RU2769318C1 - Method for the treatment of severe acne on the background of chronic opisthorchiasis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine, namely to dermatovenereology and cosmetology, and is intended for complex therapy of severe acne against the background of chronic opisthorchiasis. Treatment includes eradication therapy of opisthorchiasis with a biologically active food supplement "Ekorsol", the appointment of systemic isotretinoin 3 months after deworming at a dose of 0.5 mg/kg until a course dose of 120 mg/kg of body weight is reached, as well as the use of home facial skin care in the form of Avène TriXéra Nutrition Nettoyant Nutri-Fluide softening gel for skin cleansing and Avene XeraCalm A.D. Concentre Apaisant soothing concentrate, Lactolan cream-mask from Holy Land 2 times a week under an occlusive dressing for 15 minutes.

EFFECT: use of the invention provides a reduction in the complications of the skin process in patients with acne on the background of deworming, as well as a decrease in the severity of undesirable effects, such as dryness and irritation of the skin of the face, in patients with severe acne receiving a course of systemic isotretinoin.

1 cl, 1 ex

Description

The invention relates to medicine, dermatovenereology and cosmetology, and can be recommended for use in the complex therapy of severe acne against the background of chronic opisthorchiasis.

Acne is a complex polyetiological disease, in the pathogenesis of which a significant role is assigned to the pathology of the digestive tract.

For the regions of Western Siberia, one of the frequent pathologies of the gastrointestinal tract is chronic opisthorchiasis. According to epidemiological data, infection on average varies from 78 to 95% of the population.

To date, numerous studies have been carried out to analyze the effect of chronic opisthorchiasis infection on skin processes (Aripova M.L., Khardikova S.A., Zima A.P. Treatment of chronic opisthorchiasis in patients with rosacea // Bulletin of Avicenna. 2014. No. 3 ( 60).URL).

With combined pathology, today one of the ways to deworm chronic opisthorchiasis is carried out using the drug Praziquantel, prescribed in the usual dose of 60 mg / kg of body weight, according to the night scheme in 3 doses with an interval of 4 hours. The effectiveness of deworming is 100%, but the disadvantage of this method in patients with acne is the difficulty in conducting this therapy, as this can cause exacerbation or aggravation of dermatosis, especially in the first days after deworming. The reason for this is an imbalance in the immune system, oriented in chronic opisthorchiasis to maintain a long-term symbiosis "host - parasite" (Kelhälä H-L, Palatsi R, Fyhrquist N, Lehtimäki S, Väyrynen JP, Kallioinen M, et al. IL-17 / Th17 Pathway Is Activated in Acne Lesions, Bobé P, editor, PLoS ONE [Internet], Public Library of Science (PLoS), 2014 Aug 25;9(8):e105238).

Severe acne is an indication for systemic isotretinoin. However, against the background of the use of this drug, such undesirable phenomena as itching, peeling and redness of the skin develop. These symptoms can be combined into one concept, like retinoid dermatitis. In order to stop side effects, patients should be prescribed care products, the action of which is aimed at eliminating dryness, flaking and itching.

Thus, the problem of complex treatment of severe acne against the background of opisthorchiasis infection with subsequent administration of systemic isotretinoin and prevention of the development of retinoid dermatitis is relevant.

There is a known method for the treatment of various forms of acne with systemic isotretinoin (Kruglova L.S., Talybova A.M., Gluzmina M.M. The effectiveness of various regimens for the use of isotretinoin in the treatment of patients with acne. Clinical dermatology and venereology. 2018. V. 17. No. 1. S. 64-71.), the disadvantage of this method is the frequent occurrence of adverse reactions, the lack of results of therapy within a year after treatment.

Another method of treating acne patients with systemic isotretinoin and care products is known (Aripova M.L., Khardikova S.A. Psychoemotional state of patients with severe acne during isotretinoin therapy. Bulletin of dermatovenereology and cosmetology. - 2015. - No. 5. - S. 122-127), the disadvantage of the known method is the exacerbation of the skin process and the manifestation of severe dryness of the skin.

The closest to the proposed method is the method of combined treatment of severe acne (Patent RU2713938 "Method of combined treatment of severe acne", 2019), which consists in reducing the number of complications in the form of exacerbation of the skin process and dry skin with high efficiency of therapy due to the expansion of the arsenal products for skin care, overdried during treatment and a deeper introduction of a moisturizer using the phonophoresis method.

A new technological result - a reduction in the complications of the skin process in patients with acne on the background of deworming, as well as a decrease in the severity of undesirable effects, such as dryness and irritation of the skin of the face, by expanding the arsenal of external agents for dry and atopic skin in patients with acne severe severity, receiving a course of systemic isotretinoin.

To achieve a new technical result in the method of combined treatment of severe acne against the background of opisthorchiasis infection, including the use of systemic isotretinoin and care products, systemic isotretinoin is taken at a dose of 0.5 mg/kg, until a course dose of 120 mg/kg of body weight is reached, care for facial skin is carried out morning and evening with Avène TriXéra Nutrition Nettoyant Nutri-Fluide Facial Cleansing Gel and Avene XeraCalm A.D. Concentre Apaisant Soothing Concentrate. Twice a week, apply the nourishing cream of the Lactolan mask from Holy Land under an occlusive dressing for 15-20 minutes. 3 months before the start of taking systemic isotretinoin, a course of deworming is carried out with a biologically active food supplement "Ekorsol". During this period, hepatoprotectors are used to restore liver function.

The method of combination therapy is as follows.

Before starting therapy, patients undergo a complete clinical and laboratory examination, which includes a general clinical examination (general blood count, general urinalysis, biochemical blood test), liver ultrasound, enzyme immunoassay for IgG to opisthorchia, and duodenal sounding to confirm the diagnosis of opisthorchiasis. Consultation of patients with related specialists (infectious disease specialist, gastroenterologist, therapist) to exclude concomitant diseases that could be a contraindication for anthelmintic therapy.

Three months before the start of taking systemic isotretinoin, anthelmintic therapy is carried out with the biologically active food supplement "Ecorsol", which is a phytocomplex consisting of herbs - extracts of aspen bark, golden volodushka herb and glucose. Aspen bark contains aromatic and fatty acids, carbohydrates, phenol glycosides, tannins, which have anti-inflammatory, analgesic, antipyretic, astringent and diuretic effects. Solyanka holmovaya contains alkaloids salsonin and salsolidin - these are derivatives of isoquinoline, it has a diuretic, choleretic, laxative effect, and is an antioxidant. Aspen bark acts on parasites, saltwort protects the liver from their destructive effect on the health of organ cells caused by infection itself, then deworming and decay products of opisthorchis.

To cleanse the skin of the face in the morning and evening, use Avène TriXéra Nutrition Nettoyant Nutri-Fluide, a light foaming emollient gel, after washing in the morning and evening, apply Avene XeraCalm A.D. 20 minutes.

Avène TriXéra Nutrition Nettoyant Nutri-Fluide softening gel contains: primrose oil - restores the hydro-lipid film on the skin surface and softens it; selectose - soothes the skin, reduces irritation and skin sensitivity; glycerin - helps moisturize the skin; soy seed extract - has a softening effect and fights against dehydration of the skin; Tocopherol - protects skin cells. The gel has a delicate texture, developed by experts specifically for atopic and dry skin. The lipids included in the composition protect against the irritating effect of hard water, do not irritate the eyes and mucous membranes.

Avene XeraCalm A.D. Concentre Apaisant contains: I-MODULIA complex - the first postbiotic active ingredient from Avene thermal water - eliminates itching and irritation, stimulates the protective functions of the epidermis; protective and regenerating complex (Cer-omega + ultra-concentrated vegetable oil) provides intensive restoration of severely dehydrated and dry skin; Aven thermal water has a calming, softening effect.

The Lactolan cream mask from Holy Land includes bioactive components obtained from natural milk that has undergone special processing and combined into a special Lactolan complex: milk proteins, lactic acid, enzymes and trace elements. The mask is designed to restore facial skin. The Lactolan complex nourishes skin cells with amino acids and microelements, prevents skin flaking. Milk and whey proteins moisturize the skin and enhance tissue regeneration. Lactic acid gently removes dead skin cells, has an anti-inflammatory effect and restores the natural acid-base balance, soothes irritated skin.

Avène TriXéra Nutrition Nettoyant Nutri-Fluide Gel, Avene XeraCalm A.D. Concentre Apaisant, and Holy Land Lactolan Cream Mask are used throughout systemic isotretinoin therapy.

Clinical example

Patient S., 28 years old, sought medical help from a dermatologist with complaints of: rashes in the face, chest and back in the form of inflammatory pustular elements, subcutaneous painful rashes, atrophic scars and congestive red-burgundy spots after rashes. From the anamnesis, it was revealed that these symptoms have been disturbing since adolescence, about 15 years. I turned to a dermatologist a few years ago, was treated in the form of local preparations. The therapy had a temporary effect. The last few years have been marked by an exacerbation of the skin process.

Status localis at the time of treatment: facial skin type is oily, there are many papulo-pustular elements of red color with purulent contents in the area of the face, back and chest, subcutaneous elements in the amount of 7 pieces on the chin, cheeks and back are bluish in color, soft-elastic on palpation consistency, soreness is noted, the pores are enlarged, many black dots and closed comedones.

The diagnosis was made: acne, severe severity.

The patient underwent a complete clinical and laboratory examination, was consulted by related specialists: a gynecologist-endocrinologist, a gastroenterologist.

The parameters of the general blood test and biochemical blood test were in the reference values. According to the results of examination by a gastroenterologist, a concomitant diagnosis was made: chronic gastritis, Hp+ associated. As a result of duodenal sounding, opisthorchiasis was found.

The patient was treated as follows:

1. Eradication therapy for opisthorchiasis invasion was carried out with the drug "Ecorsol" and further restoration of liver function with a hepatoprotector. During repeated duodenal sounding, opisthorchia eggs were not found. The parameters of the general and biochemical blood tests after deworming also remained within the normal range. The patient tolerated this therapy well: there was no exacerbation of acne against the background of eradication.

2. Taking into account the duration of the disease, the clinical picture and the ineffectiveness of the previous therapy, the patient was prescribed the systemic isotretinoin Aknekutan at a dose of 0.5 mg/kg. Until a course dose of 120 mg/kg of body weight is reached. The patient's body weight is 60 kg. The daily dosage of the drug was 32 mg per day (16 mg in the morning and 16 mg in the evening). The course of therapy was 225 days (7.5 months).

A biochemical blood test was repeated after 1 month of therapy and then every three months. Deviations from the norm were not revealed.

3. To reduce the side effects of systemic isotretinoin in the form of dryness, redness and peeling of the skin, facial skin care was prescribed in the form of Avène TriXéra Nutrition Nettoyant Nutri-Fluide emollient gel and Avene XeraCalm A.D. Holy Land 2 times a week for 15 minutes under an occlusive dressing.

The patient tolerated the therapy with Aknekutan quite well. In the second month, an exacerbation of the skin process was noted, which decreased by the 4th month, and a stable remission was noted at the 6th month.

Before therapy, during and after therapy, patients were assessed by the dermatological quality of life index (DQLI), the Cardiff Acne Disability Index (CADI).

Each question of the questionnaire for determining the DIQA suggests one of four response options: "no", "a little", "moderately", "very much", evaluated in points: 0, 1, 2, 3, respectively. The maximum score (30) corresponds to the most severe impairment of the quality of life. The questionnaire assesses the quality of life of patients according to six main parameters: symptoms/well-being, daily activity, leisure, work/study, personal relationships, treatment.

The Cardiff Acne Disability Index (CADI) associated with acne is a simplified 5-point questionnaire. CADI shows how acne prevents a person from getting positive emotions from life. For each answer option, a certain score is set from 0 to 3. The CADI index is calculated by summing the scores, the higher the score, the lower the quality of life.

The DIQ in the patient before treatment was 18 points, during treatment (at 3 months) it decreased to 6 points, and after the end of the course to 0 points, which indicates that the disease after therapy does not reduce the quality of life of the patient.

A similar picture is observed in the dynamics of the CADI index: before therapy 13 points, during therapy 6 points, after the end of therapy 1 point. It can be concluded that after acne therapy, this disease does not interfere with receiving positive emotions from life.

Under observation were 23 patients with acne on the background of chronic opisthorchiasis. All patients receiving deworming therapy noted good tolerance, no exacerbation of acne was observed. During the administration of Acnecutane, side effects in the form of dryness, peeling and redness were not observed due to the use of the facial skin care described above. After the course of therapy, all patients had a persistent remission of acne.

It can be concluded that this method of acne treatment against the background of chronic opisthorchiasis is highly effective. Biologically active food supplement "Ekorsol" allows for eradication therapy of opisthorchiasis from side effects and exacerbation of the skin process, and the proposed facial skin care while taking systemic isotretinoin helps to avoid such negative consequences of retinoid dermatitis as dryness, peeling and redness.

Claims (1)

A method for the treatment of severe acne on the background of chronic opisthorchiasis, which includes taking systemic isotretinoin at a dose of 0.5 mg/kg until a course dose of 120 mg/kg of body weight is reached and the use of skin care products, characterized in that 3 months before the use of systemic isotretinoin, eradication therapy of opisthorchiasis is carried out with a biologically active food supplement "Ekorsol", while throughout the entire therapy with systemic isotretinoin, an emollient gel is used to cleanse the skin of the face in the morning and evening Avène TriXéra Nutrition Nettoyant Nutri-Fluide, after cleansing the skin, Avene XeraCalm A.D. Concentre Apaisant concentrate is applied and 2 times a week under an occlusive bandage in the form of a plastic film for 15 minutes, use the Lactolan cream-mask from Holy Land.