RU2649505C1 - Method of treating seborrheic dermatitis with the use of laser oxytherapy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to dermatology, and can be used to treat seborrheic dermatitis in patients with essential hypertension. Defocused laser beam is applied to the affected area of the skin at a distance of 5–10 mm by nanosecond pulses, followed by two harmonics pausing one after another with wavelengths of 756–764 nm and 1262–1272 mn. Radiation power is 0.01–3 W, the duration of the harmonics pulses is 10 ns – 1 mcs. Duration of the pause between the harmonics pulses is 10 ns – 2 mcs. Treatment is carried out every other day for 8–10 sessions. Duration of each session is no more than 5 minutes.

EFFECT: method provides regression of rashes, reduction of itching, infiltration; improves the quality of life of patients due to the combined effect of laser radiation and singlet oxygen generated during the laser therapy session.

1 cl, 2 ex, 1 tbl

Description

The invention relates to medicine, to the section of dermatology, namely for the treatment of inflammatory conditions of the skin, such as seborrheic dermatitis in patients with hypertension.

Seborrheic dermatitis is a disease accompanied by peeling that affects the face and skin of the skull.

In the case of seborrheic dermatitis, alternative therapies based on hydrogenated vegetable oils, or on hydrophilic petrolatum, or on therapeutic shampoos (based on zinc pyrithione, selenium sulfide, sulfur, and the like) are not effective.

Known treatment with corticosteroids, which have well-known side effects: they reduce immune defense; discontinuation of treatment should be gradual; they cannot be used during the acute phase of weeping; after discontinuation of treatment, the opposite effect may follow. In addition, corticosteroids should not be used for long-term treatment, especially in children, as they can cause systemic effects.

Seborrheic dermatitis in the presence of chronic venous insufficiency (CVI), according to domestic and foreign researchers, is found in 2% of the population. Against the background of diabetes mellitus (DM), they occur in 8-10% of patients and present a serious interdisciplinary medical problem, in the solution of which dermatovenerologists are largely involved.

Most of the drugs used have a number of side effects, which are often harder than the disease itself - all this forces dermatologists around the world to develop new methods of treatment.

The use is known (Yu.K. Skripkin et al., Guide to dermatovenereology. - M .: Medicine, 1999). for the treatment of seborrheic skin diseases (seborrhea, acne, baldness), hypersensitizing, sedative, antibiotic, hormone-regulating, anti-inflammatory and multivitamin preparations (sodium thiosulfate, telfast, diazolin, calcium preparations, Diane 35, a complex of B vitamins, etc.). However, when using the above drugs in the chronic course of diseases, resistance often develops, undesirable side effects (biliary dyskinesia, dysbiosis, atonic colitis, etc.).

In the treatment of seborrheic dermatitis, only a temporary effect is often achieved and sooner or later relapses occur. Moreover, due to the deterioration of the environmental situation, especially in urban conditions, the influence of adverse factors (pollution of the atmosphere and water environment, intense electromagnetic radiation from mobile phones and computers, an overdose of the ultraviolet component of solar radiation due to a decrease in the ozone layer, etc., is increasing). ) on the skin and mucous membranes of a person. This leads to an increase in the number of chronic skin diseases, an increase in the incidence of cancer and skin melanoma, the appearance of cosmetic problems - premature aging of the skin, alopecia, pigmentation disorders.

Based on these facts, the problem of finding new therapeutic methods of exposure in pathologies and anomalies of the surface tissues of the human body remains very relevant.

Among modern therapeutic methods in dermatology, promising methods are those based on photodynamic effects - phototherapy and photodynamic therapy (the use of photosensitizers and laser radiation). In a number of cases, these methods make it possible to achieve remission of certain diseases and even complete clinical recovery.

The scientific, technical and patent literature describes many methods of phototherapy (FT) and photodynamic therapy (PDT) used for therapeutic and cosmetic purposes. All of them can be divided into two groups.

The first group includes phototherapy methods based on the fact that irradiation of the human body is carried out with the light of various wavelengths that directly affect target molecules in the human body; these methods do not imply a preliminary artificial introduction of substances containing the above target molecules into the human body. In this case, depending on what characteristics of light are used and on which target light quanta act, target molecules can transform into a new state that directly or indirectly affects the vital processes of tissues. This can lead to: 1) the destruction of pathologically altered tissues and the elimination of their pathological elements from the body and / or 2) the normalization of physiological processes in tissues (US Patents No. 7036516, No. 7066941, No. 6149644). Despite the fact that these methods are relatively easy to reproduce, since they require only a light source and, in some cases, devices for conducting light radiation to a pathological site, they have limitations in their application. The main disadvantages of these methods are the lack of effectiveness in the treatment of chronic diseases, as well as the conditions existing in a number of patients in which phototherapy is contraindicated - for diseases of the skin and skin appendages associated with exposure to light radiation (photodermatitis, light (solar) urticaria, polymorphic light rash photokeratitis (actinic keratitis), photochemical granuloma, photochemical reticuloid).

The second group includes methods based on other principles of phototherapeutic effects on pathological tissues of the body - photodynamic therapy (PDT). This therapy is based on the introduction into the body in one way or another of special substances - photoactive agents. Photoactive agents alone do not have a direct therapeutic effect on pathologically altered tissues. The introduced photoactive agents can be dispersed throughout the body, or selectively concentrated in a particular tissue. Irradiation of pathological tissues with light, during which a photoactive agent located in the tissues of the body, under the influence of photon energy, turns into a photoactivated substance, which has the necessary healing properties; the transformation process is called photodynamic activation or photo dynamic transformation.

However, when conducting photodynamic therapy using, for example, chlorin-type photosensitizers, it leads to the preferential accumulation of the drug in organs and tissues characterized by rapid cell division. Accumulating in the vessels of the microvasculature of the tissues, the drug is able to disrupt the integrity of the vascular walls, leading to disruption of microcirculation in the pathological foci.

Closest to the proposed method relates to a method for the treatment of inflammatory conditions of the skin, for example, atopic dermatitis (RF patent No. 21588617). In this case, they act with polychromatic polarized light with a wavelength of 450-2500 nm paravertebrally to the right and left of the spinous processes of the spine on the reflex-segmental zones at the level of C2-T1, T10-L2 and on the lesions. The distance is 5-15 cm from the irradiator to the skin surface. The exposure time for each field is 1-4 minutes. The total duration of the procedure is 4-24 minutes. Irradiate until the patient feels pleasant warmth. A course of 8-12 daily procedures. The method allows to achieve a decrease in the severity of the process, reduce itching, positive clinical effects in the absence of side effects on the visual system. The therapy with polarized light in this method is based on the use of polychromatic polarized light with a wavelength of 450 - 2500 nm from the Vita-Steam apparatus. As a result of this effect, light of the infrared and visible ranges acts on the skin surface, providing: infrared, red, orange, yellow spectra - thermal effect, causing anti-inflammatory,

analgesic, antipruritic, trophic effects, green, blue, blue spectra - electronic excitation of molecules, which is associated with the epithelizing, regenerative effect. The penetration depth of polarized polychromatic light is 1-2 cm, which causes a targeted effect on pathological lesions. Its disadvantages: too wide a band of radiation, which can lead to damaging effects in the tissues, the effect on the reflex zones, and not on the lesion, which can cause side complications.

The maximum absorption of light energy by photosensitizers occurs at a wavelength of 675 nm. The generally accepted maximum power density value is 40 mW / cm ² . These indicators are traditionally used to treat chronic dermatological diseases.

The objective of the invention was the creation of a more effective, non-toxic method of treating seborrheic dermatitis in patients with hypertension, achieving complete clinical remission with a minimum of side effects.

Using the invention allows to obtain the following technical result. The method is effective, there is no toxic effect of photosensitizers. The method allows to achieve a complete regression of rashes within 40 days, reduce itching after the first laser exposure and stop it within 10 days from the start of treatment, significantly reduce infiltration after the first laser treatment procedure. It helps to improve the quality of life of patients as a result of the rapid disappearance of itching, rapid and complete regression of rashes.

The technical result is achieved through the use of a method for the treatment of seborrheic dermatitis in patients with hypertension by using laser oxytherapy. Affect the affected area of the skin at a distance of 5-10 mm by a defocused laser beam with nanosecond pulses following two harmonics in succession with wavelength ranges of 756-764 nm and 1262-1272 ns with a radiation power of 0.01 W - 3 W with a duration of harmonics pulses 10 ns - 1 μs, while the pause between harmonics pulses is 10 ns - 2 μs, treatment is carried out every other day for 8-10 sessions.

The authors studied the possibility of conducting photodynamic therapy in tissues without the use of photosensitizers, i.e. direct generation of singlet oxygen.

When searching for acceptable solutions, it was found that singlet oxygen can also be generated without photosensitizers by directly exciting oxygen molecules with infrared laser radiation, corresponding to the maxima of the absorption bands of molecular oxygen dissolved in tissues in the wavelength ranges of 756-764 nm and 1262-1272 nm.

The proposed type of therapy is based on the combined action of laser radiation and oxygen. Laser radiation, in turn, promotes the manifestation of stimulation of electrolyte metabolism in the protoplasm of cells, accelerates metabolic processes, increases the proliferative activity of cells, oxygen consumption, protein synthesis, nucleic acids and the activation of numerous cytoplasmic enzymes. In addition, laser radiation has fibrin- and thrombolytic properties, has a wide anti-inflammatory and decongestant effect.

As a result of applying the proposed method for the treatment of seborrheic dermatitis, the following significant advantages were obtained.

Firstly, new, previously unused characteristics of radiation and combination of parameters were achieved (continuous pulsed nanosecond radiation regime in the form of two harmonics following each other pausing), secondly, the biological activity of radiation increased and tissue heating at the same time decreased upon exposure to radiation, thirdly, destructive changes in the skin have decreased; fourthly, the treatment method has allowed to abandon expensive photosensitizers; fifthly, the terms of restoration of the skin were reduced to 1-1.5 months; sixth, the risk of complications in patients with hypertension has decreased, especially if the disease is chronic or in an acute stage.

The laser module used in the proposed treatment of seborrheic dermatitis using laser oxytherapy is capable of working in a quasi-continuous nanosecond pulsed mode, which allows you to generate powerful short pulses of laser radiation, which, in turn, allows you to increase the peak power of the light flux without significant heating of biological tissues and launch a cascade of photochemical effects in tissues with the release of singlet oxygen and free radicals.

The used laser source is placed from the area of inflammation at a distance of 5-10 mm. At the same time, exogenous photosensitizers (photoprotectors) are not used. Affect the surface with a defocused beam. In the process, nanosecond pulses are generated in the form of two harmonics with a pause one after another with wavelength ranges of 756-764 nm and 1262-1272 nm, which corresponds to the local peak of oxygen absorption by tissues emitting singlet oxygen with a radiation power of 0.01 W - 3 Tue Duration of harmonics pulses 10 ns - 1 μs, pause duration between harmonics pulses 10 ns - 2 μs. Treatment of seborrheic dermatitis is carried out every other day for 8-10 sessions, each lasting no more than 5 minutes. Subject to all indicators of the proposed method does not occur irreversible thermal effects in biological tissue.

The high efficiency of the proposed method for the treatment of seborrheic dermatitis by laser oxytherapy without the use of photosensitizers is confirmed by the following clinical examples.

The invention is illustrated by the following experimental data.

Example No. 1, stationary stage of therapy.

Patients diagnosed with seborrheic dermatitis are initially given complex therapy. For external treatment, agents were used that have anti-inflammatory, antipruritic, antifungal, and in the case of secondary infection, antibacterial and antiseptic effects. In the acute stage of the process with severe itching, sleep disorders, antihistamines and sedatives were used. Upon reaching the results of the stationary stage (the absence of new rashes, a decrease in the level of skin erythema, a decrease in the intensity of peeling on the surface of the plaques), a laser therapy course is then carried out.

Example 2 Laser Treatment Stage

A radiation source — a laser pulse module operating in a quasi-continuous nanosecond mode — is placed outside the affected area at a distance of 5–10 mm and is contacted without using various photoprotectors by a laser beam, while during operation the module generates nanosecond pulsed laser radiation in two harmonics with pauses one after another with wavelength ranges of 756–764 nm and 1262–1272 nm, corresponding to the local peak of oxygen absorption by tissues, with a radiation power of 0.01 - 3 W harmonic pulse duration 10 ns - 1 s, the duration of the pause between pulses harmonics 10ns - 2 microseconds. Treatment was carried out every other day for 8-10 sessions, each lasting no more than 5 minutes.

The treatment results are summarized in table 1.

Clinical example 1

Patient S., 39 years old, suffers from seborrheic dermatitis of the head and face for 5 years. Rashes are localized on the skin of the scalp. Represented by clearly delimited plaques, often merging and occupying a large area with spreading to the skin of the forehead. On the face, rashes are localized in the cheekbones, wings of the nose. Rashes are represented by foci of erythema of a rounded shape with peeling and crusting. The skin in the affected area has a yellowish-red tint, follicular holes are pronounced. Repeatedly received treatment. Recent rashes were diagnosed on November 4, 2016.

The following course of the stationary stage was carried out:

hyposensitizing (calcium gluconate 10.0 10% w / m No. 10), topical glucocorticosteroid preparations (methylprednisolone aceponate 0.1%, cream, ointment, externally 1 time per day No. 10) were prescribed, anti-inflammatory drugs for local use (in the form of lotions) ( boric acid, 2% solution 1-2 times a day externally No. 6), antihistamine (cetirizine 4 mg orally 2 times a day No. 15), topical antifungal drugs in the form of shampoo (Bifonazole 3 times a week). When the results of the stationary stage were achieved, laser therapy was performed according to example 2.

Clinical example 2.

Patient S., 42 years old, suffers from a common hypertension and a form of seborrheic dermatitis of 12 years. Rashes are localized on the skin of the elbows and the front surface of the legs. They are represented by coarse-grained elements with silver scales on the surface, peeling does not go beyond the pathological focus. The psoriatic triad is positive. Over the past 11 years, he repeatedly received treatment in a hospital, but clinical remission was not achieved. The patient underwent a stationary stage of therapy.

Hyposensitizing therapy was carried out (calcium gluconate 10.0 10% w / m No. 10), topical glucocorticosteroid preparations (betamethasone dipropionate 0.025%, cream, ointment, outwardly No. 14 outwardly once a day), zinc pyrithione 0.2% aerosol, cream 2 were prescribed once a day externally No. 14), anti-inflammatory drugs for topical application (in the form of lotions) (resorcinol, 1% solution 1-2 times a day externally No. 7), antibacterial therapy (hydrocortisone + neomycin + natamycin, cream / ointment, 2- 4 times a day externally No. 14), antihistamine (loratadine U mg orally 1 time per day No. twenty). Then, laser therapy was performed according to example 2. Patients were observed after 1, 3, 6 and 24 months. In the immediate follow-up, patients did not complain. Complete healing after 1-1.5 months. Skin condition without signs of damage. After 6 months, a scheduled examination, the condition is satisfactory, no peeling foci have been identified.

The conditions and results of treatment are summarized in table 1.

Complete remission was achieved in 98% of cases, partial remission - in 2%. No allergic or toxic reactions have been observed. Remission in 97% of cases was less than 1 year.

Thus, an effective, non-toxic method of treating seborrheic dermatitis has been proposed, which allows lengthening the period of remission, to achieve complete clinical remission with a minimum of side effects.

To date, the use of laser therapy in the treatment of pathologies such as seborrheic dermatitis has not been described.

As a result of the patent information search, not a single source of information was found containing the entire set of essential features of the claimed invention, which allows us to conclude that it meets the patentability criteria of “novelty”, “inventive step” and “industrial applicability”.

Claims (1)

A method for the treatment of seborrheic dermatitis in patients with hypertension by applying laser oxytherapy, including a physiotherapeutic effect, characterized in that the physiological effect is the use of a defocused laser beam on the affected area of the skin at a distance of 5-10 mm nanosecond pulses, followed by pauses one after another two harmonics with wavelength ranges of 756-764 nm and 1262-1272 mn with a radiation power of 0.01 W - 3 W with a harmonic pulse duration of 10 ns - 1 μs, with this length The duration of the pause between the harmonics pulses is 10 ns - 2 μs, the treatment is carried out every other day for 8-10 sessions, the duration of each session is no more than 5 minutes.