RU2462232C1 - Method of external treatment of psoriatic onychodystrophy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to dermatology and can be applied for external treatment of psoriatic onychodystrophy. For this purpose mixture of gel tisol and ointment daivonex is applied on nidus of affection in ratio 1:2 with following keeping under adhesive plaster during 8-10 h two times per day. Course of treatment constitutes not less than 14 days.

EFFECT: method ensures reduction of treatment terms and duration of remission and obtaining high therapeutic effect.

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Description

The invention relates to the field of medicine - dermatology, and in particular to a method for the treatment of dystrophic lesions of the nail plates in psoriasis (onychodystrophy).

Changes in the nail plates of non-fungal and fungal etiology are one of the most common reasons for patients to contact a dermatologist. On a number of issues of pathogenesis, differential diagnosis and treatment of onychodystrophy, there is no consensus of specialists of various profiles. Differential diagnosis is quite complicated and, first of all, it is necessary to exclude the mycological nature of the disease. The lack of treatment, as well as the wrong tactics of pharmacotherapy with onychodystrophy often leads to the progression of the process, significantly reduces the quality of life of patients.

In the treatment of onychodystrophy, massage, hydrotherapy, applications of an oil solution of retinol acetate 3.44%, intradermal injections of triamcinolone in the nail rollers, local PUVA therapy, long-term use of retinoids, cytostatics (Fitzpatrick T. et al. "Dermatology, atlas-reference book", McGraw-Hill - Practice, 1999, p. 89). The need to use these means of systemic treatment of psoriasis is determined by the severity of the process, and also leads to the development of a number of side effects and complications (increased blood pressure, impaired renal function, increased concentration of potassium and uric acid in the body, etc.) and is characterized by the high cost of the course of treatment (Dobritsa V.P. et al. “Modern immunomodulators for clinical use”, 2001, p. 236-238, A. Kubanova “Dermatovenereology. Clinical recommendations”, 2006, 2007, p. 48).

There is also known a method of treating one of the options for psoriatic onychodystrophy - onycholysis with the application of corticosteroid ointments after massage of the affected fingers (V. S. Novoselov. - Handbook “Skin and sexually transmitted diseases”, edited by O. L. Ivanov. M .: Medicine, 1997 , p. 181). However, the clinical effectiveness of this method has not been proved, not only with onycholysis, but also with other variants of psoriatic onychodystrophy.

The objective of the invention is to improve the method of treatment of various variants of psoriatic onychodystrophy.

The technical result is to reduce the duration of treatment and the duration of remission when achieving a high therapeutic effect.

This technical result is achieved by the fact that in the method of external treatment of psoriatic onychodystrophy by applying an ointment agent of pathogenetic antisoriatic action on the lesions and exposure under adhesive plaster, a mixture of gel insulator and daivonex ointment in a ratio of 1: 2, exposure under the adhesive plaster is used as an ointment agent of pathogenetic antisoriatic action spend 8-10 hours twice a day for a course of treatment of at least 14 days.

The essence of the invention lies in the optimal combination of the ratio of the used drugs of pathogenetic action with time parameters.

The drug tizol gel for external use and the gel structure provides its conductive properties. The drug has anti-inflammatory, accelerating reparative processes and antipruritic effect.

Ointment daivonex - an agent for external therapy of psoriasis, contains the active substance calcipotriol (50 μg, a synthetic analogue of the active metabolite of vitamin D). The essence of the pathogenetic action of this external agent in the treatment of psoriasis is explained by its ability to reduce the inflammatory process in the skin, inhibit the proliferation of keratinocytes, inhibiting DNA synthesis, and stimulate the differentiation of epidermocytes. The immunomodulatory effect of calcipotriol by reducing the synthesis of interleukins - 1, 2, 6, 8, which are relevant for activated T-lymphocytes during psoriasis, has been proved. Calcipotriol reduces the inflammatory response in psoriatic plaques, which is expressed by a significant decrease in dermal periovascular infiltrate. Calcipotriol preparations (daivonex - solution, cream, ointment), at the same time, have low calcium potential due to the insignificant ability to be absorbed through the skin and quick elimination from the body.

The use of thysol-daivonex mixture in the ratio of 1: 2 under the adhesive plaster for 8-10 hours twice a day for at least 14 days in the external therapy of psoriatic onychodystrophy is the most optimal way to reduce the course of treatment while maintaining a high therapeutic effect.

From an analysis of the scientific, technical and patent literature of the claimed combination of features that provide a significant reduction in treatment time and an increase in the duration of remission, we have not identified that allows us to conclude that the proposed solution meets the criteria of "novelty" and "inventive step".

The invention is as follows.

After the diagnosis of psoriasis is diagnosed - psoriatic onychodystrophy, clinical and laboratory examination of the patient is carried out systemic therapy in accordance with the Standard of care for psoriasis patients (Order of the Ministry of Health and CP No. 433 of 05/30/2006). External treatment is prescribed differentially depending on the stage of the disease (progressive, inpatient), the nature of the clinical manifestations and the prevalence of individual symptoms, taking into account the peculiarities of the localization of the process.

After a soap and soda bath, accessible mechanical treatment of the changed nail plates of the feet (brushes) 2 times a day, apply a thin layer of the treatment composition - tizol gel and daivonex ointment in a ratio of 1: 2 under the adhesive plaster for 8-10 hours daily. The duration of treatment is 2 weeks, if necessary, it is possible to continue the course of therapy up to 30 days.

Example No. 1.

Patient S., 35 years old, was admitted to the dermatology department of the URHIIDVI with complaints of extensive rashes, peeling and mild itching during the day, diffuse dystrophic lesion of the nail plate of the feet, the 1st and 5th nail plate of the hands in the form of a “thimble” symptom , grooves of various kinds, "oil stain", distal-lateral hypertrophy, fragility of the free edge. The periungual ridges are not changed. Anamnesis: suffers from psoriatic onychodystrophy from 22 years old 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 to moderate disturbances, vascular component of rashes was visually expressed. Mycological examination of the nail plates is negative.

Conducted treatment: traditional therapy. The proposed method of treatment with tizol gel - daivonex ointment for 14 days was applied to the area of affected nail plates. Active growth of healthy nail plates has begun.

Drug tolerance was satisfactory, no side effects were noted.

Example 2

Patient K., 39 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 11 years ago after suffering psychoemotional stress, followed by annual exacerbations in autumn 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, largely due to the presence of dystrophic pathology of the nail plates of the hands and feet. I, II-th nail plates of both feet are changed according to the hypertrophic type, the free edge is brittle, fissures, various dystrophic changes in the nail plates of the hands; periungual ridges are not changed; Mycological examination is negative.

Conventional therapy is prescribed; externally, the ointment is prescribed ointment dyvobet 1 time per day. The treatment of the nail plates was carried out by the proposed method — tizol gel — daivonex ointment for 18 days.

As a result of the therapy, hyperemia, a pronounced hemorrhagic component, and infiltration of elements decreased, insignificant peeling persisted only on the lower extremities, PASI - 5, 6, DICI - 2. The beginning of the active growth of healthy nail plates on the 9th day of therapy.

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.

Relapses of onychodystrophy during follow-up within 12 months were not observed.

Comparison group 15 patients.

Comparative data of the invention and prototype are shown in the table (clinical efficacy of treatment of psoriatic onychodystrophy).

Table 1. The proposed method Known method 1. Duration of treatment, weeks 3-4 weeks 4-5 weeks 2. The effectiveness of the treatment: - clinical recovery 88.7% 48.4% significant improvement 11.2% 7.3% 3. The duration of the remission period 11-12 months 1-2 months 4. Side effects are absent Several cases of hyperemia, pustulation, irritation of the periungual ridges of the skin (data from the Institute

The proposed course of treatment allows to achieve a more pronounced clinical efficacy of treatment of psoriatic onychodystrophy, to shorten the patient’s stay in hospital, to achieve an extension of the period of 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 the external treatment of psoriatic onychodystrophy, including applying an ointment agent of pathogenetic antipsoriatic action to the lesions and exposure under an adhesive plaster, characterized in that a mixture of gel insulation and daivonex ointment in a ratio of 1: 2 are used as an ointment agent of pathogenetic antipsoriatic effect, the exposure is carried out under a leukoplast for 8-10 hours twice a day for a course of treatment of at least 14 days.