RU2231359C1 - Method for treatment of skin angiitis ulcerous forms - Google Patents

Abstract

FIELD: medicine, dermatology.

SUBSTANCE: method involves alternation of 5-9 procedures of intravenous injection to patient in the process of it treatment the ozonized physiological solution and 6-9 procedures of gassing damaged foci with oxygen-ozone mixture with reducing the ozone concentration from 30 mg/l to 2 mg/l. The treatment method involves prescription of delagil, tavegil and ascorutin for 3-4 weeks and treatment of ulcerous defects with xeroform ointment up to their cleansing followed by treatment with methyluracil ointment up to their healing. Method provides reducing adverse effects in treatment of skin angiitis ulcerous forms.

EFFECT: improved and enhanced treatment method.

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Description

The invention relates to medicine, namely to dermatology, and can be used to treat ulcerative forms of various skin angiitis: polymorphic-dermal angiitis, lvedoangiitis, hypodermic nodular-ulcerative angiitis.

Angiitis (vasculitis) of the skin (AK) is one of the most pressing problems of modern medicine, primarily dermatology. AK refers to relapsing acute or chronic dermatoses, which occupy a significant place (from 10 to 30%) in the structure of skin diseases. AK is a group of diseases combined by a common immunopathological developmental mechanism with obligatory non-specific inflammation of the walls of dermal and hypodermal blood vessels of various calibers. The clinical manifestations of AK are diverse, but the most common polymorphic rashes are ulcerative defects of the skin (mainly on the lower extremities), due to the inflammatory process in the walls of the vessels.

Modern approaches to the treatment of AK involve the elimination or correction of various links in the pathogenesis of the disease.

A known method of treating AK with the use of cyclophosphamide cytostatic - oral administration at a dose of 1-2 mg / kg / day or pulse therapy 500-1000 mg / m ² / day (10-15 mg / kg / day) for the first 4-6 months monthly, and then once every 3 months (Luqmani RA, Pall A., Adu D. et al. Therapy of vasculitis. In: The Vasculitides / Eds. Ansell V.M., Bacon PA, Lie J. T., Yazici H. - London, 1996 .-- P.315-331).

Aminoquinoline preparations are often used to treat chronic AK: chloroquine diphosphate (delagil) and hydroxychloroquine sulfate (plaquenil). In addition to anti-inflammatory properties, these drugs inhibit platelet aggregation and adhesion and reduce blood viscosity. The following doses are suggested during treatment: a daily dose of plaquenil 400 mg (6.5 mg / kg); delagila - 250 mg (4 mg / kg) (Petri M. Hydroxychloroquine use in the Baltimore lupus cohort: effects on lipids, glucose and thrombosis // Lupus. - 1996. - Vol.5 (suppl. 1). - P.16 -22).

In the complex therapy of AK, the use of drugs that improve the delivery of oxygen to tissues is justified. One of these agents is pentoxifylline and its metabolites. The following scheme is proposed: treatment begins with intravenous drip infusions of pentoxifylline at 200-300 mg / day in 200 ml of physiological saline. The course of treatment consists of 10-15 infusions. Immediately after the end of infusion therapy, they switch to oral administration of the drug at 600-800 mg / day for 30-40 days, followed by a dose reduction to 200-300 mg / day and its administration for a long time (6-12 months) (Matsubara T ., Yabuta K., Furukawa S. Treatment of Kawasaki disease with pentoxifylline, an inhibitor of TNF-alfa transcription // Clin. Research.-1994 - Vol. 42. - P.751-756).

It is known that modern powerful anti-inflammatory drugs, primarily cytostatics, have undesirable side effects, especially with prolonged use: severe inhibition of bone marrow hematopoiesis and impaired gastrointestinal function. Taking for a long time aminoquinoline drugs requires constant monitoring of the level of leukocytes in the blood, liver function, as well as conducting ophthalmological studies. Antispasmodic pentoxifylline (trental) with parenteral administration can cause arterial hypotension. The complex prescription of pharmacological drugs in patients with AK is often limited by the presence of concomitant diseases in these patients, as well as the side effects of each of the medicines.

Closest to the proposed method for the treatment of ulcerative forms of skin angiitis is a method consisting in the appointment of PUVA therapy procedures (irradiation with ultraviolet rays with a wavelength of the A-spectrum) with a methoxalen photosensitizer at a dose of 4 J / cm ² 3 times a week while prescribing prednisolone dose of 20 mg / day, pentoxifylline at 1600 mg / day, aspirin at 750 mg / day; then the dose is increased by another 1 J / cm ² at each session. PUVA therapy was carried out for 7 weeks, the total dose was 197 J / cm ² (Choi H.-j., Hann S.-K. Livedo reticularis and livedoid vasculitis responding to PUVA therapy // J. Amer. Acad.of Dermatology -1999 - vol. 40 - No. 2 - p. 456-463).

The disadvantage of this method of treatment is that PUVA therapy due to its side effects is largely limited to the presence of impaired parenchymal organs in the patient - the liver and kidneys. In addition, an undoubted drawback is that for the success of treatment it is necessary to combine PUVA therapy with prednisolone and other medications, which aggravates the possibility of side effects.

The objective of the invention is to develop a method for the treatment of ulcerative forms of angiitis of the skin, which can reduce side effects by eliminating cytostatic and corgicosteroid preparations from the treatment complex and shorten the treatment time for patients.

The problem is solved by the method, which consists in the fact that alternate 5-9 procedures for intravenous administration of ozonized physiological saline and 6-9 procedures for flowing aeration of foci of damage with an oxygen-ozone mixture with a decrease in ozone concentration from 30 mg / l to 2 mg / l, Delagil is prescribed , tavegil, ascorutin for 3-4 weeks and treatment of ulcer defects with xeroform ointment until they are cleaned and then with methyluracil ointment until they heal.

In practice, the method is as follows.

Alternate 5-9 procedures for intravenous administration of ozonized physiological solution and 6-9 procedures for flowing aeration of foci of lesions with an oxygen-ozone mixture with a decrease in ozone concentration from 30 mg / l to 2 mg / l, Delagil is prescribed at 0.25 g per day, tavegil at 1 mg 2 times a day, ascorutin 0.3 g 3 times a day for 3-4 weeks, ulcer defects are treated with xeroform ointment until they are cleaned and then with methyluracil ointment until they heal.

To obtain the oxygen-ozone mixture, the automatic ozone-therapeutic unit UOTA-60-01 “Medozon” was used. Saturation of physiological solution with medical ozone (ozonation) was carried out in standard bottles until the concentration of ozone in the solution was 2 mg / l; ozonated physiological saline (OGF) was administered to the patient intravenously using standard single-use systems in an amount of 400 ml, with an injection rate of 60-80 drops per minute. Procedures were prescribed from the first day of taking medications. When conducting external ozone therapy (flowing aeration of lesions on the extremities with an oxygen-ozone mixture), a plastic bag in the form of a “boot” was put on the treated limb. The tightness of the space of the bag filled with the oxygen-ozone mixture was achieved through the use of a sealing cuff in which increased pressure was created. Then the plastic bag was filled with oxygen-ozone mixture for 15 minutes. After the procedure, the chamber was purged with pure oxygen for at least 10 minutes to release it from ozone residues before being removed from the limb. The procedure lasted 15-30 minutes.

Clinical examples.

1) Patient G., 53 years old, disabled person II gr. She complained of the presence of multiple itchy papular rashes, as well as painful ulcerative defects up to 5 cm in diameter on the skin of the legs. Sick for 5 years, repeatedly received treatment with various anti-inflammatory and angiotropic drugs (delagil, trental) - without effect. The course of plasmapheresis and the use of corticosteroid ointments led to a short-term improvement, however, after 3-4 months, multiple ulcerative defects again appeared on the skin of the legs.

A course of drug therapy was prescribed: delagil 0.25 1/2 t. 2 p. per day, tavegil 1 mg 1 t. 2 p. per day, ascorutin 0.3 g 3 p. in a day. In parallel, a course of ozone therapy was carried out in the form of intravenous infusions of an ozonized physiological solution with an ozone concentration of 2 mg / L in solution No. 8 and sessions of flowing aeration of the lesions on the lower legs with an oxygen-ozone mixture No. 7 with an ozone concentration of 30 mg / L in the gas mixture and its gradual decrease 5-10 mg / l during each next session up to 2 mg / l. 1 hour after flowing aeration, bandages with xeroform ointment were applied externally; such procedures were carried out until the ulcer defects were cleansed, and then methyluracil ointment was prescribed instead of xeroform.

The treatment was tolerated without side effects. As a result of the course of treatment carried out over 25 days, a significant clinical improvement was noted in the form of regression of papular rashes, healing of ulcerative defects, the disappearance of pain and itching and persistent clinical remission for 8 months.

2) Patient K., 39 years old, engineer. Complains of rashes on the lower extremities, pain, itching, swelling of the legs. Sick for about 2 years, was repeatedly treated with various anti-inflammatory ointments, angiotropic drugs (troxevasin) - without effect. On examination: the skin of both legs is swollen, stagnantly hyperemic, it has numerous small ulcerative defects, sharply demarcated from healthy skin and covered with dense purulent-hemorrhagic crusts, multiple papulonodular island-inflammatory elements and hemosiderosis spots. During the examination: general, biochemical blood tests, general urine analysis, coagulogram - within normal limits.

Treatment: delagil 0.25 on 1 tablet. at night, tavegil 1 mg 1 tablet. 2 p. per day, ascorutin 0.3 g, 1 t. 2 p. per day, externally: xeroform and methyluracil ointment. The treatment course included intravenous drip infusions of ozonized physiological solution with an ozone concentration of 2 mg / L in solution No. 5 and sessions of flowing aeration of the lesions on the lower legs with oxygen-ozone mixture No. 5 with an ozone concentration in the gas mixture of 30 mg / L and its gradual decrease 5 mg / l during each subsequent session up to 2 mg / l.

The treatment was tolerated without side effects. As a result of the course of treatment, regression of inflammatory phenomena, healing of ulcerative defects, and reduction of swelling of the skin of the legs were noted.

The proposed method treated 25 patients, while in 72% of cases a positive clinical effect was achieved (clinical cure or significant improvement) in the form of healing of skin ulcers, regression of swelling and inflammation, the disappearance of itching and soreness. No side effects were noted. It takes 3-4 weeks to complete the course of treatment with our proposed method, while it takes from one and a half to 3 months or more to achieve a clinical effect using only traditional medications.

The high clinical effectiveness of the proposed method of treatment is provided by a combination of oxygen-ozone therapy with selected drugs. The anti-inflammatory effect of the proposed treatment complex is determined by the activation of the antioxidant system and the improvement of the oxygen supply to tissues, which are realized when the therapeutic doses of ozone are systemically introduced into the body. The immunomodulating effect of medical ozone is also manifested, consisting in the activation of phagocytosis, as well as the modulating effect on humoral immunity. In addition, when external application of the oxygen-ozone mixture is combined with xeroform and methyluracil ointment, bactericidal and repairing therapeutic effects occur, i.e. phased treatment of ulcers is provided. In addition to the known biological properties of medical ozone, possibly in combination with drugs prescribed in the treatment complex, ozone can have a pronounced effect on improving microcirculation at the level of the vessels of the dermis and hypodermis.

The method according to the invention allows to reduce the side effects of drugs and reduce treatment time.

Claims (1)

A method of treating ulcerative forms of skin angiitis, including the appointment of anti-inflammatory drugs, characterized in that 5-9 alternating intravenous administration of ozonized physiological saline and 6-9 procedures for flowing aeration of foci of oxygen-ozone mixture with a decrease in ozone concentration from 30 to 2 mg / l , appoint delagil, tavegil, ascorutin for 3-4 weeks and the treatment of ulcer defects with xeroform ointment until they are cleansed and then methyluracil ointment until they heal.