RU2665150C1 - Treatment of psoriasis of nail plates - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely to dermatovenereology, and can be used to treat psoriasis of nail plates. Irradiation of the affected nail plates with psoriasis in the region of the hands and/or feet is carried out at a wavelength of 308 nm, which is produced by the XeCl excimer lamp. Influenced with a frequency of 3 times during a five-day workweek. Effects after a day with a duration of exposure of 30 seconds in the first sessions with an increase in the exposure time at each 3rd session for 5 seconds, until the exposure time reaches 1.5 minutes. Effect is carried out at a distance of 2–3 cm from the radiation source.EFFECT: method provides for stable rehabilitation of patients, an increase in the period of convalescence due to a decrease in excess DNA synthesis, a decrease in the proliferation of epidermal cells and the normalization of keratinization processes.1 cl, 2 ex

Description

The invention relates to medicine, in particular to dermatovenerology, and can be used to treat psoriasis.

Psoriasis with damage to the nail plates is a special subgroup of psoriatic disease, which is characterized by a severe course, resistance to standard therapy, a significant limitation of the patient’s working ability, as well as severe psychological and physical disorders due to the localization of the pathological process and the high activity of exogenous trigger factors (physical provocation, friction, pressure).

Treatment of nail psoriasis presents great difficulties: well-known methods of treating severe and resistant forms of psoriasis using, for example, synthetic retinoids have a number of contraindications (diseases of the hepatobiliary system, pregnancy, etc.) and side effects, including those that provoke a violation of the formation of the nail plate with development onychodystrophy. In this regard, the use of retinoids for the treatment of patients with nail psoriasis is not an acceptable method.

In the treatment of psoriasis, a method of heliotherapy is known. It has been established that in the spectrum from 290 to 315 nm, ultraviolet irradiation (part of the ultraviolet range - UVB) has an antiproliferative, antipsoriatic effect, in contrast to the UVC spectrum of ultraviolet radiation in the wavelength range 200-290 nm, which cause dangerous erythematic and photocarcinogenic effects (Modern external therapy of dermatoses with elements of physiotherapy / Edited by N.G. Korotkogo, Tver: Provincial medicine, 2001. - S. 379-384).

The positive effect on psoriasis during the selective wavelength of UVB is due to a decrease in excess DNA synthesis, a decrease in the proliferation of epidermal cells, and normalization of the keratinization process.

The middle part of the therapeutic range of the UVB spectrum of 295-310 nm is maximally safe, which allows you to effectively stop autoimmune pathological processes in the skin by acting on T-lymphocytes and keratinocytes in an unstable division state through their destruction without known side effects.

There are medical devices that emit ultraviolet rays of various wavelengths and are used to treat psoriasis. The well-known classical method of PUVA therapy (Psoralen-Ultraviolet Spectrum A) (Modern external therapy of dermatoses with elements of physiotherapy / Edited by N.G. Korotky, Tver: Provincial medicine, 2001. - P. 385-386) has a number of disadvantages, significantly limiting its use: the wide-spectrum spectrum with a phototherapy wavelength range of 320-400 nm is not safe for humans, and the need to use photosensitizers from the psoralen group before the treatment sessions contributes to the toxic effect, which can subsequently cause drug sheniyami function of the hepatobiliary system and the difficulty of psoriasis therapy after a course / PUVA therapy.

A method for treating psoriasis not with UVA rays, but with narrow-band UVB radiation is more effective and safe compared to PUVA. For example, developed UVB-emitting devices such as the UVB-Laser "XTRAC" (308 nm) (British Journal Dermatology. Aubin F., Vigan M, Puzenat Eetal. Evaluation of a novel 308-nm monochromatic excimer light delivery system in dermatology: a pilot study in different chronic localized dermatoses. - 2005; 152 (1), P. 99-103; Journal Europeal Academy of Dermatoogy and Venerology. Nistico SP, Saraceno R., Stefanescu S., Chimenti S. A 308- nm monochromatic excimer light in the treatment of palmoplanar psoriasis. - 2006; 20 (5), P. 523-526), which, along with well-known advantages, is also characterized by a number of disadvantages that limit the use of more patients in routine medical practice: significant gabar There is also the need for a separate room for the apparatus, and, importantly, in the conditions of the economic crisis, the high cost of the device and the expensive cost of the procedure. Given that a course of psoriasis therapy using an excimer laser requires from 4 to 10 procedures, the use of this topical method of treatment due to the high cost becomes impossible for a significant number of patients taking into account their disability.

There is a budgetary method of heliotherapy using mercury lamps (Modern external therapy of dermatoses with elements of physiotherapy / Ed. By N.G. Korotkogo, Tver: Provincial medicine, 2001. - P. 379-384), however, their use is limited by a number of side effects:

1) lack of safety due to the presence of mercury vapor;

2) the impossibility of the usual disposal of used lamps;

3) the dependence of the lamp radiation power on the ambient temperature;

4) the need for preheating a mercury lamp to generate mercury vapor in a gas discharge;

5) difficulties in calculating the time for heating a mercury lamp to obtain 100% of the radiation power and the beginning of the treatment procedure;

6) the duration of therapy sessions (depending on the model) is from 10 to 30 minutes, which limits the quantitative possibilities of using a mercury lamp;

7) lack of stability in power emission depending on the service life of the mercury lamp.

A known method of treating psoriasis, the closest in technical essence to the claimed one, selected as a prototype and described in the manual "Modern external therapy of dermatoses (with elements of physiotherapy)" / Edited by N.G. Short. - Tver: Provincial medicine, - 2001. - S. 379-386, which uses portable table-top mercury-quartz lamps (of the "Mayak" type).

The use of budgetary mercury-quartz lamps (“MAYAK” type) requires a long period of lamp warming up (at least 10-15 minutes), followed by a session lasting 10 minutes, no radiation of a certain wavelength (there is no technical possibility of radiation of a narrow-band wavelength), loss the properties of the constancy of radiation power depending on the duration of operation, and, as a result, the occurrence of a number of side effects, systemic and local risks to the patient’s health, which limit the use of mercury o-quartz lamps and do not allow to achieve a lasting positive effect.

The purpose of the proposed method for the treatment of a special form of psoriasis with nail damage is to increase the safety of therapy, reduce the duration of treatment, extend the remission of patients and increase the economic profitability of therapy when it is necessary to import expensive medical devices that emit UVB rays.

The essence of the proposed method lies in the fact that the exposure of the XeCl rays of an excimer lamp with a wavelength of 280-320 nm to the pathological foci of psoriasis in the area of the affected nail plates of the hands and / or feet is performed.

The technical result of the proposed method for the treatment of nail psoriasis consists in the possibility of stable rehabilitation of patients, increasing the period of convalescence, increasing the safety and economic profitability of the procedure, eliminating the disadvantages and side effects of the known methods of UVB therapy associated with the use of mercury-quartz lamps.

The specified technical result is achieved due to the fact that in the method of treating psoriasis of the nail plates including irradiation with UVB rays, according to the invention, the irradiation of the affected nail plates during psoriasis in the area of the hands and / or feet is carried out at a wavelength of 308 nm, which is produced by the XeCl excimer lamp, act with a frequency of 3 times during a five-day working week every other day and a duration of exposure of 30 seconds in the first sessions with an increase in exposure time in each 3rd session by 5 seconds, until the time reaches Via 1.5 minutes, during which exposure is carried out at a distance of 2-3 cm from the radiation source.

For example, treatment of affected nail plates with psoriasis in the area of the hands and / or feet can be carried out using an XeCl excimer lamp according to the following scheme: with a frequency of 3 times during a five-day working week every other day and exposure duration from 30 sec to 1.5 min with an increase exposure time at each 3rd session for 5 seconds according to the following scheme: 1 week (1-3 sessions) for 30 seconds, 2 week (4-6 sessions) for 35 seconds, 3 week (7-9 sessions) for 40 seconds 4 weeks (10-12 sessions) for 45 seconds, 5 weeks (13-15 sessions) for 50 seconds, 6 weeks (16-18 sessions) for 55 seconds, 7 weeks (19-21 sessions) for 60 seconds, 8eating (22-24 sessions) for 65 seconds, 9 weeks (25-27 sessions) for 70 seconds, 10 weeks (28-30 sessions) for 75 seconds, 11 weeks (31-33 sessions) for 80 seconds, 12 weeks ( 34-36 sessions) for 85 seconds, 13 weeks (37-39 sessions) for 90 seconds for at least 15 sessions per course.

The method is as follows. To irradiate foci of psoriasis of UVV nails with a wavelength of 308 nm, a Xe-Cl excimer lamp is used that contains an electric power source, a fan and a radiator with a screen size of 8 × 10 cm. Lamp dimensions: 21 × 17 × 10 cm, weight - 700 g. Advantages of XeCl excimer lamp, distinguishing it from other analogues:

1) safety and easy disposal (does not contain mercury and has a safe working XeCl excimer molecule);

2) the lack of dependence of the lamp operation on the ambient temperature;

3) instantaneous achievement of 100% lamp power when it is turned on and there is no need for heating, because there are no metal vapors in the working gas of the lamp;

4) a narrow-band spectrum of ultraviolet radiation with a single radiation wavelength of 308 nm;

5) service life - 10,000 astronomical hours without reducing radiation power and depending on the lamp life;

6) high power density (5-35 mW / cm ² ), which allows to reduce the duration of the phototherapy session by several times and increase the therapeutic possibilities of using the lamp to a greater number of patients;

7) an individual approach to treatment, expressed in a different number of sessions depending on the form of damage to the nail plate (distal lateral; proximal; total dystrophic), the area of damage to the nail plate (1/3, 2/3 or total) and the degree of hyperkeratosis (up to 1 mm ; 1-2 mm and more than 2 mm).

The lamp is attached to any flat surface using a spring tripod-bracket. Before the procedure, the lamp with a movable holder (spring tripod) on the side of the emitter is placed at a distance of 2-3 cm above the surface of the nail plates affected by psoriasis with their preliminary cleaning from external agents (remove varnish, ointment and / or cream with a cotton pad). Before turning on the lamp, the doctor and patient put on sunglasses or a reflective UV plastic sunscreen.

The course of therapy begins with irradiation of the nail plates affected by psoriasis for 30 seconds. Procedures are performed for patients 3 times a week. On an outpatient basis, XeCl excimer lamp was treated with 12 patients suffering from psoriasis with lesions of the nail plates of the hands and feet having an I-II-III phototype of the skin according to Fitzpatrick, subject to their informed consent to treatment.

The number of sessions (from 15 to 39), the frequency (3 times during a five-day working week every other day) and the exposure duration (from 30 seconds to 1.5 minutes) with an increase in exposure time every 3 sessions for 5 seconds according to the following scheme: 1 week (1-3 sessions) for 30 seconds, 2 week (4-6 sessions) for 35 seconds, 3 week (7-9 sessions) for 40 seconds, 4 week (10-12 sessions) for 45 seconds, 5 week ( 13-15 sessions) for 50 seconds, 6 weeks (16-18 sessions) for 55 seconds, 7 weeks (19-21 sessions) for 60 seconds, 8 weeks (22-24 sessions) for 65 seconds, 9 weeks (25- 27 sessions) for 70 seconds, 10 weeks (28-30 sessions) for 75 seconds, 11 weeks (31-33 sessions) for 80 seconds, 12 weeks (34-36 seconds Anse) for 85 seconds, 13 weeks (37-39 sessions) for 90 seconds.

Characteristics of patients with nail psoriasis treated with XeCl excimer lamp at a wavelength of 308 nm: 4 men (33.3%) and 8 women (66.7%). Age of patients: from 34 to 47 years (average value - 38.4 years). The duration of psoriasis disease ranged from 1.5 to 15 years (average value - 8.6 ± 7.5 years; fashion - 5 years).

Forms of nail psoriasis: superficial in the form of pin onychodystrophy of the thimble type - 3 patients (degree of hyperkeratosis up to 1 mm); distal lateral to 1/3 of the nail area - in 2 (degree of hyperkeratosis 1-2 mm); distal lateral with a lesion of 2/3 of the nail area - in 4 (degree of hyperkeratosis 1-2 mm), total hyperkeratotic - in 3 patients (degree of hyperkeratosis - more than 2 mm).

During the study, in the vast majority of patients (10 out of 12), the first signs of growth of a healthy nail plate are observed starting from the 15th treatment session. Analysis of changes in the state of the nail plate (surface characteristics, lesion area, degree of hyperkeratosis) before and after the course of therapy also showed a positive trend in the regression of signs of nail psoriasis.

Clinical example No. 1

A 34-year-old patient, teacher, urban resident, married, has been suffering from psoriasis for 5 years. A family history of psoriasis is not burdened. Fitzpatrick II skin phototype. Examined: chronic gastritis without exacerbation, pathology from the cardiovascular, there are no other organs and systems. The treatment is irregular, sometimes it uses emollients, moisturizers and vegetable oils. Marks significant limitations in the performance of official duties, as the primary localization of psoriasis is the fingernails of the hands and the skin of the scalp.

с одновременным выравниванием ногтевой поверхности (блеск, гладкость) и уменьшением дистрофических нарушений (число точечных пунктуаций). Курс завершен на 24-м сеансе, когда в области ногтевых пластинок разрешились признаки заболевания. Субъективных ощущений при проведении лечения не отмечалось. Наблюдение за больной в течение 6 последующих месяцев не выявило признаков рецидивирования псориаза ногтей.Objectively: the psoriatic process in the form of a lesion of all nail plate of the hands according to the distal type up to 1/3 of the area of each nail plate without hyperkeratosis. Pathognomonic symptoms of nail psoriasis are found: an “oil stain” and a “thimble”. 24 sessions of excimer Xe-Cl lamp therapy were performed 3 times a week with an increase in exposure from the initial 30 sec on the 4th, 7th, 11th, 13th, 16th, 19th, 22nd up to 65 sec. At the 12th session, a decrease in the area of damage to the nail in the distal part to

with simultaneous smoothing of the nail surface (gloss, smoothness) and a decrease in dystrophic disturbances (the number of punctuation punctures). The course was completed at the 24th session, when signs of the disease resolved in the area of the nail plates. Subjective sensations during treatment were not observed. Observation of the patient over the next 6 months showed no signs of recurrence of nail psoriasis.

Clinical example No. 2

A 37-year-old patient, married, urban dweller, has been suffering from psoriasis for more than 12 years. A family history of psoriasis is burdened - an uncle on the father's side suffers from psoriasis. Fitzpatrick II skin phototype. Examined: arterial hypertension of 1-2 degrees. Marks relapses of the disease mainly in the autumn-winter period. She regularly uses moisturizing and keratoplastic agents on her own.

в области кистей и до 1/5 в области стоп. Лечение было продолжено и завершено на 38-м сеансе (13 недель терапии) в связи с рабочей необходимостью отъезда пациентки в другой город. Субъективных ощущений при проведении лечения пациенткой не отмечалось. Наблюдение за больной через 4 месяца после завершения терапии не выявило признаков обострения псориаза и показало, что рост здоровой ногтевой пластинки продолжился: пораженный участок в дистальной части ногтей стоп сократился до 1/5 общей площади, ногтевые пластинки кистей полностью разрешились от псориатических поражений: исчезли неровность, тусклость, точечные вдавления на фоне изменения цвета.Objectively: in the region of extensor extremities, “on duty” psoriatic plaques with no growth tendency, moderately infiltrated. The nail plates of the hands and feet appear to be totally thickened (3-4 mm), with an uneven, dull surface like an “oil spot”. 38 sessions of therapy with an excimer Xe-Cl lamp in two fields (hands and feet) were performed, starting from 30 seconds with an increase in exposure by 5 seconds in every third session with a frequency of 3 times a week (mode: Monday - Wednesday - Friday). At the 18th session (exposure 55 sec), a moderately persistent decrease in the thickness of the nail plate with simultaneous leveling of its surface was objectively observed, the appearance of a healthy area of the nail surface 1-2 mm in size (1 toes) from under the nail bed, 2- 3 mm (2-5 fingers and toes), 3-4 mm (1 fingers). At the 30th session (exposure 75 sec), an increase in the size of a healthy growing nail plate to

in the area of the hands and up to 1/5 in the area of the feet. The treatment was continued and completed at the 38th session (13 weeks of therapy) due to the working need for the patient to leave for another city. Subjective sensations during the treatment by the patient were not observed. Monitoring the patient 4 months after completion of therapy showed no signs of exacerbation of psoriasis and showed that the growth of a healthy nail plate continued: the affected area in the distal part of the nails of the feet decreased to 1/5 of the total area, the nail plates of the hands completely resolved from psoriatic lesions: the unevenness disappeared , dullness, spot impressions on the background of a color change.

Thus, the proposed method for the treatment of psoriasis of the nail plates is characterized by:

1) an individual approach to each patient, which is determined by: the number of treatment sessions and, accordingly, the final exposure time of an XeCl excimer lamp of 308 nm depending on the location (nail plates of the hands and / or feet), the form of the lesion and the degree of hyperkeratosis of the nails;

2) a short interval of the procedure - from 30 to 90 seconds, which allows you to actively use the device on an outpatient basis in a large number of patients and characterizes the method of using an excimer lamp with a wavelength of 308 nm as highly cost-effective and cost-effective, taking into account the cost of the procedure;

3) the high persistent therapeutic effects of daily therapy and are expressed by the reduction of symptoms of nail psoriasis: leveling the surface, restoring the color and thickness of the nail plate in patients with nail psoriasis;

4) the absence of significant differences in the effectiveness of therapy depending on the tender characteristics and duration of the psoriatic process, which allows the use of this method in both men and women, regardless of the duration of psoriasis;

5) the speed, safety and comfort of the procedures in the absence of side effects, which allows us to recommend this method of application of the XeCl excimer lamp with a wavelength of 308 nm for use as monotherapy, or as part of the complex treatment of patients with nail psoriasis in both outpatient and inpatient settings .

Claims (1)

A method of treating psoriasis of the nail plates, including irradiation with UVB rays, characterized in that the irradiation of the affected nail plates during psoriasis in the area of the hands and / or feet is carried out at a wavelength of 308 nm, which is produced by an XeCl excimer lamp, is applied 3 times during a five-day period working week every other day with a duration of exposure of 30 seconds in the first sessions with an increase in exposure time in each 3rd session by 5 seconds, until the exposure time of 1.5 minutes, and the exposure is carried out at a distance of 2-3 cm from Radiation Source.