RU2792539C1 - Method for the treatment of petechial-arachnoid and linear forms of capillary angiodysplasia of the skin in children - Google Patents

Abstract

FIELD: medicine; dentistry.

SUBSTANCE: in the treatment of petechial-arachnoid form of capillary angiodysplasia by transcutaneous selective photodestruction (TSF), laser radiation with a wavelength of 525 nm is used, and TSF is carried out by placing the end of the manipulator in contact and perpendicular to the skin surface above the central petechial vascular element. When the central vascular element lies at a depth of 0.5 to 1.0 mm from the skin surface, laser radiation is used with a power of 2.0 W, a pulse duration of 1.6 ms, a pulse repetition rate of 50 Hz, a laser spot diameter of 1 mm, and an exposure time of 2 .0 sec. When the central vascular element lies at a depth of 0.5 to 1.0 mm from the skin surface, laser radiation is used with a power of 3.0 W, a pulse duration of 30 ms, a pulse repetition rate of 50 Hz, a laser spot diameter of 1 mm and an exposure time of 2.5 sec. In the treatment of a linear form of capillary angiodysplasia, TSF is carried out using laser radiation with a wavelength of 525 nm, moving the end of the manipulator located perpendicularly and in contact with the skin surface along the entire length of the expanded vascular element. When the diameter of the expanded capillary vascular element is less than 0.5 mm, TSF is carried out with laser radiation with a power of 2.0 W, a pulse duration of 1.6 ms, a pulse repetition rate of 50 Hz, a laser spot diameter of 1 mm, and a scanning speed of 1.0 cm per second. When the diameter of the expanded capillary vascular element is from 0.5 to 1.0 mm, TSF is carried out with laser radiation with a power of 3.0 W, a pulse duration of 30 ms, a pulse repetition rate of 50 Hz, a laser spot diameter of 1 mm, with a scanning speed of 0.5 cm per sec.

EFFECT: method provides a radical controlled destructive effect on the subepithelial vascular structures of capillary angiodysplasia of the skin, without damaging the surrounding tissue structures and epithelium, and contributes to the achievement of a good clinical and aesthetic result of treatment.

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Description

The invention relates to medicine, specifically to methods for removing vascular skin lesions in children and can be used in the treatment of petechial-arachnoid and linear forms of capillary angiodysplasia of the skin in children.

Petechial-arachnoid capillary angiodysplasia (PAKA) - spider angioma, spider nevus or spider telangiectasia, is an acquired pathological benign vascular formation located in the upper layers of the dermis. It has the appearance of a spider, consisting of an expanded central red color of a dotted vascular element, to which a telangiectatic capillary approaches from below, and thin, convoluted red-pink vascular structures diverging from it more superficially. The incidence of PAKA in children is different, in children of the younger age group it is noted in 29.5% of cases, in children aged 4 to 9 years, it occurs in 66.0% of patients. There was no difference between the incidence in boys and girls. PAKA is more often localized on the skin of open areas of the body, in the face and neck it occurs in up to 53.3% of cases, less often in the limbs and torso. The appearance of PAKA is more often associated with microtrauma of the skin, which is represented by single or several elements.

The linear form of angiodysplasia (LA) is also an acquired pathological benign formation, the reason for its appearance is often associated with a damaging factor. The linear form is represented by one or more areas of paretically dilated burgundy or purple vessels located in the upper layers of the dermis, parallel to the skin surface. The main reason for the appearance of this pathology in children is various traumatic factors that lead to damage to the skin with the formation of scar tissue, increased vascularization and restructuring of angioarchitectonics in this area. Treatment of petechial-arachnoid and linear forms of capillary angiodysplasia of the skin in children is carried out using non-invasive and invasive methods.

A conservative method for the treatment of telangiectasias for discoloration of intradermal veins is known, including an enzyme of the hydrolase class subtilisin, troxerutin, disodium stabilizer edetate, trolamine, carbomer and water, the components in the agent are in a certain ratio. The disadvantage of this method is the limited depth of penetration of the drug, as well as the preservation of the central basal supply vessel. The disadvantages of all non-invasive methods using local therapy are very long and not always effective treatment that does not provide radical removal of the formation, as well as the lack of recommendations for use in childhood (RF Patent No. 2629018).

The most commonly used invasive methods of removal of capillary angiodysplasia.

A known method of treatment of benign vascular lesions of the skin in children by cryodestruction. For this, cryodestruction of pathological biological tissues is carried out with liquid nitrogen at a temperature of -196°C to -80°C. In this case, cryodestruction is carried out using freeze/thaw cycles. For this, a cryoapplicator is applied for 20-30 seconds to an area smaller by 1-2 mm from the border of the pathological tissue, followed by thawing for 30-90 seconds and re-freezing with an exposure of 30-90 seconds (RF Patent No. 2438613). The disadvantages of the method are the pain of the procedure, uncontrolled damage to the skin, scarring after healing and a long rehabilitation period.

A known method for the treatment of skin telangiectasia by microsclerotherapy. To do this, microsclerotherapy is carried out with a 0.5% solution of ethoxysclerol, not more than 0.5 ml in one vein, from 1 to 3 injections are carried out. Followed by compression of the injection site for 30 seconds. Immediately after the introduction of the sclerosant, laser coagulation of telangiectasias is carried out by continuous treatment using laser radiation having a wavelength of 578 nm and a power of 0.7 W. Exposure time 0.4 seconds, spot diameter 0.6 mm. After laser coagulation, limb rest is created for 30 minutes. At the same time, the treatment site is cooled for 10-15 minutes. The course of treatment is 1-2 procedures for one area (RF Patent No. 2317120).

The disadvantages of this method are the duration and pain during the procedure, as well as the possibility of using this method only in adult patients.

A known method of removing vascular lesions of the skin exposure to vascular formation of neodymium laser radiation with a wavelength of 1064 nm, a flux density of 120 j/cm ² . When removing vessels with a diameter of up to 0.2 mm, exposure begins with a pulse duration of 10 ms, reducing each subsequent pulse by 1 ms. When removing venules with a diameter of 0.2 to 2 mm, the impact begins with a pulse duration of 25 ms, reducing each subsequent pulse by 5 ms. When removing reticular veins with a diameter of 2 to 5 mm, exposure begins with a pulse duration of 50 ms, reducing each subsequent pulse by 10 ms. The pulse duration is reduced until the peak temperature inside the vessel is reached, leading to its coagulation (RF Patent No. 2669551). The main disadvantage of this method is the unpredictable depth of exposure, which can lead to the formation of rough skin scars, in addition, it is used only in adult patients.

The method is taken by us as a prototype.

The objective of the invention is to develop a method for the treatment of various forms of capillary angiodysplasia of the skin in children.

The technical result of the implementation of the task is to reduce the trauma of the procedure, due to the transcutaneous selective destructive effect on pathological vascular elements, ensuring their radical removal while maintaining the viability of the surrounding tissues, which prevents the recurrence of the disease, contributes to the achievement of a good clinical and aesthetic result of treatment.

The essence of the proposed method lies in the fact that the effect on pathological capillary vessels is carried out by laser radiation with a wavelength of 525 nm, which is selectively absorbed by hemoglobin in the vessels, which provides a precise effect only on vascular structures and minimizes damage to surrounding tissues. The impact is carried out by laser radiation of the green spectral range, with a wavelength of 525 nm, a power of 2.0 and 3.0 W, a laser pulse duration of 1.6 and 30 ms, an exposure of laser radiation of 2.0 and 2.5 seconds to the elements of capillary angiodysplasia of the skin cover. The method is implemented using a laser device "Malachite", based on diodes, specially designed for medical purposes at the Institute of General Physics. A.M. Prokhorov Academy of Sciences, Moscow, Russia together with the Perm Federal Research Center of the Ural Branch of the Russian Academy of Sciences, PJSC "Perm Research and Production Instrument-Making Company" Laboratory of agrobiophotonics, Perm, Russia.

The invention is based on the concept of selective photothermolysis for the removal of abnormal skin vessels, ensuring that the surrounding healthy tissue structures are not damaged (Patent RU No. 2644690). The analysis of the performed experimental studies showed that laser radiation of the green spectral range with a wavelength of 520 ± 10.0 nm, near the absorption peaks of hemoglobin and oxyhemoglobin, is the most promising for the removal of pathological vascular manifestations of the skin, providing selective photodestruction of vascular elements, without damaging nearby healthy tissues, including the skin and its growth zone (Gorbatova N.E., Safin D.A., Gasanova E.N., Zolotov S.A., Sirotkin A.A., Kuzmin G.P., Tertychny A.S., Stankova N.V., Remennikova M.V., Tikhonevich O.V. Experimental confirmation of the selectivity of the effect of "green" laser radiation on hemoglobin-containing tissues. Laser Medicine. 2020; 24(2-3): 95-103. https:// doi.org/10.37895/2071-8004-2020-24-2-3-95-103 Gorbatova N, Safin D, Sirotkin A, Kuzmin G, Tertychny A, Zolotov S, Remennicova M, Seleznev D, Tikhonevich O. Experimental modeling of selective photodestruction of skin angiodysplasia by laser r radiation with a wavelength of 525 nm. Lasers Med Sci. March 2022; 37(2): 1119-1126. https://doi.org/10.1007/s10103-021-03363-5. Epub 2021 Jun 23. PMID: 34160720).

The method is carried out as follows.

To implement the method, a laser device "Malachite", Russia, is used, which generates laser radiation with a wavelength of 525 nm, using a power of 2 and 3 W, a pulse duration of 1.6 and 30 ms, a pulse repetition rate of 50 Hz, with a laser spot on the surface of the target 1.0 mm in diameter.

Diagnostic analysis includes anamnestic data, clinical examination and ultrasound. Preliminary ultrasound with color Doppler mapping is performed to determine the diameter and depth of pathological vascular elements and the nature of the blood flow in them, which is necessary to select the mode of laser exposure. Ultrasound examination is carried out using an HD11 XE ultrasonic scanner, linear L12-3 probe, PHILIPS (USA). Anesthesia of the area of laser exposure before manipulation with an exposure time of 60 minutes is carried out using local anesthesia with anesthetic creams Emla, Akriol-Pro.

Transcutaneous selective photodestruction (TSF) in the treatment of petechial-arachnoid capillary angiodysplasia (PAKA) is performed as follows: the end of the manipulator is placed perpendicular and in contact with the skin surface above the central petechial vascular element. The following modes of point laser exposure are used: laser radiation with a wavelength of 525 nm, laser radiation power of 2.0 and 3.0 W, pulse duration of 1.6 and 30 ms, pulse repetition rate of 50 Hz, laser radiation exposure of 2.0 and 2 .5 sec, laser spot diameter 1 mm (Table 1).

When the central vascular element is located less than 0.5 mm from the skin surface, its transcutaneous selective photodestruction is carried out using laser radiation with a power of 2.0 W, with a pulse duration of 1.6 ms, a pulse repetition rate of 50 Hz, a laser spot diameter of 1 mm and a time exposure 2.0 sec. When the central vascular element is located 0.5 to 1.0 mm from the skin surface, its transcutaneous selective photodestruction is carried out using laser radiation with a power of 3.0 W, with a pulse duration of 30 ms, a pulse repetition rate of 50 Hz, and a laser spot diameter of 1 mm and exposure time of 2.5 sec. After transcutaneous selective laser photodestruction of the central vascular element of the RACA, independent closure of the lumen of the vessels extending from it is noted. The proposed modes of laser exposure provide precise dosed thermal photodestruction of the central petechial vascular element and peripheral superficial vascular elements of PACA, without damaging the surrounding tissues.

Transcutaneous selective photodestruction in the treatment of a linear form of capillary angiodysplasia (LCA) is carried out by moving the end of the manipulator located perpendicularly and in contact with the skin surface along the entire length of the expanded vascular element. The following modes of transcutaneous selective photodestruction are used: laser radiation wavelength 525 nm, laser radiation power 2.0 and 3.0 W, pulse duration 1.6 and 30 ms, pulse repetition rate 50 Hz, laser spot diameter 1 mm, scanning speed 1 .0 and 0.5 cm/sec (Table 2).

When the diameter of the expanded capillary vascular element is less than 0.5 mm, transcutaneous selective photodestruction is carried out with laser radiation with a power of 2.0 W, a pulse duration of 1.6 ms, a pulse repetition rate of 50 Hz, a laser spot diameter of 1 mm, and a scanning speed of 1.0 cm per give me a sec. With a diameter of 10 of the expanded capillary vascular element from 0.5 to 1.0 mm, transcutaneous selective photodestruction is carried out with laser radiation with a power of 3.0 W, a pulse duration of 30 ms, a pulse repetition rate of 50 Hz, a laser spot diameter of 1 mm, and a scanning speed of 0.5 cm per second. After transcutaneous selective laser photodestruction of the dilated capillary vascular elements of the LCA, their whitening is immediately noted and, subsequently, the lumen is closed.

After exposure, dotted and linear areas of the skin were treated with a concentrated solution of potassium permanganate. Control examinations after manipulation were performed on the 14th day, 30th day and in the long term - after 6 months.

Confirmation of obtaining a technical result in the entire interval are examples of the implementation of the claimed invention in all specified intervals.

Examples of the clinical implementation of the method.

Example 1. Child L., 11 years old. Diagnosis: "Petechial-arachnoid capillary angiodysplasia (PAKA) in the region of the right half of the back of the nose." The view of PAKA before manipulation is shown in Fig. 1. Ultrasound showed that the depth of the central vascular element was less than 0.5 mm, fig. 2. Laser selective photodestruction (TSP) was performed in the following modes: wavelength 525 nm, power 2.0 W, pulse duration 1.6 ms, pulse repetition rate 50 Hz, laser spot diameter 1 mm, exposure time 2.0 sec. The postoperative period without features. After 1 month, a good clinical and aesthetic result was noted, shown in Fig. 3.

Example 2., Child N., 3 years old. Diagnosis: "Petechial-arachnoid capillary angiodysplasia in the region of the right cheek." The view of PAKA before manipulation is shown in Fig. 4. Ultrasound showed that the depth of the central vascular element was 0.8 mm, fig. 5. Laser selective photodestruction was performed in the following modes: wavelength 525 nm, power 3.0 W, pulse duration 30 ms, pulse repetition rate 50 Hz, laser spot diameter 1 mm, exposure time 2.5 sec. A photo of the formation immediately after the operation is shown in Fig. 6. Postoperative period without features. After 6 months, a good clinical and aesthetic result was noted, shown in Fig. 7.

Example 3. Child K., 4 years old. Diagnosis: "Linear capillary angiodysplasia in the region of the right cheek." The appearance of the formation before manipulation is shown in Fig. 8. The view of the vascular elements of the formation on dermatoscopy is shown in Fig. 9. Ultrasound showed that the diameter of the vessels was less than 0.5 mm, fig. 10. Laser selective photodestruction was performed in the following modes: wavelength 525 nm, power 2.0 W, pulse duration 1.6 ms, pulse repetition rate 50 Hz, laser spot diameter 1 mm, scanning speed 1.0 cm per second. The postoperative period without features. Photo of the formation after 1 month, a good clinical and aesthetic result was noted, Fig. eleven.

Example 4. Child D., 2 years old. Diagnosis: "Linear capillary angiodysplasia in the dorsal surface of the right forearm." The appearance of the formation before manipulation is shown in Fig. 12. The view of the vascular elements of the formation on dermatoscopy is shown in Fig. 13. On ultrasound, it was found that the diameter of the vessels is 0.9 mm, shown in Fig. 14. Laser selective photodestruction was performed in the following modes: wavelength 525 nm, power 3.0 W, pulse duration 30 ms, pulse repetition rate 50 Hz, laser spot diameter 1 mm, scanning speed 0.5 cm per second. The postoperative period without features. A photo of the formation after 7 days is shown in Fig. 15. After 6 months, a good clinical and aesthetic result was noted, fig. 16.

The method provides a radical controlled destructive effect on the subepithelial vascular structures of capillary angiodysplasia of the skin, without damaging the surrounding tissue structures, including without damaging the epithelium.

The prior art does not know a method for the treatment of petechial-arachnoid and linear forms of capillary angiodysplasia of the skin in children, characterized by the claimed set of features, therefore, this method meets the criterion of "novelty".

The authors for the first time established that the above set of distinctive features of the method of transcutaneous selective laser photodestruction of vascular elements of petechial-arachnoid and linear capillary angiodysplasia of the skin provides a radical result of treatment, the absence of recurrence, reduces the trauma of manipulation, which contributes to the achievement of good clinical and aesthetic results of treatment, it can be used in pediatric patients. Thus, the claimed invention meets the criterion of "inventive step".

The effectiveness of the proposed method was confirmed at the Research Institute of NDKhT by clinical results of treatment in 21 patients, including 14 patients with PAKA and 7 patients with LCA.

Claims (1)

A method for treating petechial-arachnoid and linear forms of capillary angiodysplasia of the skin in children, including exposure to vascular formation with laser radiation, characterized in that transcutaneous selective photodestruction (TSF) is performed, while in the treatment of petechial-arachnoid form of capillary angiodysplasia, TSF uses laser radiation with a wavelength of 525 nm, and TSF is carried out by placing the end of the manipulator in contact and perpendicular to the skin surface above the central petechial vascular element, and when the central vascular element occurs at a depth of 0.5 to 1.0 mm from the skin surface, laser radiation with a power of 2, 0 W, pulse duration 1.6 ms, pulse repetition rate 50 Hz, laser spot diameter 1 mm and exposure time 2.0 sec; and when the central vascular element lies to a depth of 0.5 to 1.0 mm from the skin surface, laser radiation is used with a power of 3.0 W, a pulse duration of 30 ms, a pulse repetition rate of 50 Hz, a laser spot diameter of 1 mm and an exposure time of 2, 5 sec; in the treatment of a linear form of capillary angiodysplasia, TSF is performed using laser radiation with a wavelength of 525 nm, moving the end of the manipulator located perpendicularly and in contact with the skin surface along the entire length of the expanded vascular element, and with a diameter of the expanded capillary vascular element less than 0.5 mm, TSF is performed using a laser radiation power 2.0 W, pulse duration 1.6 ms, pulse repetition rate 50 Hz, laser spot diameter 1 mm, scanning speed 1.0 cm per second, with the diameter of the expanded capillary vascular element from 0.5 to 1.0 mm TSF is carried out with laser radiation with a power of 3.0 W, a pulse duration of 30 ms, a pulse repetition rate of 50 Hz, a laser spot diameter of 1 mm, with a scanning speed of 0.5 cm per second.

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