Sen Sumit, Rudra Olympia, Gayen Tirthankar
Department of Dermatology, IPGME&R, Kolkata, West Bengal, India.
Indian J Dermatol. 2021 Jul-Aug;66(4):386-392. doi: 10.4103/ijd.IJD_897_20.
Extracorporeal therapy is a treatment modality where human blood undergoes favorable technical modifications and is reintroduced into the same patient. Since the last four decades this technique has been deployed in the management of difficult and refractory disorders in dermatology. Over a period of time newer techniques like immunoadsorption has emerged and opened new vistas in management of morbid dermatoses. In extracorporeal photopheresis a patient's leukocytes are separated and treated outside with Ultra Violet A in presence of 8-methoxypsoralen. Double filtration plasmapheresis and Immunoadsorption are techniques to remove offending immune complexes. They are safe and reduce the need of toxic medications that are conventionally used in recalcitrant skin diseases. In recent years immunoadsorption is emerging as first-line therapy in condition like immunobullous diseases. High cost is one of the important factors limiting their wider use in developing countries like India. Our review discusses different extracorporeal therapies, their applications, recommendations and guidelines based on various clinical trials.
体外治疗是一种治疗方式,即人体血液经过有益的技术改造后再重新输入同一患者体内。在过去的四十年里,这项技术已被应用于皮肤科疑难和难治性疾病的治疗。随着时间的推移,诸如免疫吸附等新技术应运而生,为病态皮肤病的治疗开辟了新的前景。在体外光化学疗法中,患者的白细胞被分离出来,并在8-甲氧基补骨脂素存在的情况下用紫外线A进行体外处理。双重滤过血浆置换和免疫吸附是去除有害免疫复合物的技术。它们安全可靠,减少了传统上用于顽固性皮肤病的有毒药物的使用需求。近年来,免疫吸附正成为免疫性大疱性疾病等病症的一线治疗方法。高成本是限制其在印度等发展中国家更广泛应用的重要因素之一。我们的综述讨论了不同的体外治疗方法、它们的应用、基于各种临床试验的建议和指南。