RU2802551C1 - Method of treatment of erosive and ulcerent form of lichen flat of mouth mucosa - Google Patents

Abstract

FIELD: medicine; therapeutic dentistry; physiotherapy.

SUBSTANCE: invention can be used for local treatment of erosive and ulcerative form of lichen planus (EUF LP) of the oral mucosa (OM). The method includes laser exposure and treatment of erosive-ulcerative lesions, while on the 1st, 3rd days of local treatment, application treatment of erosive-ulcerative elements with E6 photo wound is carried out for 5 minutes. After it is washed off, it is irradiated with a red stream of light with a wavelength of 665 nm, a power of 400 mW, a pulsed mode, a mesh exposure is carried out at a distance of 0.5 cm from the mucosa for 2 minutes, while the course of photodynamic therapy is performed in 2 procedures with an interval of 1 day. For irradiation, a Prometey diode laser is used. At home, for 7 days, 0.1% fluorocort ointment is applied for 20 minutes twice daily. The oral mucosa is treated twice daily as an oral baths for 1 minute with a 0.05% solution of dexamethasone in saline, prepared by diluting 1 ampoule of dexamethasone 4 mg/1 ml in 200 ml of saline. Then, on days 8–11 of local treatment, 3-fold daily closure of erosive-ulcerative elements with a self-adhesive Ora-Aid patch is performed until it is completely dissolved.

EFFECT: invention provides an increase in the therapeutic effect due to the rapid relief of pain, a decrease in the degree of inflammation, an increase in the process of epithelialization and regeneration of the OM.

2 cl, 2 tbl, 2 ex

Description

The invention relates to medicine, namely to therapeutic dentistry and physiotherapy, and can be used for local treatment of the erosive and ulcerative form of lichen planus (ELP) of the oral mucosa (OR).

Today, the prevalence of EJF LLP is on average 40% of cases among the identified pathology of the oral cavity; manifestations of lichen planus on the oral mucosa remain an urgent problem associated with an increase in the frequency of its detection, the lack of a unified pathogenetic concept, as well as the presence of severe forms that occur with severe pain symptom, resistant course and torpidity to local therapy. Many theories and trigger factors are considered in the development of this pathology [Gazhva S.I. Optimization of early diagnosis of pathological conditions of the oral mucosa. // S.I. Gazhva, O.V. Shkarednaya, T.P. Goryacheva, A.A. Chunikhin, E.A. Bazikyan. - 2017. - No. 3. - T. 9. - P. 119-125].

The morphological elements on the oral cavity are point or extensive erosions against the background of papules merging with each other; their most common localization is the mucous membrane of the cheeks and the lateral surface of the tongue.

Treatment of the erosive-ulcerative form of LP is carried out based on an analysis of these causative factors and medical history. Despite the wide selection of modern methods and means used in local treatment, the development and selection of optimal local therapy for the erosive-ulcerative form of LLP localized on the oral mucosa is currently ongoing [Galchenko V.M. Treatment of patients with lichen planus of the oral mucosa. // L.I. Galchenko, S.Yu. Byvaltseva, N.E. Bolshedvorskaya / Scientific almanac. - 2016. - No. 4-3(18). -WITH. 302-306.]

There is a known method of treating LP SOR using biologically active substances (BAS) to normalize metabolic processes in the body and the epithelium of the oral mucosa, both for general treatment (vitamins A, E, C multivitamins), and for local use - application of oil solutions of vitamins A, E, carotoline, rosehip oil, sea buckthorn oil, etc. ["Diseases of the oral mucosa: Textbook / Edited by L.M. Lukins. - N. Novgorod: NGMI, 1993, pp. 73-77]. The disadvantages of the known method are the low effectiveness of treatment, long periods of epithelization of erosions and elimination of inflammatory phenomena in complicated forms of LP, short periods of remission of the disease.

There is a known method of treating lichen planus, which consists in the introduction of desensitizing agents, local application of a hormonal agent to the oral mucosa, as well as a keratoplasty agent in the form of a 4% water-insoluble colloidal solution of chitosan with a degree of deacetylation of 0.95, a molecular weight of 100-120 kD. This drug is applied in a thin layer to the affected areas of the oral mucosa for 30 days, which are pre-treated with a 1% solution of hydrogen peroxide and dried. After that, treatment with the specified chitosan solution is continued once a day after meals and once at night, also for 30 days [patent RU 2258516, 2005].

There is a known method of local treatment of lichen planus of the oral mucosa of a typical form, which consists in applying two layers of a medicinal composition of Tizol with lidase evenly to the lesion twice a day with an exposure of 15 seconds, with an exposure of 15 seconds, no more than 0.01 mm in the ratio: Tizol 10 g, lidase 128 UE. The course of treatment is 14 days [patent RU 2540493, 2015].

There is a known method of treating patients with complicated forms of lichen planus of the oral mucosa, characterized by administering a solution of photoditazine prepared at the rate of 1.4 mg/kg of the patient’s body weight and dissolved in 200 ml of 0.9% sodium chloride solution, which is administered intravenously for 30 minutes in a darkened room, then 2 hours after the introduction of the photosensitizer, a session of laser irradiation of pathologically altered tissues of the oral mucosa is carried out using a laser medical device with a wavelength of 661-668 nm, a power of 350-400 mW for 10-15 minutes, at This course consists of 2-3 procedures with an interval of 4 to 7 days [patent RU 2681528, 2019].

There is a known method of treating patients with erosive and ulcerative elements of the lesion, which is characterized by the fact that before the start of treatment, a study of local immunity of the oral cavity is carried out, determining the values of immunoglobulin G, immunoglobulin A, lysozyme, the coefficient of balance of factors of local immunity of the oral cavity (KSB) is calculated, and application is prescribed applications with “Celestoderm-B” ointment 2 times a day on a sterile gauze napkin, holding with a finger, for 20 minutes with an interval of 12 hours, a course of 5 days, then if CSB values are more than 1.5, they are carried out 1 time per week, a course of 3 procedures injections of platelet autoplasma at 0.1-0.3 ml per mm under the morphological elements and along the transitional fold in their projection, while each procedure is completed with an application of platelet autoplasma on a sterile gauze pad for 15 minutes, and with CSB values equal to 1 .5 or less are limited to standard therapy, including applications with rosehip oil, mouth baths with infusions of herbs and antiseptics [patent RU 2692108, 2019].

There is a known method of treating the erosive form of LP using hyaluronic acid applications for 28 days, which helped reduce pain sensitivity within 4 hours and reduce the size of the pathological lesion [Nolan A., Badminton J., Maguire J., Seymour R.A. The efficacy of topical hyaluronic acid in the management of oral lichen planus. J Oral Pathol Med. 2009; 38:299-303].

The closest analogue of the invention is a method for treating EJF CPL SOR using an APS 450 nm device, which corresponds to the blue spectrum of action (Polironic LLC), without the use of a photosensitizer. On the 1st visit, the affected area was illuminated for 1 minute against the background of antiseptic treatment with Miramistin; on the 2nd visit, every other day, luminescence was performed for 1.5 minutes against the background of antiseptic treatment with Miramistin; on the 3rd visit, every other day, luminescence was performed for 2 minutes. against the background of antiseptic treatment with “Miramistin”, on the 4th visit every other day - glow for 3 minutes against the background of antiseptic treatment with “Miramistin”, on the 5th visit every other day - glow for 4 minutes against the background of antiseptic treatment with “Miramistin”. The number of visits is on average up to 6 sessions, exposure time is 5 minutes. At home, rinse the mouth with Miramistin solution 3 times a day for 7 days, apply Emparkol gel to the affected area for 20 minutes 3 times a day, 7 days, from the 8th day of keratoplasty - vitamin A in oil, applications to the lesions lesions for 20 minutes 3 times a day, until complete epithelization of the lesion elements, multivitamin complex "Alphabet", sequentially take 3 tablets of different colors with an interval of 4 hours between each, 30 days, antihistamine "Claritin", 1 tablet per day, 7 days [Gazhva S.I. The use of photodynamic therapy in the treatment algorithm for the erosive and ulcerative form of lichen planus of the oral mucosa / S.I. Gazhva, N.A. Kotunova, A.S. Kulikov // Modern problems of science and education. - 2018. - No. 4. - P. 154]. The disadvantages of this method are the use of a blue light stream as a photodynamic effect of a laser, capable of penetrating into the depth of tissue by approximately 2-4 mm (in contrast, the red stream provides a penetration depth into tissue from 0.5 cm to 1.5 cm), exception use of a photosensitizer, duration of laser exposure.

The objective of the invention is to develop a method for local treatment of EJF LLP, providing a reduction in the duration of local treatment, increased epithelization and regeneration, prevention of disease relapses and improved quality of life for patients.

The technical result when using the invention is to increase the therapeutic effect by quickly relieving pain, reducing the degree of inflammation, enhancing the process of epithelization and regeneration of the oral cavity.

The proposed method of local treatment of the erosive-ulcerative form of LLP is carried out as follows. On days 1 and 3 of local treatment, the mucous membrane in the area of erosive and ulcerative lesions is treated with an application of Photoran E6 for 5 minutes, then washed off with water, a session of laser irradiation of erosions on the oral mucosa is carried out with a Prometey diode laser with a wavelength of 665 nm, power 400 mW, mode pulsed, the distance from the mucous membrane is 0.5 cm, a mesh effect is applied to the pathological focus with a point waveguide for 2 minutes, while the course of photodynamic therapy is 2 procedures with an interval of 1 day. At home, for 7 days, 2 single applications of 0.1% fluorocort ointment are carried out for 20 minutes, 2 times a day irrigation of the oral mucosa in the form of oral baths for 1 minute each with a 0.05% solution of dexamethasone in physiological solution (1 ampoule of dexamethasone 4 mg/1 ml diluted in 200 ml physiological solution). On days 8, 9, 10, 11 of treatment at home, the erosive and ulcerative elements are covered daily 3 times with a self-adhesive Ora-Aid patch until it is completely dissolved. The use of the proposed complex treatment can reduce pain, inflammation, swelling, increase epithelization and regeneration of the mucosa.

During the local treatment, the patient is recommended to perform personal hygiene using a soft toothbrush and Biorepair PERIBIOMA toothpaste.

Fotoran E6 freeze-dried chlorin E6, using green microalgae - Spirulina Platensis, cultivated in an aseptic biophotoreactor, belongs to the chemical class of porphyrins (chlorin E6), the photosensitizing properties of which are widely known, increases the effectiveness of PDT.

Ora-Aid is a healing patch for the oral mucosa with vitamin E, consisting of an attached and a protective layer. The adhesive layer (self-absorbable) has strong adhesion when it is applied and moistened to the mucosa. It is a water-soluble polymer that reacts with moisture (water and saliva) in the mouth for 20-30 seconds and turns into a gel state, after which adhesive physical properties appear and adheres to the mucous membrane. The protective layer to protect the attached layer consists of a water-insoluble polymer. It is insoluble in water and covers the wound to protect the affected area from the environment (bacteria, saliva, food, etc.) in the oral cavity. Relieves pain, protects growth factors, protects the wound during the early stages of healing. Preservation of healing growth factors on the wound surface - leukocytes, macrophages, cell proteolytic enzymes, growth factors. Isolation promotes blood flow and circulation and creates conditions for increased cellular activity. Safe and easy to use, easy to cut into different shapes or sizes. Mint flavor reduces bad breath. Contains vitamin E. Attached in the oral cavity - upper jaw: 6~12 hours, lower jaw: 4~6 hours.

Triamcinolone (0.1% fluorocort) glucocorticosteroid (GCS) inhibits the release of interleukin-1,2, interferon gamma from lymphocytes and macrophages. Induces the formation of lipocortins, inhibits the release of inflammatory mediators by eosinophils, reduces the number and stabilizes the membranes of mast cells, which together has a local anti-inflammatory, antiallergic, decongestant, antiproliferative and regenerative effect. Accumulating in the epidermis, it reduces itching and exudation. Has anti-inflammatory, anti-allergic, anti-edema effects.

Dexamethasone is a synthetic glucocorticoid (GCS) that has anti-inflammatory, antiallergic, and immunosuppressive effects.

The proposed method was used in 19 patients with EJF PL SOR, who were divided into 2 groups: Group I - 10 patients with EJF PL SOR received treatment according to the proposed method, Group II - 9 patients with EJF PL SOR received treatment according to the traditional regimen according to Clinical recommendations 2020 (Table 1). It was found that in group I pain relief occurs on day 4.5, reduction of hyperemia and surface erosions with partial epithelization on day 5.75 of treatment, final epithelization and transition to the typical form of PL on day 11.0 of local treatment (Table 2) .

The essence of the invention is illustrated by the following clinical examples.

Example 1.

Patient V., 38 years old. Complaints of pain when eating. Objectively: on the mucous membrane of the cheeks, against the background of a typical pattern, erosive and ulcerative elements are observed, the mucous membrane around them is hyperemic and edematous.

The diagnosis: EJF PL of the buccal mucosa was made on the basis of complaints, anamnesis, objective data and biopsy data. The patient received a local course of treatment according to the proposed method.

On days 1 and 3, local treatment of the oral mucosa consisted of application treatment of erosive and ulcerative lesions localized on the oral mucosa with the photosensitizer Photoran E6 for 5 minutes, washing it off with water, treatment of erosive and ulcerative lesions of the oral cavity using photodynamic therapy with a Prometey diode laser with wavelength 665 nm, power 400 mW, pulse mode, distance from the mucous membrane 0.5 cm, mesh exposure to the pathological focus with a point waveguide for 2 minutes, for a course of local treatment 2 procedures with an interval of 1 day. At home, during 7 days of local treatment, the patient carries out 2 single applications of 0.1% fluorocort ointment for 20 minutes, 2 times a day treats the oral mucosa in the form of oral baths lasting 1 minute with a 0.05% solution of dexamethasone in saline solution . On days 8, 9, 10, 11 of local treatment, erosive and ulcerative elements are covered daily 3 times with a self-adhesive Ora-Aid patch until it is completely dissolved.

Personal hygiene is carried out using a soft toothbrush and Biorepair PERIBIOMA toothpaste.

When examined on the 4th day, relief of pain is noted, on the 6th day - a decrease in hyperemia and erosive-ulcerative elements on the mucous membrane, on the 12th day - complete epithelization of the mucosa and the transition to the typical form of LLP. The mucous membrane is painless, slightly hyperemic, moderately moist.

On the 12th day of local treatment, the patient had no complaints; upon objective assessment, the oral mucosa was moist, moderately hyperemic with flattened papules against the background of a typical pattern.

Example 2 (according to Clinical Guidelines 2020).

Patient K., 45 years old. Complaints of pain when eating. Objectively: on the mucous membrane of the cheeks, against the background of multiple papular elements, erosive and ulcerative elements are observed, the mucous membrane is hyperemic, painful when eating hot food. Diagnosis: erosive-ulcerative form of lichen planus. The diagnosis was made on the basis of complaints, anamnesis, and objective biopsy data. The patient received a traditional course of local therapy. Local treatment of the oral mucosa consisted of antiseptic treatment using oral baths, the use of enzymes, corticosteroid, epithelial therapy against the background of general treatment for 21 days.

When examined on the 6th day, the presence of inflammatory foci was noted, pain persists when eating hot and irritating foods, taking medications, roughness of the mucous membrane, on the 7th day a decrease in inflammation in the area of erosive-ulcerative elements, on the 10th day partial epithelization, on the 14th day transition to exudative -hyperemic form, on the 19th day complete epithelization of erosive and ulcerative elements. On the 21st day of local treatment, the patient had no complaints; upon objective assessment, the oral mucosa was moist, moderately hyperemic with flattened papules against the background of a typical pattern.

Claims (2)

1. A method of local treatment of the erosive and ulcerative form of lichen planus of the oral mucosa, including laser exposure and treatment of erosive and ulcerative lesions, characterized in that on days 1 and 3 of local treatment, the erosive and ulcerative elements are treated with photowound E6 for 5 minutes, after washing it off, it is irradiated with a red stream of light with a wavelength of 665 nm, a power of 400 mW, pulsed mode, a mesh effect is carried out at a distance of 0.5 cm from the mucosa for 2 minutes, while the course of photodynamic therapy is 2 procedures with an interval of 1 day, at home for 7 days, 2-time applications of 0.1% fluorocort ointment are carried out for 20 minutes, 2 times a day the oral mucosa is treated in the form of oral baths lasting 1 minute with a 0.05% solution of dexamethasone in saline solution prepared diluting 1 ampoule of dexamethasone 4 mg/1 ml in 200 ml of physiological solution, then on days 8-11 of local treatment, daily 3-fold closure of erosive and ulcerative elements with a self-adhesive Ora-Aid patch is carried out until it is completely dissolved. 2. The method according to claim 1, characterized in that a Prometey diode laser is used for irradiation.