Likenoid Dermatozlar ve D Vitamini
Özet
Likenoid dermatozlar, karmaşık bir etiyopatogeneze sahip inflamatuar deri hastalıklarıdır. Bu grubun prototipi olan liken planus (LP), T hücre aracılıklı bir immün yanıt ve keratinosit apoptozu ile karakterize kronik otoimmün bir süreçtir. Son yıllarda, kalsiyum homeostazisi dışındaki immünomodülatör, proapoptotik ve antiinflamatuar fonksiyonları nedeniyle D vitamininin bu hastalıklar üzerindeki rolü yoğun şekilde araştırılmaktadır. Vitamin D, Th1 ve Th17 gibi proinflamatuar sitokinleri baskılayıp Th2 ve regülatuvar T hücrelerini artırarak immün toleransı destekler. Ayrıca, D vitamini reseptörü (VDR) sinyal yolağının oral liken planusta keratinosit apoptozuna karşı koruyucu olduğu ve VDR eksikliğinin hastalık gelişimiyle ilişkili olduğu saptanmıştır. Literatürdeki vaka-kontrol çalışmalarında LP ve oral liken planus (OLP) hastalarında D vitamini düzeyleri çoğunlukla düşük bulunsa da çelişkili sonuçlar da mevcuttur. Tedavi boyutunda ise D3 analoğu olan topikal kalsipotriolün kutanöz LP ve liken sklerozis (LS) vakalarında semptomatik iyileşme sağlayabildiği, oral kalsitriolün ise dirençli LS olgularında dramatik klinik yanıtlar oluşturduğu bildirilmiştir. Sonuç olarak, D vitamininin immünomodülatör etkileri ve saptanan düşük serum düzeyleri, tedavide oral D vitamini desteğinin yer alabileceğini düşündürmektedir.
Lichenoid dermatoses are inflammatory skin diseases with a complex etiology, and lichen planus (LP), the prototype of this group, is a chronic autoimmune condition characterized by T-cell mediated immune response and keratinocyte apoptosis. Recently, due to its immunomodulatory, proapoptotic, and anti-inflammatory functions beyond calcium homeostasis, the role of vitamin net D on these diseases has been extensively investigated. Vitamin D supports immune tolerance by suppressing pro-inflammatory cytokines such as Th1 and Th17 while promoting Th2 and regulatory T-cells. Moreover, the vitamin D receptor (VDR) signaling pathway has been found to protect against keratinocyte apoptosis in oral lichen planus (OLP), and VDR deficiency is associated with disease development. Although case-control studies in the literature mostly report low vitamin D levels in LP and OLP patients, conflicting results also exist. Regarding treatment, topical calcipotriol, a vitamin D3 analog, has been shown to provide symptomatic relief in cutaneous LP and lichen sclerosus (LS), while oral calcitriol has induced dramatic clinical responses in resistant LS cases. Consequently, the immunomodulatory effects of vitamin D and the reported low serum levels suggest that oral vitamin D supplementation could be integrated into therapeutic options.
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