Phototherapy thiab Tsev Phototherapy rau Vitiligo 4
94. Cov tshuaj pleev ib ce twg feem ntau ua ke nrog kev kho mob phototherapy?
Teb: Phototherapy rau vitiligo, suav nrogUVB phototherapy, tuaj yeem ua ke nrog ntau yam tshuaj pleev xim, xws li cov tshuaj pleev glucocorticoid (dexamethasone, betamethasone, halometasone, fluticasone tshuaj pleev, thiab lwm yam), calcineurin inhibitors (tacrolimus, pimecrolimus cream), qis -concentration photosensitizers (min, ranps, ranps, thiab ranps). derivatives (calcipotriol, tacalcitol tshuaj pleev). Cov kev sib tw no txhim kho qhov tshwm sim thaumxiav lub teeb kho lub teebyog siv los ua ib qho khoom siv ntxiv hauv tsev hauv cov rooj plaub.
95. Dab tsi yog lub sijhawm ua ntu zus thaum sib txuas cov duab kho mob nrog cov tshuaj pleev ib ce?
Teb: Cov tshuaj uas muaj roj av jelly lossis lanolin tuaj yeem ua rau lub thickness ntawm txheej txheej ntawm daim tawv nqaij thiab cuam tshuam rau kev nqus ntawm ultraviolet rays. Nws feem ntau pom zoo kom tsis txhob siv cov tshuaj, tshuaj pleev ib ce, lossis cov khoom tu tawv nqaij tsis pub dhau 4 teev ua ntej phototherapy [7,8], kom tsis txhob cuam tshuam rau kev nkag mus ntawm ultraviolet rays, tshwj xeeb tshaj yog nyob rau hauvUVB kev kho lub teebcov txheej txheem. Qee cov roj ntxhia tshaj lij tuaj yeem siv los txhawb kev nkag mus rau lub teeb thaum tseem muab cov moisturizing thiab tawv nqaij -nourishing teebmeem. Cov tshuaj pleev xim tuaj yeem siv tom qab phototherapy; Txawm li cas los xij, qee cov kws tshaj lij hais tias cov tshuaj pleev uas muaj peev xwm ua rau tawv nqaij, xws li calcipotriol thiab retinoic acid cream, yuav tsum tsis txhob siv tam sim ntawd tom qab.ci ntsa iab khokev sib tham, thiab ib ntus ntawm 2 teev raug pom zoo.
96. Kev kho duab hauv tsev puas tuaj yeem ua ke nrog cov tshuaj pleev ib ce xws li cov tshuaj sib xyaw kaliziran tincture?
Teb: Kev sib xyaw ua ke ntawm ob yog tsis pom zoo. Phau ntawv qhia txog kev sib xyaw kaliziran tincture qhia pom tias muaj hnub ci tom qab siv kom ua tiav cov txiaj ntsig kho mob, thaum lub spectrum ntawm lub tsev ultraviolet phototherapy feem ntau yog NB-UVB (narrowband ultraviolet B), uas txawv ntawm lub hnub lub spectrum thiab aligns ntau ze nrog.UVB phototherapy. Yog tias tus kws kho mob tau sau cov tshuaj sib xyaw ua ke kaliziran tincture thiab tus neeg mob tseem tab tom kho mob ultraviolet phototherapy hauv tsev, nws raug nquahu kom siv ob qho tib si hloov pauv - piv txwv li, tsis txhob siv cov tshuaj sib xyaw kaliziran rau hnub ntawm kev kho mob phototherapy. Hauv cov xwm txheej tsis tshua muaj tshwm sim, axiav lub teeb kho lub teebtej zaum yuav raug txiav txim siab cais rau kev tiv thaiv - txhawb kev mob.
Cov tshuaj twg qhov ncauj feem ntau ua ke nrog kev kho mob? Dab tsi yog qhov ua tau zoo?
Teb: Kev nce qib vitiligo feem ntau yuav tsum tau ua ke nrog qis - koob tshuaj qhov ncauj glucocorticoids kom tswj tau tus kab mob sai sai, tshwj xeeb tshaj yog thaum sib xyaw nrogUVB kev kho lub teeb. Rau cov neeg laus uas muaj cov kab mob vitiligo, prednisone tuaj yeem noj ntawm ib koob ntawm 0.3mg ib kilogram ntawm lub cev hnyav ib hnub (0.3mg / (kg·d)) rau 1 mus rau 3 lub hlis; txwv tsis pub siv yog tias tsis pom muaj txiaj ntsig. Tom qab qhov kev nce qib tau nres, txo qhov koob tshuaj los ntawm 5mg txhua 2 mus rau 4 lub lis piam kom txog thaum nce mus txog 5mg txhua hnub, thiab tswj cov koob tshuaj no rau 3 txog 6 lub hlis. Ua ntej kev kho mob thiab thaum siv tshuaj, kev ntsuam xyuas xws li cov ntshav niaj hnub, lub siab thiab lub raum kev ua haujlwm, cov ntshav qabzib, thiab ntshav siab yuav tsum tau ua kom ntsuas qhov tsis zoo ntawm cov tshuaj.
Phototherapy puas tuaj yeem ua ke nrog kev hloov pauv ntawm tes, grafting daim tawv nqaij, lossis hloov plaub hau?
Teb: Yog. Kev sib xyaw ntawm phototherapy nrog kev hloov pauv ntawm epidermal tuaj yeem txhim kho qhov kev vam meej ntawm kev hloov pauv. Kev tshawb fawb [11] tau pom tias kev sib txuas ntawm epidermal autografting nrog kev kho mob phototherapy (xws li 308nm thiab 311nm) rau thaj chaw ruaj khov vitiligo yog qhov zoo dua li epidermal autografting ib leeg, nrog rauci ntsa iab khoQee zaum muab tso rau hauv kev tshaj tawm - txheej txheem rau kev kho kom zoo. Nws yuav tsum raug sau tseg tias thaum sib txuas nrog kev phais nrog kev kho mob phototherapy, koob tshuaj phototherapy yuav tsum tau tswj kom txo tau qhov tshwm sim ntawm qhov tshwm sim tsis zoo.
Yog tias phototherapy tsis zoo rau vitiligo ntawm ob txhais tes thiab ko taw, cov kev kho mob ua ke twg muaj?
Teb: Cov kab mob ntawm daim tawv nqaij ntawm ob txhais tes thiab ko taw yog cais raws li refractory vitiligo, thiab kev kho mob phototherapy 效果 feem ntau tsis zoo. Txawm hais tias siv tsev kho mob hauv tsev lossis tsev kho mob-raws li kev kho duab kho mob, thaj chaw no nyuaj heev los kho. Kev sib xyaw ua ke xws li cov tshuaj pleev xim thiab cov fractional laser tuaj yeem sim; Yog hais tias cov no tseem tsis tau zoo, epidermal transplantation ua ke nrogUVB phototherapytuaj yeem txiav txim siab.
Cov kev kho mob sib xyaw ua ke twg muaj yog tias kev kho mob ib leeg tsis muaj txiaj ntsig rau segmental vitiligo?
Teb: Segmental vitiligo muaj cov txheej txheem rov qab qeeb, yog li cov neeg mob raug qhia kom pheej nrog kev kho mob. Yog tias kev kho duab tsis zoo, kev sib xyaw ua ke xws li kev kho mob nrog cov tshuaj pleev ib ce, phototherapy nrog antioxidants, lossis kev phais nrog kev kho mob tuaj yeem siv tau. Rau cov tshuaj pleev ib ce, muaj zog glucocorticoids, calcineurin inhibitors, los yog vitamin D₃ derivatives yuav siv tau - ib leeg los yog nyob rau hauv alternating ua ke ntawm ob hom. Rau kev ruaj khov vitiligo, kev kho mob phais xws li kev hloov cov ntaub so ntswg lossis kev hloov pauv ntawm tes tuaj yeem ua ke, nrog rauUVB kev kho lub teebua hauj lwm raws li ib feem tseem ceeb.
101. Puas yog kev sib xyaw ua ke nrog lwm cov tshuaj tsim nyog rau kev kho mob thaum lub sij hawm nce qib ntawm vitiligo?
Teb: Yog, phototherapy rau kev loj hlob vitiligo yuav tsum tau ua ke nrog tshuaj. Ntxiv mus, rau kev loj hlob vitiligo sai, nws raug nquahu kom ua kom tus kab mob ruaj khov nrog cov tshuaj ua ntej pib kev kho mob. Kev sib xyaw ua ke muaj xws li cov kab mob glucocorticoids, immunomodulators, thiab antioxidants (rau kev siv lub cev), nrog rau cov tshuaj glucocorticoids, calcineurin inhibitors, thiab vitamin D₃ derivatives (rau kev siv hauv zos) [12]. Axiav lub teeb kho lub teebtuaj yeem muab cov tshuaj tiv thaiv me me los tiv thaiv- cov txiaj ntsig kev mob tshwm sim hauv cov theem thaum ntxov.
102. Yog tias feem ntau cov kab mob vitiligo rov ua dua tom qab kev kho mob phototherapy, tab sis ob peb cov kab mob seem tseem tsis kho, yuav ua li cas?
Teb: Feem ntau cov kab mob vitiligo pom zoo rov ua dua tom qab phototherapy, tab sis qee qhov mob -xws li cov qhov khoob me me los yog ntawm tes thiab ko taw- teb qeeb. Rau cov no, kev sib xyaw ntawm fractional laser thiab kev xa tshuaj tuaj yeem siv rau kev kho mob, feem ntau tom qabci ntsa iab khotxhawm rau optimize qhov chaw seem teb.
103. Cov tshuaj noj tsis tu ncua los ntawm cov neeg mob uas muaj kab mob hauv lub cev tuaj yeem cuam tshuam rau kev ua haujlwm ntawm phototherapy?
Teb: Qee cov tshuaj tuaj yeem cuam tshuam rau kev ua haujlwm ntawm phototherapy. Piv txwv li, cov tshuaj antihypertensive xws li hydrochlorothiazide thiab phenothiazines muaj cov duab zoo nkauj. Cov neeg mob noj cov tshuaj no muaj kev pheej hmoo ntau dua ntawm kev kub hnyiab thaum tau txais kev kho mob phototherapy ntawm cov tshuaj ib txwm siv, suav nrog thaum lub sijhawmUVB phototherapy. Yog li ntawd, cov neeg mob yuav tsum sib txuas lus nrog cov kws kho mob ua ntej phototherapy, nrog rau kev nthuav tawm lawv cov kab mob hauv qab thiab cov tshuaj uas lawv noj. Tsis tas li ntawd, yog tias muaj kev hloov pauv ntawm cov tshuaj thaum lub sij hawm kho duab kho mob, cov neeg mob yuav tsum sab laj nrog kws kho mob tam sim ntawd los kho cov phiaj xwm kho mob / yees duab raws li xav tau.
Yuav ua li cas yog tias ib koob tshuaj phototherapy lossis kev kho mob ntau dhau lawm?
Teb: Tam sim no pom zoo koob tshuaj phototherapy thiab zaus yog raws li cov ntaub ntawv qhia los ntawm ntau yam kev tshawb fawb hauv tsev thiab thoob ntiaj teb. Kev nce koob tshuaj ib zaug lossis ntau zaus tsis tsuas yog ua tsis tau zoo xwb tab sis kuj ua rau muaj kev pheej hmoo ntawm kev kub nyhiab, tshwj xeeb hauvUVB kev kho lub teebkev cai. Thaum kub hnyiab tau tshwm sim, phototherapy yuav tsum raug tshem tawm, uas ncua kev kho mob; Hauv qhov xwm txheej hnyav, nws tuaj yeem ua rau Koebner tshwm sim thiab ua rau tus mob hnyav dua. Tsis tas li ntawd, ntev - lub sij hawm ntev heev ntawm ultraviolet raug yuav ua rau photoaging.
Yuav ua li cas tswj qhov mob erythema, edema, los yog hlwv ntawm daim tawv nqaij tom qab phototherapy?
Teb: Cov tsos mob ntawm erythema, edema, los yog hlwv tom qab phototherapy qhia tias koob tshuaj phototherapy siab dhau lawm. Phototherapy yuav tsum tau nres tam sim ntawd; Nws tuaj yeem rov pib dua tsuas yog tom qab erythema thiab edema tau txo qis, thiab cov koob tshuaj yuav tsum raug txo los ntawm 20% mus rau 50% piv nrog cov koob tshuaj dhau los. Qhov no yog qhov tseem ceeb hauv cov kev cai uas cuam tshuam nrogci ntsa iab khotiv thaiv kev nce ntxiv.
Yuav ua li cas tiv thaiv kev sib kis ntawm cov kab mob vitiligo thaum lub sij hawm rov qab los tom qab kev kho mob phototherapy-induced burns?
Teb: Thaum lub sij hawm rov qab los ntawm kev kho mob phototherapy-induced burns, phototherapy thiab daim ntawv thov ntawm anti-vitiligo tshuaj pleev ib ce yuav tsum raug ncua. Hloov chaw, cov tshuaj uas muaj cov tshuaj tiv thaiv - kis kab mob- xws li ofloxacin gel thiab mupirocin ointment - yuav tsum tau siv los tiv thaiv kab mob ntawm daim tawv nqaij. Tsis tas li ntawd, yog tias qhov chaw hlawv loj, qhov ncauj glucocorticoids raug pom zoo los tiv thaiv kev kis kab mob. Nws yuav tsum raug sau tseg tias tom qab qhov kub hnyiab tshwm sim, cov neeg mob yuav tsum siv tshuaj raws li tus kws kho mob cov lus qhia thiab zam kev kho tus kheej -, tshwj xeeb tshaj yog thaumxiav lub teeb kho lub teebyog ib feem ntawm txoj kev dav dav.
Dab tsi yog qhov rov ua dua ntawm vitiligo tom qab tso tseg phototherapy?
Teb: Vitiligo muaj lub siab xav rov qab los, tab sis tsis muaj cov ntaub ntawv pov thawj thoob ntiaj teb ntawm tus nqi rov tshwm sim. Feem ntau, qhov rov tshwm sim hauv ib xyoos yog 20% mus rau 40%, thiab qee cov ntaub ntawv qhia tias qhov rov tshwm sim hauv ob xyoos tuaj yeem siab txog 75%, txawm tias tom qab kev teeb tsa.UVB phototherapy.
