Ukusetyenziswa kwe-toxin ye-botulinum kwi-dermatology kunye ne-cosmetology

IJavascript ivaliwe okwangoku kwibrawuza yakho.Xa i-javascript ivaliwe, eminye imisebenzi yale webhusayithi ayiyi kusebenza.
Bhalisa iinkcukacha zakho ezithile kunye neziyobisi ezithile ezinomdla, kwaye siya kuhambelana nolwazi osinika lona kunye namanqaku kwidathabheyisi yethu ebanzi kwaye sikuthumelele ikopi yePDF nge-imeyile ngexesha elifanelekileyo.
I-Piyu Parth Naik Dermatology, iSaudi German Hospitals and Clinics, Dubai, United Arab Emirates Communications: Piyu Parth Naik Dermatology, iSaudi German Hospitals and Clinics, Burj Al Arab, Dubai, United Arab Emirates Umnxeba ochasayo +971 503725616 imeyile [i-imeyile efunyenwe uKhuseleko] Abstract : I-Botulinum toxin (BoNT) yi-neurotoxin eveliswa yi-Clostridium botulinum bacteria.Inomsebenzi owaziwayo kunye nokhuseleko kunyango lwe-focal idiopathic hyperhidrosis.I-BoNT iqulethe i-neurotoxins ezisixhenxe ezahlukeneyo;nangona kunjalo, kuphela i-toxins A kunye ne-B esetyenziswa eklinikhi.I-BoNT isandula kusetyenziselwa unyango ngaphandle kweleyibhile yezifo ezahlukeneyo zolusu.Uthintelo lwesikhumba, i-hyperhidrosis, imibimbi, i-moles encinci yokubila, ukulahleka kweenwele, i-psoriasis, isifo sika-Darier, isifo se-bullous skin, i-sweat herpes kunye ne-Raynaud's phenomenon zezinye zezibonakaliso ezintsha ze-BoNT kwizinto zokuthambisa, ngakumbi kwi-dermatology Imiba engenzi-cosmetic.Ukuze sisebenzise i-BoNT ngokuchanekileyo kwimisebenzi yeklinikhi, kufuneka siqonde kakuhle i-anatomy esebenzayo yezihlunu ezifanisiweyo.Uphando olunzulu loncwadi lwenziwe ukuze kuhlaziywe yonke imifuniselo ejoliswe kwidermatological kunye neemvavanyo zeklinikhi kwizinto ze-BoNT ukwenzela ukubonelela ngokujongwa ngokubanzi kokusetyenziswa kwe-BoNT kwidermatology.Olu hlaziyo lujolise ekuhlalutyeni indima ye-toxin ye-botulinum kwi-dermatology kunye ne-cosmetology.Amagama angundoqo: ityhefu ye-botulinum, i-toxin ye-botulinum, i-botulinum, i-dermatology, i-cosmetology, i-neurotoxin
I-Botulinum neurotoxin (BoNT) iveliswa ngokwendalo yiClostridium botulinum, eyintsholongwane ye-anaerobic, igram-positive, evelisa i-spore.1 Ukuza kuthi ga ngoku, ii-serotypes ezisixhenxe ze-BoNT (A ukuya ku-G) zifunyenwe, kwaye kuphela iintlobo ze-A kunye ne-B ezingasetyenziselwa ukusetyenziswa konyango.I-BoNT A (i-Oculinum) yavunywa yi-US Food and Drug Administration (FDA) kwi-1989 yonyango lwe-blepharospasm kunye ne-strabismus.Ixabiso lonyango le-BoNT A lamiselwa okokuqala.Kwakungekho kude kube ngu-Epreli ka-2002 apho i-FDA ivume ukusetyenziswa kwe-BoNT A ukunyanga imigca ye-glabellar.I-FDA ivume i-BoNT A yonyango lomgca ongaphambili kunye nomgca wecala le-canthal ngo-Oktobha 2017 kunye noSeptemba 2013, ngokulandelanayo.Ukusukela ngoko, iindlela ezininzi ze-BoNT ziye zaziswa kwimarike.2 Ukususela ekuthengisweni kwayo, i-BoNT isetyenziselwa ukunyanga i-cramps, ukudakumba, i-hyperhidrosis, i-migraine, kunye nokuguga kwentamo, ubuso, kunye namagxa kwiinkalo zonyango kunye ne-cosmetic.3,4
I-Clostridium botulinum ikhupha i-complex ye-protein ezintathu ezibandakanya i-toxin ye-150 kDa, i-non-toxic, i-non-hemagglutinin protein, kunye ne-non-toxic hemagglutinin protein.I-Bacterial proteases idiliza i-toxin ibe yimveliso esebenzayo ephindwe kabini kunye ne-50 kDa "i-light" chain kunye ne-100 kDa "enzima".Emva kokuthuthwa kwi-terminal ye-presynaptic nerve terminal, ikhonkco elinzima le-toxin esebenzayo libophelela kwi-synaptic vesicle glycoprotein 2, ukukhuthaza i-endocytosis ye-toxin-glycoprotein complex, kunye nokukhulula ikhonkco lokukhanya kwe-toxin kwindawo ye-synaptic.I-Toxin light chain cleavage vesicle-associated in membrane protein/synaptoxin (BoNT-B, D, F, G) okanye synaptosome-associated protein 25 (BoNT-A, C, E) ukuthintela ukukhutshwa kweperipheral motor neuron axons Acetylcholine nayo ibangela ixeshana. ukuchithwa kweekhemikhali kunye nokukhubazeka kwemisipha.2 E-United States, kukho amalungiselelo amane e-BoNT-A akhoyo ngokurhweba avunywe yi-FDA: incobotulinumtoxinA (eFrankfurt, eJamani), onabotulinumtoxinA (California, US), prabotulinumtoxinA-xvfs (California, US), kunye ne-abobotulinumtoxinA (Arizona, US) ;kunye Nolunye uhlobo lwe-BoNT-B: rimabotulinumtoxinB (California, USA).5 IsiKhokelo et al.I-6 ihlomle ngendima ye-BoNT kwinkalo yedermatology.Nangona kunjalo, akukhange kubekho uphononongo lwakutsha nje malunga nokusetyenziswa kwe-BoNT kwinkalo yedermatology kunye nobuhle.Ke ngoko, olu hlaziyo lujolise ekuhlalutyeni indima ye-BoNT kwidermatology kunye ne-cosmetology.
Amagama angundoqo athile abandakanya i-botulinum toxin, ulusu olunamafutha, i-rosacea, ukugungxulwa kobuso, amanxeba, imibimbi, ukulahleka kweenwele, i-psoriasis, isifo solusu se-bullous, isifo sika-Darier, i-exocrine moles, i-sweat herpes, i-Raynaud's phenomenon, i-hyperhidrosis Ekuphenduleni, i-dermatology, kunye nobuhle, uphando lwamanqaku. ziqhutywa kwezi nkcukacha zilandelayo: i-Google Scholar, i-PubMed, i-MEDLINE, i-Scopus, kunye ne-Cochrane.Umbhali ujonge ikakhulu amanqaku malunga nendima ye-BoNT kwidermatology kunye ne-cosmetology.Uphando lokuqala loncwadi luveze amanqaku angama-3112.Amanqaku apapashwe phakathi kukaJanuwari 1990 kunye noJulayi 2021 echaza i-BoNT kwidermatology kunye ne-cosmetology, amanqaku apapashwe ngesiNgesi, kunye nalo lonke uyilo lophando lubandakanyiwe kolu hlaziyo.
I-Canada ivume ukusetyenziswa kwe-BoNT kunyango lwe-cosmetic ye-spasms ye-muscle yendawo kunye nemibimbi yamashiya ngo-2000. I-FDA yase-US yavuma ukusetyenziswa kwe-BoNT ngeenjongo zokuthambisa ngo-Aprili 15, 2002. Iimpawu ze-BoNT-A ezisanda kusetyenziswa kwi-cosmetic applications ziquka imigca phakathi amashiya, iinyawo zikanomyayi, imigca yembila, imigca ebunzi ethe tyaba, imigca ejikelezayo, ukugoba kwengqondo kunye nokuxinezeleka kwesilevu, iibhanti zeplatysma, ukushwabana komlomo, kunye nemigca yentamo ethe tye.I-7 Izibonakaliso zohlobo lwe-botulinum A oluvunyiweyo yi-US FDA luyimodareyitha ukuya kwimigca enqabileyo ehambelana nomsebenzi ogqithiseleyo we-prefrontal kunye / okanye imisipha edibeneyo phakathi kwamashiya, kunye ne-moderate ukuya kwi-lateral lateral canthal imigca ehambelana nomsebenzi ogqithiseleyo we-orbicularis muscle.Kwaye umgca webunzi ophakathi ukuya kobunzima ohambelana nomsebenzi ogqithiseleyo wemisipha yangaphambili.8
I-Sebum inceda ukubonelela nge-antioxidants e-fat-soluble kumphezulu wolusu kwaye ineempawu zokulwa ne-antibacterial;ngoko ke, isebenza njengesithintelo solusu.I-sebum eninzi inokuvala i-pores, ivelise iibhaktheriya kwaye inokubangela ukuvutha kolusu (umzekelo, i-seborrheic dermatitis, i-acne).Ngaphambili, ulwazi olufanelekileyo malunga nemiphumo ye-BoNT kwi-sebum lubhengeziwe.I-9,10 Rose kunye ne-Goldberg10 ivavanye ukusebenza kunye nokhuseleko lwe-BoNT kubantu be-25 abanesikhumba esinamafutha.I-BoNT (abo-BNT, i-dose ye-30-45 IU) ijojowe kumanqaku e-10 ebunzi, ephucula kakhulu ukwaneliseka kwesigulane kunye nokunciphisa imveliso ye-sebum.Min et al.kwabelwa ngokungacwangciswanga izifundo ezingama-42 ezinemibimbi ebunzi ukuze zifumane iiyunithi ezili-10 okanye ezingama-20 ze-BoNT kwiindawo zokutofa ezintlanu ezahlukeneyo.Omabini amaqela afumene unyango lwe-BoNT, olukhokelele ekuncipheni okubonakalayo kwe-sebum kwindawo yokutofa kunye nethayimdi ye-sebum ejikeleze indawo yokutofa.Kwiveki ye-16, imveliso ye-sebum yamaqela amabini onyango ibuyele kumanqanaba aqhelekileyo, kwaye ngokunyuka kwe-dose ye-injection, umphumo wonyango awuzange uphucule kakhulu.
Indlela apho i-intradermal injection ye-toxin ye-botulinum ikhokelela ekunciphiseni i-sebum secretion ayiqondwa ngokupheleleyo, kuba imiphumo yenkqubo ye-nervous kunye ne-acetylcholine kwiingqungquthela ze-sebaceous ayizange ichazwe ngokupheleleyo.Iziphumo ze-neuromodulatory ze-BoNT ezinokuthi zijolise kwi-receptors ye-muscarinic yendawo kwi-erector pili muscle kunye ne-sebaceous glands.Kwi-vivo, i-nicotinic acetylcholine receptor 7 (nAchR7) ibonakaliswe kwiingqungquthela ze-sebaceous zabantu, kwaye ukubonakaliswa kwe-acetylcholine kwandisa i-lipid synthesis ngendlela exhomekeke kwidosi kwi-vitro.11 Uphando olongezelelweyo luyafuneka ukufumanisa ukuba ngubani oyena mviwa obaluleke kakhulu kunye neyona nkqubo yokutofa kunye nedosi (Umfanekiso 1A kunye no-B).
Umzobo 1 Umfanekiso ophezulu (A) wesigulana esinolusu olunamafutha olucacileyo, ngelixa kwelinye ipali, umfanekiso osezantsi (B) wesigulane esifanayo emva konyango lwe-BoNT ezimbini ubonisa ukuphucuka okukhulu.(Ubuchwephesha: iiyunithi ze-100, i-2.5 ml ye-intradermal BoNT-A yafakwa kanye ebunzini. Itotali ezimbini zonyango ezifanayo zenziwa iintsuku ze-30 ngaphandle. Impendulo efanelekileyo yeklinikhi yahlala kwiinyanga ze-6).
I-Rosacea sisifo solusu esixhaphakileyo esibonakaliswa ngokugungqa ebusweni, i-telangiectasia, i-papules, i-pustules kunye ne-erythema.Amayeza omlomo, unyango lwe-laser, kunye namayeza e-topical asetyenziswa ngokuqhelekileyo ukunyanga ukugungxulwa kobuso, nangona engasoloko esebenza.Olunye uphawu olungathandekiyo lokuyeka ukuya exesheni kukugungxulwa kobuso.Uphononongo oluninzi lubonise ukuba i-BoNT inokunceda ukunyanga ubushushu be-menopausal kunye ne-rosacea.I-12-14 Impembelelo ye-BoNT kwi-Dermatological Quality of Life Index (DLQI) yezigulane ezinokugungxula ubuso ziya kuphandwa kuphononongo lokulinga lwexesha elizayo.15 I-BoNT yatofwa esidleleni kanye, ukuya kuthi ga kwithamo lilonke leeyunithi ezingama-30, okubangele ukwehla okubonakalayo kwe-DLQI kwiinyanga ezimbini.Ngokuka-Odo et al., i-BoNT inciphise kakhulu umndilili we-avareji ye-menopausal hot flashes ngosuku lwe-60.12 Isiphumo se-abo-BoNT saphononongwa kwizigulane ezili-15 ezine-rosacea.Kwiinyanga ezintathu kamva, i-15-45 IU ye-BoNT yafakwa ebusweni, nto leyo eyakhokelela ekuphuculeni okubonakalayo kwi-erythema.13 Xa kusenziwa uphando, kunqabile ukuba kukhankanywe izenzo ezingathandekiyo.
Ukugungxulwa okwandisiweyo kwe-BoNT sesinye sezizathu ezinokuthi zithintele ngamandla ukukhutshwa kwe-acetylcholine kwi-peripheral autonomic neurons yenkqubo ye-vasodilation yesikhumba.I-16,17 Kuyaziwa kakuhle ukuba abalamli abavuthayo njenge-calcitonin ye-peptide ehlobene ne-gene (CGRP) kunye ne-substance P (SP) nayo ivinjelwe yi-BoNT.18 Ukuba ukudumba kwesikhumba sendawo kuncitshisiwe kwaye kulawulwe, i-erythema inokunyamalala.Ukuze uvavanye indima ye-BoNT kwi-rosacea, izifundo ezibanzi, ezilawulwayo, ezingahleliwe ziyafuneka.Iinaliti ze-BONT zokugungxulwa kobuso zineenzuzo ezongezelelweyo ngenxa yokuba zinokunciphisa ubunzima boxinzelelo lobuso, ngaloo ndlela ziphucula imigca emihle nemibimbi.
Abantu abaninzi ngoku bayakuqonda ukubaluleka kokuphepha ngokukhutheleyo izivubeko kunyango lwezibazi zasemva kotyando.Uxinzelelo olwenzeka kumda wenxeba ngexesha lenkqubo yokuphilisa yeyona nto iphambili ekuqinisekiseni ukubonakala kokugqibela kwesiva sotyando.I-19,20 BoNT ikhusela ukukhutshwa kwe-acetylcholine neurotransmitter, phantse ukuphelisa ngokupheleleyo ubunzima bemisipha eguqukayo kwinxeba lokupholisa kwi-peripheral nerve.Iipropati zokunciphisa uxinzelelo lwe-BoNT, kunye nokuthintela ngokuthe ngqo kwe-fibroblast kunye ne-TGF-1 intetho, ibonisa ukuba ingasetyenziselwa ukuphepha izibazi zotyando.I-21-23 I-anti-inflammatory effect ye-BoNT kunye nefuthe layo kwi-skin vasculature inokunciphisa inqanaba lenkqubo yokuphulukisa isilonda esivuthayo (ukusuka kwi-2 ukuya kwiintsuku ze-5), enokukunceda ukukhusela ukubunjwa kwesikhumba.
Kwizifundo ezahlukeneyo, i-BoNT ingasetyenziselwa ukuthintela amanxeba.I-24-27 kwi-RCT, ukhuseleko kunye nokusebenza kwe-injection ye-BoNT yokuqala emva kokuhlinzwa kwizigulane ze-15 ezinezibazi ezivela kwi-thyroidectomy zihlolwe.I-24 izibazi ezintsha (ngaphakathi kweentsuku ze-10 ze-thyroidectomy) zinikwe i-BoNT (20-65 IU) okanye i-0.9% ye-saline eqhelekileyo (ulawulo) kanye.Isiqingatha sonyango lwe-BoNT sibonise amanqaku angcono kakhulu kunye nokwaneliseka kwesigulana kunonyango oluqhelekileyo lwe-saline.U-Gassner et al.25 baphande ukuba ngaba inaliti ye-BoNT ebusweni emva kokutyunjwa kwebunzi kunye nokuhlanjululwa kunokuphilisa amanxeba obuso.Xa kuthelekiswa ne-placebo (i-saline eqhelekileyo) i-injection, i-BoNT (15-45 IU) yafakwa kwi-scar postoperative emva kokuvalwa kwenxeba kwiiyure ze-24 ukuphucula umphumo we-cosmetic kunye nokuphulukiswa kwesilonda.
Imibimbi enamandla kunye ne-static yenziwa ngokugqithisileyo kwezicubu zomzimba, umonakalo okhanyayo kunye nokuguga, kwaye izigulane zikholelwa ukuba zibenza babonakale bediniwe okanye banomsindo.Inokunyanga imibimbi yobuso kwaye ibonelele abantu ngenkangeleko ekhululekileyo nehlaziyayo.I-FDA okwangoku inogunyaziso olulodwa lwe-BoNT ukunyanga umgca we-periorbital kunye ne-interbrow.I-BoNT isetyenziselwa ukunyanga i-masseter hypertrophy, uncumo lwe-gingival, i-platysma band, i-mandibular margin, ukudakumba kwe-chin, umgca webunzi othe tye, uncumo olugobileyo, umgca we-perioral, umgca wempumlo othe tye kunye namashiya ahexayo.Umphumo weklinikhi uhlala malunga neenyanga ezintathu.28,29 (Umfanekiso 2A kunye no-B).
Umzobo we-2 Umfanekiso ophezulu (A) ngaphambi kokuba i-injection ye-Botox yecala ibonisa ukuba umgca webunzi othe tye kunye nomgca we-glabellar wenza ukuba isifundo sibonakale sinomsindo.Ngakolunye uhlangothi, umfanekiso ongezantsi wemeko efanayo (B) emva kwenyama ezimbini Emva kwenaliti ye-toxin, le migca isuswa ngokukhululekile.(Ubuchwephesha: iiyunithi ze-36, i-0.9 mL ye-intradermal BoNT-A yafakwa ebunzi ngexesha. Indawo yokutofa yayiphawulwe ngepensile yesikhumba ngaphambi kokuba unyango. Itotali ezimbini zonyango ezifanayo zenziwe, iintsuku ze-30 ngaphandle).
I-BoNT inokuphucula iimvakalelo zesigulana kunye nokuzithemba okubonwayo xa isetyenziswa kunye nokunciphisa isingqi.Ukuphuculwa kwenqaku le-FACE-Q kwabonwa emva kokunyangwa kwemigca ye-glabellar ephakathi ukuya kwi-glabellar.Kwanasemva kweentsuku ze-120, xa iziphumo zekliniki ze-BoNT kufanele ukuba zinciphile, izigulana zichaze uphuculo kwimpilo yengqondo kunye nokuphucuka komtsalane wobuso.
Ngokungafaniyo nokufakwa kwakhona kwe-BoNT ngokuzenzekelayo rhoqo emva kweenyanga ezintathu ukufumana eyona mpendulo ilungileyo yeklinikhi neyengqondo, ugqirha kufuneka axoxe nesigulana xa kunyangwa kwakhona.I-30,31 Ukongezelela, i-BoNT isetyenziswe ngempumelelo ukukhusela nokuphatha i-migraine kwi-neurology, ukuphucula umgangatho wobomi kunye nentlalontle yezigulane32 (Umfanekiso 3A kunye ne-B).
Umzobo 3 Umfanekiso ophezulu (A) wesifundo ubonisa ukuba imigca yecala ye-periorbital inika imvakalelo yokuguga kunye nokudinwa.Ngakolunye uhlangothi, umfanekiso ongezantsi (B) wecala elifanayo liphelisa le migca kwaye liphakamisa emva kokutofa kweBotox Amashiya asecaleni abonakala ngokucacileyo.Emva kokuhlala phantsi ngeli xesha, lo mxholo ukwabonakalisa ubutyebi bempilo yeemvakalelo.(Iteknoloji: iiyunithi ze-16, i-0.4 ml ye-intradermal ye-BoNT-A ifakwe kanye, kanye kwindawo nganye ye-periorbital esecaleni. Kuphela kube kanye kuphelile ngempendulo ebalulekileyo ethatha iinyanga ze-4.)
I-Alopecia areata, i-androgenetic alopecia, intloko ebuhlungu kunye ne-radiation-induced alopecia ziye zanyangwa nge-BoNT-A.Nangona indlela echanekileyo i-BoNT inceda ngayo iinwele ukuba zihlaziyeke, kucingelwa ukuba ngokukhulula izihlunu ukunciphisa uxinzelelo lwe-microvascular, inokuphucula ukunikezelwa kwe-oksijini kwiifollicle zeenwele.Kwiikhosi ze-1-12, i-30-150 U ijojowe kwi-lobe yangaphambili, i-periauricular, temporal kunye ne-occipital muscles (Umfanekiso 4A kunye no-B).
Umzobo we-4 Isiqingatha sasekhohlo (A) sesithombe seklinikhi sibonisa uhlobo lwe-6 yendoda yempandla yendoda eneminyaka engama-34 ubudala ngokohlelo olwamkelweyo lwaseNorwood-Hamilton.Ngokwahlukileyo, isigulane esifanayo sabonisa ukuhla kwe-3V emva kwe-injection ye-botulinum ye-12 (B).(Ubuchwephesha: iiyunithi ze-100, i-2.5 mL ye-intradermal BoNT-A yafakwa kwindawo ephezulu yentloko kanye. Itotali ye-12 yonyango efanayo eyahlulwa ngeentsuku ze-15 ibangele impendulo eyamkelekileyo yeklinikhi, ehlala iinyanga ze-4).
Nangona uninzi lwezifundo lubonisa ukuphuculwa kweklinikhi ekuxinaniseni kweenwele okanye ukukhula kunye nokwaneliseka okuphezulu kwesigulana, ii-RCT ezongezelelweyo ziyafuneka ukumisela isiphumo sokwenene se-BoNT ekukhuleni kweenwele.I-33-35 Kwelinye icala, iinaliti ezininzi ze-BoNT zokushwabana kwebunzi ziye zaqinisekiswa ukuba zinxulumene nesehlo sokulahleka kweenwele zangaphambili.36
Izifundo ezininzi zibonise ukuba inkqubo ye-nervous idlala indima kwi-psoriasis.Uxinzelelo lwemicu ye-nerve eluswini lwe-psoriasis luphezulu, kwaye amanqanaba eCGRP kunye ne-SP aphuma kwi-sensory nerves aphezulu.Ngoko ke, ubungqina beklinikhi obubonisa ukuxolelwa kwe-psoriasis emva kokulahlekelwa kwe-innervation kuyanda, kwaye umonakalo wenkqubo ye-nervous okanye umsebenzi we-nerve uxhasa le ngcamango.I-37 BoNT-A inciphisa ukukhutshwa kwe-neurogenic CGRP kunye ne-SP, enokuthi ichaze ukuqwalaselwa kweklinikhi ye-subjective yesi sifo.38 Kubantu abadala be-KC-Tie2 iimpuku, inaliti ye-intradermal ye-BoNT-A inokunciphisa kakhulu i-lymphocyte yesikhumba xa kuthelekiswa ne-placebo Infiltrate kwaye iphucule kakhulu i-acanthosis.37 Nangona kunjalo, zimbalwa kakhulu iingxelo zeklinikhi ezipapashiweyo kunye nezifundo zoqwalaselo, kwaye akukho nanye kuzo elawulwa yi-placebo.Phakathi kwezigulane ze-15 ezine-psoriasis e-inverse, i-Zanchi et al.38 ibike impendulo enhle kwi-BoNT-A yonyango;nangona kunjalo, iziphumo zokuvavanya isigulane kunye nokuhlolwa kwefoto yokungena kunye nokuhlolwa kwe-erythema kusetyenziswe.Ngoko ke, uChroni et al39 ubonise iinkxalabo ezahlukahlukeneyo malunga nophononongo, kubandakanywa nokungabikho kwezibonakaliso zobungakanani bokuqikelela ukuphuculwa (njengamanqaku e-PA).Umbhali uqikelele ukuba i-BoNT-A inefuthe elihle ekunciphiseni ukubila kwendawo kwiindawo, ezifana nesifo se-Hailey-Hailey, apho umphumo we-BoNT-A ubangelwa ukunciphisa ukubila.I-40-42 Ikhono le-BoNT-A ukukhusela i-hyperalgesia Nangona kunjalo, ukukhululwa kwe-neuropeptides kukhokelela kwiintlungu ezincinci kunye nokubetha kwizigulane.43
I-Off-label, i-BoNT isetyenziselwe ukunyanga izifo zesikhumba ze-bullous, ezifana ne-linear IgA bullous skin disease, isifo se-Weber-Cockayne kunye nesifo se-Hailey-Hailey.I-injection ye-BoNT-A, i-tacrolimus yomlomo, i-yttrium aluminium garnet ablation laser, kunye ne-BoNT-A equkethe i-erbium isetyenziselwe ukunyanga isifo se-Hailey-Hailey kwi-sub-breast, i-axillary, inguinal kunye ne-intergluteal cleft.Emva kokonyango, iimpawu zeklinikhi ziphuculwe, kwaye uluhlu lwedosi luyi-25 ukuya kwi-200 U rhoqo kwiinyanga ezi-3 ukuya kwezi-6.42,44 Kwimeko exeliweyo, umfazi oneminyaka ephakathi kunye ne-epidermolysis bullosa yengingqi wajova i-50 U ngekhwapha ezinyaweni zakhe, kwaye i-100 U yafakwa kwisigulane esine-linear IgA bullosa Foot yesigulane esincinci esinesifo solusu.45,46
Kwi-2007, u-Kontochristopoulos et al47 baphatha ngokufanelekileyo indawo engaphantsi kwesigulana esineminyaka engama-59 ubudala, besebenzisa i-BoNT-A njengonyango lwe-adjuvant yesifo sikaDarier okokuqala.Kwesinye imeko kwi-2008, umntwana omncinci onokuzibandakanya okukhulu kwe-anogenital wayenenzuzo ekunciphiseni ukujuluka kwindawo enqabileyo.48 Usulelo lwakhe oluhambelanayo lwaphathwa nge-10 mg ye-acitretin kunye ne-antibiotics kunye namachiza e-antifungal ngosuku, kodwa umgangatho wobomi bakhe wawuphantsi kwaye ukungonwabi kwakhe kwaqhubeka.Kwiiveki ezintathu emva kokutofwa kwetyhefu ye-botulinum, iimpawu zakhe kunye nezilonda zasekliniki zaphuculwa kakhulu.
I-Eccrine nevus yi-hamartoma yesikhumba enqabileyo ebonakaliswe ngokunyuka kwenani lee-eccrine glands kodwa akukho phuhliso lwemithambo yegazi.Ngenxa yenqaku lokugqibela, i-eccrine nevus yahlukile kwezinye izifo ezifana ne-angiomatous eccrine hamartoma.49 Iintshulube ezincinci zokubila zixhaphake kakhulu kwiingalo zangaphambili, zineengxaki ezimbalwa zolusu, kodwa kukho iindawo ezihlala kwindawo ye-hyperhidrosis.50 Uqhaqho loqhaqho okanye iyeza lonyango lolona nyango ludumileyo, kuxhomekeke kubungakanani bokhuselo kunye nequmrhu le-hyperhidrosis.U-Honeyman et al51 babhale umntwana oneminyaka eli-12 ubudala onombilo omncinci we-nevi esihlahleni sasekunene esixhathisayo kwi-antiperspirants.Ngenxa yobukhulu be-tumor kunye nendawo yayo ye-anatomical, ukuchithwa kokuhlinzwa kwakungabandakanywa.I-Hyperhidrosis yenza ukuba ukuthatha inxaxheba kwimisebenzi yentlalo kunye nengqondo ibe ngumngeni.Abaphandi bakhetha ukujova i-5 U ye-BoNT-A ngexesha le-0.5-1 cm.Ababhali abazange bacacise xa impendulo yokuqala yonyango lwe-BoNT-A lwenzeka, kodwa bathi emva konyaka, baqaphela ukuba inani lokubila lancitshiswa kakhulu libe kanye ngenyanga, kwaye umgangatho wobomi besigulane uphuculwe.U-Lera et al49 waphatha isigulane esinomgangatho ophantsi wobomi kunye ne-HDSS amanqaku e-3 kwi-forearm ene-sweat naevi encinci (HDSS) (enzima).I-BoNT-A (i-100 IU) yaphinda yahlanganiswa kwi-2.5 mL isisombululo se-saline eyinyumba equlethe i-0.9% ye-sodium chloride kwaye ifakwe kwindawo yovavanyo lwe-iodine.Emva kweeyure ze-48, isigulane sabona ukunciphisa ukubila, kunye neziphumo ezilungileyo kwiveki yesithathu.Amanqaku e-HDDS ahla ukuya kwi-1. Ngenxa yokuphindaphinda ukubila, unyango lwe-BoNT-A luphindwe emva kweenyanga ezilithoba.Kunyango lwe-exocrine hemangioma hamartoma, unyango lwe-injection ye-BoNT-A luluncedo.52 Nangona le meko inqabile, kulula ukubona ukuba kubaluleke kangakanani kwaba bantu ukuba babe nokhetho olusebenzayo lonyango.
I-Hidradenitis suppurativa (HS) sisifo solusu esinganyangekiyo esibonakaliswa ziintlungu, izibazi, izoni, i-fistulas, amaqhuqhuva adumbileyo, kwaye ibonakala kumadlala e-apocrine omzimba ekupheleni.53 I-pathophysiology yesi sifo ayicacanga, kwaye iingcamango ezamkelwe ngaphambili malunga nophuhliso lwe-HS ziyacelwa umngeni ngoku.Ukuvalelwa kweenwele zeenwele kubaluleke kakhulu kwiimpawu ze-HS, nangona indlela ebangela ukuba i-occlusion ingabonakali.Ngenxa yokuvuvukala okulandelayo kunye nokudityaniswa kokukhubazeka kokuzalwa kunye nokulungelelanisa, i-HS inokuphuhlisa umonakalo wesikhumba.54 Uphononongo olwenziwa nguFeito-Rodriguez et al.55 luchaze ukuba i-BoNT-A iphathe ngempumelelo i-prepubertal HS kumantombazana aneminyaka emi-6 ubudala.Ingxelo yecala likaShi et al.56 yaqaphela ukuba i-BoNT-A yaphathwa ngempumelelo kwi--3 HS isigaba se-41 yeminyaka ubudala.Uphononongo olutshanje olwenziwe nguGrimstad et al.57 luvavanye ukuba i-injection ye-intradermal ye-BoNT-B iyasebenza kwi-HS kwizigulane ze-20.I-DLQI yeqela le-BoNT-B inyuke ukusuka kwi-median ye-17 kwisiseko ukuya kwi-8 kwiinyanga ze-3, ngelixa i-DLQI yeqela le-placebo yehla ukusuka kwi-13.5 ukuya kwi-11.
I-Notalgia paresthetica (NP) yi-sensory neuropathy eqhubekayo echaphazela indawo ye-interscapular, ngokukodwa i-T2-T6 dermatome, kunye ne-back back itching kunye neempawu zesikhumba ezinxulumene nokukhuhla kunye nokukrazula.I-BoNT-A inokunceda ukunyanga ukurhawuzelelwa kwendawo ngokuthintela ukukhutshwa kwento engu-P, intlungu kunye nokurhawuzelela umlamli.58 Ingxelo yetyala lika-Weinfeld59 ivavanye ukusebenza kwe-BoNT-A kwiimeko ezimbini.Zombini zaphathwa ngempumelelo nge-BoNT-A.Uphononongo olwenziwa nguPerez-Perez et al.58 luvavanye ukusebenza kwe-BoNT-A kwizigulane ze-5 ezifunyanwe neNP.Emva kwenaliti ye-intradermal ye-BoNT, iziphumo ezininzi zabonwa.Akukho kwamntu ukurhawuzelelwa kwakhululeka ngokupheleleyo.Ulingo olulawulwa ngokungahleliwe (RCT) lwe-Maari et al60 luvavanye ukusebenza kunye nokhuseleko lwe-BoNT-A kwizigulane ezine-NP kwi-Canadian Dermatology Research Clinic ukususela ngoJulayi 2010 ukuya kuNovemba 2011. Uphononongo aluphumelelanga ukuqinisekisa imiphumo emihle ye-BoNT-A.Inaliti ye-Intradermal kwidosi ukuya kuthi ga kwi-200 U ukunciphisa ukurhawuzelelwa kwizigulane ezine-NP.
I-Pompholyx, ekwabizwa ngokuba yi-hyperhidrosis eczema, sisifo se-vesicular bullous esichaphazela iintende kunye neenyawo zeenyawo.Nangona i-pathophysiology yale meko ingacacanga, ngoku ithathwa njengophawu lwe-atopic dermatitis.61 Umsebenzi omanzi, ukubila, kunye nesithintelo zezona zinto zixhaphakileyo zokukhokelela.62 Ukunxiba iiglavu okanye izihlangu kunokubangela intlungu, ukutshisa, ukurhawuzelelwa, kunye nokungakhululeki kwizigulana;usulelo lwebhaktiriya luxhaphakile.U-Swartling et al61 wafumanisa ukuba izigulane ezine-palm hyperhidrosis ziphathwa nge-BoNT-A ephuculweyo ye-eczema yesandla.Ngo-2002, bapapasha iziphumo zophononongo olubandakanya izigulane ezilishumi ezine-bilateral vesicular hand dermatitis;esinye isandla safumana inaliti ye-BoNT-A, kwaye esinye isandla sasebenza njengolawulo ngexesha lokulandela.Unyango lube neziphumo ezilungileyo okanye ezibalaseleyo kwizigulane ezi-7 kwezili-10.Kwizigulane ezi-6, u-Wollina kunye no-Karamfilov63 basebenzise i-corticosteroids ye-topical ezandleni zozibini kwaye batofa i-100 U ye-BoNT-A nge-intracutaneously kwezona zandla zichaphazeleke kakhulu.Kunyango lwesandla sonyango oludityanisiweyo, ababhali bafumanisa ukuba ukurhawuzelelwa kunye namadyungudyungu kwehla ngokukhawuleza.Baye babalela ukusebenza kwe-BoNT-A kwi-impetigo ngenxa yesiphumo sokungabilisi kunye nokuthintelwa kwe-SP.
Finger vasospasm, ekwaziwa ngokuba yiRaynaud's syndrome, ingumcelimngeni wokunyanga kwaye idla ngokumelana namachiza odidi lokuqala anjengebosentan, iloprost, phosphodiesterase inhibitors, nitrate, kunye ne-calcium channel blockers Agent.Iinkqubo zotyando ezibandakanya ukubuyiswa kunye nokuvalwa, njenge-sympathectomy, ziyingozi.Into kaRaynaud enxulumene neprayimari kunye ne-sclerosis iye yanyangwa ngempumelelo ngenaliti ye-BoNT.Abaphandi be-64,65 baqaphele ukuba izigulane ze-13 zifumana ukukhululeka kweentlungu ezikhawulezayo, kwaye izilonda ezingapheliyo ziphiliswa kwiintsuku ze-60 emva kokufumana i-50-100 U ye-BoNT.Izitofu zanikwa izigulane ezili-19 ezine-Raynaud's phenomenon.66 Emva kweeveki ezintandathu, ubushushu beminwe yeminwe ephathwa nge-BoNT buye yanda kakhulu xa ithelekiswa nenaliti ye-saline eqhelekileyo, ebonisa ukuba i-BoNT iluncedo kunyango lwe-vasospasm ehlobene ne-Raynaud.67 Ngoku, ngaba kukho naziphi na iinkqubo zokutofa ezisemgangathweni ezisetyenzisiweyo;Ngokutsho kwesinye isifundo, ii-injection kwiminwe, i-wrists, okanye i-distal metacarpal amathambo ayizange iholele kwiziphumo ezihlukeneyo zeklinikhi, nangona zisebenza kakuhle ekuphatheni i-vasospasm ehlobene ne-Raynaud.68
I-50-100 ye-U ye-BoNT-A ngekhwapha, elawulwa nge-intradermally kwi-grid-like design, ingasetyenziselwa ukunyanga i-primary axillary hyperhidrosis.Iziphumo zeklinikhi zibonakala kwiveki kwaye zihlala kwiinyanga ezi-3 ukuya kwezi-10.Uninzi lwezigulane zanelisekile lunyango lwazo.Izigulane kufuneka zixelelwe ukuba ukuya kuthi ga kwi-5% yamatyala aya kufumana ukubila okuhlawulelayo kwangoku.I-69,70 ye-BoNT inokunyanga ngokufanelekileyo i-palm kunye ne-plantar hyperhidrosis (Umfanekiso 5A kunye no-B).
Umzobo 5 Umfanekiso wekliniki wezinga eliphezulu (A) ubonisa umfundi omncinci wekholeji one-diffuse palm hyperhidrosis oxhalabileyo malunga nesi sifo kwaye akaphenduli kumayeza.Izigulana ezifanayo ezifumene unyango lwe-toxin ye-botulinum zibonise isisombululo esipheleleyo se-hyperhidrosis (B).(Ubuchwephesha: Emva kokuqinisekiswa ngovavanyo lwe-iodine ye-starch; iiyunithi ze-100, i-2.5 mL ye-intradermal BoNT-A yafakwa kanye ngesandla. Iikhosi ezimbini ezifanayo zeentsuku ze-15 ngaphandle zivelise impendulo ebalulekileyo ehlala iinyanga ze-6).
Umnwe ngamnye unezikhundla ze-injection ye-2-3, kwaye ii-injection kufuneka zilungiswe kwigridi kunye nomgama we-1 cm.I-BoNT-A inokunikwa isandla ngasinye kuluhlu lweeyunithi ezingama-75-100 kunye nonyawo ngalunye kuluhlu lweeyunithi ezingama-100-200.Iziphumo zeklinikhi zinokuthatha ukuya kwiveki ukuba zibonakale, kwaye zinokuhlala iinyanga ezintathu ukuya kwezintandathu.Ngaphambi kokuqala unyango, izigulane kufuneka zaziswe ngeziphumo ebezingalindelekanga ze-BoNT iinaliti ezintendeni nasezinyaweni.Emva kwesitofu sesundu, isigulane sinokubika ubuthathaka.Kwelinye icala, iinaliti zezityalo zinokwenza kube nzima ukuhamba, ngakumbi ukuba iibhloko zemithambo-luvo zenziwe phambi konyango lwe-BoNT.I-71,72 Ngelishwa, i-20% yezigulane ze-plantar hyperhidrosis aziphenduli kunyango emva kokufumana i-injection ye-BoNT.72
Kwizifundo zamva nje, i-BoNT isetyenziselwe ukunyanga i-hyperhidrosis ngendlela entsha.Kwimeko enye, isigulane esiyindoda esinesilonda soxinzelelo safumana i-100 U ye-BoNT-A iinaliti kwi-gluteal cleft rhoqo kwiinyanga ze-6-8 ukunciphisa ukuveliswa kokubila kunye nokuhamba kunye ne-maceration yesilonda;ukunyaniseka kwesikhumba kwagcinwa iminyaka engaphezu kwemibini, akukho nto iyancipha kwikliniki yokulimala koxinzelelo.73 Olunye uphando lusebenzise i-2250 U ye-BoNT-B ukuba ifakwe kwi-scalp ye-occipital, i-scalp ye-parietal, i-scalp ebunzi kunye ne-bunzi, kunye neendawo ze-perioral kunye ne-peri-eye kwipatheni ye-strip ukunyanga i-postmenopausal craniofacial hyperhidrosis.I-DLQI yezigulane ezifumana i-BoNT-B iphuculwe ngama-91% kwiiveki ezintathu emva konyango, ngelixa umgangatho wobomi bezigulane ezifumana i-placebo wehle nge-18%.74 Inaliti ye-BoNT iyasebenza kunyango lwe-salivation kunye nesifo se-Frey.Ii-Otolaryngologists zihlala zenza unyango ngenxa yendawo ye-anatomical yenaliti.75,76
Ukujuluka kombala kunokuba yimeko ephazamisayo ngokucacileyo kwisigulane.Nangona esi sifo sinqabile kakhulu;ukubandakanyeka kobuso namakhwapha kunokuyenza mandundu ingxaki yomguli.Iingxelo ezininzi zeemeko kunye nopapasho lubonisa ukuba i-BoNT-A iyasebenza emva kokuba itofwe ngeentsuku ezi-7 kuphela.77-79
Iphunga elingathandekiyo elivela kwi-armpit hyperhidrosis kunye nevumba lomzimba linokuba neentloni okanye lizothe.Oku kunokuba nefuthe elibi kwindawo yengqondo yesigulane kunye nokuzithemba.Kutshanje, uWu et al.ingxelo yokuba emva kokutofa kwe-intradermal ye-BoNT-A, ivumba elibi kumakhwapha laliphantse lapheliswa ngokupheleleyo.80 Kolunye uphononongo olulindelekileyo lwangoku;Abakwishumi elivisayo abangama-62 abanoxilongo lwedermatological yevumba eliphambili langaphantsi kwekhwapha baye baqeshwa.I-82.25% yezigulane zaziva ukuba ukuvumba kwancitshiswa kakhulu emva kokuba i-BoNT-A ifakwe kwindawo ye-axillary.81
I-Meh ichongwa ngezilonda ezingatshatanga okanye ezininzi ze-benign cystic kubasetyhini abakwiminyaka ephakathi, ikakhulu ebekwe kwindawo ephakathi yobuso, kunye nekhosi ende yesifo kunye nokuguquguquka kwexesha.I-Meh ngokuqhelekileyo ibonakala kwiimeko zelanga kwaye idibene ne-hyperhidrosis.Abaphandi abaninzi baye baqaphela iziphumo ezingaqhelekanga kwezi meko emva kokutofa i-BoNT-A.82 malunga nesilonda.
I-Post-herpetic neuralgia (PHN) yeyona nto ixhaphakileyo kwi-neurological complication yosulelo lwe-herpes zoster, oluxhaphake kakhulu kubantu abangaphezu kweminyaka engama-60 ubudala.I-BoNT-A ivelisa ngokuthe ngqo i-pan-inhibitory effects kwi-nerve endings yendawo kwaye ilawula i-microglia-astrocytic-neuronal crosstalk.Izifundo ezininzi ziye zaqaphela ukuba emva kokufumana unyango lwe-BoNT-A, izigulane ezineentlungu ezincitshisiweyo ubuncinane kwi-30% ukuya kwi-50% ziye zanciphisa kakhulu amanqaku okulala kunye nomgangatho wobomi.83
I-lichen engapheliyo ichazwa njenge-pruritus ye-focal egqithisileyo ngaphandle kwesizathu esicacileyo.Oku kunokumenza buthathaka kakhulu umguli.Uvavanyo lwe-dermatological lweklinikhi lubonakalise iiplaque ezizimeleyo ze-erythema, ukwanda kweempawu zolusu kunye nokukhutshwa kwe-epidermal exfoliation.Uphononongo oluphawulekayo lwakutsha nje oluvela eYiputa lubonisa ukuba i-BoNT-A inokunyanga ngokukhuselekileyo nangempumelelo i-lichen simplex engapheliyo, i-hypertrophic lichen planus, i-lichen planus, ukutshisa, i-psoriasis eguquguqukayo, kunye nokungathinteki kwendawo ye-post-herpetic neuralgia Pruritus.84
I-Keloids ziziva ezingaqhelekanga zezicubu ezenzeka emva kokwenzakala.I-Keloids inxulumene nofuzo, kwaye unyango oluninzi luye lwazanywa, kodwa umphumo ulinganiselwe.Noko ke, akukho nanye kuzo ephiliswe ngokupheleleyo.Nangona i-intralesional corticosteroids iseyeyona ndlela yonyango iphambili, inaliti ye-intralesional ye-BoNT-A ibe yeyona ndlela ibalaseleyo kwezi ntsuku zidlulileyo.I-BoNT-A inokunciphisa amanqanaba e-TGF-β1 kunye ne-CTGF, kwaye ekugqibeleni yenza buthathaka ukuhlukana kwe-fibroblasts.Uninzi lwezifundo zibonakalise impumelelo ye-BoNT-A kunyango lwe-keloids.Enyanisweni, uchungechunge lwecala lezigulane ezimbini ze-keloid zaze zabika impendulo ye-100%, kwaye izigulane zanelisekile kakhulu ngokusetyenziswa kwe-injection ye-intralesional BoNT-A.85
I-Congenital thick onychomycosis sisifo esinqabileyo sofuzo esikhatshwa yi-plantar hyperkeratosis, i-nail hypertrophy kunye ne-hyperhidrosis.Abaphandi abambalwa baye bagqiba ekubeni inaliti ye-BoNT-A ayinakuphucula kuphela i-hyperhidrosis, kodwa iyanciphisa intlungu kunye nokungahambi kakuhle.86,87
I-keratosis yamanzi sisifo esingaqhelekanga.Xa isigulana sidibana namanzi, iingqalutye ezimhlophe ezijiyileyo ezintendeni nasezintendeni zezandla zinokurhawuzelelwa.Iingxelo ezininzi zetyala kuncwadi zibonisa unyango oluyimpumelelo kunye nokuphuculwa emva konyango lwe-BoNT-A, nakwiimeko ezixhathisayo.88
Ukopha, i-edema, i-erythema kunye neentlungu kwindawo yokutofa zonke zinokuba ziziphumo ebezingalindelekanga ze-BoNT.89 Ezi ziphumo bezingalindelekanga zinokuthintelwa ngokusebenzisa inaliti ebhityileyo kunye nokuxutywa kwe-BoNT ngesaline.Iinaliti ze-BoNT zinokubangela intloko ebuhlungu;nangona kunjalo, bahlala benyamalala emva kweeveki ezi-2-4.I-analgesics ye-systemic ingasetyenziselwa ukujongana nale mpembelelo yecala.90,91 I-nausea, i-malaise, iimpawu ezifana nomkhuhlane kunye ne-ptosis zezinye iziphumo ebezingalindelekanga ezirekhodiweyo.89 I-Ptosis yindawo yesiphumo esisecaleni sokusebenzisa i-BoNT ukunyanga amashiya.Ibangelwa kukusasazwa kwe-BoNT yendawo.Oku kusasazeka kunokuhlala iiveki ezininzi, kodwa kunokusonjululwa ngamathontsi e-alpha-adrenergic agonist eye.Xa i-BoNT ifakwe kwi-eyelid engezantsi, inokubangela i-ectropion ngenxa yenkqubo yokusasazwa kwendawo.Ukongeza, izigulana ezifumana inaliti ye-BoNT ukunyanga iinyawo zikagwayi okanye iipateni zomvundla (i-periorbital) zinokuba ne-strabismus ngenxa yenaliti ye-BoNT engaqondanga kunye nokusasazeka kwe-BoNT yendawo.89,92 Nangona kunjalo, njengoko umphumo wokukhubazeka we-toxin uphela ngokuthe ngcembe, zonke ezi ziphumo bezingalindelekanga ziya kunyamalala ngokuthe ngcembe.93,94
Umngcipheko weengxaki ezivela kwiinaliti ze-BoNT zokuthambisa uphantsi.I-Ecchymosis kunye ne-purpura zezona ziphumo zixhaphakileyo kwaye zinokuncitshiswa ngokufaka iicompresses ezibandayo kwindawo yokutofa ngaphambi nasemva kwesitofu se-BoNT.I-90,91 BoNT kufuneka ifakwe kwi-dose ephantsi, ubuncinane i-1 cm ukusuka kumda wethambo le-orbital elingaphantsi, elingaphezulu okanye elisecaleni, kunye nedosi efanelekileyo.Isigulana akufanele sisebenzise indawo yokutofa kwiiyure ezingama-2-3 emva kokuba unyango, kwaye uhlale okanye ume ngokuthe tye kwiiyure ezingama-3-4 emva konyango.95
I-BoNT-A kwimixube emitsha eyahlukeneyo ngoku iyavavanywa ukunyanga imigca yeglabellar kunye nemigca yamehlo.I-daxibotulinumtoxinA yesihloko kunye ne-injection iye yaphononongwa, kodwa ukuqulunqwa kwezihloko kuboniswe kungasebenzi.Inaliti ye-DAXI ingene kulingo lwesigaba sesi-III se-FDA, ebonisa ukuba ukusebenza ngempumelelo kunye neziphumo zeklinikhi kunyango lwemigca yeglabellar zingafikelela kwiiveki ezi-5 ubude kune-onabotulinumtoxinA.96 I-LetibotulinumtoxinA ngoku ikwimarike e-Asia kwaye yamkelwe yi-FDA kunyango lwemibimbi ye-periorbital.97 Xa kuthelekiswa ne-incobotulinumtoxinA, i-LetibotulinumtoxinA inomlinganiselo ophezulu weprotheyini ye-neurotoxic kwiyunithi nganye, kodwa inani le-neurotoxin engasebenziyo nalo liphezulu, elinyusa umngcipheko wokuphendula komzimba.98
Ukongeza kuqulunqo olutsha lwe-BoNT-A, i-BoNT-E yolwelo iyaphononongwa kuba kuthiwa inokuqala ngokukhawuleza kwesenzo kunye nexesha elifutshane leziphumo zeklinikhi (iintsuku eziyi-14-30).I-EB-001 ifunyenwe ikhuselekile kwaye iyasebenza ekunciphiseni ukubonakala kwemigca ephothiweyo kunye nokuphucula ukubonakala kwamanxeba ebunzi emva kwe-Mohs microsurgery.99 Oogqirha besikhumba banokuvunyelwa ukuba basebenzise ezi ncwadi.Ukongeza kwiinjongo zobuhle zangoku, iinkampani zamachiza zifuna amalungiselelo e-BoNT-A yonyango olungekho ngeleyibhile yeemeko zonyango zezifo zolusu.
I-BoNT lichiza elitofwayo elikwaziyo ukulungelelanisa kakhulu elinokusetyenziswa ukunyanga izifo ezahlukahlukeneyo zolusu, kuquka i-hidradenitis suppurativa, ipsoriasis, isifo solusu se-bullous, amanxeba angaqhelekanga, ukulahleka kweenwele, i-hyperhidrosis, kunye ne-keloids.Kwizicelo zokuthambisa, i-BoNT ikholelwa ukuba ikhuselekile kwaye iyasebenza ekunciphiseni imibimbi yobuso, ngakumbi isithathu esiphezulu sokushwabana kobuso.I-BoNT A iyaziwa ngokusetyenziswa kwayo ekunciphiseni imibimbi kwintsimi yezithambiso.Nangona i-BoNT ikhuselekile ngokubanzi, kusoloko kubalulekile ukuqonda indawo yokutofa kuba i-toxins inokusasazeka kwaye ichaphazele kakubi iindawo ekungafanelanga ukuba zinyangwe.Oogqirha kufuneka baqaphele iingxaki kwiindawo ezithile xa betofa i-BoNT ezinyaweni, ezandleni, okanye entanyeni.Oogqirha besikhumba kufuneka baqhelane nokusetyenziswa kwe-BoNT kwileyibhile kunye ne-off-label ukuze babonelele izigulana ngonyango olufanelekileyo kunye nokunciphisa ukugula okuhlobene.Ukusebenza kwekliniki ye-BoNT kwiisethingi ezingekho kwileyibhile kunye nayo nayiphi na imiba enokubakho yokhuseleko lwexesha elide kufuneka ivavanywe ngolingo lwezonyango oluyilwe kakuhle.
Ukwabelana ngedatha akusebenzi kweli nqaku kuba akukho datha yedatha eyenziwe okanye ihlalutywe ngexesha lophando lwangoku.
Ukuhlolwa kwezigulane kwenziwa ngokuhambelana nemigaqo yeSibhengezo saseHelsinki.Umbhali uqinisekisa ukuba ufumene zonke iifom zemvume yesigulane ezifanelekileyo apho isigulane sivuma ukubandakanya imifanekiso kunye nolunye ulwazi lwekliniki kwiphephancwadi.Izigulane ziyaqonda ukuba amagama azo kunye nee-initials aziyi kubhengezwa esidlangalaleni, kwaye ziya kuzama ukufihla iinkcukacha zabo.
UGqr Piyu Parth Naik ufake isandla kuphela ekubhalweni kombhalo-ngqangi.Umbhali wenze igalelo elibalulekileyo kwingcamango kunye noyilo, ukufumana idatha kunye nokutolikwa kwedatha;uthathe inxaxheba ekuyilweni kwamanqaku okanye umxholo wolwazi oluhlaziyiweyo ngokunzulu;uvumile ukungenisa kwijenali yangoku;ekugqibeleni ivume inguqulelo ukuba ipapashwe;kwaye wavuma umsebenzi Unoxanduva lwazo zonke iinkalo.