RU2597277C1 - Method of treating lichen acuminatus - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to dermatology, and can be used in treating lichen acuminatus. At the disease exacerbation with underlying standard drug therapy performed is a contactless supply of modulated radiation during 40-45 minutes with the frequency of 0.022 Hz-270 kHz with rectangular form of initial pulses and output current with the voltage amplitude up to 20 V followed by a contact supply of modulated radiation during 42-48 minutes with the frequency of 0.2-360 kHz with triangular form of initial pulses and output current with the voltage amplitude up to 20 V. In the remission stage performed is a contactless supply of modulated radiation during 40-45 minutes with the frequency of 2-48 kHz with rectangular form initial pulses and output current with the voltage amplitude up to 20 V. For one year 3-4 courses are performed. Therapeutic course is 10 procedures 1 time a day.

EFFECT: method provides higher clinical effectiveness of various forms of lichen acuminatus, reduced drug load on patients, reduced rate of recurrences, higher quality of life of patients due to correction of immune and vegetative body system disorders, anti-inflammatory and desensitizing effects, normalization of psycho-emotional state.

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Description

The invention relates to medicine, namely to the field of dermatology, and can be used in the treatment of lichen planus.

The problem of treatment of lichen planus (CPL), especially common recurrent forms accompanied by intense itching, as well as forms accompanied by hypertrophic changes and lesions of the oral mucosa, is still far from being resolved and requires further improvement. Therefore, the search for effective, pathogenetically substantiated, medical and physiotherapeutic methods that act directly on the whole body as a whole and on altered skin, stimulating the compensatory mechanisms of the body itself and not having side effects, is relevant. Currently, the most common methods of medical treatment for lichen planus include the use of desensitizing and antihistamines, sorbents, glucocorticoids (systemic and local), the use of cytostatics, immunocorrective agents, sedatives, vitamins, probiotics, herbal remedies. These treatment methods are accompanied by a number of undesirable effects and complications, such as the duration of treatment courses, addiction to drugs and, as a result, withdrawal syndrome, skin atrophy, impaired liver function, dyspeptic symptoms, allergic reactions, treatment resistance of the hypertrophic form of CPL, difficult to stop itching with disseminated forms of CPL, the absence of preventive schemes for the prevention of relapse.

A wide range of physiotherapeutic techniques has proven itself in the treatment of chronic recurrent dermatoses, both in complex and in the form of monotherapy. Currently, of physiotherapeutic methods for CPL, PUVA and selective phototherapy are successfully used:

- selective phototherapy (SFT) - a combination of medium-wave radiation at a wavelength of 295-330 nm with long-wave UV radiation (UVA);

- narrow-wave UVB phototherapy with a maximum emission at a wavelength of 311 nm;

- photochemotherapy (PUVA) - the combined use of long-wave UV radiation (UVA) with photosensitizers;

- phototherapy using long-wavelength UV radiation of a narrow spectrum (UVA-1) at a wavelength of 370 nm.

According to a number of domestic and foreign authors, these phytotherapeutic methods of treatment, on the one hand, have a relatively high cost, not available to a wide range of patients, and, at the same time, have a number of side effects associated, for example, with the use of a photosensitizer (ammifurin, oxoralen). Headache, dizziness, cardialgia, dyspepsia, insomnia, and depression are noted. Itching and dryness, redness and skin burns are associated with the action of ultraviolet radiation. There are other contraindications for use: hypersensitivity to photosensitizers (ammifurin, oxoralen); severe diseases of the gastrointestinal tract, liver and kidneys (acute gastritis, peptic ulcer of the stomach and duodenum, pancreatitis, hepatitis, cirrhosis, nephritis); decompensated endocrine diseases (diabetes mellitus, thyrotoxicosis); decompensated arterial hypertension and heart failure; oncological diseases; multiple pigmented nevi; lupus erythematosus; blood diseases (leukemia); tuberculosis; cachexia; cataract; pregnancy, lactation; age up to 16 years; the use of potential carcinogens in the past (arsenic preparations, X-ray therapy of tumors) [V. Vladimirov Broad-wave medium-wave ultraviolet radiation (selective phototherapy) in the phototherapy of chronic dermatoses. Modern problems are dermatovenerologists, immunology and medical cosmetology. 2009, No 1. S. 46-50].

There are long-term consequences associated with prolonged exposure to ultraviolet radiation (with ultra-long, frequent use of PUVA therapy for many years) and with neglect of protective measures (glasses, sunscreens, protective regimen) - symptoms of skin aging, skin tumors, cataracts. Unfortunately, the above facts limit the use of these physiotherapeutic techniques in a wide range of patients. [Olisova O.Yu., Mikryukov A.V. The combination of medium-wave ultraviolet radiation of a narrow spectrum of 311 nm and diprospan in the treatment of common forms of lichen planus. Grew up. journal leather and veins. bol. - 2007 No. 3 from 12-16.]

Known (RU, patent 2317116, publ. 02.20.2008) is a method of electromagnetic therapy used in the treatment of a number of somatic diseases, as well as increasing the level of health, physical and functional reserves of the body.

The disadvantage of this method is the lack of a practically justified algorithm for a differentiated approach in the combination therapy of dermatological diseases and, in particular, the treatment of various forms of lichen planus.

Known (SU, copyright certificate 908376, publ. 02.28.1982) a method of treating lichen planus. According to a known method, the patient is administered the drug Beroxan and is exposed to the focus of the disease with ultraviolet rays.

The disadvantage of this method should be recognized as its low efficiency, duration, as well as almost inevitable relapses.

Also known (RU, application 94031062, publ. 03/27/1997) a method for the treatment of tumor diseases of the skin of the face and mucous membrane of the oral cavity, including lichen planus, including laser irradiation with a wavelength of 0.52-0.57 microns in pulsed generation mode.

The disadvantage of this method should be recognized as its low efficiency.

The specified technical solution was taken as the closest analogue.

The technical problem solved by the developed method consists in expanding the methods and technical tools used in the treatment of lichen planus.

The technical result achieved by the implementation of the developed technical solution in the treatment of patients with lichen planus consists in increasing the effectiveness of treatment of various forms of lichen planus, reducing the drug load on patients of this nosological unit, reducing the frequency of relapses while improving the quality of life of patients.

To achieve the specified technical result, it is proposed to use the developed method for the treatment of lichen planus. According to the developed method for the treatment of lichen planus by exposure to a physical factor, electromagnetic radiation is used as a physical factor, in the stage of exacerbation of the disease against the background of standard drug therapy, contactless supply of modulated radiation is carried out for 40-45 minutes with a frequency of 0.022 Hz - 270 kHz in a rectangular shape the initial pulses and the output current with a voltage amplitude of up to 20 V, and then the contact supply of modulated radiation for 42-48 min with a frequency of 0.2-360 kHz at the rectangular shape of the initial pulses and the output current with a voltage amplitude of up to 20 V, in the remission stage, the contactless supply of modulated radiation is carried out for 40-45 min with a frequency of 2-48 kHz with a rectangular shape of the initial pulses and an output current with a voltage amplitude of up to 20 V during the year 3-4 courses per course of 10 procedures 1 time per day.

When contacting the supply of electromagnetic radiation in a disseminated form of the disease, preferably the electrodes are applied to the collar region.

When contacting the supply of electromagnetic radiation with a verrucous form of the disease, predominantly electrodes are applied around large foci.

With a combined lesion of the oral mucosa, the electrodes are usually placed symmetrically with a capture of the upper and lower jaw.

In the future, the effectiveness of the developed method will be justified using experimental material.

The first clinical group (24 people) (14 women and 10 men) in the age category of 26 to 58 years old, suffering from various forms of lichen planus, was divided into 3 subgroups:

- 1st subgroup - 8 people - patients with a disseminated typical form, who, along with standard drug therapy, simultaneously took treatment according to the developed method, including contactless delivery of modulated radiation with a frequency of 0.022 Hz-270 kHz for 40-45 min with a rectangular shape of the initial pulses and an output current with a voltage amplitude of up to 20 V, and then contact supply for 42-48 min of modulated radiation with a frequency of 0.2-360 kHz with a triangular shape of the initial pulses and an output current with an amplitude of voltages up to 20 V, in the remission stage for the prevention of exacerbations of lichen planus, during the course of a year, 3-4 courses of contactless delivery for 40-45 minutes are carried out, for a course of 10 procedures 1 time per day, modulated radiation with a frequency of 2-48 kHz with a rectangular the shape of the initial pulses and the output current with a voltage amplitude of up to 20 V;

- 2nd subgroup - 8 people - patients with a hypertrophic (verrucous) local form, who, in combination with standard drug therapy, simultaneously took treatment according to the developed methodology, including contactless delivery of modulated radiation for 40-45 min with a frequency of 0.022 Hz - 270 kHz with a rectangular shape of the initial pulses and an output current with a voltage amplitude of up to 20 V, and then contact supply for 42-48 minutes of modulated radiation with a frequency of 0.2-360 kHz with a triangular shape of the initial pulses and an output current ohms with a voltage amplitude of up to 20 V, in the remission stage for the prevention of exacerbations of lichen planus, 3-4 courses of contactless delivery are performed during the course of a year for 40-45 minutes, for a course of 10 procedures 1 time per day, modulated radiation with a frequency of 2-48 kHz with a rectangular shape of the initial pulses and with an output current with a voltage amplitude of up to 20 V;

- 3rd subgroup - 8 people - patients with a disseminated form with simultaneous damage to the oral mucosa, who, along with the typical drug treatment with standard drug therapy, simultaneously took treatment according to the developed method, including contactless delivery of modulated radiation for 40-45 min with a frequency of 0.022 Hz-270 kHz with a rectangular shape of the initial pulses and an output current with a voltage amplitude of up to 20 V, and then contact supply for 42-48 min of modulated radiation with a frequency 0.2-360 kHz with a triangular shape of the initial pulses and an output current with a voltage amplitude of up to 20 V, in the remission stage for the prevention of exacerbations of lichen planus, 3-4 courses of contactless delivery are performed during the course of a year for 40-45 minutes, for a course of 10 procedures 1 once a day, modulated radiation with a frequency of 2-48 kHz with a rectangular shape of the initial pulses and an output current with a voltage amplitude of up to 20 V.

The second clinical group - the control group - 28 people aged 26 to 58 years old - patients suffering from similar clinical forms of lichen planus: disseminated typical CPL (15 people), local hypertrophic (verrucous) (8), disseminated CPL with mucosal lesions mouth (5), who received exclusively traditional drug therapy: desensitizers (calcium gluconate 10% - 10 ml or sodium thiosulfate 30% - 10 by 10 intravenous injections, antihistamines (desloratodine), Unna cream, vitamins, sedatives plant origin.

Patients of all groups and subgroups were carefully examined by clinical and anamnestic methods (DIC from 0 to 30), an index reflecting the effect of pruritus on the patient's daily life-Behavioral Rating Scores (BRS), index of severity of the skin process Index Lichen Planus (ILP) - from 0 -18 points, psychophysiological methods (TACT) on the scales: hypertimity, social activity, energy, sensitivity, timidity, aggressiveness, emotional lability, rigidity, paraclinical methods (OAK, OAM, blood test) before treatment and upon completion [V.P. Adaskevich. Diagnostic indices in dermatology. M .: Medical book. 2004], [Test of accentuated properties of temperament: method. Ruk. / V.V., Severyanova D.V. - St. Petersburg: IMATON, 2006.80 p.].

For a comparative assessment of the effectiveness of long-term results and the advisability of anti-relapse courses of monotherapy, the condition of the patients was evaluated during the year of observation (similar methods + duration of the remission period). The reliability of the results was determined by paired unpaired t-student test, non-parametric Mann-Whitney criterion and z-criterion for the difference in shares.

Differences and relationships were considered significant at p <0.05.

The clinical picture of disseminated forms was characterized upon admission by the presence of multiple, sometimes confluent, papules of a polygonal shape with an umbilical depression in the center of a bluish-red color. The hypertrophic form was characterized by the localized symmetrical nature of large pathological elements, represented by polygonal drainage wart formations in a single area, rising above the level of healthy skin with a nosy hyperkeratotic surface, with clear uneven borders with a stagnant red color, the skin process was widespread.

The clinical form of CPL with a combined mucosal lesion was characterized by multiple, sometimes confluent polygonal papules, mainly on the flexion surfaces of the limbs, in some places linearly located papules from bright red to bluish in color, with a depression in the center. There was an isomorphic Kebner reaction, there was a clear visualization of the Wickham grid. The oral mucosa is hypiemated, on the gums, cheeks, tongue, bright red erosion with whitish contours. The main subjective symptom was severe itching, psycho-emotional instability, and sleep disturbance.

In the group of patients in the control group, itching was observed in 100% of patients, but in varying degrees of intensity, and was stopped only with the help of antihistamines on days 6-8, after which it was quickly restored. By the end of the 17-21 day standard therapy, itching completely disappeared in 4 (16.3%) of 24 people.

Sleep disturbance was observed in 21 (87.5%) of 24 patients. 10 days after the start of treatment, sleep returned to normal in 5 (23.8%) patients, and by the end of the full course of treatment - in 13 (54.2%) patients.

In three subgroups of the first clinical group, in which, along with traditional therapy, the developed method was used, there were 24 people. In this group, 24 (100%) people were affected by pruritus before treatment. A decrease in the intensity of pruritus was observed 2-4 days after the start of treatment, and by the end of the first week of combination therapy, itching completely stopped in (87.5%). After a full course of therapy, the disappearance of pruritus was noted in 100% of patients. Along with a decrease in the intensity of pruritus in patients receiving combined treatment, normalization of sleep was observed in 23 (95.8%) of 24 patients 10 days after the start of treatment.

The effectiveness of the new comprehensive methodology for the differentiated treatment and prevention of exacerbation of various forms of lichen planus was determined in accordance with the positive dynamics of the main diagnostic criteria (clinical and laboratory) and was evaluated using: TACT, the dynamics of which reflected psycho-emotional stabilization, a dermatological index of quality of life ( DIC) - improved (decreased) by more than 86% and amounted to 1.6 ± 0.6 points, Index of severity of the skin process Index Lichen Planus (ILP) with disseminated dissemin Rowan form KPL decreased by 85.8%, while hypertrophic form - at 78.3% recovery, overall BRS index 7.6 ± 0.4 decreased to almost zero value - 0.4 ± 0.2. Thus, a combined assessment of the regression of clinical symptoms and dynamics of the severity of the skin process testified to the high effectiveness of combination therapy. A general positive therapeutic effect (clinical recovery) was observed in almost all patients who received the combined technique during the follow-up when conducting anti-relapse monotherapy with the developed method.

Example No. 1

Patient S., 51 years old, was treated in a day hospital from 12/05/13 to 12/16/2013 with a diagnosis of lichen planus, typical shape, diffuse distribution.

Complaints of rashes in the chest, abdomen, back, upper and lower extremities, severe itching, sleep disturbance. Sick for about a year and a half, periods of remission of not more than a month (against the background of drug treatment). The manifestation of the disease is associated with dental disease (long-term untreated caries). He received treatment: desensitizing, antihistamines, external steroid ointments. There is no history of chronic somatic diseases. General condition is satisfactory. Objectively: the skin process is common. Pathological elements are represented by multiple, sometimes confluent polygonal papules of cyanotic color, with a diameter of up to 0.3 cm to 0.8 cm, with clear boundaries, transverse striation along the surface (the Wickham grid is well visualized), and the umbilical depression is visible in the center. The patient underwent complex treatment: sodium thiosulfate 30% -10 ml i / v e / d No. 10, desloratodine 0.05 mg per day No. 10, novopasit 1 t 3 times a day, aevit 1 tablet 3 times a day within a month. Locally applied "Unna cream" for 12 days. From the first day in the day hospital, the patient was treated according to the developed technique.

Normalization of sleep and a significant reduction in pruritus was observed on day 2. By the end of the first week of treatment, itching was absent. The positive dynamics of skin symptoms was noticeable by the end of the 1st week after the start of treatment. Discharged from a day hospital in a state of clinical recovery on day 12, with slight small focal hyperpigmentation in places of resolved inflammatory elements.

General analysis of blood, urine, liver tests, immunological parameters of blood without pathology. During the follow-up, during the year, 4 courses of anti-relapse mototherapy were carried out according to the developed technique with an interval of three months. During the observation of recurrence of lichen planus was not.

Example No. 2

Patient M., 56 years old, was on outpatient treatment since 02/05/14. on 02/17/14. with a diagnosis of Red lichen skin. Hypertrophic (verrucous) localized form.

Complaints of rashes in the region of the lower extremities (the anterior surface of the legs, more on the right, intense, poorly stopped by self-administration of suprastin (up to 3 tablets per day), itching, sleep disturbance. She became ill about 2 years ago, is associated with pneumonia and prolonged a course of antibiotic therapy. Previously, I did not contact a dermatologist (regarding CPL). The general condition is satisfactory. Objectively: the skin process is localized symmetrical. Pathological elements are represented by polygonal warty plums formations rising into a single area, towering above the level of healthy skin with a nosy hyperkeratotic surface, with clear irregular borders with a stagnant red color. The patient underwent complex treatment: calcium gluconate 10% -10.0 ml iv, f / d No. 10, desloratodine 0.05 mg per day, novopasit 1 tablet 3 times a day, aevit 1 tablet 3 times a day for a month. Locally used "Unna cream" for 14 days. From the first day in a day hospital, the patient was treated developed methodology.

Normalization of sleep was observed on the 3rd day. By the 4th day of treatment, the disappearance of itching, as well as the positive dynamics of skin symptoms, a significant decrease in hyperkeratosis were noted. In the foci of defeat, a distinct flattening of verrucous papular elements. By the 13th day, hyperpigmentation from the periphery to the center was observed, without hyperkeratosis in the foci, the patient was discharged from the day hospital in the stage of clinical recovery.

General analysis of blood, urine, liver tests, immunological blood counts in the range of normal values.

During the follow-up, during the year 3 courses of anti-relapse mototherapy were carried out according to the developed technique. There was no relapse of lichen planus during the observation; persistent large focal hyperpigmentation occurred in the areas of resolved verrucous plaques.

Example No. 3

Patient V., 38 years old, was treated in a day hospital on 01/13/2014 to 01/24/2014 with a diagnosis of Red lichen planus, disseminated form. With damage to the oral mucosa.

Complaints of excruciating itching, rashes in the forearms and legs, damage to the oral mucosa, soreness when eating food, burning mouth, sleep disturbance, depression, anxiety. Sick for about 2 years, remissions unstable no more than 1-2 months. The disease is associated with stress. The last exacerbation began two weeks ago. The hereditary history is not burdened, there are no diseases of the internal organs. General condition is satisfactory. In the past, she received antihistamines, aevit, steroid ointments with a temporary effect. About a year ago, I independently pierced 5 injections of diprospan, after a two-month improvement, I noticed for the first time changes in the oral mucosa.

Objectively: the skin process is common.

The lesions are represented by multiple, sometimes confluent polygonal papules, mainly on the flexion surfaces of the limbs, in some places linearly located papules from bright red to cyanotic color, with a depression in the center. An isomorphic Kebner reaction takes place; the Wickham net is clearly visualized. The oral mucosa is hypiemated, on the gums, cheeks, tongue, bright red erosion with whitish contours.

General blood test (leukocytosis-9.1 * 10 to 9 degrees / l, with a slight shift of the leukocyte formula to the left), liver tests without pathology. The patient underwent a comprehensive treatment: calcium gluconate 10% -10 ml iv, e / d No. 10, desloratodine 0.05 mg per day, Novoproso 1 table. 3 times a day, aevit 1 tablet 3 times a day for a month. Locally on the oral mucosa, rinse with a decoction of chamomile, “Unna cream” was applied to the skin for 12 days.

Along with traditional treatment, at the same time, the complex used treatment according to the developed technique.

By day 3, sleep and psycho-emotional state returned to normal, itching decreased significantly, there was no discomfort in the oral mucosa, and by the 5th day itching completely disappeared, by the 6th day of treatment positive dynamics of skin symptoms were observed, persistent epithelization of oral erosion, normalization of the leukocyte formula were observed. In the lesions by the 12th day, the papules regressed to hyperpigmented spots, the oral mucosa cleared of inflammatory changes.

General analysis of blood, urine, liver tests, immunological parameters of blood after treatment were within normal limits. During the follow-up, during the year 3 courses of anti-relapse motor therapy were carried out. During the observation of recurrence of lichen planus was not.

During all courses of treatment according to the developed method, neither local nor general adverse reactions were noted.

To assess the frequency of exacerbations of the disease, a follow-up period of 12 months was chosen. It was found that during treatment according to the developed method, no relapses were observed during the year, and the control group had 28 relapses per year.

Clinical examination data before and immediately after a course of treatment according to the developed technique reflected a significant regression of clinical indices reflecting the severity of lichen planus: BRS, DIC, ILP, TACT, and the evaluation of long-term follow-up results showed great therapeutic and preventive efficacy of the developed method. Summarizing the overall data, it can be stated that the application of the developed method has an active adaptogenic effect, which helps to eliminate the disorders caused by the disease (red lichen planus) from the body’s immune and vegetative systems, having a pronounced anti-inflammatory and desensitizing effect, normalizes the psychoemotional status, accelerates the positive the dynamics of dermatological indices (disease severity index, dermatological index of quality of life), ostoverno improves the clinical course of the red flat

depriving compared with a group of patients who received only standard therapy.

Claims (4)

1. A method for the treatment of lichen planus by exposure to a physical factor, characterized in that electromagnetic radiation is used as a physical factor, in the stage of exacerbation of the disease, against the background of standard drug therapy, contactless delivery of modulated radiation is carried out for 40-45 min with a frequency of 0.022 Hz - 270 kHz with a rectangular shape of the initial pulses and an output current with a voltage amplitude of up to 20 V, and then the contact supply of modulated radiation for 42-48 min with a frequency of 0.2-360 kHz at tre the carbon form of the initial pulses and the output current with a voltage amplitude of up to 20 V, in the remission stage, the modulated radiation is contactlessly supplied for 40-45 min with a frequency of 2-48 kHz with a rectangular shape of the initial pulses and the output current with a voltage amplitude of up to 20 V during the year 3-4 courses per course of 10 procedures 1 time per day. 2. The method according to p. 1, characterized in that when the contact supply of electromagnetic radiation with a disseminated form of the disease, the electrodes are applied to the collar region. 3. The method according to p. 1, characterized in that when the contact supply of electromagnetic radiation with a verrucous form of the disease, the electrodes are applied around large foci. 4. The method according to p. 1, characterized in that with a combined lesion of the oral mucosa, the electrodes are placed symmetrically with the capture of the upper and lower jaw.