Gebelik ve laktasyon döneminde scabies ve ebelik yaklaşımı

Yıl 2024, Cilt: 5 Sayı: 1, 80 - 96, 30.04.2024

Resmiye Özdilek , Suzi Özdemir , Nursena Duran

https://doi.org/10.59244/ktokusbd.1409750

Öz

İnsan uyuzu olarak bilinen scabies dünyanın en yaygın hastalıklarından biridir. Yoğun kaşıntı ve genellikle yaygın papüler veya ekzematöz lezyonlarla karakterize olan scabiesin daha çok insandan insana cilt teması ile bulaştığı bilinmektedir. Uyuz tanısı genellikle klinik muayene ve hasta öyküsüne dayalı olarak konulmaktadır. Gebelikte uyuz prevalansı sistematik olarak araştırılmamış olmasına rağmen, gözlem çalışmalarının sonuçları, gebelikte gelişen tüm cilt hastalıklarının %2-6’sını oluşturduğunu göstermektedir. Gebelikte uyuz tedavisi seçenekleri sınırlı olup belirli bir standart bulunmamaktadır. Uyuzdan etkilenen hastanın tedavi yönetimi, akarların farmakolojik bir yöntemle yok edilmesini, uyuzun diğer bireylere yayılmasını önleme stratejilerini ve uyuzla ilişkili komplikasyonların, yani ilişkili kaşıntının gözetimini ve tedavisini içermektedir. Permethrin %5 krem (kanıt düzeyi III, Kategori B), gebelikte tercih edilen bir tedavi yöntemidir. Plasentayı geçebilmesine rağmen, permetrin sadece küçük miktarlarda emildiği ve hızla metabolize olduğu için fetal maruziyet riski minimumdur. Oral ivermektin ile ilişkili risk düşük olsa da gebelikte kullanımla ilgili veriler sınırlıdır. Malathion kullanımı gebe kadınlarda çalışılmamış olup hayvan çalışmaları sonucunda teratojenik etki saptanmamıştır. Topikal kükürt ve %25 benzil benzoat losyon ikinci basamak tedavilerdir. Travmatize cilt üzerine uygulandığında maternal nörotoksisite ve aplastik anemi riski nedeniyle Lindane gebelikte kullanılmamalıdır. Laktasyon dönemi ise anne ve bebeğin yakın temasta olduğu bağlanma sürecinin de parçasını oluşturan bir dönemdir. Uyuzla enfekte olan emziren kadınların, anne sütüyle beslenmeyi sürdürmeye ve bebeğe uyuz bulaşma riskini sınırlamaya izin veren etkili bir tedavi almadıkları sürece, sütlerini sağmaları gerekmektedir. Emzirme döneminde uyuz tedavisinde kullanılan ilaçların güvenliğine ilişkin veriler sınırlıdır. Potansiyel yan etkileri nedeniyle emzirme döneminde Lindane’dan kaçınılmalıdır. Uyuzun tedavisinde toksisitenin çok düşük olduğu düşünülen Permethrin, emziren annelerde de güvenle kullanılmıştır. Bu bağlamda uyuzun gebelik ve laktasyon dönemindeki tedavi ve bakımını kapsayan ebelik yaklaşımlarını inceleyen araştırmalara ihtiyaç vardır.

Anahtar Kelimeler

Scabies, Gebelik, Laktasyon, Ebelik bakımı

Kaynakça

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