Browsing by Author "Güleç, A. Tülin"

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Kronik el ekzemalarında pimekrolimus kremin etkinliğinin flutikazon propiyonat krem ile karşılaştırılması
(Başkent Üniversitesi Tıp Fakültesi, 2005) Seda Battaloğlu; Güleç, A. Tülin
El ekzeması, ellerde eritem, skuam, vezikül ve fissürler ile karakterize, tekrar etme eğilimi gösteren, sık görülen bir deri hastalığıdır. Topikal steroidler el ekzeması tedavisinde ilk seçenektir. Ekzemanın sık tekrarlaması, bu kremlerin uzun süreli kullanılmasına ve yan etkilerinin ortaya çıkmasına neden olmaktadır. Bu nedenle, hastalığın tedavisinde etkili ve uzun süre güvenle kullanılabilecek yeni topikal ajanlara ihtiyaç vardır. Pimekrolimus, non-steroid antiinflamatuvar bir kalsinörin inhibitörüdür. Atopik dermatit tedavisinde uzun süredir güvenle kullanılmaktadır. Kronik el ekzemalarında pimekrolimus krem ile flutikazon propiyonatın etkinlik ve güvenilirliğini kıyaslamak için, tek kör ve randomize bir klinik çalışma planlanmıştır. Her iki tedavi maliyet açısından da karşılaştırılmıştır. Şubat 2005-Haziran 2005 tarihleri arasında Başkent Üniversitesi Tıp Fakültesi Dermatoloji Anabilim Dalı'na başvuran kronik el ekzemalı 16 hasta çalışmaya alınmıştır. Her iki tedavi ekzemada iyileşme sağlamıştır. 16 hastanın 10'unda (%62,5) tama yakın ya da tam düzelme, bir hastada belirgin, 2 hastada orta ve 3 hastada da hafif düzeyde düzelme tespit edilmiştir. Pimekrolimus grubu ve flutikazon propiyonat grubu arasında tedaviye yanıt açısından istatistiksel fark tespit edilmemiştir (p>0,05). Tedavi sırasına pimekrolimus grubunda yer alan 3 hastada yan etki izlenmiştir. İki hastada tedavinin ilk birkaç gününde görülen ve tedaviyi kesmeyi gerektirmeyen yanma hissi ve bir hastada tedavinin ikinci haftasından tedavi sonuna kadar devam eden deride incelme hissi saptanmış, ancak klinik değerlendirmede deride atrofi tespit edilmemiştir. Sonuç olarak pimekrolimus krem kronik el ekzemalarının tedavisinde flutikazon propiyonat kadar etkili ve güvenilir bulunmuştur. Ancak tedavi maliyetinin flutikazon propiyonattan 6 kat fazla olduğu belirlendiği için kronik el ekzemalarında tedavi seçilirken bu durumun göz önüne alınması gerektiği düşünülmektedir. Hand eczema is a common skin disease with remissions and exacerbations, characterized by erythema, squam, vesicle and fissures. Pimecrolimus is a new non-steroid anti-inflammatory calcineurin inhibitory that can be used in the treatment of chronic hand eczema. A randomized, observer blinded, comparison study of pimecrolimus cream versus fluticasone propionate was designed in order to evaluate the efficacy and safety profile between two agents. 16 patients with chronic hand eczema were enrolled in the study and randomized in two groups. They were all outpatients seen at the dermatology department of Baþkent University Faculty of Medicine between February 2005 and June 2005. Both pimecrolimus and fluticasone propionate improved the eczema. 10 of the total 16 patients (62,5%) showed complete or nearly complete response, one significant, 2 moderate and 3 minimal response was achieved. Statistical difference between two groups was not significant (p>0,05). Adverse events occurred in 3 of the 16 patients, all in the pimecrolimus group. Two patients complained a temporary burning sensation occurred in the first few days of therapy and one patient with a feeling of thinning of the skin but atrophy was not seen clinically. The cost of both therapies were investigated and compared with each other. The cost of both therapies were investigated and compared with each other.Pimecrolimus cream was found to be safe and equally effective to fluticasone propionate in the treatment of chronic hand eczema . But cost effect analyse showed that total cost of therapy was 6 times higher in the pimecrolimus group.
Üremik pruritus tedavisinde endokannabinoid içerikli nemlendirici kremlerin etkinliği
(Başkent Üniversitesi Tıp Fakültesi, 2014) Yücel, Sedat; Güleç, A. Tülin
Uremic pruritus is still a common and distressing symptom in patients with chronic renal failure undergoing dialysis treatment, despite advances made in its treatment. Cannabinoids, obtained from marijuana plants, seem to be a rational therapeutic option for pruritic diseases via their antiinflammatory effects. There has been only one study in literature regarding the antipruritic effects of cannabinoids in uremic pruritus. The aim of this retrospective study was to evaluate the efficacy and safety of emollients with endocannabinoids in the treatment of uremic pruritus. All 40 uremic pruritus patients (24 male and 16 female) included in this retrospective study applied a cream with structured natural lipids (derma membrane structure) and endocannabinoids (N-acetylethanolamine and N-palmitoylethanolamide) twice daily for 4 weeks and were followed up for 3 months. İntensity of pruritus was evaluated using two scoring methods: the "Visual analogue scale" and the "Modified itch severity scale". Xerosis was also assessed using the "El Gammal xerosis scale". Pruritus was evaluated before treatment, at weekly intervals during treatment and at biweekly intervals over a 3-month follow-up period. Xerosis was assessed before and after the treatment period. After a 4-week treatment period, pruritus was completely eliminated in 8 patients (20%) and a significant reduction of pruritus was noted in 26 patients (65%) using both scales for itching intensity assessment (p=0.000). Xerosis scores were also significantly reduced in 29 patients (72.5%) (p=0.000). Three months after discontinuation of the treatment, pruritus remained significantly less intensive compared to the beginning of the study (p=0.000). The cream was well tolerated by all patients. The results of our study revealed that emollient creams containing endocannabinoids are an effective and safe option for the treatment of uremic pruritus. In addition, the antipruritic effect of the cream is sustained for a long period after discontinuation of treatment. These emollients could also be of help in controlling xerosis in the patients