RU2640447C1 - Method of treatment of rosazea - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: processing of abnormal focus of facial skin by laser equipment SP Dualis Spectro Nd: YAG by laser with 1064 nm wavelength is carried out, using a laser scanner headpiece S-11.40 j/cm², frequency of 3Hz, pulse length 30-50 Ms. Wherein the number of treatments per procedure is from 1 to 3 times. Then immediately consistently injections of ozone-oxygen mixture, obtained on installation of "Medozons BM" in the concentration of 1300-1600 mcg/l is carried out both directly under the abnormal focus and on the entire face surface, maintaining the distance between injections 2.5 cm. At the same time, 6 procedures are performed at intervals of 2 times a week, then 3 procedures at an interval of 1 time per week and 3 procedures at an interval of 1 time per month, the course of treatment is repeated after 1.5-3 months. Method allows to lengthen the remission up to 24 months at I stage of erythematous-telangiectatic, at stage II papulopustular at 81.2% of patients and up to 14-18 months, at stage III pustular-nodulous form of disease at 58.2% of cases up to 12-16 months.

EFFECT: method has a higher therapeutic efficacy.

2 ex

Description

The present invention relates to medicine, in particular to dermatology, cosmetology, physiotherapy, and can be used in skin and venereological dispensaries, cosmetic hospitals, in various medical and preventive and spa institutions, including in a specialized dermatological clinic.

Rosacea is one of the most common dermatoses in people over 35 years old and occurs the same in both sexes; it can also develop in children, adolescents, and young people. (Wilkin J et al: Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the classification and staging of rosacea. J Am Acad Dermatol 46: 584, 2002 [PMID: 11907512], Kroshinsky D, Glick SA: Pediatric rosacea Dermatol Ther 19: 196, 2006 [PMID: 17004995]). But in modern times, this pathology in patients older than 40 years is accompanied by higher resistance to standard therapy, the duration and severity of clinical manifestations (Powell F: Clinical Practice. Rosacea. N Engl J Med 352: 793, 2005 [PMID: 15728812]).

Rosacea is also considered as angioneurosis, which develops mainly in the trigeminal nerve innervation zone. The prerequisites for development are constitutional angiopathies, neurovegetative disorders, emotional stress, dishormonal conditions, infectious processes, and gastrointestinal dysfunction. Associated factors - provocateurs - these are hot and hot drinks, intense solar insolation and the peculiarity of the anatomical and physiological vascularization of the skin of the face (large veins are superficial, have a short length and extend vertically into the deep dermal network), providing prerequisites for stagnation, especially in the cheek area , nose, forehead, chin. (G.N. Ponomarenko. Physiotherapy in cosmetology, St. Petersburg, 2002, p. 260-262).

Damage to the facial skin, persistent erythema, multiple telangiectasias, hypertrophic changes in the soft tissues of the face lead to serious psychological problems, a decrease in social activity and the quality of life of people and require further dermatological correction.

The recurrent course of the disease and resistance to existing methods of treatment, as well as the age characteristics of patients, are characteristic, as the presence of concomitant pathology increases by this age, which leads to a limitation of the use of standard therapy and the impossibility of a complete cure for rosacea.

There is a method of treating inflammatory rosacea with antibiotic therapy - tetracycline drugs are prescribed for a month (Verbenko E, Katsman L: [Experience with the retin-A treatment of acne vulgaris and rosacea]. [Article in Russian] Vestn Dermatol Venerol 2:47, 1977 [ PMID: 140557]) The disadvantage of this method is the high relapse rate - after 4 months of treatment, every 4th patient has relapse and after 6 months in more than half of the patients (Lachgar S et al: Inhibitory effects of retinoids on vascular endothelial growth factor production by cultured human skin keratinocytes Dermatol 199: 25, 1999 [PMID: 10473956]), especially since this group of drugs has wide list of contraindications and side effects, the possibility of existence of which increases with duration of use, in particular the development of dysbiosis, followed by low immunity.

In the treatment of rosacea, local therapy is used, such drugs as synthetic retinoids, in particular tretinoin cream. It promotes remodeling of connective tissue and a decrease in the inflammatory process in the dermis. The disadvantage of this method is the long clinical response and therefore it requires 4-6 months, which leads to an increase in its irritating effect, stimulation of angiogenesis, as well as its use requires the constant use of protective creams from sun exposure and there is a high risk of developing skin pigmentation disorders (Arndt K, Bowers K: Manual of Dermatologic Therapeutics, 6th edition, Philadelphia, Lippincott, 2002).

The closest in technical essence to the proposed method is a method of treating rosacea by exposure to intense pulsed light, which covers a wide spectrum wavelengths from 550 nm to 1200 nm of infrared color and can be an alternative in the treatment of papular-pustular elements, vascular formations actively present with rosacea (Wilkin J: Effect of subdepressor clonidine on flushing reactions in rosacea. Change in malar thermal circulation index during provoked flushing reactions. Arch Dermatol 119: 211, 1983 [PMID: 6218789]). The disadvantage of this method is the development of side effects such as edema, purpura, dyschromia and scarring. A known method of using short-wave lasers, which are selectively absorbed by oxyhemoglobin and allows you to destroy surface vessels. The disadvantage of this method is the high risk of side effects such as transient erythema, edema, purpura, dyschromia, burns with the possibility of subsequent scarring (Mauss J: [Cyproterone therapy of papulopustular rosacea in women] [Article in German] Hautarzt 32:94, 1981 [PMID: 6453108]).

The technical result of the proposed method for the treatment of inflammatory rosacea is safe use in patients, especially with a burdened somatic history; lack of side effects of local and general; high treatment efficiency, reduction of treatment time, duration of remission, improvement of the general psychosomatic status of the patient, the absence of the need for antibiotic therapy.

The specified technical result is achieved by the fact that, depending on the initial state, patients with rosacea are treated with a pathological lesion with surrounding tissues, in particular, facial skin using a Dualis SP Spectro Nd: YAG laser with a 1064 nm laser - scanning S-11, 40 J / cm2, frequency 3 Hz, pulse length 30-50 ms, the number of skin treatments per procedure is from 1 to 3 times, depending on the stage of the process; sequentially, injections of the oxygen-ozone mixture obtained at the Medozons BM installation at a concentration of 1300-1600 mcg / l both directly under the foci and across the entire face surface are maintained, immediately maintaining an injection distance of 2.5 cm; at the same time, the procedures are carried out 2 times a week No. 6, then 1 time a week No. 3, 1 time per month No. 3, followed by a repeat of the course after 1.5-3 months. The main advantage of the application is the effect on the deeper layers and coagulation of the expanded vasculature, as well as the immediate fixation of the effect by oxygen donors followed by the reorganization of the dermis (Pelle M, Crawford G, James W: Rosacea: II. Therapy. J Am Acad Dermatol 51: 499, 2004 [PMID: 15389184]) and an increase in the skin's natural resistance to bacterial and viral infections and self-healing of impaired homeostasis.

DESCRIPTION OF THE METHOD FOR TREATING ROSATSEA

In the proposed method for treating patients with inflammatory rosacea, a pathological lesion is treated, in particular, facial skin using a Dualis SP Spectro Nd: YAG laser with a wavelength of 1064 nm, a scanning S-11 manipulator, 40 J / cm2, frequency 3 Hz, pulse length 30-50 ms, the number of skin treatments is from 1 to 3 times per procedure, depending on the stage of the process; sequentially, injections of the oxygen-ozone mixture obtained at the Medozons BM installation at a concentration of 1300-1600 mcg / l both directly under the foci and on the entire surface of the face are carried out immediately, keeping the distance between injections 2.5 cm. The procedures are carried out 2 times a week No. 6, then once a week No. 3, 1 time per month No. 3, followed by a repeat course after 1.5-3 months. This method is applied without additional treatment methods, i.e. in pure form. Patients performed daily hygienic treatment of facial skin with skin type products without additional topical therapeutic agents.

EXAMPLES OF IMPLEMENTING THE METHOD

Example 1. Patient A., 45 years old, with a diagnosis of inflammatory rosacea (according to the classification of J K. Wilkin, 1994). Upon receipt - complaints of inflammatory elements on the skin of the face. Dermatological status: facial skin combined, with a characteristic shine in the T-zone, multiple papules and pustules in the forehead, both cheeks, multiple telangiectasias in the cheeks, chin, congestive infiltrates. The duration of the disease is 4 years, without visible improvement from the treatment. History: frequent respiratory infections.

The patient in the supine position treated the pathological focus, in particular the facial skin on a Dualis SP Spectro Nd: YAG laser with a wavelength of 1064 nm - scanning S-11, 40 J / cm ² , frequency 3 Hz, pulse length 50 ms, number facial skin treatments amounted to 3 times; sequentially, injections of the oxygen-ozone mixture obtained at the Medozons BM installation with a concentration of 1600 μg / l both directly under the foci and across the entire face surface are maintained, immediately maintaining an injection distance of 2.5 cm. Procedures in such dosages were performed No. 3 with a frequency of 2 times a week, then the laser pulse length was reduced to 40 ms, and the concentration of the oxygen-ozone mixture was reduced to 1300 μg / l, because The regression of clinical rashes began and no new pustular elements were observed. The number of procedures with a frequency of 2 times a week was No. 6, then once a week No. 3, 1 time per month No. 3, followed by a repeat of the course after 3 months. Dosages were maintained as in procedure No. 4. The regression of clinical manifestations began to be noted after the 3rd procedure and was expressed in a decrease in inflammatory elements, the absence of new ones, a decrease in the number of telangiectasias, and swelling of the face. After the course of therapy, a prolonged clinical regression was observed, no side effects were observed either local or general. After the course of treatment there were no complaints. No new papular-pustular rashes appeared. The duration of remission was 2 years.

Example 2. Patient C., 54 years old, with a diagnosis of inflammatory rosacea (according to the classification of J K. Wilkin, 1994). Upon receipt - complaints of inflammatory elements on the skin of the face. Dermatological status: face skin is dry, with areas of peeling and papulopustular elements in the area of both cheeks and chin, multiple telangiectasias are presented in the cheeks, wings of the nose, chin. The duration of the disease is 12 years, without visible improvement from the treatment (externally used shakeable mixtures with sulfur, resorcinol, dimexidum, erythromycin, took antibacterial drugs inside. According to the patient, she considers herself healthy, is not registered in the dispensary, any drugs in the last 6 months (except vitamins) did not accept.

The patient in the supine position underwent facial skin treatment using a Dualis SP Spectro Nd: YAG laser with a wavelength of 1064 nm - S-11 scanning handle, 40 J / cm ² , frequency 3 Hz, pulse length 50 ms), the number of treatments was 3 times ; sequentially, injections of the oxygen-ozone mixture obtained at the Medozons BM installation with a concentration of 1600 μg / l both directly under the foci and across the entire face surface, withstanding 2.5 cm distance between injections, are immediately carried out. Procedures in such dosages were performed No. 6 with a frequency of 2 times a week, the laser pulse length was not changed, and the concentration of the oxygen-ozone mixture was also preserved at 1600 μg / L. The number of procedures with a frequency of 2 times a week was No. 6, then once a week No. 3, 1 time per month No. 3, followed by a repeat of the course after 3 months. The regression of clinical manifestations began to be noted after the 3rd procedure and was expressed in a decrease in inflammatory elements, the absence of new ones, a decrease in the number of telangiectasias, and swelling of the face. After a course of therapy, a prolonged clinical remission was observed - 2 years, there were no complaints from patients, no side effects were observed either local or general.

The proposed method of treatment was used in 130 patients suffering from inflammatory rosacea aged 38-57 years, among which 45% in stage I erythematous-telangiectatic, 46% in stage II papulopustular and 9% in stage III pustular-nodular (classification AM Kligman )

All patients showed good tolerability of the procedures; adverse reactions were not observed. All patients showed a positive dynamics of clinical manifestations - regression of rashes without the appearance of new papulopustular rashes, the disappearance of puffiness of the skin, a decrease in the number of telangiectasias, an increase in skin turgor, a decrease in pores, which was positively reflected in the patients' psychostatus. Clinical remission ranged from 16 months to 24 months.

Indications for the appointment of the proposed method of treatment are: inflammatory rosacea - all stages, with a prolonged, often recurring course, torpid to previous treatment, in patients with a burdened somatic history who are contraindicated in the use of AB therapy, synthetic retinoids, etc.

The achieved therapeutic effect lasts from 12 months to 18 months. In addition, this method allows patients with inflammatory rosacea to exclude antibiotic therapy and, accordingly, to avoid its side effects.

The proposed method for the treatment of patients with inflammatory rosacea, in comparison with other therapeutic methods, has higher therapeutic efficacy (91.4%) and prolongs remission up to 24 months with erythematous-telangiectatic stage I, papulopustular stage II in 81.2% of patients and up to 14-18 months, with stage III pustular-nodular form of the disease in 58.2% of cases up to 12-16 months.

No complaints were made during or after treatment.

The proposed method of treatment differs in comparison with the known simplicity of the technique, good tolerance to patients and the possibility of its use in outpatient, inpatient and spa facilities.

Claims (1)

A method of treating inflammatory rosacea, including exposure to a physical factor, characterized in that the treatment of pathological foci of the skin of the face is performed on a Dualis SP Spectro Nd: YAG laser with a wavelength of 1064 nm using a S-11.40 J / cm ² scanning key, frequency 3 Hz, the pulse length is 30-50 ms, while the number of treatments per procedure is from 1 to 3 times, then injections of the oxygen-ozone mixture obtained at the Medozons BM installation at a concentration of 1300-1600 μg / l are directly carried out immediately below foci, and in her face surface, withstanding a distance between injections of 2.5 cm, while 6 procedures are performed at intervals of 2 times a week, then 3 procedures at intervals of 1 time per week and 3 procedures at intervals of 1 time per month, repeat the treatment after 1, 5-3 months.