Uloga ljekarnika u sprječavanju i liječenju hiperpigmentacija kože

professional thesis

• Author: Nives Nanaši
• Mentor: Jelena Filipović-Grčić (mentor)
• Committee member: Ivan Pepić (predsjednik povjerenstva)
• Committee member: Jelena Filipović-Grčić (član povjerenstva)
• Committee member: Ines Sjerobabski Masnec (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Department of pharmaceutical technology); Zagreb
• Defense date and country: 2021-05-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy

Abstract

Cilj istraživanja: Pretraživanjem dostupne literature moguće je pronaći stotine djelatnih tvari koje su pokazale učinkovitost u in vitro uvjetima, ali samo mali broj se pokazao djelotvornim u kliničkim in vivo ispitivanjima i u kliničkoj praksi. Cilj ovog istraživanja je pregledno opisati liječenje hiperpigmentacija, raspraviti prednosti i nedostatke djelatnih tvari koje se najčešće propisuju, s posebnim naglaskom na mogućnost izrade magistralnog pripravka i pružanje individualne terapije pacijentu. Odabir ispravnog lijeka u odgovarajućoj formulaciji i koncentraciji te edukacija pacijenta su ključni za osiguravanje djelotvornosti terapije i za adherenciju pacijenta.
Metode istraživanja: Pretražena je literatura vezana za hiperpigmentacije i njihovo liječenje koristeći baze podataka PubMed, Wiley, Medscape, Cochrane library, Europsku farmakopeju i udžbenike iz područja dermatologije Fitzpatrick´s dermatology i European Handbook of Dermatological Treatments. Ključni pojmovi za pretraživanje literature su uključivali individualna imena lijekova i sljedeće pojmove na engleskom jeziku: hyperpigmentation, treatment, pharmacist, compounding, formulation . Izdvojeni su najvažniji rezultati i zaključci koji su prikazani u ovom radu.
Rezultati: Topikalnu terapiju ograničuje njezina učinkovitost i ispravna aplikacija lijeka, kao i visok stupanj recidiva nakon prekida terapije. Hidrokinon i kombinirana terapija su učinkoviti, ali nose rizik od egzogene okronoze i hipopigmentacije. Prirodne djelatne tvari imaju niži rizik od nuspojava, ali nedostaje još istraživanja koja bi dokazala njihovu učinkovitost i definirala optimalne formulacije i primjerene koncentracije tih novih spojeva. Fizikalno-kemijski postupci su povezani s potencijalnim komplikacijama i sami mogu dovesti do postupalnih hiperpigmentacija. Svakodnevna fotozaštita, kao i edukacija pacijenata, su ključ uspješne terapije.
Zaključak: Za optimalne rezultate treba istovremeno koristiti više lijekova koji djeluju u različitim fazama melanogeneze. Pacijente treba savjetovati o njihovoj terapiji i važnosti dugoročne ustrajnosti u terapiji hiperpigmentacija. Ljekarnici mogu dati značajni doprinos liječenju pacijenata s hiperpigmentacijama kroz edukaciju i savjetovanje pacijenata i izradu magistralnih pripravaka.

Abstract (english)

Objectives: A cursory review of available literature will reveal hundreds of active substances that work on various aspects of melanogenesis in in vitro conditions, but only a small number of them has shown efficacy in in vivo experiments and clinical practice. The purpose of this research is to provide a comprehensive overview of hyperpigmentation treatments, discuss advantages and disadvantages of commonly prescribed drugs, with a special emphasis on compounding and on adjusting therapy to an individual’s needs. Choosing the correct medicine in the appropriate formulation and concentration, as well as patient education are key to ensuring effective treatment and patient adherence.
Methods: A review of the literature surrounding hyperpigmentation management was completed using PubMed, Wiley, Medscape, Cochrane library, European pharmacopeia as well as Fitzpatrick’s dermatology and European Handbook of Dermatological Treatments. Scientific literature was searched using key words including hyperpigmentation treatment, pharmacist, compounding, formulation and individual drug names. Relevant findings were outlined and presented in this paper.
Results: Topical treatments are limited by their efficacy and proper application, as well as high rates of recurrence after therapy discontinuation. Hydroquinone and triple combination therapy are effective but carry risks for ochronosis and hypopigmentation. Natural compounds are associated with low risk for adverse events, but more research is needed to determine the efficacy, optimal formulations, and appropriate concentrations of novel treatments. Procedural interventions are associated with potential complications and may cause postinflammatory
hyperpigmentation themselves. Daily photoprotection and patient education is key to ensuring a successful therapy.
Conclusion: Drugs that work at different steps of melanogenesis should be used for achieving optimal results. Patients need to be counseled about their therapy and the importance of long term adherence to the treatment. Pharmacists can make a valuable contribution to the care of patients with hyperpigmentations through patient education, counseling and compounding.

• Keywords: koža; hiperpigmentacija kože; uloga ljekarnika; terapija; magistralni pripravci
• Keywords (english): skin; skin hyperpigmentation; pharmacists' role; therapy; compounding
• Language: croatian
• URN:NBN: urn:nbn:hr:163:916818
• Study programme: Title: Clinical pharmacy; Study programme type: university; Study level: postgraduate specialist; Academic / professional title: sveučilišni/a magistar/sveučilišna magistra kliničke farmacije (sveučilišni/a magistar/sveučilišna magistra kliničke farmacije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-03-17 12:20:21