IV.3 Autres indications :
IV.3.2 Les indications inflammatoires :
Il existe de nombreuses dermatoses dites «sensibles aux stéroïdes» et d'autres affections inflammatoires de la peau susceptibles de faire l'objet d'un traitement par immunosuppresseurs macrolides.
Des rapports de cas et de petites études ont été publiés dans la littérature sur l'utilisation de macrolides dans l'alopécie areata ,la maladie de Behçet, le pyoderma gangrenosum, le lichen sclérodermie ,le lupus érythémateux cutané, le lichen sclerosus, maladie du greffon contre l'hôte et la dermatite atopique et l’urticaire.
Marsland et Griffiths Expert Opin. Enquête Drugs (2004) 13 (2)ont fait une étude sur 129 autres dermatoses. Ces maladies ont toutes des cellules T autoréactives impliqués dans au moins une partie de leur pathogenèse .
Les macrolides sont largement utilisés pour traiter les infections des tissus mous et des voies respiratoires en raison de leur efficacité contre les bactéries à Gram négatif et à Gram positif notamment des staphylococcies cutannées et des infections à streptocoques.
Des preuves croissantes suggèrent que les antibiotiques macrolides ont à la fois des propriétés anti-inflammatoires et immunomodulatrices et sont donc bénéfique pour les maladies inflammatoires notamment en dermatologie pédiatrique. C’est en partant de ce principe que l’utilisation des macrolides a connu un effet rebond durant les dernières décennies en vue de l’accroissement de leurs indications thérapeutiques .Leur succès dans le traitement des maladies inflammatoires de la peau a conduit à leur raffinement pour des applications topiques et systémiques .Malgré le petit nombre d’études éclairant les mécanismes anti-inflammatoires et immunomodulateurs de les macrolides, il existe des preuves solides fournissant un soutien au profit de l'utilisation de ce type de médicament à long terme et à faible dose pour traiter certaines dermatoses inflammatoires sur lesquelles l es macrolides exercent des effets potentiellement immunomodulateurs dans le tels que la dermatite atopique ,le psoriasis, la rosacée , etc …. Bien que des études supplémentaires soient nécessaire, le traitement par macrolides dans certaines dermatoses chroniques a le potentiel de modifier la morbidité et éventuellement améliorer la gravité de ces pathologies. Des essais comparatifs randomisés bien conçus et bien alimentés sont nécessaires.
Dans cette thèse qui traite de la place des macrolides dans le traitement des pathologies dermatologiques en pédiatrie , nous présentons une collection de recherches bibliographiques et d’études cliniques et rapports de cas traitant des avantages potentiels des antibiotiques macrolides dans le traitement de certaines dermatoses qui ont été principalement classés comme non infectieuses.
RESUME
Titre: La place des macrolides en dermatologie pédiatrique Auteur : El Harfaoui Yassine
Rapporteur : Pr Fatima Jabouirik
Mots clés : Macrolide immunosuppresseur ; Dermatologie pédiatrique ; Indication inflammatoire ; Indication infectieuse
Les macrolides sont des molécules à propriétés antibiotiques, qui ont des macrocycles de lactone souvent associés à des sucres neutres ou aminés. Elles constituent une famille d'antibiotiques capables de diffuser dans les tissus, voire à l'intérieur des cellules.
Les antibiotiques macrolides ont à la fois des propriétés anti-inflammatoires et immunomodulatrices et sont donc bénéfiques pour les maladies inflammatoires notamment en dermatologie pédiatrique . C’est en partant de ce principe que l’utilisation des macrolides s’avère relativement efficace dans le traitement de dermatoses inflammatoires tels que la dermatite atopique ,le psoriasis, la rosacée.
Bien que des études supplémentaires soient nécessaire, le traitement par macrolides dans certaines dermatoses chroniques a le potentiel de modifier la morbidité et éventuellement améliorer la gravité de ces pathologies. Des essais comparatifs randomisés bien conçus et bien alimentés sont nécessaires. Leur succès dans le traitement des maladies inflammatoires de la peau a conduit à leur raffinement pour des applications topiques et systémiques .
Malgré le petit nombre d’études éclairant les mécanismes anti-inflammatoires et immunomodulateurs des macrolides, il existe des données solides fournissant un soutien au profit de l'utilisation de ce type de médicament à long terme et à faible dose .
Cependant la recherche d’autres macrolides immunosuppresseurs a conduit au développement de nouveaux agents dotés de profils moléculaires améliorés pour le traitement des maladies de la peau.
ABSTRACT
Title : The place of macrolides in pediatric dermatology Author :El Harfaoui Yassine
Reporter : Pr Fatima Jabouirik
Keywords : Macrolide ; Immunosuppressive ; Pediatric Dermatology ; Inflammatory Indication ; Infectious indication
Macrolides are molecules with antibiotic properties, which have lactone macrocycles often associated with neutral or amine sugars. They constitute a family of antibiotics able to diffuse in the tissues, even inside the cells.
The macrolide are antibiotics that have both anti-inflammatory and immunomodulatory properties and are therefore beneficial for inflammatory diseases, particularly in pediatric dermatology. It is from this principle that the use of macrolides is relatively effective in the treatment of inflammatory dermatoses such as atopic dermatitis, psoriasis, rosacea .
Although additional studies are needed, treatment with macrolides in some chronic dermatoses has the potential to alter morbidity and possibly improve the severity of these conditions. Well-designed and well-informed randomized controlled trials are needed. Their success in the treatment of inflammatory skin diseases has led to their refinement for topical and systemic applications.
Despite the small number of studies illuminating the anti-inflammatory and immunomodulatory mechanisms of macrolides, there is strong evidence supporting benefit from the use of this type of drug in the long term and low dose.
However the search for other immunosuppressive macrolides has led to the development of new agents with improved molecular profiles for the treatment of skin diseases.
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ناﻮﻨﻌﻟا لﺎﻔطﻸﻟ ﺔﯾﺪﻠﺠﻟا ضاﺮﻣﻷا ﻲﻓ تاﺪﯿﻟوﺮﻛﺎﻤﻟا ﻊﺿو : فﺮط ﻦﻣ ﻦﯿﺳﺎﯾ يوﺎﻓﺮﺤﻟا : فﺮﺸﻤﻟا ﻚﯾرﻮﺑﺎﺟ ﺔﻤطﺎﻗ رﻮﺴﯿﻓوﺮﺒﻟا : ﺔﯿﺳﺎﺳﻷا تﺎﻤﻠﻜﻟا ،ﺔﻋﺎﻨﻤﻟا تﺎﻄﺒﺜﻣ ،ﺪﯿﻟوﺮﻛﺎﻤﻟا : طﻷا ﺐط ،ﺔﯾﺪﻠﺠﻟا ضاﺮﻣﻷا ﻔ ،ﻲﻠﺒﮭﻤﻟا بﺎﮭﺘﻟﻻا ،لﺎ ﺔﯾﺪﻌﻣ ةرﺎﺷإ ﻋ ﺐﻟﺎﻐﻟا ﻲﻓ يﻮﺘﺤﺗ ﻲﺘﻟاو ،ﺔﯾﻮﯿﺤﻟا تادﺎﻀﻤﻠﻟ ﺺﺋﺎﺼﺧ تاذ تﺎﺌﯾﺰﺟ ﻲھ تاﺪﯿﻟوﺮﻛﺎﻤﻟا ﻰﻠ ةﺪﯾﺎﺤﻤﻟا تﺎﯾﺮﻜﺴﻟﺎﺑ ﺔﻄﺒﺗﺮﻣ ﺔﯿﻧﻮﺘﻛﻻ ﺔﯿﻧﻮﺘﻛﺎﻣ تﺎﺟارد ﻦﻣ ﺔﻠﺋﺎﻋ ﻞﻜﺸﺗ ﺎﮭﻧإ ﺔﯿﻨﻣﻷا وأ ﺔﯾﻮﯿﺤﻟا تادﺎﻀﻤﻟا .ﺎﯾﻼﺨﻟا ﻞﺧاد ﻰﺘﺣ ،ﺔﺠﺴﻧﻷا ﻲﻓ رﺎﺸﺘﻧﻻا ﻰﻠﻋ ةردﺎﻗ ةﺪﯿﻔﻣ ﻲﮭﻓ ﻲﻟﺎﺘﻟﺎﺑو ﺔﻋﺎﻨﻤﻟاو تﺎﺑﺎﮭﺘﻟﻼﻟ ةدﺎﻀﻣ صاﻮﺧ ﺪﯾﻻوﺮﻛﺎﻤﻟ ﺔﯾﻮﯿﺤﻟا تادﺎﻀﻤﻠﻟ ضاﺮﻣﻸﻟ ﺔﯿﺑﺎﮭﺘﻟﻻا ماﺪﺨﺘﺳا نأ أﺪﺒﻤﻟا اﺬھ ﻦﻣ .لﺎﻔطﻷا ىﺪﻟ ﺔﯾﺪﻠﺠﻟا ضاﺮﻣﻷا ﻲﻓ ﺔﺻﺎﺧ ، جﻼﻋ ﻲﻓ ﺎﯿﺒﺴﻧ لﺎﻌﻓ تاﺪﯿﻟوﺮﻛﺎﻤﻟا ﺔﯿﻓﺪﺼﻟاو ﻲﺒﺗﺄﺘﻟا ﺪﻠﺠﻟا بﺎﮭﺘﻟا ﻞﺜﻣ ﺔﯿﺑﺎﮭﺘﻟﻻا ﺔﯾﺪﻠﺠﻟا ضاﺮﻣﻷا تاﺪﯿﻟوﺮﻛﺎﻤﻟﺎﺑ جﻼﻌﻟا نﺈﻓ ،تﺎﺳارﺪﻟا ﻦﻣ ﺪﯾﺰﻣ ﻰﻟإ ﺔﺟﺎﺤﻟا ﻦﻣ ﻢﻏﺮﻟا ﻰﻠﻋ .ﻚﻟذ ﻰﻟإ ﺎﻣو ﺔﯾﺪﯾرﻮﻟاو هﺬھ ةﺪﺷ ﻦﯿﺴﺤﺗ ﺎﻤﺑرو ﺔﺿاﺮﻤﻟا ﺮﯿﯿﻐﺗ ﻰﻠﻋ ةرﺪﻘﻟا ﮫﻟ ﺔﻨﻣﺰﻤﻟا ﺔﯾﺪﻠﺠﻟا ضاﺮﻣﻷا ﺾﻌﺑ ﻲﻓ ا اﻮﺷ تاذ ةﺎﺸﻌﻣ برﺎﺠﺘﻟ ﺔﺟﺎﺣ ﻚﻟﺎﻨھ . تﻻﺎﺤﻟ ھ ﻲﻓ ﺎﮭﺣﺎﺠﻧ ىدأ ةﺮﯿﻨﺘﺴﻣو اﺪﯿﺟ ﺎﻤﯿﻤﺼﺗ ﺔﻤﻤﺼﻣ ﺪ ﻮﻤﻟا تﺎﻘﯿﺒﻄﺘﻠﻟ ﺎﮭﻨﯿﺴﺤﺗ ﻰﻟإ ﺔﯿﺑﺎﮭﺘﻟﻻا ﺪﻠﺠﻟا ضاﺮﻣأ جﻼﻋ ﺿ ﺔﯾزﺎﮭﺠﻟاو ﺔﯿﻌ . ،ﺔﻋﺎﻨﻤﻟاو تﺎﺑﺎﮭﺘﻟﻼﻟ ةدﺎﻀﻤﻟا تاﺪﯿﻟوﺮﻛﺎﻤﻟا تﺎﯿﻟآ ءﻲﻀﺗ ﻲﺘﻟا تﺎﺳارﺪﻟا ﺔﻠﻗ ﻦﻣ ﻢﻏﺮﻟا ﻰﻠﻋو ﻲﻓ تارﺪﺨﻤﻟا ﻦﻣ عﻮﻨﻟا اﺬھ ماﺪﺨﺘﺳا ﻦﻣ ةدﺎﻔﺘﺳﻻا ﻢﻋﺪﺗ ﺔﯾﻮﻗ ﺔﻟدأ كﺎﻨﮭﻓ ا ﺔﻀﻔﺨﻨﻣو ﻞﯾﻮﻄﻟا ىﺪﻤﻟ .ﺔﻋﺮﺠﻟا ةﺪﯾﺪﺟ ﻞﻣاﻮﻋ ﺮﯾﻮﻄﺗ ﻰﻟإ ىﺮﺧﻷا ﺔﻌﺗﺎﻨﻤﻠﻟ ﺔﻄﺒﺜﻤﻟا تاﺪﯿﻟوﺮﻛﺎﻤﻟا ﻦﻋ ﺚﺤﺒﻟا ىدأ ﺪﻘﻓ ، ﻚﻟذ ﻊﻣو ﺰﺟ ﺢﻣﻼﻣ ناذ ﯾ . ﺔﯾﺪﻠﺠﻟا ضاﺮﻣﻷا جﻼﻌﻟ ﺔﻨﺴﺤﻣ ﺔﯿﺌ
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