์ˆ˜์˜ํ•™ ์ „๋ฌธ๊ฐ€๋ฅผ ์œ„ํ•œ ์„ธ๊ณ„์ ์ธ ์ˆ˜์˜ํ•™ ์ €๋„
์ˆ˜์˜ํ•™ ์ „๋ฌธ๊ฐ€๋ฅผ ์œ„ํ•œ ์„ธ๊ณ„์ ์ธ ์ˆ˜์˜ํ•™ ์ €๋„

๋ฐœํ–‰ํ˜ธ ๋ฒˆํ˜ธ 31.2 ๊ธฐํƒ€ ํ•™์ˆ  ์ฃผ์ œ

TREATING CANINE ATOPIC DERMATITIS (๊ฐœ ์•„ํ† ํ”ผ ํ”ผ๋ถ€์—ผ์˜ ์น˜๋ฃŒ)

์ถœ๊ฐ„์ผ 14/10/2021

์ €์ž Annette van der Lee

์„ ํƒ ๊ฐ€๋Šฅ ์–ธ์–ด Français , Deutsch , Italiano , Românฤƒ , Español ๊ทธ๋ฆฌ๊ณ  English

1์ฐจ ๋™๋ฌผ๋ณ‘์›์—๋Š” ์•„ํ† ํ”ผ ํ”ผ๋ถ€์—ผ์ด ์žˆ๋Š” ๊ฐœ๋“ค์ด ์ •๋ง ๋งŽ์ด ๋‚ด์›ํ•œ๋‹ค. ์ด ๊ธ€์—์„œ๋Š” ๊ฐœ ์•„ํ† ํ”ผ ํ”ผ๋ถ€์—ผ์˜ ์น˜๋ฃŒ ๋ฐฉ๋ฒ•์„ ๊ฒ€ํ† ํ•˜๊ณ  ๋‹ค์ค‘ ์ ‘๊ทผ ๋ฐฉ์‹์˜ ํ•„์š”์„ฑ์„ ๊ฐ•์กฐํ•œ๋‹ค.

์•„ํ† ํ”ผ๊ฐ€ ์žˆ๋Š” ๊ฐœ์˜ ํ„ธ์ด ๊ณผ๋„ํ•˜๊ฒŒ ์ž๋ผ๋‚˜ ์žˆ๋‹ค. ์ด ๊ฐœ๋Š” ์‚ฌ์ดํด๋กœ์Šคํฌ๋ฆฐ ์œ ์ง€ ์š”๋ฒ•์„ 1๋…„ ๋™์•ˆ ๋ฐ›์•˜๋‹ค.

ํ•ต์‹ฌ ํฌ์ธํŠธ

๊ฐœ ์•„ํ† ํ”ผ ํ”ผ๋ถ€์—ผ์€ ํ”ํ•œ ๋งŒ์„ฑ ์งˆํ™˜์œผ๋กœ ๊ฐœ์™€ ๋ณดํ˜ธ์ž์˜ ์‚ถ์˜ ์งˆ์— ์˜ํ–ฅ์„ ๋ฏธ์นœ๋‹ค.


์„ฑ๊ณต์ ์ธ ์น˜๋ฃŒ๋ฅผ ์œ„ํ•ด์„œ๋Š”, ํŠนํžˆ ํ”ผ๋ถ€์ฆ์ƒ ์žฌ๋ฐœ(flares)์ด ์žˆ์„ ๋•Œ ์†Œ์–‘๊ฐ ์—ญ์น˜์— ์˜ํ–ฅ์„ ๋ฏธ์น˜๋Š” ๋‹ค์–‘ํ•œ ์š”์ธ๋“ค์— ๋Œ€ํ•ด์„œ๋„ ๋™์‹œ์— ๋‹ค๋ฃจ์–ด์•ผ ํ•œ๋‹ค. 


๋Œ€์ฆ์  ๋ฉด์—ญ์–ต์ œ ์น˜๋ฃŒ์™€ ์•Œ๋Ÿฌ์   ํŠน์ด ๋ฉด์—ญ์š”๋ฒ•์€ ๋‘˜ ๋‹ค ๊ฐœ ์•„ํ† ํ”ผ ํ”ผ๋ถ€์—ผ ์กฐ์ ˆ์— ์ค‘์š”ํ•œ ์—ญํ• ์„ ํ•˜๋ฉฐ ๋™์‹œ์— ์‚ฌ์šฉํ•  ์ˆ˜ ์žˆ๋‹ค.


์น˜๋ฃŒ๋Š” ํ•ญ์ƒ ๊ฐœ๋ณ„ ํ™˜์ž์—๊ฒŒ ๋งž์ถ”์–ด ์ง„ํ–‰๋˜์–ด์•ผ ํ•˜๊ณ  ํ”ผ๋ถ€์ฆ์ƒ ์žฌ๋ฐœ, ๊ณ„์ ˆ์„ฑ, ํ™˜์ž์˜ ์ „๋ฐ˜์ ์ธ ๊ฑด๊ฐ•์ƒํƒœ์— ๋งž๊ฒŒ ์กฐ์ •๋˜์–ด์•ผ ํ•œ๋‹ค. 


์„œ๋ก 

๊ฐœ ์•„ํ† ํ”ผ ํ”ผ๋ถ€์—ผ(CAD)์€ ์ฃผ๋กœ ํ™˜๊ฒฝ ์š”์ธ ์•Œ๋Ÿฌ์  ์œผ๋กœ ์ธํ•ด ๋ฐœ์ƒํ•˜๋Š” ํ”ํ•œ ์•Œ๋Ÿฌ์ง€ ํ”ผ๋ถ€ ์งˆํ™˜์œผ๋กœ, ํ™˜๊ฒฝ ์š”์ธ ์•Œ๋Ÿฌ์  ์—๋Š” ์ง‘๋จผ์ง€ ์ง„๋“œ๊ธฐ, ๊ฝƒ๊ฐ€๋ฃจ, ํ’€, ๋‚˜๋ฌด, ์žก์ดˆ์™€ ๊ฐ™์€ ๊ฒƒ์ด ์žˆ๋‹ค. ๋ณ‘์ธ์€ ๋‹ค์ธ์„ฑ์œผ๋กœ ๊ฐ„์ฃผ๋˜๋Š”๋ฐ, ํ‘œํ”ผ ์žฅ๋ฒฝ ๊ธฐ๋Šฅ์žฅ์• ๊ฐ€ ๋ฉด์—ญ๊ณ„์˜ ์กฐ์ ˆ ์žฅ์• ์™€ ๊ฒฐํ•ฉ๋˜์–ด CAD์— ๋Œ€ํ•œ ์œ ์ „์  ๋ฐฐ๊ฒฝ์ด ์žˆ๋Š” ๊ฐœ์—๊ฒŒ์„œ ์ž„์ƒ ์งˆํ™˜์œผ๋กœ ์ „๊ฐœ๋œ๋‹ค. ๋Œ€๋ถ€๋ถ„์˜ ๊ฒฝ์šฐ, ์–ด๋ฆฐ ๋‚˜์ด๋ถ€ํ„ฐ ์ฆ์ƒ์ด ์‹œ์ž‘๋˜์–ด ํ‰์ƒ ๋™์•ˆ ํ”ผ๋ถ€์—ผ๊ณผ ์†Œ์–‘์ฆ์œผ๋กœ ๋ถˆํŽธ๊ฐ์„ ๊ฒช๋Š”๋‹ค.

๋‹ค์–‘ํ•œ CAD ์น˜๋ฃŒ๋ฒ•์ด ๊ฐœ๋ฐœ๋˜์—ˆ์ง€๋งŒ, ๊ฐ๊ฐ์˜ ์น˜๋ฃŒ๋ฒ•์€ ํšจ๋Šฅ ๋ฐ ๊ฑด๊ฐ•์ƒ ๋ฌธ์ œ์™€ ๊ด€๋ จํ•˜์—ฌ ์žฅ๋‹จ์ ์ด ์žˆ๋‹ค. ์ด ๊ธ€์—์„œ๋Š” "์–ด๋””๋ถ€ํ„ฐ ์‹œ์ž‘ํ•ด์•ผ ํ• ๊นŒ์š”?"๋ผ๋Š” ์–ด๋ ค์šด ์งˆ๋ฌธ์— ๋Œ€ํ•ด ๋…ผ๋ฆฌ์ ์œผ๋กœ ์ ‘๊ทผํ•ด๋ณด๊ณ ์ž ํ•œ๋‹ค. ์ค‘์š”ํ•œ ๊ฒƒ์€ ํ™˜์ž๋ฅผ ์„ฑ๊ณต์ ์œผ๋กœ ์น˜๋ฃŒํ•˜๋Š” ๊ฒƒ๋ฟ๋งŒ ์•„๋‹ˆ๋ผ ์‹ฌ๊ฐํ•œ ํ”ผ๋ถ€์ฆ์ƒ ์žฌ๋ฐœ์„ ํ”ผํ•˜๋Š” ๊ฒƒ์ด๋‹ค. ์ด๋Ÿฌํ•œ ์ด์œ ๋กœ CAD์˜ ์น˜๋ฃŒ์—๋Š” ๋‹ค๊ฐ์ ์ธ ๊ด€๋ฆฌ๊ฐ€ ํ•„์š”ํ•˜๋‹ค (๊ทธ๋ฆผ 1). ์น˜๋ฃŒ์˜ ์„ฑ๊ณต์ด๋ž€ ์ž„์ƒ ์ง•ํ›„๋ฅผ ์ œ์–ดํ•˜๊ณ  ํ”ผ๋ถ€์ฆ์ƒ ์žฌ๋ฐœ์„ ๋ฐฉ์ง€ํ•˜๊ธฐ ์œ„ํ•œ ๊ฒƒ์œผ๋กœ ์ด๋Š” ๋‹ค์–‘ํ•œ ์น˜๋ฃŒ๋ฒ•์„ ์กฐํ•ฉํ•˜์—ฌ ์ ‘๊ทผํ•จ์œผ๋กœ์จ ๊ฐ€๋Šฅํ•˜๋ฉฐ, ์น˜๋ฃŒ ์˜ต์…˜์€ ํ™˜์ž์˜ ๊ฐœ๋ณ„ ์š”๊ตฌ์™€ ์‹œ๊ฐ„ ๊ฒฝ๊ณผ์— ๋”ฐ๋ฅธ ์งˆ๋ณ‘์˜ ์ค‘์ฆ๋„์— ๋”ฐ๋ผ ๋‹ฌ๋ผ์ง„๋‹ค.

๊ทธ๋ฆผ 1.๊ฐœ ์•„ํ† ํ”ผ ํ”ผ๋ถ€์—ผ์— ๋Œ€ํ•œ ๋‹ค์ค‘ ์น˜๋ฃŒ๋ฒ• ๋ฐ ๊ด€๋ฆฌ๋ฒ•

๊ทธ๋ฆผ 1. ๊ฐœ ์•„ํ† ํ”ผ ํ”ผ๋ถ€์—ผ์— ๋Œ€ํ•œ ๋‹ค์ค‘ ์น˜๋ฃŒ๋ฒ• ๋ฐ ๊ด€๋ฆฌ๋ฒ•

 

[* Allergen-specific immunotherapy ์•Œ๋Ÿฌ์   ํŠน์ด ๋ฉด์—ญ์š”๋ฒ•  ** Subcutaneous immunotherapy ํ”ผํ•˜ ๋ฉด์—ญ์š”๋ฒ•  *** Sublingual immunotherapy ์„คํ•˜ ๋ฉด์—ญ์š”๋ฒ• ]

์•Œ๋Ÿฌ์   ์ ‘์ด‰ ์ตœ์†Œํ™”

๊ฐ€์žฅ ํ”ํ•œ ์›์ธ ์•Œ๋Ÿฌ์  ์€ ์ง‘๋จผ์ง€ ์ง„๋“œ๊ธฐ ๋‹น๋‹จ๋ฐฑ(house  dust mite glycoproteins)๊ณผ ๊ฝƒ๊ฐ€๋ฃจ์™€ ๊ฐ™์€ ๊ณต๊ธฐ ๋งค๊ฐœ์„ฑ ์•Œ๋Ÿฌ์  (aeroal-lergens)์ด๊ธฐ ๋•Œ๋ฌธ์—, ์•Œ๋Ÿฌ์   ์ ‘์ด‰์„ ์˜ˆ๋ฐฉํ•˜๋Š” ๊ฒƒ์€ ์–ด๋ ต๊ฑฐ๋‚˜ ๋ถˆ๊ฐ€๋Šฅํ•˜๋‹ค. ํ•œ ํŽธ์˜ ๋น„๋Œ€์กฐ ์—ฐ๊ตฌ(uncontrolled study)์—์„œ ์•„ํ† ํ”ผ ํ”ผ๋ถ€์—ผ์ด ์žˆ๋Š” ๊ฐœ์—๊ฒŒ ์ง‘๋จผ์ง€ ์ง„๋“œ๊ธฐ ์•Œ๋Ÿฌ์  ์˜ ์–‘์„ ์ค„์ด๊ธฐ ์œ„ํ•ด ๋ฒค์งˆ๋ฒค์กฐ์—์ดํŠธ ์ง„๋“œ๊ธฐ ๊ตฌ์ถฉ์ œ(benzyl benzoate acaricide) ์Šคํ”„๋ ˆ์ด๋ฅผ ์‚ฌ์šฉํ•˜์˜€๋”๋‹ˆ ์ž„์ƒ ์ฆ์ƒ์ด ์•ฝ๊ฐ„ ๊ฐœ์„ ๋˜์—ˆ๋‹ค 1 . ํ˜„์žฌ ์‚ฌ๋žŒ์šฉ์œผ๋กœ ํŒ๋งค๋˜๋Š” ๋‹ค๋ฅธ ์ง„๋“œ๊ธฐ ์Šคํ”„๋ ˆ์ด์—๋Š” ์ง‘๋จผ์ง€ ์ง„๋“œ๊ธฐ์˜ ๋ฐฐ์„ค๋ฌผ ๋‹จ๋ฐฑ์„ ๋ถ„๋ฆฌํ•˜๋Š” ํšจ์†Œ๋ฅผ ์ƒ์‚ฐํ•˜๋Š” ํ”„๋กœ๋ฐ”์ด์˜คํ‹ฑ์Šค(probiotics)๊ฐ€ ํฌํ•จ๋˜์–ด ์žˆ๋‹ค. ์ด ์Šคํ”„๋ ˆ์ด๋ฅผ ์‚ฌ์šฉํ•˜์—ฌ ์ง‘๋จผ์ง€ ์ง„๋“œ๊ธฐ ์•Œ๋Ÿฌ์  ์ด ๊ฐ์†Œํ•œ ๊ฒƒ๊ณผ ์•„ํ† ํ”ผ๊ฐ€ ์žˆ๋Š” ๊ฐœ์˜ ์ž„์ƒ ์ฆ์ƒ์ด ๊ฐœ์„ ๋˜๋Š”์ง€์˜ ์ƒ๊ด€๊ด€๊ณ„๋ฅผ ๋ช…ํ™•ํžˆ ํ•˜๊ธฐ ์œ„ํ•ด์„œ๋Š” ํ†ต์ œ ์—ฐ๊ตฌ๊ฐ€ ๋”์šฑ ํ•„์š”ํ•˜๋‹ค. ์ง‘๋จผ์ง€ ์ง„๋“œ๊ธฐ๊ฐ€ ์—†๋Š” ๋งคํŠธ๋ฆฌ์Šค ์‚ฌ์šฉ, ์ง„๊ณต ์ฒญ์†Œ๊ธฐ๋ฅผ ์ด์šฉํ•˜์—ฌ ์ •๊ธฐ์ ์œผ๋กœ ์ฒญ์†Œ, 60°C ๋ฌผ์— ๋‹ด์š” ์„ธํƒ ๋“ฑ์„ ํ†ตํ•ด ๊ฐœ์˜ ํ”ผ๋ถ€๊ฐ€ ์ง‘๋จผ์ง€ ์ง„๋“œ๊ธฐ ์•Œ๋Ÿฌ์  ์— ๋…ธ์ถœ๋˜๋Š” ์ƒํ™ฉ์„ ์ตœ์†Œํ™”ํ•  ์ˆ˜ ์žˆ๋‹ค.


๋“œ๋ฌผ๊ฒŒ, ์ง‘์— ์žˆ๋Š” ๋‹ค๋ฅธ ๋ฐ˜๋ ค ๋™๋ฌผ(์˜ˆ: ์•ต๋ฌด์ƒˆ, ๊ธฐ๋‹ˆํ”ผ๊ทธ)์˜ ์ƒํ”ผ์กฐ์ง์— ์•„ํ† ํ”ผ๊ฐ€ ์žˆ๋Š” ๊ฐœ์˜ ํ”ผ๋ถ€๊ฐ€ ๋ฐ˜์‘ํ•  ์ˆ˜ ์žˆ๋‹ค. ์ด๋Ÿฌํ•œ ์ƒํ™ฉ์—์„œ๋Š” ์›์ธ์ด ๋˜๋Š” ๋ฐ˜๋ ค ๋™๋ฌผ์ด๋‚˜ ์•„ํ† ํ”ผ๊ฐ€ ์žˆ๋Š” ๋ฐ˜๋ ค๊ฒฌ์˜ ๊ฑฐ์ฒ˜๋ฅผ ๋‹ค๋ฅธ ๊ณณ์œผ๋กœ ์˜ฎ๊ธฐ๋Š” ๊ฒƒ์ด ๊ถŒ์žฅ๋œ๋‹ค.

์Œ์‹์— ์˜ํ•ด ์œ ๋ฐœ๋œ ์•„ํ† ํ”ผ ํ”ผ๋ถ€์—ผ์ด ์žˆ๋Š” ๊ฒฝ์šฐ, ์Œ์‹ ์•Œ๋Ÿฌ์  ๊ณผ ํ™˜๊ฒฝ ์•Œ๋Ÿฌ์  ์ด ๋ชจ๋‘ ์ธ๊ณผ์  ์—ญํ• ์„ ํ•œ๋‹ค 2 . ์Œ์‹ ์•Œ๋Ÿฌ์  ์€ ํ”ผ๋ถ€์ฆ์ƒ ์žฌ๋ฐœ(flares)์ด ์žˆ์„ ๋•Œ ํŠนํžˆ ์ค‘์š”ํ•˜๋ฉฐ, ์ œํ•œ์‹์ด์‹œํ—˜ ์‹œํ–‰๊ณผ ๋ฐ˜์‘ ์œ ๋„๋ฅผ ํ†ตํ•ด  ํ”ผ๋ถ€์ฆ์ƒ์— ์Œ์‹์ด ์–ด๋–ค ์—ญํ• ์„  ํ•˜๋Š”์ง€๋ฅผ ํ•„์ˆ˜์ ์œผ๋กœ ํ™•์ธํ•ด์•ผ ํ•œ๋‹ค. ์›์ธ์ด ๋˜๋Š” ์Œ์‹ ์•Œ๋Ÿฌ์  ์ด ํ™•์ธ๋œ ๊ฒฝ์šฐ, ํ•ด๋‹น ์•Œ๋Ÿฌ์   ์„ญ์ทจ๋ฅผ ํ”ผํ•˜๋„๋ก ์กฐ์น˜๋ฅผ ์ทจํ•˜๋Š” ๊ฒƒ์€ ๋น„๊ต์  ์‰ฌ์šด ํŽธ์ด๋‹ค.

 

ํ”ผ๋ถ€์žฅ๋ฒฝ ํšŒ๋ณต

์•„ํ† ํ”ผ๊ฐ€ ์žˆ๋Š” ๊ฐœ๋Š” ํ‘œํ”ผ ์žฅ๋ฒฝ ์†์ƒ์œผ๋กœ ์ธํ•ด ๊ฒฝํ”ผ์  ์ˆ˜๋ถ„ ์†์‹ค(transepidermal water loss, TEWL)์ด ์ฆ๊ฐ€ํ•œ๋‹ค๋Š” ์‚ฌ์‹ค์ด ์ž˜ ์•Œ๋ ค์ ธ ์žˆ๋‹ค. ์ผ๋ถ€ ํ’ˆ์ข…์—์„œ๋Š” ๊ฑด์กฐํ•˜๊ณ  ๋น„๋Š˜์ด ๋ฎํžŒ ํ”ผ๋ถ€(๊ฑดํ”ผ์ฆ, xerosis)๊ฐ€ ๋‚˜ํƒ€๋‚  ์ˆ˜ ์žˆ๋‹ค. ๊ธ€๋ฆฌ์„ธ๋กค, ๊ธ€๋ฆฌ์„ธ๋ฆฐ, ํ”„๋กœํ•„๋ Œ๊ธ€๋ฆฌ์ฝœ, ํŒํ…Œ๋†€, ์šฐ๋ ˆ์•„์™€ ๊ฐ™์€ ๊ตญ์†Œ ๋ณด์Šต์ œ๋กœ ํ‘œํ”ผ ์žฅ๋ฒฝ์„ ์ง€์ง€ํ•ด์ฃผ๋ฉด ํ‘œํ”ผ์˜ ์ˆ˜๋ถ„ ๊ฒฐํ•ฉ ๋Šฅ๋ ฅ์ด ์ฆ๊ฐ€ํ•˜๋Š”๋ฐ, ํŠนํžˆ ๋ชฉ์š• ํ›„ ์‚ฌ์šฉํ•  ๋•Œ ๊ทธ๋ ‡๋‹ค. ์ด์™€ ๊ด€๋ จํ•˜์—ฌ ๋งŒ์„ฑ์ ์œผ๋กœ ํŒŒ๊ดด๋œ ๊ฐœ ํ‘œํ”ผ ์žฅ๋ฒฝ ๋ชจ๋ธ์—์„œ ์ตœ๊ทผ ๊ทธ ํšจ๋Šฅ์ด ์ž…์ฆ๋˜์—ˆ๋‹ค 3 . ํ”ผํ† ์Šคํ•‘๊ณ ์‹ (phytosphingosine)๊ณผ ์˜คํ”ผํŠธ๋ฆฌ์›€(ophytrium)์„ ํ•จ์œ ํ•œ ์ œํ’ˆ์—๋Š” ์™œ๋ž€(Japanese mondo grass plant)์˜ ๋ฟŒ๋ฆฌ์—์„œ ์ถ”์ถœํ•œ ์ฒœ์—ฐ ์„ฑ๋ถ„์ด ํฌํ•จ๋˜์–ด ์žˆ์–ด ์†์ƒ๋œ ํ”ผ๋ถ€ ์žฅ๋ฒฝ์„ ํšŒ๋ณตํ•˜๊ณ  ํ‘œํ”ผ์˜ ์†Œ์–‘์ฆ๊ณผ ๋ฏธ์ƒ๋ฌผ ์ง‘๋ฝํ™”(colonization)๋ฅผ ์ค„์ด๋Š” ๋ฐ ๋„์›€์ด ๋  ์ˆ˜ ์žˆ๋‹ค 4 . 


์•„ํ† ํ”ผ๊ฐ€ ์žˆ๋Š” ๊ฐœ๋Š” ๊ฐ์งˆ์ธต(stratum corneum)์˜ ์„ธํฌ๊ฐ„ ์ง€์งˆ์ธต๋„ ํŒŒ๊ดด๋œ๋‹ค. ์ด๋ฅผ ํšŒ๋ณตํ•˜๊ธฐ ์œ„ํ•ด, ํ•„์ˆ˜ ์ง€๋ฐฉ์‚ฐ(essential fatty acids, EFA)์„ ๋ณด์ถฉ์ œ ํ˜•ํƒœ๋กœ ์ œ๊ณตํ•˜๊ฑฐ๋‚˜ ์‚ฌ๋ฃŒ์— ์„ž์–ด์ฃผ์—ˆ์„ ๋•Œ ๋‹ค์–‘ํ•œ ๊ฒฐ๊ณผ๊ฐ€ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ํ•œ ์–‘์งˆ์˜ ์—ฐ๊ตฌ๋ฅผ ํ†ตํ•ด EFA๋ฅผ 12์ฃผ๊ฐ„ ํˆฌ์—ฌํ–ˆ์„ ๋•Œ ์•„ํ† ํ”ผ๊ฐ€ ์žˆ๋Š” ๊ฐœ์˜ ์ฆ์ƒ ๊ด€๋ฆฌ์— ํ•„์š”ํ•œ ํ”„๋ ˆ๋“œ๋‹ˆ์†”๋ก  ์šฉ๋Ÿ‰์ด ํฌ๊ฒŒ ๊ฐ์†Œํ–ˆ์Œ์ด ๋ฐํ˜€์ ธ ํฅ๋ฏธ๋กญ๋‹ค 5 . ํ”ผ๋ถ€ ์žฅ๋ฒฝ ํšŒ๋ณต์— ๋„์›€์„ ์ฃผ๋Š” ์„ฑ๋ถ„์„ ์˜จ์ „ํžˆ ํ•จ์œ ํ•œ ์‚ฌ๋ฃŒ๋ฅผ ๊ธ‰์—ฌํ•ด๋„ ๊ฐ™์€ ๊ฒฐ๊ณผ๋ฅผ ๋ณผ ์ˆ˜ ์žˆ๋‹ค. ๋ณ‘๋ณ€ ๋ถ€์œ„์—๋งŒ ๋ฐ”๋ฅด๋Š” ๋ฐฉ์‹์˜ ๊ตญ์†Œ EFA ์ œ์ œ๋„ ํšจ๊ณผ์ ์ธ ๊ฒƒ์œผ๋กœ ์ž…์ฆ๋˜์—ˆ๋‹ค 6 . ํ•˜์ง€๋งŒ, ์žฅ๊ธฐ๊ฐ„ ์‚ฌ์šฉ์ด ํ•„์š”ํ•œ ๊ฒฝ์šฐ๋ผ๋ฉด ์ด ๋ฐฉ์‹์€ ๋น„์šฉ์ ์ธ ์ธก๋ฉด์—์„œ ํšจ์œจ์ ์ด์ง€ ๋ชปํ•˜๋‹ค. ์ง€๋ฐฉ์‚ฐ๊ณผ ์„ธ๋ผ๋งˆ์ด๋“œ๋ฅผ ํ•จ์œ ํ•œ ์ƒดํ‘ธ, ์Šคํ”„๋ ˆ์ด, ๋กœ์…˜์„ ๋น„๋กฏํ•œ ๊ธฐํƒ€ ๊ตญ์†Œ ์ œ์ œ ๋˜ํ•œ CAD์˜ ์น˜๋ฃŒ์— ์‚ฌ์šฉ๋˜์—ˆ์ง€๋งŒ, ์ด๋Ÿฌํ•œ ์ œํ’ˆ์˜ ํšจ๊ณผ์— ๋Œ€ํ•ด์„œ๋Š” ์—ฌ์ „ํžˆ ๋…ผ๋ž€์ด ์žˆ๋‹ค. ์•„๋ฌด์ชผ๋ก ์ž„์ƒ์ˆ˜์˜์‚ฌ๋Š” ํ‘œํ”ผ ์žฅ๋ฒฝ์ด ํšŒ๋ณต๋˜๋ฉด ํ™˜๊ฒฝ ์•Œ๋Ÿฌ์  ์ด ํ”ผ๋ถ€์— ์นจํˆฌํ•˜๋Š” ์ˆ˜์ค€๋„ ๊ฐ์†Œํ•  ์ˆ˜ ์žˆ๋‹ค๋Š” ์ ์„ ์—ผ๋‘์— ๋‘๋Š” ๊ฒƒ์ด ์ข‹๋‹ค.

 

ํ”ผ๋ถ€ ์ด์ฐจ๊ฐ์—ผ ๊ด€๋ฆฌ

๋Œ€๋ถ€๋ถ„์˜ ์•„ํ† ํ”ผ๊ฐ€ ์žˆ๋Š” ๊ฐœ๋Š” ํ‘œ์žฌ์„ฑ ๋†ํ”ผ์ฆ(superficial pyoderma)์ด ์žฌ๋ฐœํ•˜๊ธฐ ์‰ฌ์šฐ๋ฉฐ, ๊ตฌ์ง„(papules), ๋†ํฌ(pustules), ํ‘œํ”ผ์ž”๊ณ ๋ฆฌ(collarettes), ๋น„๋Š˜(squames), ์ง€๋ฃจ์ฆ(seborrhea)์ด ํ”ํžˆ ๋‚˜ํƒ€๋‚œ๋‹ค (๊ทธ๋ฆผ 2). ๊ฑด๊ฐ•ํ•œ ํ”ผ๋ถ€์— ๋น„ํ•ด ์•„ํ† ํ”ผ ํ”ผ๋ถ€์—๋Š” ๋ณ‘์›์„ฑ ํฌ๋„์ƒ๊ตฌ๊ท (Staphylococci  spp.)(๋ณดํ†ต S.  pseudintermedius)์˜ ์ง‘๋ฝํ™”๊ฐ€ ์ฆ๊ฐ€ํ•˜๋Š”๋ฐ, ์ด๋Š” ๋ถ€๋ถ„์ ์œผ๋กœ ์„ ์ฒœ์„ฑ ๋ฉด์—ญ๊ณ„์˜ ํ”ผ๋ถ€ ํ•ญ๊ท  ํŽฉํƒ€์ด๋“œ์˜  ํ•ญ๊ท  ํ™œ์„ฑ์ด ๋‚ฎ๊ธฐ ๋•Œ๋ฌธ์ธ ๊ฒƒ์œผ๋กœ ์„ค๋ช…๋  ์ˆ˜ ์žˆ๋‹ค. ํ”ผ๋ถ€์ฆ์ƒ์ด ์žฌ๋ฐœํ•  ๋•Œ๋Š” ์•„ํ† ํ”ผ ํ”ผ๋ถ€์˜ ๋ฏธ์ƒ๋ฌผ์ด(microbiota)์— ๋ถˆ๊ท ํ˜•(dysbiosis)์ด ๋ฐœ์ƒํ•˜๊ณ , ํฌ๋„์ƒ๊ตฌ๊ท  ์ˆ˜์น˜๊ฐ€ ์ƒ๋Œ€์ ์œผ๋กœ ์ฆ๊ฐ€ํ•œ๋‹ค. ํ•ญ๊ท  ์š”๋ฒ•์„ ํ†ตํ•ด ๋ณ‘๋ณ€์ด ํšŒ๋ณต๋˜๋ฉด์„œ ์ด๋Ÿฌํ•œ ์„ธ๊ท ์ด์˜ ๋ถˆ๊ท ํ˜• ๋˜ํ•œ ๋ณต์›๋œ๋‹ค 7 . 


์•„ํ† ํ”ผ๊ฐ€ ์žˆ๋Š” ๊ฐœ์˜ ์•ฝ 40%๋Š” ๋ง๋ผ์„ธ์ง€์•„(Malassezia pachydermatis)์— ์˜ํ•ด ํ”ผ๋ถ€๊ฐ์—ผ์ด ์žฌ๋ฐœํ•˜๋Š”๋ฐ, ์ด ๊ฒฝ์šฐ, ๊ฐ•ํ•œ ์•…์ทจ, ๊ณผ๋„ํ•œ ์œ ๋ถ„, ๋ฒŒ์ง‘๋ชจ์–‘ ๊ฐ€ํ”ผ(honeycomb crusts), ๋น„๋Š˜(squames), ๋ฐœํ†ฑ์ด ๊ฐˆ์ƒ‰์œผ๋กœ ๋ฌผ๋“œ๋Š” ๋ฐœํ†ฑ์ฃผ์œ„์—ผ(paronychia)์ด ์ž์ฃผ ๋‚˜ํƒ€๋‚˜๋Š” ๊ฒƒ์œผ๋กœ ๋ณด๊ณ ๋œ๋‹ค (๊ทธ๋ฆผ 3). ๋ง๋ผ์„ธ์ง€์•„์— ๋Œ€ํ•œ ์ œ1ํ˜• ๊ณผ๋ฏผ๋ฐ˜์‘๋„ ๋ฐœ์ƒํ•  ์ˆ˜ ์žˆ์œผ๋ฉฐ ์‹ฌํ•œ ์†Œ์–‘๊ฐ์ด ์œ ๋ฐœ๋  ์ˆ˜ ์žˆ๋‹ค 8 . ๋”ฐ๋ผ์„œ ์„ธ๊ท  ๋ฐ ํšจ๋ชจ์— ์˜ํ•œ ํ”ผ๋ถ€์˜ ์ด์ฐจ๊ฐ์—ผ์€ ํ•ญ์ƒ ๊ด€๋ฆฌ๊ฐ€ ํ•„์š”ํ•˜๋ฉฐ, ๊ด€๋ฆฌ๋ฅผ ์œ„ํ•ด ๊ตญ์†Œ ํ•ญ๊ท  ์š”๋ฒ•(์ƒดํ‘ธ, ๋ฌด์Šค, ์Šคํ”„๋ ˆ์ด, ๋ฌผํ‹ฐ์Šˆ, ์ ค)์„ ์ •๊ธฐ์ ์œผ๋กœ ์‚ฌ์šฉํ•ด์•ผ ํ•œ๋‹ค. ํด๋กœ๋ฅดํ—ฅ์‹œ๋”˜ 3%๊ฐ€ ํฌํ•จ๋œ ์„ธ์ •์ œ๋Š” ์„ธ๊ท ๊ณผ ํšจ๋ชจ์— ๋Œ€ํ•ด ํด๋กœ๋ฅดํ—ฅ์‹œ๋”˜ 2% ์šฉ์•ก๊ณผ ๋ฏธ์ฝ”๋‚˜์กธ ๋ณตํ•ฉ์ œํ’ˆ๋งŒํผ ์ž„์ƒ์ ์œผ๋กœ ํšจ๊ณผ์ ์ธ ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค 9 . ์ผ์ฃผ์ผ์— ๋‘ ๋ฒˆ ์„ธ์ •ํ•˜๋Š” ๊ฒƒ์ด ๋ณดํ†ต ํšจ๊ณผ์ ์ด๋‹ค. ํ•˜์ง€๋งŒ (๊ฐ์—ผ์˜ ์ค‘์ฆ๋„์— ๋”ฐ๋ผ) ๊ตญ์†Œ ์š”๋ฒ•์€ ์ดˆ๊ธฐ์— ๋” ์ž์ฃผ ์‹ค์‹œํ•ด์•ผ ํ•œ๋‹ค. ์ €์ž์˜ ๊ฒฝ์šฐ, ์ผ์ฃผ์ผ ๋™์•ˆ์€ ๋งค์ผ, ๊ทธ ๋‹ค์Œ ์ผ์ฃผ์ผ์€ ๊ฒฉ์ผ, ๊ทธ ์ดํ›„๋กœ๋Š” ์ผ์ฃผ์ผ์— ๋‘ ๋ฒˆ ์„ธ์ •ํ•˜๋Š” ๋ฐฉ์‹์„ ์‚ฌ์šฉํ•œ๋‹ค. ๋ณ‘๋ณ€์— ๋งค์ฃผ ๋‘ ๋ฒˆ ๋ฌด์Šค๋‚˜ ์ ค, ์Šคํ”„๋ ˆ์ดํ˜• ์ œ์ œ๋ฅผ ๋ฐ”๋ฅด๊ฑฐ๋‚˜ ๋ฟŒ๋ ค์ฃผ๊ณ  ๋งค์ฃผ ์ƒดํ‘ธ๋ฅผ ํ•˜๋Š” ํ”„๋กœํ† ์ฝœ ์—ญ์‹œ ๋™์ผํ•œ ํšจ๊ณผ๊ฐ€ ์žˆ๋‹ค.

์ „์‹  ํ•ญ์ƒ์ œ๋Š” ๋†ํ”ผ์ฆ์ด ์‹ฌ๋ถ€์— ์žˆ๊ฑฐ๋‚˜(๋†์–‘, furunculosis) (๊ทธ๋ฆผ 4), ์ „์‹ ์œผ๋กœ ํผ์ ธ ์žˆ๊ฑฐ๋‚˜, ๋ณดํ˜ธ์ž๊ฐ€ ๊ฐœ์—๊ฒŒ ๊ตญ์†Œ ์š”๋ฒ•์„ ์ ์šฉํ•  ์ˆ˜ ์—†๋Š” ๊ฒฝ์šฐ์— ํ•œ์ •ํ•˜์—ฌ, ์ดˆ๊ธฐ์— ์‚ฌ์šฉํ•ด์•ผ ํ•œ๋‹ค. ์ ์ ˆํ•œ ์•ฝ๋ฌผ์„ ์„ ํƒํ•  ๋•Œ๋Š” ๋ฐฐ์–‘๊ฒ€์‚ฌ ๋ฐ ๊ฐ์ˆ˜์„ฑ๊ฒ€์‚ฌ ํ›„, ํ•ญ์ƒ์š”๋ฒ•์˜ ๊ธฐ๋ณธ ์›์น™์— ๋”ฐ๋ผ์•ผ ํ•œ๋‹ค. ์„ ํƒ ๊ฐ€๋Šฅํ•œ ์•ฝ๋ฌผ๋กœ๋Š” ํด๋ฆฐ๋‹ค๋งˆ์ด์‹ (10mg/kg q12H), ์„ธํŒ”๋กœ์Šคํฌ๋ฆฐ(์„ธํŒ”๋ ‰์‹  10-30mg/kg q8-12H) ๋˜๋Š” ์•„๋ชฉ์‹œ์‹ค๋ฆฐ/ํด๋ผ๋ถˆ๋ž€์‚ฐ  ๋ณตํ•ฉ์ œ(12.5mg/kg  q12H)๊ฐ€ ์žˆ๋‹ค. ํ•ญ์ƒ ๋†ํ”ผ์ฆ์˜ ์ž„์ƒ ์ง•ํ›„์™€ ์„ธํฌํ•™์  ์†Œ๊ฒฌ์ด ๋ชจ๋‘ ํ•ด๊ฒฐ๋  ๋•Œ๊นŒ์ง€ ์น˜๋ฃŒํ•˜๋„๋ก ํ•œ๋‹ค. ํ•ญ์ƒ์ œ์˜ ๋ฐ˜๋ณต์ ์ธ ์‚ฌ์šฉ์€ ์„ธ๊ท  ๋‚ด์„ฑ์„ ์œ ๋ฐœํ•  ์œ„ํ—˜์ด ์žˆ์œผ๋ฏ€๋กœ ํ”ผํ•ด์•ผ ํ•œ๋‹ค. ๋งˆ์ฐฌ๊ฐ€์ง€๋กœ, ๊ฒฝ๊ตฌ์šฉ ์ผ€ํ† ์ฝ”๋‚˜์กธ(10mg/kg q24H ๋˜๋Š” 5mg/kg q12H)์ด๋‚˜ ์ดํŠธ๋ผ์ฝ”๋‚˜์กธ(5 mg/kg q24H)์„ ์‚ฌ์šฉํ•˜์—ฌ ํšจ๋ชจ ๊ฐ์—ผ์„ ์น˜๋ฃŒํ•  ๋•Œ๋Š” ํšจ๋ชจ๊ฐ€ (๋“œ๋ฌผ๊ฒŒ) ์•„์กธ ์œ ๋„์ฒด(azole derivatives)์— ๋‚ด์„ฑ์„ ๊ฐ€์งˆ ์ˆ˜ ์žˆ์œผ๋ฏ€๋กœ ๋งค์šฐ ์‹ฌ๊ฐํ•œ ๊ฒฝ์šฐ์—๋งŒ ์‚ฌ์šฉํ•ด์•ผ ํ•œ๋‹ค 10 . ๋˜ํ•œ (ํŠนํžˆ ์ผ€ํ† ์ฝ”๋‚˜์กธ์˜ ๊ฒฝ์šฐ) ๋ณต์žกํ•˜๊ณ ๋„ ์œ„ํ—˜ํ•œ ์•ฝ๋ฌผ ์ƒํ˜ธ ์ž‘์šฉ์ด ๋ฐœ์ƒํ•  ๊ฐ€๋Šฅ์„ฑ์—๋„ ์ฃผ์˜ํ•ด์•ผ ํ•œ๋‹ค.

 

 

์ „ํ˜•์ ์ธ ์•„ํ† ํ”ผ ํ”ผ๋ถ€ ๋ณ‘๋ณ€ - ์†๋ฐœ์„ฑ ํ‘œ์žฌ์„ฑ ๋†ํ”ผ์ฆ(pyoderma)์œผ๋กœ ์ธํ•œ ๊ตฌ์ง„, ๋†ํฌ, ํ‘œํ”ผ์ž”๊ณ ๋ฆฌ(collarettes)

๊ทธ๋ฆผ 2.์ „ํ˜•์ ์ธ ์•„ํ† ํ”ผ ํ”ผ๋ถ€ ๋ณ‘๋ณ€ - ์†๋ฐœ์„ฑ ํ‘œ์žฌ์„ฑ ๋†ํ”ผ์ฆ(pyoderma)์œผ๋กœ ์ธํ•œ ๊ตฌ์ง„, ๋†ํฌ, ํ‘œํ”ผ์ž”๊ณ ๋ฆฌ(collarettes). © Annette van der Lee

๋ง๋ผ์„ธ์ง€์•„ ํ”ผ๋ถ€์—ผ(Malassezia dermatitis)์œผ๋กœ ์ธํ•ด ๋ฐœํ†ฑ์ด ๊ฐˆ์ƒ‰์œผ๋กœ ์ฐฉ์ƒ‰๋œ ์•„ํ† ํ”ผ๊ฐ€ ์žˆ๋Š” ๊ฐœ์˜ ๋ฐœํ†ฑ์ฃผ์œ„์—ผ(Paronychia)

๊ทธ๋ฆผ 3. ๋ง๋ผ์„ธ์ง€์•„ ํ”ผ๋ถ€์—ผ(Malassezia dermatitis)์œผ๋กœ ์ธํ•ด ๋ฐœํ†ฑ์ด ๊ฐˆ์ƒ‰์œผ๋กœ ์ฐฉ์ƒ‰๋œ ์•„ํ† ํ”ผ๊ฐ€ ์žˆ๋Š” ๊ฐœ์˜ ๋ฐœํ†ฑ์ฃผ์œ„์—ผ(Paronychia) © Annette van der Lee

์•„ํ† ํ”ผ๊ฐ€ ์žˆ๋Š” ๊ฐœ์˜ ์†๋ฐœ์„ฑ ์‹ฌ๋ถ€ ๋†ํ”ผ์ฆ(deep pyoderma)์„ ๋™๋ฐ˜ํ•œ ์ง€๊ฐ„ ํ™”๋†์„ฑ์œก์•„์ข…(Interdigital pyogranuloma)

๊ทธ๋ฆผ 4. ์•„ํ† ํ”ผ๊ฐ€ ์žˆ๋Š” ๊ฐœ์˜ ์†๋ฐœ์„ฑ ์‹ฌ๋ถ€ ๋†ํ”ผ์ฆ(deep pyoderma)์„ ๋™๋ฐ˜ํ•œ ์ง€๊ฐ„ ํ™”๋†์„ฑ์œก์•„์ข…(Interdigital pyogranuloma) © Annette van der Lee

Annette van der Lee

๊ฐœ์˜ ์•„ํ† ํ”ผ ํ”ผ๋ถ€์—ผ์„ ์„ฑ๊ณต์ ์œผ๋กœ ์น˜๋ฃŒํ•ด์•ผ ํ•  ๋ฟ๋งŒ ์•„๋‹ˆ๋ผ, ์‹ฌ๊ฐํ•œ ํ”ผ๋ถ€์ฆ์ƒ ์žฌ๋ฐœ๋„ ํ”ผํ•ด์•ผ ํ•œ๋‹ค๋Š” ๊ฒƒ์ด ์–ด๋ ค์šด ์ ์ž…๋‹ˆ๋‹ค. ์ด ๋•Œ๋ฌธ์— CAD ์น˜๋ฃŒ๋Š” ๋‹ค๊ฐ์ ์ธ ๊ด€๋ฆฌ๊ฐ€ ํ•„์š”ํ•ฉ๋‹ˆ๋‹ค.

Annette van der Lee

ํ”ผ๋ถ€์—ผ๊ณผ ์†Œ์–‘์ฆ ๊ด€๋ฆฌ

CAD์—์„œ ์†Œ์–‘์ฆ๊ณผ ํ”ผ๋ถ€์—ผ์„ ์™„ํ™”์‹œํ‚ค๋Š” ๊ฒƒ์œผ๋กœ ์ž˜ ์•Œ๋ ค์ง„ ๊ทผ๊ฑฐ ๊ธฐ๋ฐ˜ ๋Œ€์ฆ์š”๋ฒ• ์•ฝ๋ฌผ๋กœ๋Š” ๊ธ€๋ฃจ์ฝ”์ฝ”๋ฅดํ‹ฐ์ฝ”์Šคํ…Œ๋กœ์ด๋“œ, ์‚ฌ์ดํด๋กœ ์Šคํฌ๋ฆฐ, ์˜คํด๋ผ์‹œํ‹ฐ๋‹™, ๋กœํ‚ค๋ฒ ํŠธ๋ง™์ด ์žˆ์œผ๋ฉฐ, ์ด์— ๋Œ€ํ•ด์„œ๋Š” ์•„๋ž˜์—์„œ ์ฐจ๋ก€๋กœ ๋…ผ์˜ํ•  ๊ฒƒ์ด๋‹ค. ์†Œ์–‘๊ฐ ์—ญ์น˜๋ฅผ ์ค„์ด๊ธฐ ์œ„ํ•ด ๋ฒผ๋ฃฉ ์˜ˆ๋ฐฉ ์น˜๋ฃŒ๋Š” ํ•ญ์ƒ ํ•„์ˆ˜๋ผ๋Š” ์ ์— ์œ ์˜ํ•œ๋‹ค. ์ œ1ํ˜• ๊ณผ๋ฏผ๋ฐ˜์‘์— ์“ฐ์ด๋Š” ๊ฒฝ๊ตฌ์šฉ ํ•ญํžˆ์Šคํƒ€๋ฏผ์ œ๊ฐ€ ํ™œ์„ฑ(active) CAD ๋˜๋Š” ๋งŒ์„ฑ CAD ๋ณ‘๋ณ€์„ ํšจ๊ณผ์ ์œผ๋กœ ์น˜๋ฃŒํ•œ๋‹ค๋Š” ๊ฒฐ์ •์ ์ธ ์ฆ๊ฑฐ๋Š” ์—†๋‹ค 11. ๊ทธ๋Ÿผ์—๋„ ํ•ญํžˆ์Šคํƒ€๋ฏผ์ œ๊ฐ€ ํ•„์š”ํ•œ ๊ฒฝ์šฐ ์„ธํ‹ฐ๋ฆฌ์ง„(0.5-1.0mg/kg q24H) ๋˜๋Š” ํ•˜์ด๋“œ๋ก์‹œ์ง„(2mg/kg q12H)์„ ํˆฌ์—ฌํ•˜๋Š” ๊ฒƒ์ด ๊ฐ€์žฅ ํšจ๊ณผ์ ์ด๋‹ค 12.

 

๊ธ€๋ฃจ์ฝ”์ฝ”๋ฅดํ‹ฐ์ฝ”์Šคํ…Œ๋กœ์ด๋“œ

๊ธ€๋ฃจ์ฝ”์ฝ”๋ฅดํ‹ฐ์ฝ”์Šคํ…Œ๋กœ์ด๋“œ(Glucocorticosteroids, GC)๋Š” ์‚ฌ์ดํ† ์นด์ธ, ์‚ฌ์ดํ† ์นด์ธ ์ˆ˜์šฉ์ฒด, ๋ถ€์ฐฉ ๋ถ„์ž, ์—ผ์ฆ์ด‰์ง„ํšจ์†Œ(pro-inflammatory  enzymes), ํ™”ํ•™์ฃผ์„ฑ ๋‹จ๋ฐฑ(chemotactic  pro-teins)์„ ์ฝ”๋”ฉํ•˜๋Š”  ์œ ์ „์ž๋ฅผ ์–ต์ œํ•˜๋Š” ๋‹ค์ˆ˜์˜  ๊ณตํ†ต์ „์‚ฌ์ธ์ž(ubiquitous transcription factors)์— ๊ฐ„์„ญํ•˜์—ฌ ํšจ๊ณผ๋ฅผ ๋‚˜ํƒ€๋‚ธ๋‹ค. ๋”ฐ๋ผ์„œ GC๋Š” ๋งŽ์€ ์—ผ์ฆ ์„ธํฌ๋ฅผ ๋น„ํ™œ์„ฑํ™”ํ•˜๊ณ  ์†Œ์–‘๊ฐ์„ ๊ฐ์†Œ์‹œํ‚จ๋‹ค. GC๋Š” ๊ธฐ๋ณธ์ ์œผ๋กœ ์†ํšจ์„ฑ์ด๋ฏ€๋กœ CAD์—์„œ ๊ธ‰์„ฑ ์ง•ํ›„์˜ ์™„ํ™”๋ฅผ ์œ ๋„ํ•˜๊ธฐ ์œ„ํ•ด ์‚ฌ์šฉ๋˜๊ธฐ๋„ ํ•˜๊ณ  ์žฅ๊ธฐ๊ฐ„ ์ฆ์ƒ์„ ์กฐ์ ˆํ•˜๊ธฐ ์œ„ํ•ด ์‚ฌ์šฉ๋˜๊ธฐ๋„ ํ•œ๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ๋‹ค์–‘ํ•œ ์„ธํฌ ๊ธฐ์ „์— ์˜ํ–ฅ์„ ๋ฏธ์น˜๊ธฐ ๋•Œ๋ฌธ์— ์žฅ๊ธฐ๊ฐ„ ์ „์‹  ํˆฌ์—ฌ ์‹œ ๋ถ€์ž‘์šฉ์ด ํ”ํžˆ ๋ฐœ์ƒํ•œ๋‹ค. ๋ถ€์ž‘์šฉ์œผ๋กœ๋Š” ๋‹ค๋‡จ์ฆ(polyuria), ๋‹ค๊ฐˆ์ฆ(polydipsia), ๋‹ค์‹์ฆ(poly-phagia), ๊ทผ์œก ๋ฐ ํ”ผ๋ถ€ ์œ„์ถ•, ์„ธ๊ท  ๋ฐ ์ง„๊ท  ๊ฐ์—ผ, ๋ชจ๋‚ญ์ถฉ์ฆ(de-modicosis), ์˜์ธ์„ฑ ๋ถ€์‹ ํ”ผ์งˆ๊ธฐ๋Šฅํ•ญ์ง„์ฆ์ด ๋‚˜ํƒ€๋‚œ๋‹ค(๊ทธ๋ฆผ 5). ๋”ฐ๋ผ์„œ ๋น„๊ฒฝ๊ตฌ์šฉ ์ œํ˜•์€ ๋ฐ˜๋ณต์ ์œผ๋กœ ํˆฌ์—ฌํ•ด์„œ๋Š” ์•ˆ ๋˜๋ฉฐ, ์ž„์ƒ์ง•ํ›„๊ฐ€ ์ค‘์ฆ์ธ ๊ฒฝ์šฐ์— ํ•œํ•ด ์†ํšจ์„ฑ ๊ธ€๋ฃจ์ฝ”์ฝ”๋ฅดํ‹ฐ์ฝ”์ด๋“œ์˜ ์‚ฌ์šฉ์„ ๊ถŒ์žฅํ•œ๋‹ค. ๊ฒฝ๊ตฌ์šฉ ํ”„๋ ˆ๋“œ๋‹ˆ์†”๋ก (0.5-1mg/kg q24H) ๋˜๋Š” ๋ฉ”ํ‹ธํ”„๋ ˆ๋“œ๋‹ˆ์†”๋ก (0.4-0.8mg/kg q24H)์€ ์น˜๋ฃŒ์— ๋Œ€ํ•œ ํ™˜์ž์˜ ๋ฐ˜์‘์— ๋”ฐ๋ผ 5-14์ผ ๋™์•ˆ ํˆฌ์—ฌํ•œ๋‹ค. ๋ณต์šฉ๋Ÿ‰์„ ํ•˜๋ฃจ์— ๋‘ ๋ฒˆ์œผ๋กœ ๋‚˜๋ˆ„์–ด ํˆฌ์—ฌํ•˜๋ฉด ์ผ๋ถ€ ๊ฐœ์ฒด์—์„œ๋Š” ๋‹ค๊ฐˆ์ฆ๊ณผ ๋‹ค๋‡จ์ฆ์„ ์ค„์ผ ์ˆ˜ ์žˆ๋‹ค. ์ดํ›„ ํˆฌ์—ฌ ์šฉ๋Ÿ‰์„ ์„œ์„œํžˆ ์ค„์—ฌ๊ฐ€์•ผ ํ•˜๋Š”๋ฐ(ํ…Œ์ดํผ๋ง), ์ฆ์ƒ์ด ์™„ํ™”๋˜๋ฉด ๊ฒฉ์ผ๋กœ ํˆฌ์—ฌํ•  ์ˆ˜ ์žˆ๋‹ค. 

๊ตญ์†Œ์šฉ ์—ฐ๊ณ , ์Šคํ”„๋ ˆ์ด, ๋กœ์…˜ ์ œํ˜•์˜ GC ์ œ์ œ๊ฐ€ ์ฃผ๋กœ ์“ฐ์ธ๋‹ค. ํŠธ๋ฆฌ์•”์‹œ๋†€๋ก  ์•„์„ธํ† ๋‹ˆ๋“œ(triamcinolone acetonide)์™€ ํžˆ๋“œ๋กœ์ฝ”๋ฅดํ‹ฐ์† ์•„์„ธํฌ๋„ค์ดํŠธ ์Šคํ”„๋ ˆ์ด(hydrocortisone aceponate sprays)๋Š” ๋‘˜ ๋‹ค ๊ตญ์†Œ ๋ณ‘๋ณ€์„ ์กฐ์ ˆํ•˜๋Š” ๋ฐ ํšจ๋Šฅ ์ข‹๋‹ค 13. ์น˜๋ฃŒ๋ฅผ ์œ„ํ•ด์„œ๋Š” ์•ฝ 2์ฃผ ๋™์•ˆ ๋งค์ผ ์‚ฌ์šฉํ•ด์•ผํ•˜๋ฉฐ, ๊ทธ ๋‹ค์Œ ๋งค์ฃผ 2ํšŒ์˜ ๋นˆ๋„๋กœ ๊ฐœ๋ณ„ ๋ณ‘๋ณ€์— ์ง€์†์ ์œผ๋กœ ๋„ํฌํ•ด์•ผ ํ•œ๋‹ค. ํžˆ๋“œ๋กœ์ฝ”๋ฅดํ‹ฐ์† ์•„์„ธํฌ๋„ค์ดํŠธ๋Š” ์ž ์žฌ์ ์œผ๋กœ ์ฝœ๋ผ๊ฒI๊ณผ ์ฝœ๋ผ๊ฒIII ํ”„๋กœํŽฉํƒ€์ด๋“œ(pro-peptides)๋ฅผ ์–ต์ œํ•˜์—ฌ ๊ฒฝ๋ฏธํ•œ ํ”ผ๋ถ€ ์†์ƒ์„ ์œ ๋„ํ•  ์ˆ˜ ์žˆ์ง€๋งŒ, ํ•œ ์—ฐ๊ตฌ๋ฅผ ํ†ตํ•ด CAD ์ฆ๋ก€์—์„œ ์žฅ๊ธฐ๊ฐ„ ๊ฐ„ํ—์ (์ฃผ 2ํšŒ)์ธ ๊ตญ์†Œ ๋„ํฌ๋ฅผ ํ•˜๋Š” ๋™์•ˆ ๋ˆˆ์— ๋„๋Š” ํ”ผ๋ถ€ ์œ„์ถ•์€ ์—†์—ˆ๋˜ ๊ฒƒ์œผ๋กœ ๋ฐํ˜€์กŒ๋‹ค 14.  ๋ฒ ํƒ€๋ฉ”ํƒ€์†(betamethasone) ๋˜๋Š” ๋ชจ๋ฉ”ํƒ€์† ํ‘ธ๋กœ์—์ดํŠธ(mometasone furoate) ํฌ๋ฆผ๊ณผ ๊ฐ™์€ ์ธ๊ฐ„์—๊ฒŒ๋„ ์‚ฌ์šฉํ•˜๋Š” ๊ตญ์†Œ GC์ œํ’ˆ์ด ๋™๋ฌผ์—๊ฒŒ๋„ ํšจ๊ณผ๊ฐ€ ์žˆ๋Š” ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ๊ตญ์†Œ GC๋ฅผ ์‚ฌ์šฉํ•˜์—ฌ ์œ ์ง€ ์น˜๋ฃŒ(maintenance treatment)๋ฅผ ํ•˜๋Š” ๊ถ๊ทน์ ์ธ ๋ชฉํ‘œ๋Š”, ๋ณ‘๋ณ€์ด ์ž„์ƒ์ ์œผ๋กœ ๋ณด์ผ ๋•Œ๋งŒ ์น˜๋ฃŒํ•˜๋Š” ๊ฒƒ ๋ณด๋‹ค๋Š” ํ”ผ๋ถ€์ฆ์ƒ ์žฌ๋ฐœ์— ๋Œ€ํ•œ ์œ„ํ—˜์„ ์ตœ๋Œ€ํ•œ ์ค„์ด๊ณ  ํšŒ๋ณต๊ธฐ๊ฐ„์„ ์—ฐ์žฅํ•˜๋Š” ๋ฐ ์žˆ๋‹ค 14.

 

์˜คํด๋ผ์‹œํ‹ฐ๋‹™
์˜คํด๋ผ์‹œํ‹ฐ๋‹™(Oclacitinib)์€ ์•ผ๋ˆ„์Šค ํ‚ค๋‚˜์ œ(Janus kinase, JAK) ์–ต์ œ์ œ์ด๋‹ค. JAK๋Š” ๋‹ค์–‘ํ•œ ์‚ฌ์ดํ† ์นด์ธ(cytokine) ์ˆ˜์šฉ์ฒด์— ์˜ํ•ด ํ™œ์„ฑํ™”๋˜๋Š” ๋น„์ˆ˜์šฉ์ฒด ํ‹ฐ๋กœ์‹  ํ‚ค๋‚˜์ œ(tyrosine kinases)์ด๋‹ค. ํฌ์œ ๋™๋ฌผ์—๋Š” 4๊ฐœ์˜ JAKํŒจ๋ฐ€๋ฆฌ(JAK1, JAK2, JAK3 ๋ฐ ํ‹ฐ๋กœ์‹  ํ‚ค๋‚˜์ œ 2)๊ฐ€ ์กด์žฌํ•˜๋ฉฐ, ์ด๋“ค์€ ๋‹ค์ค‘ ์—ผ์ฆ ์œ ์ „์ž์˜ ๋ฐœํ˜„์„ ์กฐ์ ˆํ•œ๋‹ค. ์˜คํด๋ผ์‹œํ‹ฐ๋‹™์€ JAK1-(๋ฐ ์ตœ์†Œํ•œ์˜ JAK2-) ์˜์กด์„ฑ ์‚ฌ์ดํ† ์นด์ธ์„ ์„ ํƒ์ ์œผ๋กœ ์–ต์ œํ•จ์œผ๋กœ์จ ์—ผ์ฆ์„ฑ ๋ฐ ์•Œ๋Ÿฌ์ง€์„ฑ ์‚ฌ์ดํ† ์นด์ธ์˜ ํšจ๊ณผ๋ฅผ ๊ฐ์†Œ์‹œํ‚ฌ ์ˆ˜ ์žˆ๋‹ค. ์ด๋Š” CAD์—์„œ ๋„“์€ ์ž‘์šฉ ๊ธฐ์ „์„ ๊ฐ–๋Š” ๊ฒƒ์œผ๋กœ ๊ฐ„์ฃผ๋œ๋‹ค.

์˜คํด๋ผ์‹œํ‹ฐ๋‹™์€ ์†Œ์–‘์ฆ ์™„ํ™”์ž‘์šฉ์ด ๋น ๋ฅด๊ฒŒ ๋‚˜ํƒ€๋‚˜๊ธฐ ๋•Œ๋ฌธ์—, ๊ธ‰์„ฑ์œผ๋กœ ํ”ผ๋ถ€์ฆ์ƒ์ด ์žฌ๋ฐœ๋œ ๊ฒฝ์šฐ ์†Œ์–‘์ฆ์„ ์น˜๋ฃŒํ•˜๋Š”๋ฐ ๋งค์šฐ ์œ ์šฉํ•˜๋‹ค. ์˜คํด๋ผ์‹œํ‹ฐ๋‹™์€ 14์ผ ๋™์•ˆ 1์ผ 2ํšŒ์”ฉ ํˆฌ์—ฌํ•˜๊ณ  ๊ทธํ›„ 1์ผ 1ํšŒ ํˆฌ์—ฌ(0.4-0.6 mg/kg)๋ฅผ ์ง€์†ํ•œ๋‹ค. ํŠนํžˆ ๋งŒ์„ฑ ํ”ผ๋ถ€์—ผ์ด ์žˆ๋Š” ๊ฒฝ์šฐ์—๋Š” 1์ผ 2ํšŒ ํˆฌ์—ฌ๊ฐ€ ํ•„์š”ํ•˜๋ฉฐ, 12๊ฐœ์›” ์ด์ƒ ์„ฑ๊ฒฌ์˜ CAD ์น˜๋ฃŒ๋ฅผ ์œ„ํ•ด ์žฅ๊ธฐ ํˆฌ์—ฌ๊ฐ€ ์•ˆ์ „ํ•œ ๊ฒƒ์œผ๋กœ ์•Œ๋ ค์ ธ ์žˆ๋‹ค 15. ์ด๋ก ์ ์œผ๋กœ ์˜คํด๋ผ์‹œํ‹ฐ๋‹™์€ ๊ถŒ์žฅ ์šฉ๋Ÿ‰ ์ด์ƒ์œผ๋กœ ์‚ฌ์šฉํ•  ๋•Œ ๋ฉด์—ญ ์–ต์ œ ํŠน์„ฑ์ด ์žˆ์œผ๋ฉฐ 16, ๋ฉด์—ญํ•™์ ์œผ๋กœ ์ทจ์•ฝํ•œ ๊ฐœ์—๊ฒŒ ์‚ฌ์šฉํ•  ๊ฒฝ์šฐ, ๊ธฐํšŒ ๊ฐ์—ผ, ๋ฐ”์ด๋Ÿฌ์Šค ์œ ๋‘์ข…, ๋ชจ๋‚ญ์ถฉ์ฆ(demodicosis)์„ ์œ ๋ฐœํ•  ์ˆ˜ ์žˆ๋‹ค. ์ด๋Ÿฌํ•œ ๊ฒฝ์šฐ์—๋Š” ์น˜๋ฃŒ๋ฅผ ์ค‘๋‹จํ•ด์•ผ ํ•˜์ง€๋งŒ, ์ผ๋ฐ˜์ ์œผ๋กœ ์˜คํด๋ผ์‹œํ‹ฐ๋‹™์„ ํˆฌ์—ฌํ•  ๊ฐœ์—๊ฒŒ ํ˜ˆ์•ก๊ฒ€์‚ฌ, ํ˜ˆ์ฒญํ™”ํ•™๊ฒ€์‚ฌ, ์†Œ๋ณ€๋ฐฐ์–‘๊ฒ€์‚ฌ๋ฅผ ํ•  ํ•„์š”๋Š” ์—†๋Š” ๊ฒƒ์œผ๋กœ ๋ณธ๋‹ค 17.
 
An atopic dog with iatrogenic Cushingโ€™s syndrome due to prednisolone treatment.

๊ทธ๋ฆผ 5. ํ”„๋ ˆ๋“œ๋‹ˆ์†”๋ก  ์š”๋ฒ•์œผ๋กœ ์ธํ•œ ์˜์ธ์„ฑ ์ฟ ์‹ฑ ์ฆํ›„๊ตฐ์„ ์•“๊ณ  ์žˆ๋Š” ์•„ํ† ํ”ผ๊ฐ€ ์žˆ๋Š” ๊ฐœ. ๋“ฑ์ชฝ์˜ ๋„“์€ ๋ถ€์œ„์— ๋‹จ๋‹จํ•œ ์„ํšŒ ์นจ์ฐฉ(calcinosis) ๋ณ‘๋ณ€์ด ๋ณด์ธ๋‹ค. © Annette van der Lee

์‚ฌ์ดํด๋กœ์Šคํฌ๋ฆฐ๊ณผ ํƒ€ํฌ๋กœ๋ฆฌ๋ฌด์Šค

์‚ฌ์ดํด๋กœ์Šคํฌ๋ฆฐ A(Cyclosporine A)๋Š” ํŠน์ด์  ๋ฉด์—ญ์–ต์ œ ์ž‘์šฉ ๋ฐฉ์‹์„ ๊ฐ€์ง„ ์นผ์‹œ๋‰ด๋ฆฐ ์–ต์ œ์ œ(calcineurin inhibitor)์ด๋‹ค. ์„ธํฌ๋‚ด ์ด๋ฎค๋…ธํ•„๋ฆฐ(immunophilins)์— ๊ฒฐํ•ฉํ•˜์—ฌ ์‚ฌ์ดํ† ์นด์ธ ์ธํ„ฐ๋ฃจํ‚จ-2(IL-2)๋ฅผ ์–ต์ œํ•˜๊ณ , T์„ธํฌ ์ฆ์‹์„ ๊ฐ์†Œ์‹œํ‚ค๋ฉฐ, ๋ณด์กฐ T์„ธํฌ (T-helper cells) ์˜์กด B์„ธํฌ์˜ ํ•ญ์ฒด ์ƒ์‚ฐ์„ ๊ฐ์†Œ์‹œํ‚จ๋‹ค. ๋˜ํ•œ ์‚ฌ์ดํด๋กœ์Šคํฌ๋ฆฐ์€ ๊ด‘๋ฒ”์œ„ํ•œ ์ž‘์šฉ ๊ธฐ์ „์„ ๊ฐ€์ง€๊ณ  ์žˆ๊ณ  5mg/ kg q24H๋กœ ํˆฌ์—ฌํ•˜๋ฉฐ, ํšจ๋Šฅ์˜ ๊ฐœ์‹œ๋Š” ๋Š๋ฆฌ๋‹ค. ์†Œ์–‘์ฆ๊ณผ ํ”ผ๋ถ€์—ผ์˜ ์ž„์ƒ ์ง•ํ›„๊ฐ€ ํšŒ๋ณต๋˜๊ธฐ๊นŒ์ง€ 4-8์ฃผ๊ฐ€ ์†Œ์š”๋  ์ˆ˜ ์žˆ์œผ๋ฏ€๋กœ, CAD์˜ ์œ ์ง€ ์š”๋ฒ•์œผ๋กœ๋งŒ ์‚ฌ์šฉํ•  ์ˆ˜ ์žˆ๋‹ค. ์‹œ์ž‘ ๋‹จ๊ณ„์—์„œ ๋‹ค๋ฅธ ์†ํšจ์„ฑ ์•ฝ๋ฌผ๊ณผ์˜ ๋™์‹œ ์น˜๋ฃŒํ•˜๋ฉด ํšจ์œจ์ ์ด๊ณ  ์•ˆ์ „ํ•œ ๊ฒƒ์œผ๋กœ ๋ฐํ˜€์กŒ๋‹ค. ํ”„๋ ˆ๋“œ๋‹ˆ์†”๋ก ์„ 1์ฃผ ๋™์•ˆ 1mg/kg q24H๋กœ ํˆฌ์—ฌํ•œ ๋‹ค์Œ, 2์ฃผ ๋™์•ˆ ๊ฒฉ์ผ๋กœ ๊ณ„์† ํˆฌ์—ฌํ•˜๊ณ , ์น˜๋ฃŒ ์‹œ์ž‘ ํ›„ ์ฒซ 3์ฃผ ๋™์•ˆ ์‚ฌ์ดํด๋กœ์Šคํฌ๋ฆฐ๊ณผ ํ•จ๊ป˜ ํˆฌ์—ฌํ•œ๋‹ค 18 .  ๋งˆ์ฐฌ๊ฐ€์ง€๋กœ, 14์ผ ๋™์•ˆ ์˜คํด๋ผ์‹œํ‹ฐ๋‹™(0.4-0.6 mg/kg q12H)์„ ๋ณ‘์šฉ ํˆฌ์—ฌํ•œ ๋‹ค์Œ, 7์ผ ๋™์•ˆ ํ•˜๋ฃจ์— ํ•œ ๋ฒˆ ํˆฌ์—ฌํ•ด๋„ ๋‚ด์•ฝ์„ฑ์ด ์šฐ์ˆ˜ํ•˜๋‹ค 17 . ์•„ํ† ํ”ผ๊ฐ€ ์žˆ๋Š” ๊ฐœ๊ฐ€ ์‚ฌ์ดํด๋กœ์Šคํฌ๋ฆฐ์œผ๋กœ ํšŒ๋ณต๋˜๋ฉด ์šฉ๋Ÿ‰์„ ์ ์ง„์ ์œผ๋กœ ์ค„์ด๊ฑฐ๋‚˜(2์ฃผ๋งˆ๋‹ค ์•ฝ 1mg/kg์”ฉ ์ ์ฐจ์ ์œผ๋กœ ๊ฐ์†Œ์‹œํ‚ด) ๊ฒฉ์ผ๋กœ ์ฆ์ƒ์„ ๋ณด์•„๊ฐ€๋ฉฐ ๊ฐ€๋Šฅํ•œ ๊ฐ€์žฅ ์ ์€ ์œ ์ง€ ์šฉ๋Ÿ‰์„ ์ฐพ๋Š”๋‹ค. ์žํ•œ์„ฑ(self-limiting) ๋ถ€์ž‘์šฉ(์˜ˆ: ๊ตฌํ† , ์„ค์‚ฌ)์€ ํ™˜์ž ์ค‘ 30% ์—๊ฒŒ ๋ฐœ์ƒํ•˜๋Š”๋ฐ, ์ฃผ๋กœ ์•ฝ๋ฌผ ํˆฌ์—ฌ ์ฒซ ์ฃผ ์ด๋‚ด์— ๋ฐœ์ƒํ•˜๋ฏ€๋กœ, ์ €์ž๋Š” ์ฒ˜์Œ ์‚ฌ์ดํด๋กœ์Šคํฌ๋ฆฐ ์š”๋ฒ•์„ ์‹œ์ž‘ํ•  ๋•Œ ์ข…์ข… ๋‚ฎ์€ ์šฉ๋Ÿ‰์„ ํˆฌ์—ฌํ•˜์˜€๋Š”๋ฐ(์˜ˆ: 3์ผ ๋™์•ˆ 1.5mg/kg q24H, ์ดํ›„ 3์ผ ๋™์•ˆ 3mg/kg q24H๋กœ ํˆฌ์—ฌ), ํŠนํžˆ ์†Œํ™”๊ด€์ด ๋ฏผ๊ฐํ•œ ๊ฐœ์—๊ฒŒ ๊ทธ๋ ‡๊ฒŒ ํ•˜์˜€๋‹ค. ์‚ฌ๋ฃŒ์™€ ํ•จ๊ป˜ ํˆฌ์—ฌํ•˜๋Š” ๊ฒƒ๋„ ์œ„์žฅ ์žฅ์• ๋ฅผ ์ค„์ด๋Š” ๋ฐ ๋„์›€์ด ๋œ๋‹ค. ํˆฌ์—ฌ ์šฉ๋Ÿ‰์— ๋”ฐ๋ฅธ ๋ถ€์ž‘์šฉ์€ ๋ฐœ์ƒ ๋นˆ๋„๊ฐ€ ์žฆ์ง€๋Š” ์•Š์ง€๋งŒ, ์น˜์€ ์ฆ์‹, ๊ณผ๋„ํ•œ ๋ชจ๋ฐœ ์„ฑ์žฅ(๊ทธ๋ฆผ 6), ๊ธฐํšŒ ๊ฐ์—ผ( ์ง„๊ท )์— ๋Œ€ํ•œ ์ทจ์•ฝ์„ฑ, ์ฆ์‹์„ฑ ์‚ฌ๋งˆ๊ท€๋ชจ์–‘๋ณ‘๋ณ€ ๋ฐ ๊ฑด์„ ํ˜•-ํƒœ์„  ์–‘ ํ”ผ๋ถ€์—ผ(psoriasiform-lichenoid-like dermatitis)์ด ์žˆ๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ์ด๋Ÿฌํ•œ ๋ถ€์ž‘์šฉ์€ ์ผ๋ฐ˜์ ์œผ๋กœ ์•ฝ๋ฌผ์„ ์ค‘๋‹จํ•˜๋ฉด ์›๋ž˜ ์ƒํƒœ๋กœ ๋Œ์•„์˜จ๋‹ค.


์นผ์‹œ๋‰ด๋ฆฐ ์–ต์ œ์ œ ํƒ€ํฌ๋กœ๋ฆฌ๋ฌด์Šค(tacrolimus)๋Š” ๊ตญ์†Œ์ ์œผ๋กœ ๋ช‡ ์ฃผ ๊ฐ„ ์‚ฌ์šฉํ•˜๋ฉด ๋ณ‘๋ณ€ ์ ์ˆ˜(lesional scores)๋ฅผ ๊ฐ์†Œ์‹œํ‚ค๋Š” ๊ฒƒ์œผ๋กœ ๋ฐํ˜€์กŒ๋‹ค 19 . ํƒ€ํฌ๋กœ๋ฆฌ๋ฌด์Šค๋Š” ์น˜๋ฃŒ ์ฒซ ๋‚ ์—๋Š” ํ”ผ๋ถ€๋ฅผ ์ž๊ทนํ•  ์ˆ˜ ์žˆ์ง€๋งŒ 0.1% ์ œ์ œ๋ฅผ ์‚ฌ์šฉํ•˜์—ฌ 1์ผ 2ํšŒ ๋„ํฌํ•˜๋ฉด ๋Œ€๋ถ€๋ถ„์˜ ๊ฐœ๋“ค์€ ์ž˜ ๊ฒฌ๋ŽŒ๋‚ธ๋‹ค.

์•„ํ† ํ”ผ๊ฐ€ ์žˆ๋Š” ๊ฐœ์˜ ํ„ธ์ด ๊ณผ๋„ํ•˜๊ฒŒ ์ž๋ผ๋‚˜ ์žˆ๋‹ค. ์ด ๊ฐœ๋Š” ์‚ฌ์ดํด๋กœ์Šคํฌ๋ฆฐ ์œ ์ง€ ์š”๋ฒ•์„ 1๋…„ ๋™์•ˆ ๋ฐ›์•˜๋‹ค.

๊ทธ๋ฆผ 6a. ์•„ํ† ํ”ผ๊ฐ€ ์žˆ๋Š” ๊ฐœ์˜ ํ„ธ์ด ๊ณผ๋„ํ•˜๊ฒŒ ์ž๋ผ๋‚˜ ์žˆ๋‹ค. ์ด ๊ฐœ๋Š” ์‚ฌ์ดํด๋กœ์Šคํฌ๋ฆฐ ์œ ์ง€ ์š”๋ฒ•์„ 1๋…„ ๋™์•ˆ ๋ฐ›์•˜๋‹ค. © Annette van der Lee

์˜คํด๋ผ์‹œํ‹ฐ๋‹™ ์œ ์ง€ ์š”๋ฒ•์œผ๋กœ ์ „ํ™˜ํ•œ ํ›„ 6๊ฐœ์›” ๋’ค, (a)์™€ ๋™์ผํ•œ ๊ฐœ.

๊ทธ๋ฆผ 6b. ์˜คํด๋ผ์‹œํ‹ฐ๋‹™ ์œ ์ง€ ์š”๋ฒ•์œผ๋กœ ์ „ํ™˜ํ•œ ํ›„ 6๊ฐœ์›” ๋’ค, (a)์™€ ๋™์ผํ•œ ๊ฐœ. © Annette van der Lee

๋กœํ‚ค๋ฒ ํŠธ๋ง™

๊ฐœ ์ธํ„ฐ๋ฃจํ‚จ-31 ์–ต์ œ(anti-canine interleukin-31) ๋‹จ์ผํด๋ก  ํ•ญ์ฒด(monoclonal antibody) ์•ฝ๋ฌผ์ธ ๋กœํ‚ค๋ฒ ํŠธ๋ง™(lokivetmab)์€ ์ž‘์šฉ ๋ฒ”์œ„๊ฐ€ ์ข๊ณ  ๋ถ€์ž‘์šฉ์ด ๊ฐ€์žฅ ์ ์œผ๋ฉฐ ๊ฐ€์žฅ ํŠน์ด์ ์œผ๋กœ ์ž‘์šฉํ•˜๋Š” ์•„ํ† ํ”ผ ๋Œ€์ฆ์š”๋ฒ• ์•ฝ๋ฌผ์ด๋‹ค. ๋กœํ‚ค๋ฒ ํŠธ๋ง™์€ ์†Œ์–‘์ฆ์— ๊ด€์—ฌํ•˜๋Š” ์‚ฌ์ดํ† ์นด์ธ์ธ ๊ฐœ ์ธํ„ฐ๋ฃจํ‚จ-31(canine IL-31)์„ ์ค‘ํ™”ํ•œ๋‹ค. ๋กœํ‚ค๋ฒ ํŠธ๋ง™์˜ ์ž‘์šฉ ๊ธฐ์ „์€ ์˜คํด๋ผ์‹œํ‹ฐ๋‹™์˜ ์ž‘์šฉ ๊ธฐ์ „๊ณผ ๋‹ค๋ฅด๋‹ค. IL-31์ด ์ˆ˜์šฉ์ฒด์— ๊ฒฐํ•ฉํ•˜๊ธฐ ์ „์— ๋กœํ‚ค๋ฒ ํŠธ๋ง™๊ณผ ๊ฒฐํ•ฉํ•˜๋Š” ๊ฒƒ์„ ํ†ตํ•ด IL-31์ด ์ˆ˜์šฉ์ฒด์— ๊ฒฐํ•ฉํ•˜๋ฉด์„œ ์œ ๋ฐœ๋˜๋Š” ์†Œ์–‘๊ฐ์„ ๋ฐฉ์ง€ํ•œ๋‹ค. ๋กœํ‚ค๋ฒ ํŠธ๋ง™์€ ๋งค์›” ํ”ผํ•˜ ์ฃผ์‚ฌ๋กœ 1-2mg/kg(๊ฐ ๊ตญ๊ฐ€๋งˆ๋‹ค ์•ฝํ’ˆ ํ—ˆ๊ฐ€ ๊ธฐ์ค€ ๋ฐ์ดํ„ฐ์— ๋”ฐ๋ผ ๋‹ค๋ฆ„)์„ ์‚ฌ์šฉํ•  ์ˆ˜ ์žˆ์œผ๋ฉฐ, ์ผ๋ถ€ ๊ฐœ๋Š” ๊ณ ์šฉ๋Ÿ‰์—๋„ ์ž˜ ๋ฐ˜์‘ํ•˜๋ฉฐ ์ผ๋ฐ˜์ ์œผ๋กœ 4-8์ฃผ๋งŒ์— ์ฆ์ƒ์ด ์‚ฌ๋ผ์ง„๋‹ค. ๋กœํ‚ค๋ฒ ํŠธ๋ง™์€ ๋ฐ˜๊ฐ๊ธฐ๊ฐ€ ๋งค์šฐ ๊ธธ๋ฉฐ ๋‹ค๋ฅธ CAD ๋Œ€์ฆ์š”๋ฒ• ์•ฝ๋ฌผ๊ณผ ํ•จ๊ป˜ ์‚ฌ์šฉํ•˜์—ฌ๋„ ์•ˆ์ „ํ•˜๋‹ค. ์ด ์•ฝ๋ฌผ๋กœ ์น˜๋ฃŒ๋ฅผ ์‹œ์ž‘ํ•œ์ง€ 28์ผ ํ›„์— ํ”ผ๋ถ€ ์†Œ์–‘๊ฐ๊ณผ ํ”ผ๋ถ€ ๋ณ‘๋ณ€ ์ ์ˆ˜[๊ฐ๊ฐ PVAS(Pruritus Visual Analog Score) ๋ฐ CADESI(Canine Atopic Dermatitis Extent and Severity Index)๋ฅผ ํ™œ์šฉํ•˜์˜€์Œ]๋ฅผ ๊ฐ์†Œ์‹œํ‚ค๋Š” ํšจ๋Šฅ์˜ ์ •๋„๊ฐ€ ๊ด‘๋ฒ”์œ„ ์ŠคํŽ™ํŠธ๋Ÿผ ์•ฝ๋ฌผ์ธ ์‚ฌ์ดํด๋กœ์Šคํฌ๋ฆฐ์— ๋น„ํ•ด ๋’ค์ง€์ง€ ์•Š๋Š” ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ๋กœํ‚ค๋ฒ ํŠธ๋ง™์— ๋Œ€ํ•œ ์ดˆ๊ธฐ ์น˜๋ฃŒ ๋ฐ˜์‘์€ ๋น ๋ฅด๊ฒŒ ๋‚˜ํƒ€๋‚ฌ์ง€๋งŒ(์•„ํ† ํ”ผ๊ฐ€ ์žˆ๋Š” ๊ฐœ์˜ 77%์—์„œ PVAS๋ฅผ 50%์ด์ƒ ๊ฐ์†Œ์‹œํ‚ด) ์น˜๋ฃŒ 9๊ฐœ์›” ํ›„์˜ ์ „๋ฐ˜์ ์ธ ํšจ๋Šฅ์€ 59%์ธ ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค 20 . ์ €์ž์˜ ๊ฒฝํ—˜ ์ƒ, ์ด ์•ฝ๋ฌผ์€ ๋ถ€์ž‘์šฉ์ด ๊ฑฐ์˜ ์—†๊ฑฐ๋‚˜ ์ „ํ˜€ ์—†์œผ๋ฉฐ, ๊ฒฝ์ฆ์—์„œ ์ค‘๋“ฑ๋„์˜ ์†Œ์–‘์ฆ์ด ์žˆ๋Š” ๊ฐœ๋ฅผ ์น˜๋ฃŒํ•˜๋Š”๋ฐ ํƒ์›”ํ•˜๊ณ  ํŠนํžˆ ์˜คํด๋ผ์‹œํ‹ฐ๋‹™(oclacitinib)์— ๋Œ€ํ•œ ์น˜๋ฃŒ ๋ฐ˜์‘์ด ๋ถˆ์ถฉ๋ถ„ํ•œ ์ผ๋ถ€ ์ฆ๋ก€์—์„œ ๋กœํ‚ค๋ฒ ํŠธ๋ง™์ด ํšจ๊ณผ๊ฐ€ ์žˆ์—ˆ๋‹ค. ๊ทธ๋Ÿฌ๋‚˜, ์ค‘์ฆ(๋งŒ์„ฑ) ๋ณ‘๋ณ€์ด ์žˆ๋Š” CAD ์ฆ๋ก€๋ฅผ ์น˜๋ฃŒํ•˜๋Š” ๋ฐ๋Š” ํšจ๋Šฅ์ด ๋–จ์–ด์ง„๋‹ค. ๋กœํ‚ค๋ฒ ํŠธ๋ง™์€ ํšจ๊ณผ๊ฐ€ ์‹ ์†ํ•˜๊ฒŒ ๋‚˜ํƒ€๋‚˜๋Š” ์•ˆ์ „ํ•œ ์•ฝ๋ฌผ์ด์ง€๋งŒ, ๋น„์šฉ์ด ๋งŽ์ด ๋“ค๊ธฐ ๋•Œ๋ฌธ์— CAD์˜ ์œ ์ง€ ์š”๋ฒ•์„ ์œ„ํ•œ ์•ฝ๋ฌผ๋กœ ์‚ฌ์šฉํ•˜๋Š”๋ฐ ๋Œ€์ฒด๋กœ ํ•œ๊ณ„๊ฐ€ ์žˆ๋‹ค.

 

์•Œ๋Ÿฌ์   ํŠน์ด ๋ฉด์—ญ์š”๋ฒ•

์•Œ๋Ÿฌ์   ํŠน์ด ๋ฉด์—ญ์š”๋ฒ•(allergen-specific immunotherapy, ASIT)์€ ํƒˆ๊ฐ์ž‘(desensitization) ๋˜๋Š” ์ €๊ฐ์ž‘(hyposenยญsitization) ์š”๋ฒ•์œผ๋กœ๋„ ์•Œ๋ ค์ ธ ์žˆ๋‹ค. ASIT์— ์˜ํ•œ ๋ฉด์—ญ ๋ฐ˜์‘์˜ ๋ณ€ํ™”๋Š”, ํ™˜๊ฒฝ ์•Œ๋Ÿฌ์  ์— ๋Œ€ํ•ด ๋ฉด์—ญ ๊ด€์šฉ(tolerance)์„ ์œ ๋„ํ•˜์—ฌ ๊ณผ๋ฏผ์„ฑ ๋ฉด์—ญ์ฒด๊ณ„๋ฅผ ์ค‘ํ™”์‹œํ‚ค๋Š” ์œ ์ผํ•œ ์งˆ๋ณ‘์กฐ์ ˆ์น˜๋ฃŒ๋ฒ• (disease-modifying therapy)์ด๋‹ค. ASIT๋ž€ "ํŠน์ • ์•Œ๋Ÿฌ์   ์ถ”์ถœ๋ฌผ์„ ํ•ด๋‹น ์•Œ๋Ÿฌ์ง€๊ฐ€ ์žˆ๋Š” ๋Œ€์ƒ์ž์—๊ฒŒ ์ ์ง„์ ์œผ๋กœ ์ฆ๋Ÿ‰ ํˆฌ์—ฌํ•˜์—ฌ ์ถ”ํ›„ ๋™์ผ ์•Œ๋Ÿฌ์  ์— ๋…ธ์ถœ๋˜์—ˆ์„ ๋•Œ ๊ด€๋ จ ์ง•ํ›„๋ฅผ ๊ฐœ์„ ํ•˜๋Š”" ์น˜๋ฃŒ๋ฒ•์ด๋ผ ์ •์˜ํ•  ์ˆ˜ ์žˆ๋‹ค. ์ž‘์šฉ ๊ธฐ์ „์—๋Š” ์•Œ๋Ÿฌ์   ํŠน์ด ์กฐ์ ˆ T์„ธํฌ ์œ ๋„์— ์ž‡๋”ฐ๋ฅธ ์‚ฌ์ดํ† ์นด์ธ ์ธํ„ฐ๋ฃจํ‚จ-10(IL-10)์˜ ์œ ๋„, ์•Œ๋Ÿฌ์   ํŠน์ด IgG4 ์ˆ˜์น˜์˜ ์ฆ๊ฐ€, Th2/Th1 ์‚ฌ์ดํ† ์นด์ธ์˜ ๋น„์œจ ๊ฐ์†Œ์™€ ์•Œ๋Ÿฌ์   ํŠน์ด IgE ์ˆ˜์น˜ ๊ฐ์†Œ๊ฐ€ ํฌํ•จ๋œ๋‹ค 21 .

ํ”ผํ•˜ ๋ฉด์—ญ์š”๋ฒ•(Subcutaneous immunotherapy, SCIT)์€ 1980๋…„๋Œ€ ์ดˆ๋ฐ˜๋ถ€ํ„ฐ ASIT ์ค‘ ๊ฐ€์žฅ ๋งŽ์ด ์‚ฌ์šฉ๋˜์–ด์˜จ ์น˜๋ฃŒ๋ฒ•์ด๋‹ค. ๊ฐœ์—๊ฒŒ๋Š” 2๊ฐ€์ง€ ์ œํ˜•, ์ฆ‰ ์ˆ˜์„ฑ ์šฉ์•ก๊ณผ ๋ช…๋ฐ˜(alum) ์šฉ์•ก์„ ์‚ฌ์šฉํ•  ์ˆ˜ ์žˆ์œผ๋ฉฐ ํ”„๋กœํ† ์ฝœ๋Œ€๋กœ ์˜ฌ๋ฐ”๋ฅด๊ฒŒ ์‹œํ–‰ํ•˜๋ฉด ์ „์‹  ๋ถ€์ž‘์šฉ์€ ๊ฑฐ์˜ ๋‚˜ํƒ€๋‚˜์ง€ ์•Š๋Š”๋‹ค. ์ด ํ”„๋กœํ† ์ฝœ์€ ์น˜๋ฃŒ ํšจ๋Šฅ์„ ํ–ฅ์ƒ์‹œํ‚ค๊ธฐ ์œ„ํ•ด์„œ๋‚˜ ํŠน์ • ๊ธฐ๊ฐ„(์˜ˆ: ๊ณ„์ ˆ์  ๋ณ€๋™๊ธฐ)์ธ ๊ฒฝ์šฐ ๊ฐœ๋ณ„ ํ™˜์ž์—๊ฒŒ ์ ์šฉ ์‹œ ์กฐ์ •์ด ํ•„์š”ํ•  ๋•Œ๊ฐ€ ๋งŽ๋‹ค. ์˜ˆ๋ฅผ ๋“ค์–ด, ์žฌํˆฌ์—ฌ 1์ฃผ์ผ ์ „์— ํ”ผ๋ถ€์ฆ์ƒ์ด ์žฌ๋ฐœํ•˜๋ฉด ์ฃผ์‚ฌ ๊ฐ„๊ฒฉ์„ ๋‹จ์ถ•ํ•  ์ˆ˜ ์žˆ์œผ๋ฉฐ, ํ™˜์ž๊ฐ€ ํ”ผํ•˜ ๋ฉด์—ญ ์š”๋ฒ• ์ฃผ์‚ฌ๋ฅผ ๋งž์„ ๋•Œ๋งˆ๋‹ค ์†Œ์–‘์ฆ์ด ์ฆ๊ฐ€ํ•˜๋Š” ๋ฐ˜์‘์„ ๋ณด์ด๋ฉด ๋” ๋‚ฎ์€ ์šฉ๋Ÿ‰์œผ๋กœ ์กฐ์ ˆํ•˜์—ฌ ํˆฌ์—ฌํ•  ํ•„์š”๊ฐ€ ์žˆ๋‹ค.

๋ช‡๋ช‡ ์„ ํ–‰ ์—ฐ๊ตฌ๋ฅผ ํ†ตํ•ด, ์•„ํ† ํ”ผ๊ฐ€ ์žˆ๋Š” ๊ฐœ๋ฅผ ๋Œ€์ƒ์œผ๋กœ ํ•œ ํ”ผํ•˜ ๋ฉด์—ญ์š”๋ฒ•(SCIT)์˜ ์ „์ฒด ์„ฑ๊ณต๋ฅ ์€ ์น˜๋ฃŒ 9~12๊ฐœ์›” ํ›„ 50~70% ์ธ ๊ฒƒ์œผ๋กœ ์ถ”์ •๋˜์—ˆ๋‹ค 22 . "๋Ÿฌ์‹œ(rush)" ํ”„๋กœํ† ์ฝœ์„ ์‚ฌ์šฉํ•˜์—ฌ ํšจ๋Šฅ์„ ๋†’์ด๊ณ  ์ฆ์ƒ์ด ๋‚˜ํƒ€๋‚˜๋Š” ๊ธฐ๊ฐ„์„ ์ค„์ด๋ ค๋Š” ์‹œ๋„๊ฐ€ ์žˆ์—ˆ์œผ ๋ฉฐ, ํ•œ ์—ฐ๊ตฌ์—์„œ๋Š” ์ด ๋ฐฉ์‹์ด ์•ˆ์ „ํ•˜๊ณ  ํšจ๊ณผ์ ์ธ ์น˜๋ฃŒ๋ฒ•์ด๋ผ๊ณ  ๋ฐํ˜”๋‹ค 23 . ๊ทธ๋Ÿฌ๋‚˜ ์ˆ˜์˜ํ”ผ๋ถ€๊ณผ ์ „๋ฌธ์˜๊ฐ€ ์ง์ ‘ ์ˆ˜ํ–‰ํ•˜์ง€ ์•Š๋Š” ํ•œ, ํ˜„์žฌ๋กœ์„œ๋Š” ์ด ์น˜๋ฃŒ๋ฒ•์˜ ํ™œ์šฉ์„ ๊ถŒ์žฅํ•  ์ˆ˜ ์—†๋‹ค.

์„คํ•˜ ๋ฉด์—ญ์š”๋ฒ•(sublingual immunotherapy, SLIT)์€ SCIT์˜ ๋Œ€์•ˆ ์š”๋ฒ•์œผ๋กœ, ์•Œ๋Ÿฌ์  ์„ ํ•˜๋ฃจ์— ํ•œ ๋ฒˆ์ด๋‚˜ ๋‘ ๋ฒˆ ๊ฒฝ๊ตฌ ํˆฌ์—ฌํ•œ๋‹ค. ๊ฐœ๊ฐ€ ์•ฝ๋ฌผ์„ ํˆฌ์—ฌ ๋ฐ›๊ธฐ ์ „ํ›„ 10๋ถ„ ๋™์•ˆ ๋จน๊ฑฐ๋‚˜ ๋งˆ์‹œ์ง€ ์•Š์•„์•ผ ํ•˜๋ฏ€๋กœ ๋ณดํ˜ธ์ž์˜ ๊ทœ์น™ ์ค€์ˆ˜๊ฐ€ ํ•„์ˆ˜์ ์ด๋‹ค. ์†Œ์ˆ˜์˜ ๋น„๋Œ€์กฐ ๊ณต๊ฐœ ์—ฐ๊ตฌ(uncontrolled open studies)์—์„œ, SLIT๊ฐ€ SCIT์„ ์›ƒ๋„๋Š” ๋†’์€ ํšจ๋Šฅ์ด ์žˆ๋‹ค๋Š” ์ผ๊ด€๋œ ๊ทผ๊ฑฐ๋ฅผ ์ฐพ์„ ์ˆ˜ ์—†์—ˆ๋‹ค 24 .

์ตœ๊ทผ ์ƒˆ๋กญ๊ฒŒ ๊ฐœ๋ฐœ๋œ ๋ฆผํ”„๋‚ด ๋ฉด์—ญ์š”๋ฒ•(intralymphatic immuยญnotherapy, ILIT) ๋ฐฉ์‹๋„ ๋งค์šฐ ํฅ๋ฏธ๋กญ๋‹ค. ์ตœ๊ทผ ์—ฐ๊ตฌ์— ๋”ฐ๋ฅด๋ฉด, ILIT๋Š” ์ž„์ƒ ์ฆ์ƒ ์™„ํ™”๊ฐ€ ๋ณด๋‹ค ๋น ๋ฅด๊ฒŒ ๋‚˜ํƒ€๋‚˜๋ฉฐ ์‹œ๊ฐ„์ด ์ง€๋‚จ์— ๋”ฐ๋ผ ์ง€์† ๊ฐ€๋Šฅํ•œ ํšจ๋Šฅ๋„ ๋” ๋†’๋‹ค๊ณ  ๋ณด๊ณ ๋˜์—ˆ๋‹ค 25 .

ASIT๋ฅผ ์–ด๋–ค ๋ฐฉ์‹์œผ๋กœ ์ ์šฉํ•˜๋“ ์ง€ ๊ฐ„์—, ์‚ถ์˜ ์งˆ ๊ฐœ์„ ์„ ์œ„ํ•ด์„œ ๋ฉด์—ญ์š”๋ฒ•์ด ํšจ๊ณผ์ ์ด๋ผ๊ณ  ํŒ๋‹จ๋  ๋•Œ๊นŒ์ง€ ํ”ผ๋ถ€ ์—ผ์ฆ๊ณผ ์†Œ์–‘์ฆ์„ ์–ต์ œํ•˜๊ธฐ ์œ„ํ•œ ๋Œ€์ฆ์š”๋ฒ•์ด ํ•œ๋™์•ˆ ์ด๋ฃจ์–ด์ ธ์•ผ ํ•œ๋‹ค. ASIT๋Š” ๋งž์ถคํ˜• ์น˜๋ฃŒ๋ฒ•์ด๊ธฐ ๋•Œ๋ฌธ์— ์ตœ์ƒ์˜ ๊ฒฐ๊ณผ๋ฅผ ์–ป์œผ๋ ค๋ฉด ํˆฌ์—ฌ ์šฉ๋Ÿ‰, ํˆฌ์—ฌ ๊ฐ„๊ฒฉ์„ ์กฐ์ •ํ•˜๋ฉด์„œ ํ”ผ๋ถ€์ฆ์ƒ ์žฌ๋ฐœ์„ ํ†ต์ œํ•ด์•ผ ํ•œ๋‹ค.


๊ฒฐ๋ก 

์•„ํ† ํ”ผ๊ฐ€ ์žˆ๋Š” ๊ฐœ๋Š” ๋ณด๋‹ค ๋‚˜์€ ์‚ถ์˜ ์งˆ์„ ์œ„ํ•ด ์žฅ๊ธฐ์ ์ธ ๋‹ค์ค‘ ์น˜๋ฃŒ๋ฒ•์œผ๋กœ ๊ด€๋ฆฌ๊ฐ€ ํ•„์š”ํ•˜๋ฉฐ, ์ตœ์ƒ์˜ ์น˜๋ฃŒ ๊ฒฐ๊ณผ๋ฅผ ์–ป๊ธฐ ์œ„ํ•ด์„œ๋Š” ๋ฐ˜๋ ค๊ฒฌ ๋ณดํ˜ธ์ž์—๊ฒŒ ์ ํ•ฉํ•œ ๊ต์œก, ๋ช…ํ™•ํ•œ ์„ค๋ช…, ์ฝ”์นญ์ด ํ•„์š”ํ•˜๋‹ค. ํ”ผ๋ถ€์˜ ์ด์ฐจ๊ฐ์—ผ์— ์˜ํ•œ ์†Œ์–‘์ฆ๊ณผ ํ”ผ๋ถ€์—ผ์˜ ์•…ํ™”๋Š” ๊ตญ์†Œ ์น˜๋ฃŒ๋กœ ์กฐ์ ˆํ•˜๋ฉฐ, ํ‘œํ”ผ ์žฅ๋ฒฝ์„ ํšŒ๋ณตํ•  ์ˆ˜ ์žˆ๋Š” ๋ฐฉ์•ˆ์„ ๊ณ ๋ คํ•˜์—ฌ์•ผ ํ•œ๋‹ค. ์ผ๋ฐ˜์ ์œผ๋กœ ์ฒด๋‚ด์—์„œ ๊ด‘๋ฒ”์œ„ํ•˜๊ฒŒ ์ž‘์šฉํ•˜๋Š” ์•ฝ๋ฌผ์ผ ์ˆ˜๋ก ์•ฝ๋ฌผ ๋ถ€์ž‘์šฉ์ด ๋” ๋งŽ์ด ๋ฐœ์ƒํ•  ์ˆ˜ ์žˆ์œผ๋ฉฐ, ๊ธ€๋ฃจ์ฝ”์ฝ”๋ฅดํ‹ฐ์ฝ”์Šคํ…Œ๋กœ์ด๋“œ, ์‚ฌ์ดํด๋กœ์Šคํฌ๋ฆฐ, ์˜คํด๋ผ์‹œํ‹ฐ๋‹™๊ณผ ๊ฐ™์€ ์•ฝ๋ฌผ์˜ ์กฐํ•ฉ์€ ์žฅ๊ธฐ๊ฐ„ ์‚ฌ์šฉํ•˜๋ฉด ๋ฉด์—ญ์–ต์ œ ์ˆ˜์ค€์ด ์‹ฌ๊ฐํ•ด์งˆ ์œ„ํ—˜์ด ์žˆ์œผ๋ฏ€๋กœ ๊ฐ€๋Šฅํ•œ ์ตœ์†Œํ•œ์œผ๋กœ ์‚ฌ์šฉํ•ด์•ผ ํ•œ๋‹ค. ์•Œ๋Ÿฌ์   ํŠน์ด ๋ฉด์—ญ์š”๋ฒ•์€ CAD๋ฅผ ์น˜๋ฃŒํ•  ์ˆ˜ ์žˆ๋Š” ์œ ์ผํ•œ ์งˆ๋ณ‘์กฐ์ ˆ์น˜๋ฃŒ๋ฒ•(disease-modifying therapy)๋กœ์จ ๊ฐœ๋ณ„ ํ™˜์ž์—๊ฒŒ ๋งž์ถคํ˜•์œผ๋กœ ์ œ๊ณต๋˜์–ด์•ผ ํ•œ๋‹ค.

References

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  2. Picco F, Zini E, Nett C, et al. A prospective study on canine atopic dermatitis and food-induced allergic dermatitis in Switzerland. Vet Dermatol 2008;19(3):150-155.

  3. Panzuti P, Vidémont E, Fantini O, et al. A moisturizer formulated with glycerol and propylene glycol accelerates the recovery of skin barrier function after experimental disruption in dogs. Vet Dermatol 2020;31:344-e89.

  4. Ollivier E, Zemirline C, Marchand L, et al. Effect of the ingredient A97614A1 on the adhesion and biofilm formation of Staphylococcus pseudintermedius in a model of reconstructed canine epidermis. In; Proceedings, 62nd BSAVA Congress, Birmingham, 2019.

  5. Saevik BK, Bergvall K, Holm BR, et al. A randomized, controlled study to evaluate the steroid sparing effect of essential fatty acid supplementation in the treatment of canine atopic dermatitis. Vet Dermatol 2004;15:137-145.

  6. Popa I, Remoue N, Osta B, et al. The lipid alterations in the stratum corneum of dogs with atopic dermatitis are alleviated by topical application of a sphingolipid-containing emulsion. Clin Exp Dermatol 2012;37(6):665-671.

  7. Bradley CW, Morris DO, Rankin SC, et al. Longitudinal evaluation of the skin microbiome and association with microenvironment and treatment in canine atopic dermatitis. J Invest Dermatol 2016;136(6):1087-1089.

  8. Morris DO, DeBoer DJ. Evaluation of serum obtained from atopic dogs with dermatitis attributable to Malassezia pachydermatis for passive transfer of immediate hypersensitivity to that organism. Am J Vet Res 2003;64(3):262-266.

  9. Maynard L, Rème CA, Viaud S. Comparison of two shampoos for the treatment of canine Malassezia dermatitis: a randomised controlled trial. J Small Anim Pract 2011;52(11):566-572.

  10. Kano R, Yokoi S, Kariya N, et al. Multi-azole-resistant strain of Malassezia pachydermatis isolated from a canine Malassezia dermatitis. Med Mycol 2019; 57(3):346-350.

  11. Olivry T, DeBoer DJ, Favrot C, et al. Treatment of canine atopic dermatitis: 2010 clinical practice guidelines from the International Task Force on Canine Atopic Dermatitis. Vet Dermatol 2010;21:233-248.

  12. Olivry T, DeBoer DJ, Favrot C, et al. Treatment of canine atopic dermatitis: 2015 updated guidelines from the International Committee on Allergic Diseases of Animals (ICADA). BMC Vet Res 2015;11:210.

  13. Nuttall T, Mueller R, Bensignor E, et al. Efficacy of a 0.0584% hydrocortisone aceponate spray in the management of canine atopic dermatitis: a randomised, double blind, placebo-controlled trial. Vet Dermatol 2009;20:191-198.

  14. Lourenço AM, Schmidt V, São Braz B, et al. Efficacy of proactive long-term maintenance therapy of canine atopic dermatitis with 0.0584% hydrocortisone aceponate spray: a double-blind placebo-controlled pilot study. Vet Dermatol 2016; 27:88-92.

  15. Cosgrove SB, Cleaver DM, King VL. Long-term compassionate use of oclacitinib in dogs with atopic and allergic skin disease: safety, efficacy and quality of life. Vet Dermatol 2015;26:171-e35.

  16. Banovic F, Gordon H, Tarigo J, et al. Modulatory effects of oclacitinib on in vitro canine T-cell proliferation and cytokine production. Vet Dermatol 2019;30(1):17-e6.

  17. Panteri A, Strehlau G, Helbig R, et al. Repeated oral dose tolerance in dogs treated concomitantly with ciclosporin and oclacitinib for three weeks. Vet Dermatol 2016; 27:22-e7.

  18. Dip R, Carmichael J, Letellier I, et al. Concurrent short-term use of prednisolone with cyclosporine A accelerates pruritus reduction and improvement in clinical scoring in dogs with atopic dermatitis. BMC Vet Res 2013;9:173.

  19. Bensignor E, Olivry T. Treatment of localized lesions of canine atopic dermatitis with tacrolimus ointment: a blinded randomized controlled trial. Vet Dermatol 2005;16: 52-60.

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  21. Keppel K, Campbell K, Zuckermann F, et al. Quantitation of canine regulatory T cell populations, serum interleukin-10 and allergen-specific IgE concentrations in healthy control dogs and canine atopic dermatitis patients receiving allergen-specific immunotherapy. Vet Immunol Immunopathol 2008;123:337-344.

  22. Loewenstein C, Mueller RS. A review of allergen-specific immunotherapy in human and veterinary medicine. Vet Dermatol 2009;20(2):84-98.

  23. Hobi S, Mueller RS. Efficacy and safety of rush immunotherapy with alum-precipitated allergens in canine atopic dermatitis. Tierarztl Prax Ausg K Kleintiere Heimtiere 2014;42(3):167-173.

  24. DeBoer DJ, Verbrugge M, Morris M. Clinical and immunological responses of dust mite sensitive, atopic dogs to treatment with sublingual immunotherapy (SLIT). Vet Dermatol 2016;27(2):82-7e23.

  25. Timm K, Mueller RS, Nett-Mettler CS. Long-term effects of intralymphatic immunotherapy (ILIT) on canine atopic dermatitis. Vet Dermatol 2018;29(2):123-e49.

Annette van der Lee

Annette van der Lee

IVC Evidensia Dierenziekenhuis, Arnhem, The Netherlands ๋” ์ฝ๊ธฐ

์ด๋ฒˆํ˜ธ์˜ ๋‹ค๋ฅธ ๊ธฐ์‚ฌ

๋ฐœํ–‰ํ˜ธ ๋ฒˆํ˜ธ 31.2 ์ถœ๊ฐ„์ผ 09/12/2021

Wound management with cold plasma therapy (์ €์˜จ ํ”Œ๋ผ์ฆˆ๋งˆ ์น˜๋ฃŒ๋ฒ•์„ ํ†ตํ•œ ์ƒ์ฒ˜ ๊ด€๋ฆฌ)

์ €์˜จ ๋Œ€๊ธฐ์•• ํ”Œ๋ผ์ฆˆ๋งˆ ์š”๋ฒ•(cold atmospheric pressure plasma therapy, CAPP)์€ ์ˆ˜์˜ํ•™ ๋ถ„์•ผ์—์„œ ์ƒˆ๋กญ๊ฒŒ ๋– ์˜ค๋ฅด๋Š” ๊ธฐ์ˆ ์ด๋‹ค.

์˜ํ•˜์—ฌ Christoph J. Klinger

๋ฐœํ–‰ํ˜ธ ๋ฒˆํ˜ธ 31.2 ์ถœ๊ฐ„์ผ 03/12/2021

Isoxazolines for canine demodicosis (๊ฐœ ๋ชจ๋‚ญ์ถฉ์ฆ ์น˜๋ฃŒ์ œ, ์ด์†Œ์˜ฅ์‚ฌ์กธ๋ฆฐ(Isoxazoline))

์ง€๋‚œ ๋ช‡ ๋…„ ์‚ฌ์ด ๊ฐœ์˜ ์™ธ๋ถ€๊ธฐ์ƒ์ถฉ(ectoparasites)์„ ์น˜๋ฃŒํ•˜๊ธฐ ์œ„ํ•ด ์ƒˆ๋กœ์šด ์•ฝ๋ฌผ์ด ์‚ฌ์šฉ๋˜๊ธฐ ์‹œ์ž‘ํ•˜์˜€๋‹ค. ์ด ๊ธ€์—์„œ Vincent Defalque๋Š” ๊ฐ€์žฅ ํšจ๊ณผ์ ์ธ ์น˜๋ฃŒ์ œ์˜ ์‚ฌ์šฉ๋ฒ•์— ๋Œ€ํ•ด ์„ค๋ช…ํ•œ๋‹ค.

์˜ํ•˜์—ฌ Vincent E. Defalque

๋ฐœํ–‰ํ˜ธ ๋ฒˆํ˜ธ 31.2 ์ถœ๊ฐ„์ผ 23/11/2021

An overview of adverse food reactions in dogs (๊ฐœ์˜ ์‹์ด์—ญ๋ฐ˜์‘(AFR)์— ๋Œ€ํ•œ ๊ฐœ์š”)

์‹์ด์—ญ๋ฐ˜์‘(Adverse food reactions)์€ ๋งŽ์€ ๋‹ค๋ฅธ ํ”ผ๋ถ€ ์งˆํ™˜๊ณผ ์œ ์‚ฌํ•  ์ˆ˜ ์žˆ์œผ๋ฉฐ, ๊ทผ๋ณธ์ ์ธ ๋ณ‘๋ฆฌ ์ƒํƒœ๋ฅผ ์•Œ๊ณ  ์žˆ์–ด์•ผ ํ•œ๋‹ค.

์˜ํ•˜์—ฌ Elisa Maina

๋ฐœํ–‰ํ˜ธ ๋ฒˆํ˜ธ 31.2 ์ถœ๊ฐ„์ผ 22/11/2021

Multidrug-resistant staphylococcal skin infections (๋‹ค์ œ๋‚ด์„ฑ ํฌ๋„์ƒ๊ตฌ๊ท  ํ”ผ๋ถ€ ๊ฐ์—ผ์ฆ)

๋‹ค์ œ๋‚ด์„ฑ ํฌ๋„์ƒ๊ตฌ๊ท  ๊ฐ์—ผ(multidrug-resistant staphylococcal infections) ์˜ ๊ด€๋ฆฌ๋Š” ์ˆ˜์˜์‚ฌ๊ฐ€ ๋‹ค๋ฃจ๊ธฐ์— ์ƒ๋‹นํžˆ ์–ด๋ ค์šด ๋ฌธ์ œ๋‹ค.

์˜ํ•˜์—ฌ Eleanor K. Wyatt ๊ทธ๋ฆฌ๊ณ  Laura M. Buckley