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ÖzetPrimer hiperhidroz sebebi bilinmeyen, en sık palmar, plantar ve aksiller bölgede ortaya çıkan, çoğunlukla bilateral ve simetrik olan aşırı terleme ile karakterizedir. Etkilenen bireylerde fiziksel rahatsızlıklar ve psikososyal güçlüklere yol açtığı için etkin bir şekilde tedavi edilmelidir. Ancak, patofizyolojisinin tam olarak anlaşılmaması nedeniyle tedavisi zordur. Topikal ve sistemik ajanlar ile cerrahi ve cerrahi olmayan invaziv teknikler gibi çeşitli seçenekler bulunmaktadır. İyontoforez, iyonize maddelerin elektrik akımı aracılığıyla yüzey dokulara uygulanması işlemidir. Primer hiperhidrozda invaziv olmayan, güvenli, iyi tolere edilen, etkili ve uzun dönem yan etkiler ile kompansatuvar hiperhidroza neden olmayan bir tedavi yöntemidir. Şiddetli palmar ve/veya plantar hiperhidrozda ve topikal tedaviye yanıt vermeyen orta şiddetteki olgularda ilk tedavi seçeneği olarak önerilmektedir. Aksiller hiperhidrozda ise etkinliği düşüktür ve kullanımı pratik değildir. Zaman alıcı olması ve idame tedavisinin gerekliliği ise en önemli dezavantajlarıdır. Bu makalede, hiperhidroz ve başlıca tedavi seçenekleri, iyontoforezin primer hiperhidroz tedavisindeki endikasyonları, etki mekanizması, tedavi protokolü ile yöntemi, yan etkileri ve kontrendikasyonları derlenmiştir. AbstractPrimary hyperhidrosis is characterized by excessive sweating of unknown cause which most commonly involves the palms, soles, and axillae in a bilateral and symmetrical fashion. Since it leads to physical discomfort and psychosocial difficulties in the affected individuals, it should be treated effectively. However, treatment can be challenging as its pathophysiology is poorly understood. There are several treatment options, including topical or systemic medications and surgical or non-surgical invasive techniques. Iontophoresis is the introduction of ionized substances into the surface tissues by means of an electric current. It is a non-invasive, safe, well tolerated, and effective treatment method for primary hyperhidrosis without long-term adverse effects and compensatory hyperhidrosis. Iontophoresis is suggested as a first-line therapy in severe palmoplantar hyperhidrosis and second-line therapy in milder cases that are unresponsive to topical treatments. In axillary hyperhidrosis it is less effective and not practical to use. Being time consuming and requiring maintenance therapy are its most important disadvantages. In this article, hyperhidrosis and the principal treatment options, the indications of iontophoresis for the treatment of primary hyperhidrosis, its mechanism of action, treatment protocol and procedure, adverse effects, and contraindications are reviewed. (Turk J Dermatol 2011; 5: 5-12)
ÖzetPrimer hiperhidroz sebebi bilinmeyen, en sık palmar, plantar ve aksiller bölgede ortaya çıkan, çoğunlukla bilateral ve simetrik olan aşırı terleme ile karakterizedir. Etkilenen bireylerde fiziksel rahatsızlıklar ve psikososyal güçlüklere yol açtığı için etkin bir şekilde tedavi edilmelidir. Ancak, patofizyolojisinin tam olarak anlaşılmaması nedeniyle tedavisi zordur. Topikal ve sistemik ajanlar ile cerrahi ve cerrahi olmayan invaziv teknikler gibi çeşitli seçenekler bulunmaktadır. İyontoforez, iyonize maddelerin elektrik akımı aracılığıyla yüzey dokulara uygulanması işlemidir. Primer hiperhidrozda invaziv olmayan, güvenli, iyi tolere edilen, etkili ve uzun dönem yan etkiler ile kompansatuvar hiperhidroza neden olmayan bir tedavi yöntemidir. Şiddetli palmar ve/veya plantar hiperhidrozda ve topikal tedaviye yanıt vermeyen orta şiddetteki olgularda ilk tedavi seçeneği olarak önerilmektedir. Aksiller hiperhidrozda ise etkinliği düşüktür ve kullanımı pratik değildir. Zaman alıcı olması ve idame tedavisinin gerekliliği ise en önemli dezavantajlarıdır. Bu makalede, hiperhidroz ve başlıca tedavi seçenekleri, iyontoforezin primer hiperhidroz tedavisindeki endikasyonları, etki mekanizması, tedavi protokolü ile yöntemi, yan etkileri ve kontrendikasyonları derlenmiştir. AbstractPrimary hyperhidrosis is characterized by excessive sweating of unknown cause which most commonly involves the palms, soles, and axillae in a bilateral and symmetrical fashion. Since it leads to physical discomfort and psychosocial difficulties in the affected individuals, it should be treated effectively. However, treatment can be challenging as its pathophysiology is poorly understood. There are several treatment options, including topical or systemic medications and surgical or non-surgical invasive techniques. Iontophoresis is the introduction of ionized substances into the surface tissues by means of an electric current. It is a non-invasive, safe, well tolerated, and effective treatment method for primary hyperhidrosis without long-term adverse effects and compensatory hyperhidrosis. Iontophoresis is suggested as a first-line therapy in severe palmoplantar hyperhidrosis and second-line therapy in milder cases that are unresponsive to topical treatments. In axillary hyperhidrosis it is less effective and not practical to use. Being time consuming and requiring maintenance therapy are its most important disadvantages. In this article, hyperhidrosis and the principal treatment options, the indications of iontophoresis for the treatment of primary hyperhidrosis, its mechanism of action, treatment protocol and procedure, adverse effects, and contraindications are reviewed. (Turk J Dermatol 2011; 5: 5-12)
Peyronie's disease (PD) is an inflammatory and fibrotic disease which results in disfiguring and often distressing penile curvature deformity, affecting up to one in nine men in the United States, and between 0.3% and 13.1% of men globally. It progresses through an acute phase, associated with pain, as the fibrosis develops. In the quiescent phase, penile pain ceases and deformity stabilizes. The precise etiology remains unknown despite ongoing work to elucidate the biological underpinning. The diagnosis is guided by history and physical examination. Except for ultrasonography, imaging is not routinely recommended. Current management is predicated on symptomatic control and slowing progression in the acute phase, and correction of bothersome curvature in the stable phase. Most nonsurgical treatment options are poorly supported by available evidence, with the exceptions of traction therapy and certain intralesional injections. Surgical treatment, considered only after stabilization, is guided by severity and the presence or absence of erectile function and is highly individualized. Investigations are ongoing into several areas, including the exact biological mechanisms leading to plaque formation and failure of resolution; the effects of co‐existing systemic disease; the role of imaging in diagnosis and surgical planning; combination and regenerative nonsurgical therapies; and improvements in surgical techniques. As diagnostic accuracy improves and targeted treatments become available, management of PD will become progressively tailored to an individual's particular disease. In this review, we summarize the current knowledge regarding PD, including etiology and epidemiology, diagnosis, management, cutting‐edge research, and future directions in care of this condition.
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