli yerel ve sistemik tedaviler mevcuttur. Son zamanlarda Trombositten Zengin Plazma (PRP) işlemi tedavide daha çok kullanılmaya başlanmış. Çalışmamızda Alopesi areata hastalarında intralezyonel triamsinolon asetonid ve trombositten zengin plazma (PRP) tedavisinin etkinliğini değerlendirmek ve iki yöntemin etkililiğini karşılaştırmak amaçlanmıştır. Materyal/Metod: Çalışmamıza 27.03.2024 ve 27.03.2025 tarihleri arasında Yüzüncü Yıl Üniversitesi Tıp Fakültesi Dermatoloji Polikliniği'ne başvuran yama tipi alopesi areata hastaları katıldı. Hastalarımızın yaş aralığı 18-65 yaş arasındadır ve daha önce alopesi areata tanısı için tedavi almamış hastalardır. Hastaları 2 gruba ayırdık. Birinci gruba 4 haftada bir olmak üzere 3 seans PRP tedavisi uygulandı. İkinci gruba ise 4 haftada bir 3 seans intralezyonel triamsinolon asetonid tedavisi uygulandı. 2 grubun başlangıçta, 3.ayda ve 6.ayda saçlı derisi fotoğlanarak severity of alopecia tool (SALT, alopesi skor şiddeti) hesaplanarak istatistiksel olarak karşılaştırıldı. Yaş, cinsiyet, hastalık süresi ve aile öyküsü tedaviye yanıt etkisi araştırılıp karşılaştırıldı. Bulgular: Çalışmamıza alopesi areata tanılı 41'i (%68.33) erkek 19'u (31,66) kadın olmak üzere toplamda 60 hasta katıldı. Hastaların yaş ortalaması 27.97±7.36 yıl olarak hesaplandı. Hastalık süresi ortalaması 5±7.11 ay idi. PRP tedavisi alan hastaların başlangıç, 3.ay ve 6.ay SALT skoru ortalaması sırasıyla 6.03±0.89, 2.53±2.01 ve 0.93±1.72 idi. PRP tedavisi yapılan hastaların başlangıçta, 3.ayda ve 6.aydaki SALT skoru arasında istatistiksel olarak anlamlı bir düşüş saptandı (p<0.001). İntralezyonel triamsinolon asetonid tedavisi uygulanan hastaların başlangıç, 3.ay ve 6.ay SALT skoru ortalaması sırasıyla 6.07±0.78, 2.60±2.07 ve 1.27±2.03 idi. İntralezyonel triamsinolon asetonid tedavisi alan hastaların başlangıçta, 3.ayda ve 6.aydaki SALT skoru arasında istatistiksel olarak anlamlı bir düşüş saptandı (p<0.001). 2 grup arasında başlangıç ile 3.ay (p=0.951) arasında, başlangıç ile 6.ay (p=0.576) arasında ve 3.ay ile 6.ay (p=0.568) SALT skoru değişimleri kıyaslandığında istatiksel olarak anlamlı bir fark saptanmadı. Yaş, cinsiyet, hastalık süresi ve aile öyküsü ile tedavi yanıtı arasında anlamlı bir fark saptanmadı. PRP tedavisi yapılan 30 hastanın 3.ay tedavi yanıtına bakıldığında 4 (%13.33) hastada yanıtsız, 7 (%23.33) hastada kısmi yanıt, 7 (%23.33) hastada iyi yanıt ve 12 (%40) hastada ise çok iyi yanıt olarak değerlendirildi. 6.ayın sonunda tekrar değerlendirildiğinde 2 (%6.66) hastada yanıtsızlık, 2 (%6.66) hastada kısmi yanıt, 3 (%10) hastada iyi yanıt ve 23 (%76.66) hastada çok iyi yanıt olarak değerlendirildi. İntralezyonel triamsinolon asetonid tedavisi alan 30 hastanın 3.ay tedavi yanıtı incelendiğinde 5 (%16.66) hastada yanıtsızlık, 8 (%26.66) hastada kısmi yanıt, 7 (%23.33) hastada iyi yanıt ve 10 (%33.33) hastada çok iyi yanıt olarak değerlendirildi. 6.ayın sonunda tekrar değerlendirildiğinde 3 (%10) hastada yanıtsızlık, 3 (%10) hastada kısmi yanıt, 4 (%13.33) hastada iyi yanıt ve 20 (%66.66) hastada çok iyi yanıt olarak değerlendirildi. PRP ve İntralezyonel triamsinolon asetonid işlemi sonrası hastalarda hafif ağrı, yanma, ekimoz ve hassasiyet gibi minör yan etkiler dışında görülen başka bir yan etki bildirilmedi. Hastaların genel tedavi ve takip süreleri 6 ay olarak belirlendi. Takiplerin sonunda tedaviye cevap veren 55 hastadan PRP tedavisi alan gruptan 1 hasta, İLKS tedavisi alan gruptan 2 hasta olmak üzere toplamda hastaların 3'ünde 6 ay sonra relaps gelişti. Sonuç: 2 grup arasında fark bulunmadı. Her ne kadar istatistik olarak anlamlı bir fark bulunmamış olsa da, PRP grubundaki hastaların SALT skorundaki azalmanın, İntralezyonel triamsinolon asetonid grubundanki hastalardan daha hızlı veya yüksek olma eğiliminde olduğu gözlendi. Anahtar kelimeler: Alopesi areata, Trombositten Zengin Plazma, İntralezyonel triamsinolon asetonid
ABSTRACT Introduction and Objective: Alopecia areata (AA) is a common chronic non-scarring autoimmune disease that causes hair loss, affecting up to 2% of the general population. There are various local and systemic treatments for alopecia areata. Recently, Platelet Rich Plasma (PRP) has been used more frequently in the treatment. In our study, we aimed to evaluate the efficacy of intralesional triamcinolone acetonide and platelet rich plasma (PRP) treatment in patients with Alopecia areata and to compare the efficacy of the two methods. Materials and methods: Patients with patch type alopecia areata who applied to Yüzüncü Yıl University Faculty of Medicine, Dermatology Outpatient Clinic between 27.03.2024 and 27.03.2025 participated in our study. The age range of our patients was 18-65 years and they had not received treatment for alopecia areata before. We divided the patients into 2 groups. The first group received 3 sessions of PRP treatment every 4 weeks. The second group received 3 sessions of intralesional triamcinolone acetonide treatment every 4 weeks. The scalp photos of the 2 groups were taken at the beginning, 3rd month and 6th month, and the severity of alopecia tool (SALT, alopecia score severity) was calculated and compared statistically. The effects of age, gender, disease duration and family history on response to treatment were investigated and compared. Results: A total of 60 patients with alopecia areata, 41 (68.33%) males and 19 (31.66%) females participated in our study. The mean age of the patients was 27.97±7.36 years. The mean disease duration was 5±7.11 months. The mean baseline, 3-month and 6-month SALT scores of the patients receiving PRP treatment were 6.03±0.89, 2.53±2.01 and 0.93±1.72, respectively. A statistically significant decrease was found between the SALT scores at baseline, 3rd month and 6th month of the patients treated with PRP (p<0.001). The mean baseline, 3-month and 6-month SALT scores of the patients treated with intralesional triamcinolone acetonide were 6.07±0.78, 2.60±2.07 and 1.27±2.03, respectively. A statistically significant decrease was found between the SALT scores at baseline, 3rd month and 6th month in patients receiving intralesional triamcinolone acetonide treatment (p<0.001). No statistically significant difference was found between the 2 groups when SALT score changes were compared between baseline and 3rd month (p=0.951), between baseline and 6th month (p=0.576) and between 3rd month and 6th month (p=0.568). No significant difference was found between age, gender, disease duration and family history and treatment response. When the 3rd month treatment response of 30 patients who underwent PRP treatment was analysed, 4 (13.33%) patients had no response, 7 (23.33%) patients had partial response, 7 (23.33%) patients had good response and 12 (40%) patients had very good response. At the end of the 6th month, 2 (6.66%) patients had no response, 2 (6.66%) patients had partial response, 3 (10%) patients had good response and 23 (76.66%) patients had very good response. When the 3rd month treatment response of 30 patients receiving intralesional triamcinolone acetonide treatment was analysed, it was evaluated as non-response in 5 (16.66%) patients, partial response in 8 (26.66%) patients, good response in 7 (23.33%) patients and very good response in 10 (33.33%) patients. At the end of the 6th month, 3 (10%) patients had no response, 3 (10%) patients had partial response, 4 (13.33%) patients had good response and 20 (66.66%) patients had very good response. After PRP and intralesional triamcinolone acetonide procedure, no other side effects other than minor side effects such as mild pain, burning, ecchymosis and tenderness were reported. The general treatment and follow-up periods of the patients were determined as 6 months. At the end of the follow-up period, out of 55 patients who responded to the treatment, relapse developed in 3 patients after 6 months, 1 patient in the group receiving PRP treatment and 2 patients in the group receiving ILKS treatment. Conclusion: No difference was found between the 2 groups. However, although no statistically significant difference was found, it was observed that the decrease in SALT score tended to be faster or higher in the PRP group than in the intralesional triamcinolone acetonide group. Key words: Alopecia areata, Platelet Rich Plasma, Intralesional triamcinolone acetonide
ABSTRACT Introduction and Objective: Alopecia areata (AA) is a common chronic non-scarring autoimmune disease that causes hair loss, affecting up to 2% of the general population. There are various local and systemic treatments for alopecia areata. Recently, Platelet Rich Plasma (PRP) has been used more frequently in the treatment. In our study, we aimed to evaluate the efficacy of intralesional triamcinolone acetonide and platelet rich plasma (PRP) treatment in patients with Alopecia areata and to compare the efficacy of the two methods. Materials and methods: Patients with patch type alopecia areata who applied to Yüzüncü Yıl University Faculty of Medicine, Dermatology Outpatient Clinic between 27.03.2024 and 27.03.2025 participated in our study. The age range of our patients was 18-65 years and they had not received treatment for alopecia areata before. We divided the patients into 2 groups. The first group received 3 sessions of PRP treatment every 4 weeks. The second group received 3 sessions of intralesional triamcinolone acetonide treatment every 4 weeks. The scalp photos of the 2 groups were taken at the beginning, 3rd month and 6th month, and the severity of alopecia tool (SALT, alopecia score severity) was calculated and compared statistically. The effects of age, gender, disease duration and family history on response to treatment were investigated and compared. Results: A total of 60 patients with alopecia areata, 41 (68.33%) males and 19 (31.66%) females participated in our study. The mean age of the patients was 27.97±7.36 years. The mean disease duration was 5±7.11 months. The mean baseline, 3-month and 6-month SALT scores of the patients receiving PRP treatment were 6.03±0.89, 2.53±2.01 and 0.93±1.72, respectively. A statistically significant decrease was found between the SALT scores at baseline, 3rd month and 6th month of the patients treated with PRP (p<0.001). The mean baseline, 3-month and 6-month SALT scores of the patients treated with intralesional triamcinolone acetonide were 6.07±0.78, 2.60±2.07 and 1.27±2.03, respectively. A statistically significant decrease was found between the SALT scores at baseline, 3rd month and 6th month in patients receiving intralesional triamcinolone acetonide treatment (p<0.001). No statistically significant difference was found between the 2 groups when SALT score changes were compared between baseline and 3rd month (p=0.951), between baseline and 6th month (p=0.576) and between 3rd month and 6th month (p=0.568). No significant difference was found between age, gender, disease duration and family history and treatment response. When the 3rd month treatment response of 30 patients who underwent PRP treatment was analysed, 4 (13.33%) patients had no response, 7 (23.33%) patients had partial response, 7 (23.33%) patients had good response and 12 (40%) patients had very good response. At the end of the 6th month, 2 (6.66%) patients had no response, 2 (6.66%) patients had partial response, 3 (10%) patients had good response and 23 (76.66%) patients had very good response. When the 3rd month treatment response of 30 patients receiving intralesional triamcinolone acetonide treatment was analysed, it was evaluated as non-response in 5 (16.66%) patients, partial response in 8 (26.66%) patients, good response in 7 (23.33%) patients and very good response in 10 (33.33%) patients. At the end of the 6th month, 3 (10%) patients had no response, 3 (10%) patients had partial response, 4 (13.33%) patients had good response and 20 (66.66%) patients had very good response. After PRP and intralesional triamcinolone acetonide procedure, no other side effects other than minor side effects such as mild pain, burning, ecchymosis and tenderness were reported. The general treatment and follow-up periods of the patients were determined as 6 months. At the end of the follow-up period, out of 55 patients who responded to the treatment, relapse developed in 3 patients after 6 months, 1 patient in the group receiving PRP treatment and 2 patients in the group receiving ILKS treatment. Conclusion: No difference was found between the 2 groups. However, although no statistically significant difference was found, it was observed that the decrease in SALT score tended to be faster or higher in the PRP group than in the intralesional triamcinolone acetonide group. Key words: Alopecia areata, Platelet Rich Plasma, Intralesional triamcinolone acetonide
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