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Farmacoterapia da hidradenite supurativa
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Abstract(s)
A hidradenite supurativa (HS) é uma doença da pele crónica, inflamatória, recorrente e debilitante do folículo piloso que geralmente surge após a puberdade. Manifesta-se principalmente nas áreas portadoras de glândulas apócrinas do corpo, mais comumente nas regiões das axilas, inguinais e anogenitais, através de nódulos dolorosos, abcessos, fístulas, tratos sinusais e cicatrizes. Devido à sua natureza recorrente, dor persistente, secreções desagradáveis e à presença frequente de outras condições de saúde, a HS possui um impacto significativo na qualidade de vida dos utentes, uma vez que afeta não apenas a saúde física, mas
também aspetos sociais, psicológicos e sexuais. A origem da HS encontra-se relacionada ao funcionamento comprometido da unidade pilossebácea-apócrina. Este distúrbio resulta na hiperqueratinização, obstrução, dilatação e rutura do folículo piloso, desencadeando uma resposta imunológica local o que leva à formação de lesões inflamatórias. Mutações genéticas que afetam a via de sinalização através da γ-secretase, atividade androgénica excessiva, variações hormonais durante o ciclo menstrual,
inflamação sistémica, dietas ricas em hidratos de carbono, atrito da pele, sudorese intensa, tabagismo/nicotina e o uso de lítio são possíveis fatores desencadeantes da patologia. Com base nas considerações anteriores, os objetivos desta Dissertação são os seguintes: i) abordar a classificação, incidência, prevalência e fisiopatologia da HS; ii) referir o algoritmo de tratamento, mencionando o grupo farmacoterapêutico, mecanismo de ação, indicação terapêutica, efeitos indesejáveis, contraindicações, interações medicamentosas e propriedades farmacocinéticas para os principais fármacos; iii) descrever as medidas não farmacológicas; e iv) indicar o papel do farmacêutico ao nível da farmacoterapia e gestão da patologia. A HS permanece uma condição desafiadora a ser tratada, devido à diversidade das suas manifestações e à resposta aos fármacos disponíveis. O desenvolvimento de novas terapias biológicas e uma abordagem cada vez mais personalizada do tratamento, levando em conta as
características específicas dos pacientes, são cruciais para o progresso no controlo da doença. Assim, a gestão multidisciplinar é relevante, tendo em vista a implicação psicológica e social da patologia. O farmacêutico auxilia na escolha da medicação, monitoriza os efeitos indesejáveis, assegura a adesão e o uso racional da farmacoterapia.
Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent and debilitating skin disease of the hair follicle that usually appears after puberty. It manifests itself mainly in the apocrine gland-bearing areas of the body, most commonly in the armpit, inguinal and anogenital regions, through painful nodules, abscesses, fistulas, sinus tracts and scars. Due to its recurrent nature, persistent pain, unpleasant secretions and the frequent presence of other health conditions, HS has a significant impact on patients' quality of life, as it affects not only physical health, but also social, psychological and sexual aspects. The origin of HS is related to the impaired functioning of the pilosebaceous-apocrine unit. This disorder results in hyperkeratinisation, obstruction, dilation and rupture of the hair follicle, triggering a local immune response which leads to the formation of inflammatory lesions. Genetic mutations that affect the signalling pathway through γ-secretase, excessive androgenic activity, hormonal variations during the menstrual cycle, systemic inflammation, diets rich in carbohydrates, skin friction, intense sweating, smoking/nicotine and the use of lithium are all possible triggers of the condition. Based on the above considerations, the objectives of this Dissertation are as follows: i) to discuss the classification, incidence, prevalence and pathophysiology of HS; ii) to refer to the treatment algorithm, mentioning the pharmacotherapeutic group, mechanism of action, therapeutic indication, undesirable effects, contraindications, drug interactions and pharmacokinetic properties for the main drugs; iii) to describe the non-pharmacological measures; and iv) to indicate the role of the pharmacist in terms of pharmacotherapy and management of the pathology. HS remains a challenging condition to treat, due to the diversity of its manifestations and response to available drugs. The development of new biological therapies and an increasingly personalized approach to treatment, considering the specific characteristics of patients, are crucial for progress in controlling the disease. Therefore, multidisciplinary management is relevant, given the psychological and social implications of the disease. The pharmacist assists in the choice of medication, monitors undesirable effects, and ensures adherence and rational use of pharmacotherapy.
Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent and debilitating skin disease of the hair follicle that usually appears after puberty. It manifests itself mainly in the apocrine gland-bearing areas of the body, most commonly in the armpit, inguinal and anogenital regions, through painful nodules, abscesses, fistulas, sinus tracts and scars. Due to its recurrent nature, persistent pain, unpleasant secretions and the frequent presence of other health conditions, HS has a significant impact on patients' quality of life, as it affects not only physical health, but also social, psychological and sexual aspects. The origin of HS is related to the impaired functioning of the pilosebaceous-apocrine unit. This disorder results in hyperkeratinisation, obstruction, dilation and rupture of the hair follicle, triggering a local immune response which leads to the formation of inflammatory lesions. Genetic mutations that affect the signalling pathway through γ-secretase, excessive androgenic activity, hormonal variations during the menstrual cycle, systemic inflammation, diets rich in carbohydrates, skin friction, intense sweating, smoking/nicotine and the use of lithium are all possible triggers of the condition. Based on the above considerations, the objectives of this Dissertation are as follows: i) to discuss the classification, incidence, prevalence and pathophysiology of HS; ii) to refer to the treatment algorithm, mentioning the pharmacotherapeutic group, mechanism of action, therapeutic indication, undesirable effects, contraindications, drug interactions and pharmacokinetic properties for the main drugs; iii) to describe the non-pharmacological measures; and iv) to indicate the role of the pharmacist in terms of pharmacotherapy and management of the pathology. HS remains a challenging condition to treat, due to the diversity of its manifestations and response to available drugs. The development of new biological therapies and an increasingly personalized approach to treatment, considering the specific characteristics of patients, are crucial for progress in controlling the disease. Therefore, multidisciplinary management is relevant, given the psychological and social implications of the disease. The pharmacist assists in the choice of medication, monitors undesirable effects, and ensures adherence and rational use of pharmacotherapy.
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Keywords
Hidradenite supurativa Fisiopatologia Farmacoterapia Medidas não farmacológicas Farmacêutico