RU2810361C1 - Method of treating ophthalmic rosacea by points - Google Patents

Abstract

FIELD: medicine; dermatology; cosmetology.

SUBSTANCE: invention can be used to treat skin papillomas. Six procedures of 20 minutes each are carried out with an interval of 1 time per week, during each of which injections of 1% hyaluronic acid are performed without any local anesthesia into twelve acupuncture points. After that, in 15 minutes, 20% lactic acid is applied to the skin and left for 4 minutes.

EFFECT: method allows to stop xerosis, perform sebum regulation, restore work in the vascular component, restore the protective properties of the skin, by combining injection therapy with 1% hyaluronic acid at acupuncture points with peeling.

1 cl, 3 ex

Description

The technical field to which the invention relates.

The invention relates to medicine, namely to dermatology and cosmetology, and can be used in medical clinics, offices, dermatology departments in hospitals and hospitals for the treatment of ophthalmic rosacea.

Ophthalmic rosacea is characterized clinically by blepharitis, conjunctivitis, chalazion, iritis, iridocyclitis, keratitis. Subjectively, patients note a burning sensation, lacrimation, photophobia, itching, soreness and foreign body sensation. In severe cases of rosacea keratitis, a sharp decrease in visual acuity is possible. In rare cases, the development of eye symptoms precedes skin symptoms.

With ophthalmic rosacea, the third link of pathogenesis comes to the fore, an active inflammatory process of blood vessels, which leads to eye damage; the process often quickly spreads from the skin to the eyes. Ophthalmic rosacea is difficult to diagnose, especially when it first appears on the part of the visual organs; even with a diagnosis, therapy is complex and ineffective.

State of the art.

There are known methods for the treatment of ophthalmic rosacea, when a patient with an established diagnosis of ophthalmic rosacea is prescribed antibiotics and metronidazole as systemic therapy (Babayants R.S., Ilyinskaya A.V., Gromova S.A. et al. Metronidazole in the treatment of rosacea and perioral dermatitis // Bulletin dermatology. - 1993. - No. 1. - P. 13-17; Snitsarenko O.V. Vasoactive polypeptides in rosacea // Bulletin of Dermatology and Venereology. - 1989. - No. 9. - P. 42-44; Snitsarenko O.V. Pathogenetic rationale for the use of proteinase inhibitors in the complex treatment of rosacea // Medical Affairs. - 1996. - No. 2. - P. 90-93; Basta-Juzbasic A., Dobric I. The effect of local administration of corticosteroids on the course and therapy of rosacea // Lijec-Vjesn. - 1989. - Vol. 111, No. 3. - P. 89-93; Carmichael A.J., Marks R., Graupe K.A., Zaumseil R.P. Topical azelaic acid in the treatment of rosacea // J. Dermatol. Trear. - 1993. - No. 4 (suppl i). - P. 19-22), however, long-term use of the above drugs is associated with the development of serious side effects and does not guarantee clinical recovery.

Hormonal and antibacterial drops and ointments do not provide lasting positive dynamics; after stopping the drugs, withdrawal syndrome occurs, the patient becomes a hostage to the situation, and dependence on these drugs occurs.

At the same time, using the claimed method, it was possible to achieve a pronounced lymphatic drainage, anti-inflammatory, and calming effect, resulting in stable remission of facial skin angioedema, in particular ophthalmic rosacea.

Disclosure of the invention.

The goal of the claimed method of treatment is to achieve sustainable remission in patients with ophthalmic rosacea within one and a half months.

When creating the invention, a technical problem is solved, consisting in expanding the range of technical means for treating ophthalmic rosacea and increasing the effectiveness of therapy for ophthalmic rosacea; the technical result of the invention is the implementation of this purpose of the invention.

The technical result is achieved through six procedures of 20 minutes each with an interval of 1 time per week, during each of which injections of 1% hyaluronic acid are performed without local anesthesia at twelve points to a depth of 2 mm, after which the skin is immediately treated with a solution 0.05% chlorhexidine, after which after 15 minutes 20% lactic acid is applied to the skin and left for 4 minutes, then the said lactic acid is washed off with a 0.05% chlorhexidine solution, with injections performed at the following acupuncture points and in the following amounts:

first and second points (0.4 ml of 1% hyaluronic acid): 2 cm medial from the point, which is located 1.5 cm below the lateral corner of the eye on both sides,

third and fourth points (0.4 ml of 1% hyaluronic acid): 1 cm medial from the point, which is located 1.5 cm below the lateral corner of the eye on both sides,

fifth and sixth points (0.4 ml of 1% hyaluronic acid): 2 cm diagonally down from the third and fourth points to the commissures of the lips on both sides,

seventh and eighth points (0.4 ml of 1% hyaluronic acid): 1.5 cm down from the lateral corner of each eye,

ninth and tenth points (0.4 ml of 1% hyaluronic acid): 1 cm above the intersection point of conditional lines, the first of which runs down from the lateral corner of each eye, and the second is perpendicular to the first line at the level of the wing of the nose,

eleventh and twelfth points (0.3 ml of 1% hyaluronic acid): lateral edge of the eyebrow tail on both sides.

Implementation of the invention.

The claimed method of treating ophthalmic rosacea is unique in that it is based on an integrated pathogenetic approach and is aimed at eliminating the clinical signs of the disease within one course of treatment.

As a result of treatment by the stated method, stable remission is achieved due to the following:

1. Moisturizing the skin at the level of the epidermis and dermis, eliminating dry skin. The effect is achieved through the introduction of hyaluronic acid and its hydrophilic properties.

2. Reducing sebum production in the sebaceous glands. By feedback type, as soon as the skin's hydro reserve is restored, sebum secretion by sebocytes decreases.

3. Removal of the inflammatory process of the vascular component of the skin. Complex effect both due to the relief of previous links in pathogenesis and due to the angioprotective effect of hyaluronic acid. High efficiency of angioprotective effect is observed with the introduction of sodium hyaluronate into special points proposed in the claimed invention.

4. Restoration of the protective properties of the skin (restoration of the lipid mantle). It is observed due to the complex effect of hyaluronic acid and its hydrophilic properties (injection) in combination with lactic acid, which has an antibacterial, keratolytic and anti-inflammatory effect on the skin (applied topically after the injection part, 15 minutes later, after hemostasis occurs).

5. Providing a pronounced lymphatic drainage effect, relieving swelling. It is achieved by stopping the inflammatory process in the skin and by introducing hyaluronic acid into lymphatic drainage points (similar to acupuncture, only prolonged action, due to the gel consistency of hyaluronic acid).

The treatment method consists of a course of treatment, including 6 procedures lasting 20 minutes each. Procedures are carried out once a week. In total, the course of treatment takes one and a half months.

The course of treatment is aimed at eliminating the above set of links in the pathogenesis of the disease (xerosis, disruption of the sebaceous glands, vascular inflammation, disruption of the lipid mantle, lymphostasis). The procedures are performed on an outpatient basis. There is a recovery period, lasting up to a week in the form of peeling of the affected areas of the skin. The patient remains socially active.

Injections are administered at treatment points depending on the subtype of rosacea. It is recommended to perform injections of 1% hyaluronic acid without local anesthesia to increase efficiency.

Algorithm for selecting therapeutic active points for ophthalmic rosacea. Twelve points need to be activated. Acupuncture (biologically active) points are points at which, during electropuncture diagnostics, a pronounced change in the electrical resistance of the skin is determined, the indicators of which change with changes in the functional state of human organs and tissues. The procedure protocol uses points of general (general healing effect) and local action:

- points of reduction of eye sensitivity to external environmental factors. Localization: draw a line down from the lateral corner of the eye by 1.5 cm, draw a perpendicular medially by 2 cm, activate points symmetrically on both sides (first and second points);

- eye moisturizing points I. Localization: draw a line down from the lateral corner of the eye by 1.5 cm, draw a perpendicular medially by 1 cm, activate the points symmetrically on both sides (third and fourth points);

- eye moisturizing points II. Localization: from eye moistening point I we draw a diagonal to the commissure of the lips, we retreat from the point diagonally 2 cm, we activate the points symmetrically on both sides (the fifth and sixth points);

- points of relief of vascular inflammation I. Localization: we retreat down 1.5 cm from the lateral corner of the eye, activate the points symmetrically on both sides (seventh and eighth points);

- points of relief of vascular inflammation II. Localization: draw the first line down from the lateral corner of the eye, the second line - perpendicular from the wing of the nose to the intersection with the first line, from the intersection point upward 1 cm, on both sides (ninth and tenth points);

- points of view improvement. Localization: lateral edge of the eyebrow tail, activate points symmetrically on both sides (eleventh and twelfth points).

The insertion depth is 2 mm. The dosage (volume) of hyaluronic acid administration depends on the area of administration and the clinical subtype of rosacea. For ophthalmic rosacea, 0.4 ml of 1% hyaluronic acid is injected into the first and second points, 0.4 ml into the third and fourth points, 0.4 ml into the fifth and sixth points, and 0.4 ml into the seventh and eighth points. 0.4 ml, at the ninth and tenth points - 0.4 ml, at the eleventh and twelfth points - 0.3 ml.

In 80% of cases, after the second procedure, patients note a decrease in itching and skin irritation, the skin reacts less to external environmental factors, which has a positive effect on the general psychological and emotional state of the patient.

After the injection part, the skin is thoroughly treated with a solution of 0.05% chlorhexidine, after 15 minutes 20% lactic acid is applied to the skin. The exposure time is 4 minutes, after which the solution is washed off with a 0.05% chlorhexidine solution.

The need to introduce hyaluronic acid into the above points, its concentration, dosage, depth of injection, choice and number of points, use of 20% lactic acid, exposure time, number and duration of procedures, intervals between them are determined empirically and by many years of experience. The use of 0.05% chlorhexidine as a topical antiseptic is well known.

The combination of injection therapy with the application of medicinal solutions (peelings) is a pathogenetically important aspect, which makes it possible to relieve skin xerosis, carry out sebum regulation of the skin, restore work in the vascular component of the skin, and restore the protective properties of the skin.

20% lactic acid has a moisturizing, soothing, anti-inflammatory, local regenerating effect, which is important for patients with ophthalmic rosacea, normalizes demodex titer, and restores the lipid mantle.

Application of 20% azelaic acid after injections is safe to use for the following reasons. Firstly, it is advisable to carry out injections using specialized needles, in particular 32G nanoneedles, which have a minimal diameter, and secondly, 15 minutes pass after the injection part, this time is enough for complete hemostasis and healing of skin microdamages.

Thus, after treatment in the amount of six procedures according to the specified scheme, it is possible to achieve stagnation of neurogenic inflammation in ophthalmic rosacea.

Examples of implementation of the invention.

Clinical example 1

Patient U., 38 years old, complained of redness in the face, located mainly in the central part, burning, hot flashes after drinking alcohol, wind, temperature changes. Tearing in the wind, sun. Over the past year, she sought medical help for a skin disease 3 times; she was treated by a dermatologist and an ophthalmologist with low effectiveness.

Status localis: the inflammatory skin process is localized in the face, characterized by severe erythema in the cheek area, redness, swelling in the upper eyelids.

Subjective: pain in the cheeks, burning, high sensitivity of the skin to wind, sun, high sensitivity of the eyes, a feeling of “sand in the eyes”, marks a chronic course of the disease with a pronounced staged clinical manifestations.

Ds: Rosacea, ophthalmic rosacea.

Concomitant diseases: chronic pancreatitis.

The patient underwent a course of therapy (6 procedures) of administration of 1% hyaluronic acid at the indicated points, in the indicated sequence, with the indicated volume, and subsequent application of 20% lactic acid. The procedures were performed once a week. After 6 weeks of therapy, the erythema regressed, the patient began to react significantly less to wind and sun, discomfort in the eye area went away, and lacrimation disappeared, which indicates significant clinical improvement.

Clinical example 2

Patient N., 30 years old, complained of multiple papular inflammatory elements on the cheeks, eyelids, hot flashes, swelling of the face, in particular swelling of the eyelids, itching in the eye area. Over the past year, I sought medical help for a skin disease 2 times, but complete resolution of the skin process was not observed, and my vision began to deteriorate. There was no effect against standard methods of therapy.

Status localis: upon examination, the inflammatory skin process (multiple papules) is localized in the cheek area on both sides and eyelids, diffuse congestive erythema, pasty soft tissues of the face.

Subjective: burning sensation, burning of the skin, hot flashes after nervous tension, alcohol, lack of sleep, itching in the eye area.

Ds: Rosacea, ophthalmic rosacea.

Concomitant diseases: chronic otitis media.

The patient underwent a course of therapy (6 procedures) of administration of 1% hyaluronic acid at the indicated points, in the indicated sequence, with the indicated volume, and subsequent application of 20% lactic acid. The procedures were performed once a week. After 6 weeks of therapy, the inflammatory foci (multiple papules) regressed, the patient began to react significantly less to nervous tension, alcohol and lack of sleep, facial skin discomfort, swelling in the eyelid area, and itching disappeared, which indicates a significant clinical improvement.

Clinical Case 3

Patient S., 48 years old, complained of redness in the eye area, small papular elements, burning at rest, in the sun, and alcohol intake. Despite the therapy, relapses of the disease occurred with a frequency of 3-4 times a year. Standard methods without positive dynamics.

Objectively: upon examination, the skin process was localized in the eyelid area in the form of grouped papules on a red background, pronounced pastiness of the eyelids.

Subjective: feeling of skin tightness, feeling of “sand in the eyes”, lacrimation due to temperature changes, wind, sun, during psycho-emotional stress, sleep disturbance, labile psycho-emotional background.

Ds: Rosacea, ophthalmic rosacea.

Concomitant diseases: gastric ulcer.

The patient underwent a course of therapy (6 procedures) of administration of 1% hyaluronic acid at the indicated points, in the indicated sequence, with the indicated volume, and subsequent application of 20% lactic acid. The patient tolerated the treatment very well. The procedures were performed once a week. After 6 weeks of therapy, the papulopustular lesions regressed, the swelling of the eyelids and lacrimation due to external environmental factors went away, the patient’s sleep normalized, and the feeling of tightness of the facial skin was leveled, which indicates a significant clinical improvement.

Claims (7)

A method for treating ophthalmic rosacea by points, consisting of six procedures of 20 minutes each with an interval of 1 time per week, during each of which injections of 1% hyaluronic acid are performed without local anesthesia into twelve points to a depth of 2 mm, after which the skin treated with a solution of 0.05% chlorhexidine, after which after 15 minutes 20% lactic acid is applied to the skin and left for 4 minutes, then the said lactic acid is washed off with a 0.05% solution of chlorhexidine, and injections are performed into the following acupuncture points and in the following volumes: determine the first and second points 2 cm medial from the point, which is located 1.5 cm below the lateral corner of the eye on both sides, and inject 0.4 ml of 1% hyaluronic acid into them; determine the third and fourth points 1 cm medial from the point, which is located 1.5 cm below the lateral corner of the eye on both sides, and inject 0.4 ml of 1% hyaluronic acid into them; determine the fifth and sixth points, retreating two centimeters along a diagonal drawn from the third and fourth points to the commissure of the lips on both sides, and inject 0.4 ml of 1% hyaluronic acid into them; the seventh and eighth points are determined 1.5 cm down from the lateral corner of each eye, and 0.4 ml of 1% hyaluronic acid is injected into them; determine the ninth and tenth points 1 cm above the intersection point of the conventional lines, the first of which runs down from the lateral corner of each eye, and the second is perpendicular to the first line at the level of the wing of the nose, and inject into them 0.4 ml of 1% hyaluronic acid; The eleventh and twelfth points are determined on the lateral edge of the eyebrow tail on both sides, and 0.3 ml of 1% hyaluronic acid is injected into them.