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308 nm 엑시머 레이저를 이용한 백반증 치료에서 나타나는 색소 재침착 양상

Other Titles
 Patterns of repigmentation after 308 nm excimer laser therapy in patients with vitiligo 
Authors
 김도영 
Department
 Dept. of Dermatology (피부과학교실) 
Issue Date
2007
Description
의학과/석사
Abstract
[한글]

백반증은 표피나 점막의 멜라닌세포가 소실되어 다양한 크기와 모양의 탈색반들이 피부에 나타나는 후천성 탈색소 질환으로, 광화학 PUVA요법이나 UVB 광선요법이 중요한 치료법으로 이용된다. 광선 치료 후에 나타나는 색소 재침착의 양상은 가장 흔한 모낭형 이외에도 미만형, 경계형 또는 복합형으로 나타날 수 있다. 본 연구에서는 엑시머 레이저를 이용하여 백반증을 치료할 때 나타나는 색소 재침착의 양상과 이에 영향을 주는 요인을 알아보고자 하였다. 308 nm 엑시머 레이저 치료 후, 임상적으로 유의한 정도의 호전을 보인 92명의 백반증 환자를 대상으로 색소 재침착의 양상을 분석한 결과, 경계형 색소 재침착이 전체의 34.8%로 가장 흔하였고 모낭형 색소 재침착은 31.5%에서 관찰되었고, 미만형은 21.7%, 복합형은 12.0%에서 관찰되었다. 색소 재침착 양상은 해부학적 부위에 따라 통계적으로 유의한 차이가 있었으며, 얼굴에서는 경계형과 미만형 색소 재침착이 흔하게 관찰되었고, 목에서는 모낭형 색소 재침착이 흔하게 관찰되었다. 그러나 환자의 연령 및 이환기간, 백반증 유형, 과거 치료력, 그리고 백모증의 유무에 따른 색소 재침착 양상의 차이는 없었다. 색소 재침착 양상에 따른 색소 재침착의 출현 시기와 호전 속도, 그리고 호전에 필요한 누적광량의 차이를 비교하였으나 각 군간의 통계적 차이는 없었다. 이상의 결과로 엑시머 레이저 치료 후 색소 재침착 양상은 기존 광선치료 요법에 비해 경계형의 빈도가 높았고, 병변의 해부학적 위치가 색소 재침착 양상과 밀접한 관련이 있음을 알 수 있었다.



[영문]The mechanisms of repigmentation in vitiligo have not been elucidated. Many investigators postulated that there was a melanocyte reservoir in the human hair follicles. The mechanism of perifollicular repigmentation pattern has been researched extensively. However, there are clinically other repigmentation patterns, such as diffuse and marginal forms, which frequently are observed in phototherapy. Recently 308 nm excimer laser has been introduced as a modality, it has several characteristics in the course of treatment. Because excimer laser targets on localized lesions with high intensity of radiation, it needs lesser times of treatment session; it is comparably more effective than conventional phototherapy. Therefore, the patterns of repigmentation after excimer laser therapy are expected to be different compared with conventional phototherapy.This study was designed to observe the patterns of repigmentation after excimer laser therapy and to analyze determining factors on the patterns in various aspects of clinical parameters. Ninety-two patients enrolled in this study had been treated from March 2004 to June 2006. Excimer laser therapy was given as monotherapy once or twice a week. We observed the patterns of repigmentation, and analyzed the patterns in various clinical parameters to discover determinant factors, and surveyed differences in therapeutic outcomes according to the patterns. Ninety-two patients who achieved clinically meaningful improvement were evaluated in this study. Of 92 vitiligo patches selected, 32(34.8%) exhibited predominantly marginal pattern of repigmentation, 29(31.5%) developed perifollicular repigmentation, 20(21.7%) developed diffuse repigmentation, and 11(12.0%) showed a combined repigmentation pattern. In terms of the involved sites, among 52 patches on patients’ faces, the most common involved sites, 22(42.3%) exhibited predominantly marginal repigmentation and 14(26.9%) showed diffuse patterns, but among 21 patches on necks, perifollicular types were predominant patterns. However, no relationship could be established between patterns of repigmentation and following variables: patients’ age, duration of disease, types of vitiligo, past history of other treatment modalities, and poliosis. Number of sessions or cumulative radiation dose to achieve clinically meaningful improvement, or speed of repigmentation were not different among the patterns of repigmentation. In conclusion, marginal pattern of repigmentation is relatively common form in the treatment of excimer laser compared with conventional phototherapy. Also involved anatomical site of vitiligo is an important determining factor in the manifestation of repigmentation patterns in vitiliginous patches.
Files in This Item:
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Dermatology (피부과학교실) > 2. Thesis
Yonsei Authors
Kim, Do Young(김도영) ORCID logo https://orcid.org/0000-0002-0194-9854
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/123636
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