RU2351355C1 - Method of treating skin rosacea disease - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to dermatology and cosmetology and can be used for treatment of such skin disease as rosacea. For this purpose Doppler examination of face skin microcirculation is carried out, during which background volume rate of tissue blood flow on affected and unaffected sections of face skin is determined with further comparison of obtained parameters with each other. In case compared parameters have deviation value not less than 10%, base care of face skin is prescribed: use of purifying and moisturising preparations for sensitive skin, microcurrent therapy in lymphodrainage mode for 20 minutes 2-3 tines a week with course of 8-10 sessions, and introduction of Sulodexide 250 LSU after meal with 4-8 week course. In case compared parameters of background volume rate of blood flow have deviation value from 10 to 20% in case of papula-pustular stage of rosacea, course of microcurrent therapy in lymphodrainage mode is carried out 3 times a week with course consisting of 10 sessions, and Sulodexide is introduced with course of 4 weeks. In case compared parameters of background volume rate of blood flow have deviation value from 20% and greater, rosacea stage being hypertrophic, Sulodexide is introduced with course of 8 weeks, and microcurrent therapy in lymphodrainage mode is carried out from 4^th week 3 times a week with course consisting of 10 sessions in combination with basic care of face skin.

EFFECT: method allows ensuring stable therapeutic effect including treatment of severe forms of rosacea due to complex influence.

3 cl, 2 ex

Description

The invention relates to medicine, namely to dermatology and cosmetology, and is intended for the treatment of skin disease rosacea.

The problem of rosacea, or rosacea, is extremely important and relevant in modern dermatocosmetology in Russia and abroad. An increase in the incidence in recent decades, a chronic relapsing course of the disease, insufficient effectiveness of existing methods of treatment, inadequate therapeutic tactics, and late diagnosis make the problem of studying rosacea very urgent.

Numerous methods of treating rosacea are determined by the variety of etiological and pathogenetic factors of dermatosis, its stage and clinical form. The therapeutic effect of some drugs is aimed at reducing the inflammatory phenomena of dermatosis, others - at correcting various disorders of the functions of internal organs, vascular therapy of rosacea is of particular importance. To date, well-developed approaches to the pathogenetic therapy of rosacea (Arabian E.R., 2004; Potekaev N.N. 2000; Jansen Th. And Plewig G., 1993.). Depending on the stage of the disease, various drugs are used: calcium preparations, belladonna, nicotinic acid, sedatives, antibacterial drugs, metronidazole, synthetic retinoids, external therapy.

Tetracycline hydrochloride and oxytetracycline are widely used (Wilkin J. K., 1994), azithromycin (Fernandez-Obregon A., 2004), as well as doxycycline and minocycline having less phototoxicity (Potekaev N.N., 2000; Berman B., Zeil D., 2005; Del Rosso, JQ, 2004).

Recently, in the treatment of severe forms of rosacea, synthetic retinoids, for example, isotretinoin, have been used (Potekaev N.N., 2000, Modern ideas about the etiology, clinic and therapy of rosacea // Cosmetics and Medicine. - 2001. No. 6. - P.15-21 ; Buechner SA, Rosacea: an update / Dermatology. - 2005. - Vol. 210, No. 2. - P.100-108).

A stable therapeutic effect was achieved by complex general therapy, including, in addition to antibiotics and metronidazole, anti-allergic, antihistamines, sedatives, immunocorrective drugs, angio- and hepatoprotectors, as well as a number of non-drug methods of treating rosacea.

Non-drug methods of treating rosacea based on the effect on the vascular component of the disease are constantly being improved. It has long been known that a good therapeutic effect in rosacea is observed when using cryomassage with liquid nitrogen or snow carbonic acid (Arutyunov V.Ya. / Allergic perioral dermatitis // Bulletin of Dermatology and Venereology. - 1977. - No. 10 - S. 20-25), contrasting water procedures, darsonvalization, iontophoresis (A.I. Kartamyshev, V. A. Arnold / Cosmetic skin care. - Kiev, State Medical Publishing House of the Ukrainian SSR, 1956. - 157 p.).

At present, microcurrent effects using neuromuscular stimulation (Microcurrent Electrical Neuromuscular Stimulation - MENS), (Microcurrent neuromuscular stimulation - the method of choice in the treatment of steroid dermatitis / E.R. Arabian, K.N. Monakhov, T.V., are widely used in cosmetology). Krasnoselsky, A.V. Yakubovsky // Materials of the 35th scientific and practical conference of dermatovenerologists, obstetrician-gynecologists, urologists and laboratory assistants of St. Petersburg. - SPb., 2000. - P.44-45). This physical treatment method is used not only to correct for signs of premature skin aging, but also for various dermatoses. The method of microcurrent neuromuscular stimulation has a positive effect on the skin in various diseases due to the activation of intracellular metabolic processes, local and systemic lymphatic drainage effects, improved microcirculation and accelerated regeneration of damaged tissues. Research (The effects of electric currents on ATP generation, protein syntesis, and membran transport of rat skin / Cheng N., Van Hoof H., Bockx E. et al., // Clin. Orthop. Relat. Res. - 1982. - No. 171. - P.264-272), showed that microcurrents can increase ATP production by 3-5 times, increase membrane transport, which increases the amount of nutrients in the affected area and enhances protein synthesis, also under the influence of microcurrents in the cell enhanced synthesis of lipids, DNA and other biologically active molecules, resulting in an increase in the rate of cell differentiation and tissue regeneration. Clinical experience has shown that microcurrent therapy can reduce or completely stop lymphostasis, inflammatory erythema in patients with rosacea. They carry out treatment on the apparatus E-1000 of Bio Therapevtic computers (USA) in the mode of lymphatic drainage. The specified method of treatment is taken as a prototype as the closest in essence and the achieved result.

However, the disadvantages of this method include the lack of effectiveness of the method in the treatment of severe forms of the disease and the relative duration of treatment.

The invention is directed to the development of an effective comprehensive method for the treatment of skin disease of rosacea.

The technical result consists in increasing the effectiveness of treatment, improving the patient’s condition by reducing edema, erythema, the number of telangiectasias, regression of papules, and reduction of treatment time.

A method of treating a skin disease of rosacea includes a microcurrent effect on the affected skin of the face, in which an additional dopplerographic study of the microcirculation of the skin of the face is carried out, the background volumetric velocity of tissue blood flow in the affected areas of the face skin, the background volumetric velocity of tissue blood flow in the unaffected areas of the face skin are determined. After that, the values of these parameters are compared with each other and if deviations of the compared parameters are detected by at least 10%, basic facial skin care is prescribed by using cleansing and moisturizing agents for sensitive skin, microcurrent therapy in lymphatic drainage mode for 20 minutes 2-3 times week course consisting of 8-10 procedures, and the introduction of Sulodexide 250 LU 2 times a day after meals for 4-8 weeks

If deviations of the compared parameters of the background volumetric velocity of tissue blood flow by 10 to 20% are detected, with the papulopustular stage of rosacea, the course of microcurrent therapy in lymphatic drainage is carried out 3 times a week with a course of 10 procedures, and Sulodexide is administered in a course of 4 weeks.

If deviations of the compared parameters of the background volumetric velocity of tissue blood flow by 20% or more are detected, with the hypertrophic stage of rosacea, Sulodexide is administered for 8 weeks, and microcurrent therapy in the lymphatic drainage regime is carried out from the 4th week 3 times a week with a course of 10 treatments in combination with basic facial skin care.

The state of microcirculation of the facial skin of patients is determined by means of an ultrasonic high-frequency dopplerographic study on a Minimax-Doppler-K device (Minimax LLC, Russia).

Doppler stages include:

1. Determination of the background volumetric velocity of tissue blood flow - Qas (ml / s / cm ³ ) on the affected areas of the skin of the patient's face.

2. Determination of the background volumetric rate of tissue blood flow - Qas (ml / s / cm ³ ) on the unaffected areas of the patient’s face skin.

3. Compare the values of the measured parameters with each other Qas (ml / s / cm ³ ).

If deviations of the measured parameters are detected by at least 10%, treatment is prescribed.

Before treatment, tests are performed to assess the reactivity of skin microvessels with iontophoresis of acetylcholine chloride (endothelium-dependent vasodilation) and nitroglycerin (endothelium-independent vasodilation), determine the volumetric blood flow rate - Qas (ml / s / cm ³ ) on the back of the hand and compare with indicators healthy samples. The deviation of this indicator compared with healthy confirms the presence of the disease and its systematic nature.

The background volumetric blood flow velocity in the entire cohort of patients with rosacea was significantly lower than in the group of healthy ones (Qas of healthy women was 1.224 ± 0.012 ml / s / cm ³ ; in patients with rosacea, Qas averaged 1.136 ± 0.007 ml / s / cm ³ ( t = 4.48; p <0.001)).

The study conducted an objective assessment by the dermatologist of the skin condition of patients with rosacea before treatment, as well as at the end of the 4th week of therapy. Diagnostic assessment of the skin condition (according to V.P. Adaskevich) included determining the number of papular and papulopustular elements (0 - less than 10, 1 - from 11 to 20, 2 - from 21 to 30, 3 - more than 30), as well as high-quality assessment of the severity of erythema (0 - not noticeable, 1 - weak (light), 2 - moderately expressed, 3 - severe (strong)) and the presence of telangiectasia (0 - none, 1 - occupied less than 10% of the face, 2 - from 11 to 30 %, 3 - more than 30%). Secondary signs were also evaluated: dry skin and the presence of peeling (0 - none, 1 - weak, 2 - moderate, with slight peeling, 3 - strong, with severe peeling), subjective sensations (a feeling of "burning and tingling" of the skin), the presence of edema faces (0 - absent, 1 - weak, 2 - moderate, 3 - strong) and ophthalmorosacea (0 - absent, 1 - mild hyperemia, 2 - conjunctivitis, 3 - keratitis, corneal ulcer, other pronounced changes). All patients received MTT in accordance with the developed method.

All patients received Sulodexide 250 LE.

The overall effectiveness was evaluated at each follow-up consultation as follows: no improvement, slight improvement, medium effect (skin condition improved slightly), marked improvement (good effect), significant improvement (very good effect).

EXAMPLES OF TREATMENT

Clinical example 1.

Patient S., 30 years old, complained of redness and swelling of the facial skin that occurred about a year ago. I did not go to the doctor.

On an outpatient dermatological appointment, a diagnosis of skin disease was made: Rosacea, erythematous stage.

Using the ultrasonic computerized device "Minimax-Doppler-K" was determined the state of microcirculation of the skin of the face through dopplerographic studies, which included:

1. The determination of the background volumetric rate of tissue blood flow - Qas (ml / s / cm ³ ) on the affected areas of the skin of the patient's face, which amounted to 1,673 ml / s / cm ³ .

2. Determination of the background volumetric velocity of tissue blood flow - Qas (ml / s / cm ³ ) on the unaffected areas of the skin of the patient's face, which amounted to 1.265 ml / s / cm ³ .

3. Comparison of the measured Qas parameters (ml / s / cm ³ ) with each other, revealed a deviation of 10%.

4. Diagnostics were performed to assess the vascular reactivity of the microvasculature using samples with vasoactive substances (acetylcholine chloride and nitroglycerin) injected into the skin by iontophoresis using a Minimax-Doppler-K instrument.

5. In accordance with the revealed changes in the microvasculature of the facial skin, an MTT course was prescribed, 8 procedures with a frequency of 2 times a week, with the prescription of the tablet drug Sulodexide, 250 LE in capsules, 2 times a day, after meals, for 4 weeks.

Basic facial skin care included gentle facial cleansing using a Sensibio H ₂ O solution (Bioderma).

The procedure of microcurrent therapy was carried out in the mode of lymphatic drainage, within 20 minutes. The final cream was applied by skin type.

The treatment period is 4 weeks.

Skin condition was assessed after treatment.

Diagnostic assessment of the skin condition (according to V.P. Adaskevich) included determining the number of papular and papulopustular elements, as well as a qualitative assessment of the severity of erythema and the presence of telangiectasias. Secondary signs were also evaluated: dry skin and the presence of peeling, subjective sensations (a feeling of “burning and tingling” of the skin), the presence of facial edema and ophthalmosis. There was a decrease in edema, erythema, and the number of telangiectasias.

After treatment, the state of facial skin microcirculation was determined through a dopplerographic study, which included:

1. The determination of the background volumetric rate of tissue blood flow - Qas (ml / s / cm ³ ) on the affected areas of the skin of the patient's face, which amounted to 1.302 ml / s / cm ³ .

2. Determination of the background volumetric velocity of tissue blood flow - Qas (ml / s / cm ³ ) on the unaffected areas of the skin of the patient's face, which amounted to 1.265 ml / s / cm ³ .

3. A comparison of the values of the measured Qas parameters (ml / s / cm ³ ) among themselves revealed a deviation of less than 1%.

Diagnostics was carried out to assess the vascular reactivity of the microvasculature using samples with vasoactive substances (acetylcholine chloride and nitroglycerin) injected into the skin by iontophoresis using a Minimax-Doppler-K device.

The overall effectiveness was evaluated in this patient as a noticeable improvement (good effect).

Clinical example 2.

Patient G., 55 years old, turned in connection with redness of the skin and the appearance of rashes on the face. The year before, she was treated by a dermatologist in the Department of Internal Affairs and was diagnosed with Demodecosis. From the prescribed treatment: I received metronidazole locally in the form of an ointment and orally in tablets, for a long time in courses, without much improvement.

At an outpatient dermatological appointment, the diagnosis was made: Rosacea, papular stage.

1. The determination of the background volumetric rate of tissue blood flow - Qas (ml / s / cm ³ ) on the affected areas of the skin of the patient's face, which amounted to 1,518 ml / s / cm ³ .

2. Determination of the background volumetric velocity of tissue blood flow - Qas (ml / s / cm ³ ) on the unaffected areas of the skin of the patient's face, which amounted to 1.265 ml / s / cm ³ .

3. A comparison of the values of the measured Qas parameters (ml / s / cm ³ ) among themselves revealed a deviation of about 20%.

Diagnostics were performed to assess the vascular reactivity of the microvasculature using samples with vasoactive substances (acetylcholine chloride and nitroglycerin) injected into the skin by iontophoresis.

In accordance with the identified changes, which amounted to 15-20% in the microvasculature of the facial skin, an MTT course was prescribed, 10 procedures with a frequency of 3 times a week, with the prescription of the tablet drug Sulodexide 250 LE in capsules, 2 times a day, after meals, in a course 4 weeks.

Basic facial skin care included gentle facial cleansing using Sensibio H ₂ O solution (Bioderma).

The procedure of microcurrent therapy was carried out in the mode of lymphatic drainage, within 20 minutes. The final cream was applied by skin type. The treatment period is 4 weeks.

Skin condition was assessed after treatment.

Diagnostic assessment of the skin condition (according to V.P. Adaskevich) included determining the number of papular and papulopustular elements, as well as a qualitative assessment of the severity of erythema and the presence of telangiectasias. Secondary signs were also evaluated: dry skin and the presence of peeling, subjective sensations (a feeling of “burning and tingling” of the skin), the presence of facial edema and ophthalmosis.

There was a decrease in edema, erythema, the number of telangiectasias, a decrease in the number of papules, and a complete absence of dryness and peeling.

After treatment, the state of facial skin microcirculation was determined through a dopplerographic study, as a result of which:

The background volumetric rate of tissue blood flow is Qas (ml / s / cm ³ ) in the affected areas of the patient’s face skin, which amounted to 1.284 ml / s / cm ³ .

The background volumetric rate of tissue blood flow - Qas (ml / s / cm ³ ) in the unaffected areas of the patient’s face skin was 1.265 ml / s / cm ³ .

A comparison of the values of the measured Qas parameters (ml / s / cm ³ ) among themselves revealed a deviation of less than 1.5%.

The overall effectiveness was evaluated in this patient as a noticeable improvement (good effect).

Testing the method of treatment

Using the proposed method of treatment in the outpatient department of the Department of Dermatovenerology with the clinic of St. Petersburg State Medical University. Acad. I.P. Pavlova, from October 2005 to January 2007, 200 women with a skin disease of rosacea were examined. All patients gave informed consent to participate in the study.

The average age of the examined patients was 41.0 ± 1.4 years (from 21 to 55 years). Patients received basic therapy in accordance with the developed methodology.

As a result of treatment, 85% of women showed a marked improvement in the patient’s skin condition due to a decrease in edema, erythema, dryness and peeling of the skin, the number of telangiectasias, and regression of papules.

Claims (3)

1. A method of treating a skin disease of rosacea, comprising a microcurrent effect on the affected skin of the face, characterized in that it further conducts a dopplerographic study of microcirculation of the skin of the face, in which the background volumetric rate of tissue blood flow in the affected areas of the skin of the face, the background volumetric rate of tissue blood flow in the unaffected areas are determined facial skin with subsequent comparison of the values of these parameters with each other and when detecting deviations of the compared parameters by at least 10% They begin basic facial skin care using cleansing and moisturizing agents for sensitive skin, microcurrent therapy in lymphatic drainage for 20 minutes 2-3 times a week with a course consisting of 8-10 procedures, and the introduction of Sulodexide 250 LU 2 times a day after food course of 4-8 weeks. 2. The treatment method according to claim 1, characterized in that when deviations of the compared parameters of the background volumetric velocity of tissue blood flow are detected by 10 to 20% for the papular-pustular stage of rosacea, the course of microcurrent therapy in lymphatic drainage is carried out 3 times a week, consisting of 10 procedures, and Sulodexide is administered in a course of 4 weeks. 3. The treatment method according to claim 1, characterized in that when deviations of the compared parameters of the background volumetric velocity of tissue blood flow by 20% or more are detected, with the hypertrophic stage of rosacea, Sulodexide is administered for 8 weeks, and microcurrent therapy in the lymphatic drainage mode is carried out with 4th week 3 times a week with a course consisting of 10 procedures in combination with basic facial skin care.