RU2716617C1 - Method of treating patients with psoriasis in progressing stage - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to physiotherapy, and can be used for therapy of patients with psoriasis in progressing stage. Physical factor is exposed to the background of a drug-induced therapy involving anti-inflammatory, hyposensitising and disintoxication therapy. Physical factor is photochromotherapy with the help of the LED Spectrum-LC-02 apparatus by exposure to narrow-band optical light emitting of wavelength 650 nm on psoriasis skin plaques at radiation power 50 mW, radiation power density - 2.8 mW/cm², the total radiation dose - 30 J for a single procedure, the exposure energy - 0.2 J/cm², in a continuous mode. Duration 10 minutes, 2 minutes per one field. Total exposure area of skin in one procedure is not more than 750 cm², according to contact labile technique. 10 procedures are performed by one procedure daily.

EFFECT: method provides reduced number of procedures, itching relief, increased remission of disease by combining drug therapy and photochromotherapy.

1 cl, 4 dwg, 9 tbl

Description

The invention relates to medicine, namely to physiotherapy and can be used in the treatment of patients with psoriasis, in the progressive stage of the disease.

Psoriasis is a systemic immune-associated disease of a multifactorial nature with a dominant value in the development of genetic factors, characterized by accelerated proliferation of epidermocytes and a violation of their differentiation, immune reactions in the dermis and synovial membranes, an imbalance between pro-inflammatory and anti-inflammatory cytokines, chemokines; frequent pathological changes in the musculoskeletal system [1].

Psoriasis is the most common skin disease. Patients with psoriasis make up an average of 6-8% of all dermatological patients in specialized clinics [2].

In recent years, in Russia there has been a significant increase in the incidence of psoriasis, including among young people, an increase in the frequency of relapses and forms of the disease resistant to various treatment methods, which can lead to disability and a decrease in the quality of life [3].

Currently, various theories of the origin of psoriasis are considered: autoimmune, neurogenic, infectious, viral, allergic, metabolic, endocrine, hereditary and others [3].

The morphological essence of psoriasis is to accelerate the division of epidermal cells, and psoriasis is considered as a manifestation of the hyperplastic potential of the skin. Researchers believe that due to the synthesis of transforming growth factor-β, activation of the T-helper link promotes the proliferation of epidermal cells [4]. Psoriatic rashes are accompanied by an influx of activated T-helpers into the epidermis, as well as neutrophils and monocytes. In recent years, of great importance in the pathogenesis of psoriasis, scientists assign a violation of the regulation of apoptosis. It is known that the removal of autoreactive clones of lymphocytes from the body occurs as a result of the launch of the apoptosis program in them, impaired elimination of these cells will contribute to the development of the chronic psoriatic process [4].

The most common is vulgar, or ordinary psoriasis, characterized by the appearance (on the scalp, palms, elbows, knees, legs, soles, buttocks) of pink-red rounded flat papules with clear boundaries. The rash is covered with small silver-white scales. When scraping a psoriatic papule, the phenomena of “stearin stain”, “psoriatic film” and “blood dew” are manifested. Papules can merge into plaques [5]. Exudative psoriasis is less common, in which the rashes are covered with grayish-yellow cortical scales and itching of the skin develops. Psoriatic erythroderma due to the defeat of the main part of the skin in the form of its pronounced peeling, hyperemia, infiltration, itching and burning sensation is considered a severe form of the disease. Many patients have joint damage. Palmar-plantar pustular psoriasis, generalized pustular psoriasis and pustular psoriasis such as centrifugal annular erythema are also found [5].

The tactics of treating psoriasis depend on its variety, as well as the nature and localization of rashes [4]. In-patient drug treatment is carried out in accordance with the Federal Clinical Recommendations for Dermatovenereology. Mild forms of the disease, which affect less than 3-5% of the body area and do not give significant changes in the immune status of the patient, require only local treatment. In the external treatment of psoriasis, various ointments are used, including those containing salicylic acid, naphthalan oil, ichthyol. In addition, tar preparations, coal tar, which have keratoplastic, anti-inflammatory and antipruritic effects, as well as basic care products, are used. Topically applied corticosteroid ointments. In case of plaque psoriasis, an ointment containing vitamin D _{3 is} effective [1,5]. Systemic therapy is carried out for moderate and severe forms of psoriasis. In systemic treatment, apply: monoclonal antibodies against tumor necrosis factor, CD25 and immune synapse molecules, vitamins A, E, PP and group B, ascorbic acid, folic acid; enterosorbents (enterosgel, polyphepan, activated carbon); sodium and magnesium preparations; antihistamines; tranquilizers and antipsychotics; cytostatic and immunosuppressive drugs (methotrexate, cyclosporin A - in severe forms); synthetic retinoids (acitretin); ultraviolet radiation; photochemotherapy (PUVA - therapy) using photosensitizers (puvalen, lamadin, oxarolene, etc.); Re-PUVA is a therapy in which photochemotherapy is combined with oral synthetic retinoids [1,3,5]. However, the use of aromatic retinoids, cytostatics, photosensitizers and ultraviolet radiation has a number of side effects (from dryness, skin atrophy to the risk of carcinogenesis) [3].

Given the development of undesirable side effects of ultraviolet radiation, one of the tasks is the development and implementation of new methods of phototherapy with the absence of pronounced side effects and allergic reactions. An alternative method for patients in the complex treatment of the progressive stage of psoriasis can be treatment with narrow-band optical radiation of different optical ranges. Given that narrow-band optical radiation is an integral part of sunlight, its therapeutic use appears to be safer and physiological for the human body, in contrast to other phototherapy methods used in dermatology [6,7]

The goal of physiotherapeutic factors in the complex treatment of psoriasis is to provide anti-inflammatory action, soften plaques and resolve the foci of infiltration, improve blood supply and trophism in the foci of damage, i.e. restoration of normal color and structure of pathologically altered skin [8], as well as a reduction in the time of inpatient treatment and an increase in the period of disease remission.

The procedure for providing medical care in dermatology is regulated by the Order of the Ministry of Russia dated November 15, 2012 No. 924n “On approval of the Procedure for providing medical assistance to the population in the profile“ dermatovenerology ”(registered with the Ministry of Justice of Russia on December 21, 2012 No. 22630). Physiotherapeutic care in dermatovenerology includes the use of:

- low-frequency red spectrum laser therapy;

- low-frequency magnetic laser therapy;

- ultraviolet radiation of spectrum "B" and spectrum "A";

- the combined use of ultraviolet radiation of 320-400 nm and psoralen photosensitizers (PUVA therapy).

When prescribing low-intensity laser radiation (LLLT), it is necessary to take into account the adaptive reserves of the body of a patient with psoriasis and the possibility of laser therapy complications: exacerbation of the disease, dizziness, headache, drowsiness, psychological discomfort, decreased blood pressure, which is associated with depletion of the antioxidant defense of the body. As well as the presence of contraindications for the purpose of LLLT: diabetes mellitus in the stage of decompensation, hyperthyroidism, pregnancy in all periods, hypersensitivity to phototherapy (photodermatitis, photodermatosis, porphyrin disease, discoid and systemic lupus erythematosus), as well as general contraindications for physiotherapeutic treatment [9] . It must be borne in mind that, depending on the condition of the patient, phase of the course of the disease, etc., restrictions on the use of LLLT are possible. There are a number of limitations for BLOCK (intravenous laser irradiation of blood). The following contraindications are mentioned in the literature: all forms of porphyria and pellagra; photodermatosis and increased sensitivity to sunlight; hypoglycemia and tendency to it; acquired hemolytic anemia; hemorrhagic stroke; subacute period of myocardial infarction; renal failure; hemoblastoses in the terminal stage; cardiogenic shock; extremely severe septic conditions; severe arterial hypotension; hypocoagulation syndrome; congestive cardiomyopathy; febrile states of unclear etiology; increased bleeding [10].

The leading place in the treatment of chronic dermatosis is the use of ultraviolet therapy methods. Therapeutically valuable are long-wave ultraviolet radiation (320-400 nm) and medium-wave ultraviolet radiation (280-320 nm).

As a prototype for the closest technical essence, we have chosen the method of phototherapy for psoriasis patients in the progressive period of the disease, which consists in local exposure to medium-wave ultraviolet radiation against the background of drug therapy, including anti-inflammatory, hypersensitizing and detoxification therapy [12,13,14].

The disadvantages of the method we have chosen as a prototype include:

- insufficiently effective treatment, characterized by an index of prevalence and severity of lesions of psoriasis (PASI) equal to 74.3%, as well as the presence of itching in 11.4% of patients after 20-32 procedures;

- a large number of procedures - 20-32;

- insufficient duration of remission of the disease - from 6 months to 1 year;

- side effects that occur after the procedure, such as wrinkling and dry skin, erythema, infiltration, itching [9];

- long-term side effects that are associated with the cumulative effect of ultraviolet radiation and are characterized by the development of symptoms of photoaging of the skin, as well as the risk of atrophy, telangiectasias, cataracts, glaucoma and an increased risk of carcinogenesis, an increased risk of residual effects after infectious hepatitis up to 1 year, especially if there is icteric form [14,15,16,17,18];

- the inability to apply UV radiation to people who have a lot of age spots and moles on the body and face; elderly patients with reduced secretory activity of sweat and sebaceous glands with dry, flaky skin; with the activity of sweat and sebaceous glands having dry, flaky skin; patients with ophthalmic diseases, such as cataracts, glaucoma, patients with diseases of the central nervous system with a sharp predominance of excitation processes and patients with the first skin type.

The technical result of the invention is achieved by the fact that

in the progressive stage of psoriasis on the background of drug therapy, including anti-inflammatory,

hyposensitizing and detoxification therapy, photochromotherapy is carried out using the Spectrum-LC-02 LED apparatus by exposing psoriatic skin plaques with narrow-band optical LED radiation of 650 nm wavelength at a radiation power of 50 mW and a radiation power density of 2.8 mW / cm ² , the total radiation dose - 30 J per procedure, an energy exposure of 0.2 J / cm ² in continuous mode, lasting 10 minutes, 2 minutes per field, the total skin irradiation area per procedure is not more than 750 s m ² , by contact labile technique, 10 procedures carried out according to one procedure daily.

The method is as follows.

The patient may receive the procedure while sitting on a chair or standing.

In the progressive stage of psoriasis, against the background of drug therapy, including anti-inflammatory, hypersensitizing and detoxification therapy, photochromotherapy is carried out using the Spectrum-LC-02 LED apparatus by exposing psoriatic skin plaques of 650 nm with narrow-band optical LED radiation at a wavelength of 50 m with a radiation power of 50 m , the radiation power density is 2.8 mW / cm ² , the total radiation dose is 30 J per procedure, the energy exposure is 0.2 J / cm ² in continuous mode, the duration 10 minutes, 2 minutes per field, the total area of skin irradiation per procedure is not more than 750 cm ² , using the contact labile method, 10 procedures are carried out according to one procedure daily.

Distinctive essential features and a causal relationship between them and the achieved result:

Exposure to narrow-band optical radiation with a wavelength of 540 nm restores microcirculation processes, reduces the proliferative component of inflammation, and helps reduce itching.

The specific effect of narrow-band optical radiation with a wavelength of 540 nm is used in the treatment of various pathological processes:

- with injuries of peripheral nerves (19);

- in the rehabilitation of cancer patients (20);

- with dystrophic degenerative disease of the spine (21);

- in acute respiratory diseases (22);

- in the treatment of infected wounds, trophic ulcers, osteomyelitis (23).

To date, in the complex treatment of psoriasis, the effect on the lesions of the skin of the trunk and extremities with narrow-band optical radiation with a wavelength of 650 nm in the progressive stage of chronic dermatosis is unknown.

Red color penetrates into biological tissues to a depth of 25 mm, being absorbed in the epidermis and the skin itself (dermis). About 25% of the incident energy comes to subcutaneous fat. The red color (620-760 nm) is absorbed mainly by enzymes (catalase, ceruloplasmin), as well as by the chromatoform groups of protein molecules and, partially, by oxygen [6]. When exposed to local skin areas, the red color changes the local temperature in the irradiated tissues, causes vasodilation, an increase in blood flow, which is manifested by mild hyperemia. It increases the tone of striated and smooth muscles, stimulates the maturation of collagen structures. Marked stimulation of immunity and erythropoiesis is noted. Red color activates the reparative regeneration of damaged tissues, which is used for faster healing of wound and ulcerative defects of the skin and mucous membranes

Radiation power, radiation power density, total radiation dose, continuous mode, duration of exposure to one field, total skin irradiation area per procedure type of technique (contact labile), as well as the total number of procedures are selected during the study.

The set of distinctive essential features of the proposed method for the treatment of patients with psoriasis in the progressive stage is new and allows, in comparison with the prototype method:

• reduce the number of procedures to 10; (in the prototype - 20-32 procedures);

• stop itching at an earlier stage of treatment, that is, from 4-5 procedures (in the prototype after 20-32 procedures);

• increase the duration of remission of the disease up to 8 months -1.5 years (in the prototype method - from 6 months to 1 year);

• eliminate side effects that occur after the procedure according to the method of the prototype, as well as long-term side effects;

• expand the patient population by elderly patients with reduced secretory activity of sweat and sebaceous glands with dry, flaky skin; patients with ophthalmic diseases, such as cataracts, glaucoma, patients with diseases of the central nervous system with a sharp predominance of excitation processes, as well as due to patients with type I skin, as well as patients on whose body and face there are a lot of age spots, moles, patients with thyroid disease, decompensated diabetes mellitus, which increases the effectiveness of treating patients with psoriasis in a progressive stage and, which, in turn, improves the quality of life of patients.

We give examples from clinical practice:

Example 1. Patient D., 47 years old.

He was admitted to hospital treatment (day hospital) on August 10, 2018 with a diagnosis of Common psoriasis, progressive stage, off-season form.

Complaints of rashes on the skin of the scalp, and upper and lower extremities, itchy skin. Complaints about psychological fatigue, physical fatigue, decreased performance. According to him, he has been sick for 10 years. The last exacerbation in July 2017, received treatment on an outpatient basis and received low-intensity laser radiation of 650 nm in the complex treatment of psoriasis. This exacerbation of about 3 weeks, was not treated.

The main clinical symptoms before treatment:

The severity of psoriasis and the effectiveness of the therapy according to clinical signs before treatment and after a course of treatment were evaluated using the prevalence and severity of psoriasis (PASI-Psoriasis Area Seventy Index), which was calculated taking into account the severity of the main clinical manifestations and the area of the pathological process. The calculation is carried out according to the formula Fredriksson - Petersson (1978):

PASI = 0.1 (Eh + Ih + Dh) Ah + 0.2 (Eu + Iu + Du) Au + 0.3 (Et + It + Dt) At + 0.4 (Ei + Ii + Di) Ai, The human body was conditionally divided into 4 areas: h - head and neck, u - upper limbs, t - trunk, i - lower limbs.

Before treatment, the index of prevalence and severity of psoriasis lesions (PASI) was (Table 1), which can be regarded as moderately severe psoriasis.

Index calculation date (08/10/2018)

PASI from 10 points to 20 points - moderately severe psoriasis (Fig. 1, 2).

Analysis of the severity of itching and the disturbance of daily activity caused by it in the daytime and at night was carried out in points using the Behavioral rating scores (BRS) questionnaire.

The BRS index was 2 points. Analysis of the severity of itching showed a negative effect of itching on the daily activities of the patient. For a non-invasive assessment of skin morphology in the foci of psoriatic rashes, the method of ultrasound examination of the skin (dermoscanning) was used.

Before treatment in psoriatic plaques: the epidermis is linear, hyperechoic, homogeneous, unevenly thickened (0.06-0.07 cm); the dermis is isoechoic with many hyperechoic inclusions, linearity is preserved, thickened (0.30-0.35 cm), the border with the hypodermis is clear. The hypodermis is hypoechoic with hyperechoic septa. Marked vasodilation at the border with hypodermis, increased blood flow in ED mode. Apparently unchanged skin: the epidermis is linear, hyperechoic. homogeneous, not thickened (0.04 cm); the dermis is isoechoic, with a small number of hyperechoic inclusions, linearity is preserved, not thickened (0.23-0.25 cm), the border with the hypodermis is clear. The hypodermis is hypoechoic with hyperechoic septa. The blood flow in the ED mode is not increased. Conclusion of 08/10/2018: Signs of a chronic inflammatory process in the epidermal layers (pronounced proliferative component).

To assess the degree of negative impact of chronic dermatosis on various aspects of life, a Russified version of a specific questionnaire of the dermatological index of quality of life (DIC) was used.

Before treatment, DIC was 26 points (the maximum number of points was 30). The disease has a pronounced effect on the patient's life.

Received medical treatment in accordance with clinical recommendations:

anti-inflammatory, hypersensitizing and detoxification therapy: 10 ml of 30% sodium thiosulfate solution and 200 ml of 0.9% isotonic sodium chloride solution, iv drip slowly, 1 time per day, daily, No. 10; hepatoprotector: heptral (ademethionine) - 5 ml, iv, No. 10; 1 ml of a solution of thiamine chloride, IM, No. 5, every other day, 1 ml of a solution of pyridoxine hydrochloride, IM, No. 5, every other day (alternate); external therapy: 2% salicylic ointment 2 times a day for 10 days.

In the progressive stage of psoriasis, against the background of drug therapy, including anti-inflammatory, hypersensitizing and detoxification therapy, photochromotherapy was performed by applying narrow-band optical LED radiation of a wavelength of 650 nm to psoriatic skin plaques with a radiation power of 50 mW and a radiation power density of 2.8 mW / cm2 ² , the total radiation dose is 30 J per procedure, the energy exposure is 0.2 J / cm ² in continuous mode, lasting 10 minutes, 2 minutes per field, total area skin irradiation in one procedure is not more than 750 cm ² , according to the contact labile technique, 10 procedures carried out according to one procedure daily.

After therapy (on the 18th day of treatment) in psoriatic plaques (the back of the hand): the epidermis is linear, isoechogenic with a moderate amount of hyperechoic inclusions, heterogeneous, unevenly thickened (0.04-0.06 cm); isoechoic dera with a moderate amount of hyperechoic inclusions, linearity is preserved, thickened (0.10-0.15 cm), the border with the hypodermis is clear. Hypodermic hypoechoic is not expressed. The blood flow in the ED mode is not increased. In apparently unchanged skin: the epidermis is linear, hyperechoic, homogeneous, not thickened (0.03 cm); the dermis is isoechoic, with a small number of hyperechoic inclusions, linearity is preserved, not thickened (0.10-0.16 cm), the border with the hypodermis is clear. Hypodermic hypoechoic is not expressed. The blood flow in the ED mode is not increased. Conclusion of 08/28/2018: Pronounced positive dynamics (compared with ultrasound on 08/10/2018), the proliferative component is insignificant, pronounced regression of plaques.

The prevalence and severity index for psoriasis lesions (PASI) was _ (table 2). Index calculation date 08/28/2018

PASI of less than 10 points can be regarded as mild psoriasis. The clinical effectiveness of treatment with PASI is estimated by the percentage reduction in the value of PASI, which is calculated by the formula:

After treatment, the decrease in PASI was 54%, a decrease in PASI in the range of 50-74% is regarded as an improvement.

On the 2nd day of therapy, relief of itching. The BRS index was 0 points from the second day of complex therapy with the inclusion of photochromotherapy with a wavelength of 650 nm. Thus, the relief of a symptom such as itching and a decrease in the severity of clinical manifestations: erythema, infiltration, itching allowed the patient to go to the stationary stage of the disease on the 18th day of hospital stay. Common psoriasis passed from moderately severe to mild psoriasis, from the progressive stage of the disease to the stationary stage.

After treatment, DIC was 16 points. The decrease in DICJ was 10 points (by 61.5%).

After 4 weeks, the prevalence and severity index for psoriasis (PASI) was _ (table 3).

Index calculation date 09.25.2018

PASI of less than 10 points can be regarded as mild psoriasis (Fig. 3, 4).

After treatment, the decrease in PASI was 85%, a decrease in PASI in the range of 75% and higher is regarded as a significant clinical improvement.

4 weeks after treatment, the BRS index was 0 points. Thus, relief of a symptom such as pruritus and a decrease in the severity of clinical manifestations: erythema, infiltration, pruritus allowed the patient to go to the regressive stage of the disease on day 45 after complex therapy in a hospital. Common psoriasis passed from moderately severe to mild psoriasis, from a progressive stage of the disease to a regressive stage.

After treatment, DIC was 2 points. The decrease in DICJ was 24 points (by 92.3%).

When evaluating the effectiveness of complex therapy of the progressive stage of psoriasis with the inclusion of photochromotherapy, narrow-band optical radiation with a wavelength of 650 nm, significant positive dynamics was noted (table 4).

FIG. 1 - illustrates the condition of the skin of the feet of patient D, 47 years old, before complex therapy with the inclusion of FHT 650 nm.

FIG. 2 - illustrates the condition of the skin of the feet of patient D, 47 years old, before complex therapy with the inclusion of FHT 650 nm.

FIG. 3 - illustrates the condition of the skin of the feet of patient D, 47 years old, on day 45 after complex therapy with the inclusion of FHT 650 nm.

FIG. 4 - illustrates the condition of the skin of the feet of patient D, 47 years old, on day 45 after complex therapy with the inclusion of FHT 650 nm.

Example 2. Patient S., 36 years old.

Received inpatient treatment on July 16, 2018 with a diagnosis of Common psoriasis, progressive stage, off-season form.

Concomitant diagnosis: Hypertension II degree.

Complaints of multiple rashes on the skin of the trunk and limbs, scalp, itching of the skin. Complaints about psychological fatigue, physical fatigue, decreased performance. According to him, he has been sick for 12 years. Last exacerbation in September 2017. She received treatment at a day hospital, received physiotherapy from ultrasound treatment. This exacerbation of about 2 weeks, was treated independently. With deterioration of the skin process.

The main clinical symptoms before treatment:

Before treatment, the prevalence and severity index of psoriasis lesions (PASI) was 23.2 points (table 5)

Index calculation date (10/12/2018)

PASI over 20 points is a common severe psoriasis.

Pruritus was absent in this patient.

Before treatment, DIC was 18 points.

For a non-invasive assessment of skin morphology in the foci of psoriatic eruptions, the method of ultrasound examination of the skin (dermoscanning) was used.

Before treatment in psoriatic plaques: the epidermis is linear, hyperechoic, heterogeneous, unevenly thickened (0.06-0.09 cm); the upper layer of the dermis in the form of a pronounced hypoechoic layer (up to 0.02 cm), the dermis is isoechoic with hyperechoic inclusions, linearity is preserved, thickened (0.20-0.26 cm), the border with the hypodermis is clear (hyperechoic layer). The hypodermis is hypoechoic with hyperechoic septa. Marked vasodilation at the border with hypodermis, increased blood flow in ED mode.

Apparently unchanged skin: the epidermis is linear, isoechoic with slight hyperechoic inclusions, not thickened (0.04-0.05 cm); the dermis is isoechoic, linearity preserved, not thickened (0.14-0.15 cm), the border with the hypodermis clear. The hypodermis is hypoechoic with hyperechoic septa. The blood flow in the ED mode is not increased.

Conclusion of 08/17/2018: Signs of a chronic inflammatory process in the epidermal layers (pronounced proliferative stage).

After complex therapy in psoriatic plaques: the epidermis is linear, hyperechoic, homogeneous, unevenly thickened (0.05-0.07 cm); in places, the upper dermis is in the form of a hypoechoic layer (0.01 cm), the dermis is isoechoic with a small amount of hyperechoic inclusions, linearity is preserved, not thickened (0.04 cm), the border with the hypodermis is clear (hyperechoic layer). The hypodermis is hypoechoic with hyperechoic septa. The blood flow in the ED mode is not increased.

Apparently unchanged skin: the epidermis is linear, isoechoic with slight hyperechoic inclusions, not thickened (0.04 cm); the dermis is isoechoic, linearity is preserved, not thickened (0.14-0.15 cm), the border with the hypodermis is clear. Hypoderma hypoechoic with hyperechoic septa. Blood flow in ED mode is not enhanced.

Conclusion from 08/31/2018: pronounced positive dynamics with ultrasound from 08/17/18, an unexpressed proliferative component is noted.

Received medical treatment in accordance with clinical recommendations.

In the complex therapy of psoriasis, narrow-band optical radiation with a wavelength of 650 nm was applied to psoriatic skin plaques, with a radiation power of 50 mW, a radiation power density of 2.8 mW / cm ² , a total radiation dose of 30 J per procedure, energy exposure 0 , 2 J / cm ² in continuous mode, lasting 15 minutes, 3 minutes per field, the total area of skin irradiation per procedure is no more than 750 cm ² , using the contact labile method, 10 procedures are performed according to one procedure daily.

After the course of treatment, the prevalence and severity index of psoriasis lesions (PASI) was 11.6 points (table 6). Index calculation date 08/29/2018

The PASI index from 10 points to 20 points is moderately severe psoriasis.

After treatment, the decrease in PASI was 50%, a decrease in PASI in the range of 50-74% is regarded as an improvement.

Thus, a decrease in the severity of clinical manifestations: erythema, infiltration, itching, allowed the patient to go to the stationary stage of the disease on the 14th day of hospital stay. Common psoriasis from severe to moderate to severe.

After treatment, DIC was 15 points. The decrease in the LCJ is 3 points, which is 16.7%.

5 weeks after the course of treatment, the prevalence and severity index of psoriasis lesion (PASI) was 2.9 points (table 7).

Index calculation date 08/29/2018

PASI index less than 10 points - mild psoriasis.

5 weeks after the course of treatment, the decrease in PASI was 87.5%, a decrease in PASI of 75% or more was regarded as a significant clinical improvement.

After treatment, DIC was 13 points. The decrease in the LCJ is 5 points, which is 27.8%.

When evaluating the effectiveness of complex therapy of the progressive stage of psoriasis with the inclusion of photochromotherapy, narrow-band optical radiation with a wavelength of 650 nm, significant positive dynamics was noted (table 8).

We analyzed the treatment of 31 patients with a verified diagnosis: Common psoriasis, progressive stage, off-season form according to the claimed method (group 1) and according to literature data - 34 patients according to the prototype method (group 2). The data obtained during the testing of the proposed method were compared with the data described in the prototype method. The severity of psoriasis and the effectiveness of the therapy were evaluated by clinical signs before treatment and after a course of treatment using the prevalence and severity of psoriasis (PASI).

The dynamics of the clinical picture was also evaluated by the decrease in the PASI index in%; by the severity of itching (Behavioral rating scores (BRS)); ultrasound examination of the skin (non-invasive assessment of the morphology of the skin in psoriatic plaques). To assess the degree of negative impact of chronic dermatosis on various aspects of life, a Russified version of a specific questionnaire of the dermatological index of quality of life (DIC) was used.

The data obtained are shown in table 9.

As can be seen from the table 9, in the first group, the decrease in the PASI index after treatment, consisting of 10 procedures, is 59%, and after 56-70 days after treatment, the decrease in the PASI index is 80%. A decrease in the PASI index from 50 to 74% is regarded as a clinical improvement. Based on the fact that the PASI index of 59% is regarded as a clinical improvement, we decided not to increase the number of procedures.

In group 2, the PASI index was 74.3% after 32 procedures performed on a 3-4 procedure weekly, that is, after 56-70 days of treatment.

In group 1, itching was stopped from 4 to 5 procedures.

The clinical picture corresponded to improvement, psoriatic plaques were divided into smaller papules, there was slight redness or moderate erythema, infiltration was slightly expressed, peeling was absent.

In group 2, in 11.4% of patients, moderate pruritus persisted after treatment. Erythema was observed in 10% of patients, photodermatitis developed in 7.1% of patients, and increased dry skin was observed in 12.6% of patients.

A decrease in the BRS index in group 1 was achieved in 98.8% of patients, and in group 2 - in 68.0%.

The decrease in the severity of clinical manifestations in group 1 was completed with the exception of side effects that occur immediately after the procedure and long-term side effects, in contrast to the propototype.

In group 1, remission was observed from 8 months to 1.5 years. In the second group - from 6 months to 1 year.

When assessing the dynamics of skin morphology in the foci of psoriatic rashes in patients of group 1, positive clinical dynamics, structural normalization were observed, the thickness and density of the dermis were reduced, signs of epidermal structuring appeared. There was a regression of hypoechoic areas in the upper layer of the dermis, extinction exudation (regression of plaques) was more pronounced in comparison with the prototype.

Thus, the claimed method of treating patients with psoriasis in a progressive stage allows:

• stop itching at an earlier stage of treatment, that is, from the second to fifth procedures;

• reduce the number of procedures to 10;

• increase disease remission up to 8 months - 1.5 years;

• eliminate such side effects that occur after the procedure as wrinkling and dry skin, erythema,

infiltration, itching, and also such distant side effects as symptoms of photoaging of the skin, the development of atrophy, telangiectasia, cataracts and an increased risk of carcinogenesis;

- to expand the patient population by patients having a lot of age spots, moles, patients with thyroid diseases, decompensated diabetes mellitus, elderly patients with reduced secretory activity of sweat and sebaceous glands, with dry, flaky skin; patients with ophthalmic diseases such as cataracts, glaucoma, patients with diseases of the central nervous system with a sharp predominance of excitation processes and patients with the first type of skin, which together increases the effectiveness of treatment and, thus, improves the quality of life of patients.

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Claims (1)

A method of treating psoriasis patients in a progressive stage, which consists in exposure to a physical factor against the background of drug therapy, including anti-inflammatory, hyposensitizing and detoxification therapy, characterized in that photochromotherapy is performed as a physical factor using the Spectrum-LC-02 LED apparatus by exposure to narrow-band optical LED radiation with a wavelength of 650 nm on psoriatic skin plaques, with a radiation power of 50 mW, a radiation power density of 2.8 m W / cm ² , the total radiation dose - 30 J per procedure, energy exposure - 0.2 J / cm ² , in continuous mode, lasting 10 minutes, 2 minutes per field, the total skin irradiation area per procedure is not more than 750 cm ² , according to the contact labile technique, 10 procedures carried out according to one procedure daily.

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