RU2394575C1 - Method of treating psoriasis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, dermatology, and can be used for treating psoriasis. For this purpose photochemotherapy with application of photosensibiliser and long-wave ultraviolet radiation is carried out. Additionally pentoxyphillin in amount 200 mg 3 times per day is introduced.

EFFECT: method allows to reduce number of procedures, reduce dose of ultraviolet radiation, obtain faster beginning of remission and elongation of its terms, reduce possibility of side effects and complications.

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Description

The invention relates to medicine, namely to dermatology, and can be used to treat patients with psoriasis.

Researchers are currently considering psoriasis as a systemic chronic multifactorial disease with a predominant skin lesion, a leading autoimmune component in pathogenesis. Of great importance in the pathogenesis of psoriasis belongs to disorders in the immune system: an imbalance of the T-cell system, an increase in the content of circulating immune complexes, activation of macrophages and pro-inflammatory cytokines (TNF-α, IL-1α, IL-2, IL-6, IL-8). The morphological essence of psoriasis is the hyperproliferation of epidermal cells, a violation of keratinization and an inflammatory reaction in the dermis due to a violation in the cAMP / cGMP system, pathognomonic changes in the basal layer of capillaries in the form of loosening and sharp expansion.

A traditional method of treating psoriasis is known, including detoxifying, desensitizing, antihistamines, vitamin preparations and agents for external therapy. The effectiveness of traditional therapy is low, especially in cases of a common, severe, prolonged course of the disease and remains an urgent problem of dermatology ("Modern methods of treatment of psoriasis" - guidelines, edited by prof. Skripkina Yu.K., M., 1995, p. 3; Treatment of patients with hereditary skin diseases and psoriasis - a guide to pharmacotherapy for doctors under the editorship of Prof. Mordovtsev V.N., Prof. Rasskazova N.I., Astrakhan, 1996, p. 71; Yakubovich A.I., Korepanov A .R., Novitskaya NN, Chuprin AE Clinical efficacy of the drug psorian gamut in treatment and care of patients with psoriasis // Siberian Journal of Dermatology and Venereology -. 2009. - №10 (1) -. P.31).

The closest to the proposed method for the treatment of patients with psoriasis is the use of photochemotherapy (PCT). The method is based on the use of photosensitizers and ultraviolet rays of spectrum A (320-400 nm) (Mordovtsev V.N., Mushet G.V., Albanova V.I. “Psoriasis.” - Chisinau, Shtiintsa, 1991., p.135 ; Clinical recommendations. Dermatovenerology. Edited by A.A. Kubanova - M .: DEKS-Press, 2007. - 149. 152 p.).

The experience of using the method of photochemotherapy (PCT) made it possible to note its high efficiency, but also demonstrated the possibility of developing a number of side effects and complications due to both the action of the photosensitizer and the total dose of long-wave ultraviolet radiation (UVA).

In order to reduce side effects, complications, more quickly achieve clinical remission and reduce the number of procedures, reduce the dose of long-wave ultraviolet radiation, a combination of the PCT method with other medications is recommended. The most promising development of schemes for the combined treatment of patients with psoriatic disease with simultaneous effects on various pathological processes.

The objective of the invention is to increase the therapeutic effectiveness of the treatment of patients with psoriasis.

The technical result is achieved by the fact that in the method of treating psoriasis with photochemotherapy, which consists in the combined use of a photosensitizer and long-wave ultraviolet radiation, additionally 200 mg pentoxifylline is used 3 times a day in parallel with PCT.

The essence of the invention lies in the appointment of a drug from the group of agents that improve peripheral circulation - angioprotectors in combination with photochemotherapy.

Pentoxifylline is a derivative of methylxanthine (Russian Medicines Register, 1999). Its main pharmacological effects are associated with the ability of nonspecific inhibition of type 4 phosphodiesterase activity, which leads to an increase in the content of cyclic 3,5 AMP in platelets and erythrocytes along with a decrease in the intracellular concentration of calcium ions. In addition, pentoxifylline has the ability to block adenosine receptors. Both in experimental and in clinical conditions, the ability of the drug to exert a pronounced positive effect on the state of microcirculation has been proved. The change in the rheological properties of the blood is associated primarily with an increase in the deformability of red blood cells, as well as with a decrease in the viscosity of whole blood and platelet disaggregation. Pentoxifylline differs from most known antiplatelet agents in its ability to influence the functional properties of red blood cells. At the same time, the drug has a positive effect on the state of hemodynamics due to vasodilation with a decrease in total and regional peripheral vascular resistance. Thus, pentoxifylline affects the state of the vascular wall, activating the production of prostacyclin, eliminates vascular spasm; causes a decrease in fibrinogen level, platelet adhesion and aggregation activity, which significantly reduces the risk of thrombosis; increases elasticity and reduces the aggregation ability of red blood cells.

Numerous experimental and clinical studies have established the ability of pentoxifylline to increase blood flow in various vascular systems. Studies of the last decade have revealed new properties inherent in the drug.

It was found that in therapeutic dosages it inhibits the activity of circulating mononuclear cells, neutrophils and T-lymphocytes, and also reduces the synthesis of pro-inflammatory cytokines. It is with these properties, and not just with the ability to correct the rheological properties of blood, that its protective effect on various tissues, including skin cells, can be associated.

The additional use of pentoxifylline 200 mg 3 times a day in parallel with PCT provides a vasodilating, antiplatelet effect, improves microcirculation and rheological properties of blood, improves tissue oxygen supply, which represents a therapeutic effect on a number of significant aspects of the pathogenesis of psoriasis.

From an analysis of the scientific, technical and patent literature of the claimed combination of properties, which leads to a significant increase in therapeutic efficacy by reducing the number of procedures and the course dose of UVA and the course dose of the photosensitizer, the complex effect on the main mechanisms of the pathogenesis of the disease, reducing the duration of exacerbation, preventing side effects and prolonging the duration remission, not identified, which allows us to conclude that the claimed technical solution meets the criteria of "novelty" and "invention tel level. "

The method is as follows.

Patients with vulgar psoriasis, a duration of a disease or exacerbation of 1 month, a PASI value of 10-20 points are subjected to a general clinical examination, consultation with an ophthalmologist, endocrinologist, gynecologist to identify diseases in which photochemotherapy is contraindicated.

If contraindications to PCT are identified, traditional therapy is recommended in accordance with the clinical recommendations “Dermatovenerology 2007” (edited by A.A. Kubanova). Patients of this group are given detoxification-hormonal, hyposensitizing, antihistamine therapy, a complex of vitamins, external therapy, physiotherapy are prescribed.

The absence of concomitant diseases allows us to recommend the appointment of complex therapy - photochemotherapy and pentoxifylline.

Photochemotherapy (PCT) is carried out four times a week: after eating, the patient is prescribed an ammifurin photosensitizer at a dose of 0.8 mg / kg body weight. After 2 hours, ultraviolet irradiation with a wavelength of 320-400 nm is carried out. In the presence of persistent hyperkeratosis in psoriatic foci, external agents with exfoliating and anti-inflammatory action are preliminarily prescribed for 2-3 days 2 times a day.

Pentoxifylline is prescribed from the 1st day of treatment at 200 mg (1 tablet 100 mg) 3 times a day, washed down with plenty of water.

The proposed method of therapy is easily reproducible, accessible and feasible in medical institutions.

Example 1

Patient K., 33 years old, was admitted to the dermatological department of the UrNIIDViI with complaints of extensive rashes, peeling and moderate itching during the day. Anamnesis: suffers from psoriasis since the age of 23 with autumn-spring exacerbations. Traditional treatment with a slight positive effect. The duration of this exacerbation is 4 months. A traditional paraclinical examination was performed, PASI - 23.2, BSA - 45%, dermatological index of quality of life (DIC) - 19, clinical evaluation of pruritus - mild disturbances, vascular component of rashes was visually expressed. The proposed method of treatment was applied: detoxification hormone therapy was carried out for 2 days, then photochemotherapy (PCT) four times a week according to the above method and in parallel with pentoxifylline 200 mg 3 times a day.

In the presence of persistent hyperkeratosis in psoriatic foci, 2-5% salicylic ointment with active exfoliating and mild anti-inflammatory action is preliminarily prescribed for 2-3 days 2 times a day.

Against the background of the treatment, on the 15th day of therapy, a decrease in hyperemia of the elements, residual mild infiltration in the region of the lower extremities and slight peeling were noted. PASI - 9.9, DIC - 4, clinical assessment of pruritus - no significant violations.

Example 2

Patient P., 38 years old, was admitted to the hospital with complaints of widespread rashes, dry skin, moderate itching during the day, and slight flaking. Anamnesis: first fell ill in 1998 after suffering emotional stress, followed by annual exacerbations in the fall and winter. Inpatient treatment was carried out annually, with a subsequent remission of about 2 months. This exacerbation is 2-3 months, self-treatment with external agents with insignificant positive dynamics. A traditional laboratory examination was conducted, PASI - 22.1, BSA - 38%, DICI - 20, average anxiety level - 22 points.

The treatment was prescribed according to the developed scheme: photochemotherapy (PCT) four times a week according to the above method and at the same time, pentoxifylline 200 mg 3 times a day; externally, an ointment was prescribed dyvobet once a day.

As a result of the therapy, hyperemia, a pronounced hemorrhagic component, element infiltration decreased, slight peeling persisted only on the lower extremities, PASI - 5.6, DIC - 2.

Tolerance to the drug was satisfactory, no side effects were noted.

The indicated scheme was used in the treatment of 30 patients with vulgar psoriasis.

Relapse of the disease during follow-up within 24 months was not observed.

Comparison group of 16 patients receiving traditional therapy.

Comparative data of the invention and prototype are shown in the table.

Table 1 The proposed method Known method 1. Duration of treatment, weeks 3 weeks 4-5 weeks 2. The effectiveness of the treatment: - clinical recovery 98.8% 49.4% - significant improvement - improvement 1.2% 21.3% - 29.3% 3. The duration of the remission period 8-11 months 1-2 months 4. Side effects are absent toxic-allergic (data from UrNIIDViI), itching

As can be seen from the table, the proposed course of treatment can reduce the patient’s stay in the hospital, with the non-invasive route of administration of the drug pentoxifylline in combination with the PCT method, to achieve a longer remission due to the impact on the pathogenetically significant psoriasis factor. In addition, the proposed method of treatment allows the treatment of patients with psoriasis in both inpatient and outpatient settings, with a clear clinical effect, confirmed by clinical indicators, preventing complications, reducing the length of hospital stay of patients and increasing the duration of remission compared to existing treatment methods.

Claims (1)

A method for treating psoriasis with photochemotherapy, which consists in combining the use of a photosensitizer and long-wave ultraviolet radiation, characterized in that pentoxifylline is additionally used in parallel with photochemotherapy, 200 mg 3 times a day.