RU2810400C1 - Method of treating steroid rosacea by points - Google Patents

Abstract

FIELD: medicine; dermatology; cosmetology.

SUBSTANCE: invention can be used for the treatment of steroid rosacea. Six procedures of 20 minutes each are carried out with an interval of once every two weeks, during each of which injections of 1% hyaluronic acid are performed without any local anesthesia into nine acupuncture points. After that, in 15 minutes, 20% lactic acid and 20% arginine are applied to the skin and left for 2 minutes.

EFFECT: method allows to relieve 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 steroid rosacea.

Steroid rosacea develops with long-term use of topical glucocorticosteroids, mainly fluoridated or potent drugs, but it can develop during the use of any topical glucocorticosteroids. The development of steroid rosacea is facilitated by the superficial location of an extensive network of arterial vessels, the presence of wide mouths of the follicles of numerous sebaceous glands, capable of accommodating an abundance of ointment and cream. Steroid rosacea is characterized by atrophic changes in the skin and thinning of the epidermis. Against the background of bright erythema with a copper tint, papules, pustules and multiple telangiectasias quickly form. Often the rashes are accompanied by painful sensations. An exacerbation of the pathological skin process after discontinuation of topical glucocorticosteroids is typical.

Steroid rosacea is virtually untreatable. The number of patients with steroid dependence increases, according to various sources, from 2% to 4%, when the share of rosacea in the structure of dermatological diseases is from 5 to 10% (Olisova O.Yu., Dodina M.I. “Modern ideas about the pathogenesis of rosacea.”/ / Experimental and clinical dermatocosmetology". 2010. No. 6. P. 18-22).

Steroid rosacea is often clinically similar to papulopustular or erythematous subtypes of rosacea that have been complicated by long-term use of topical corticosteroids. In this case, the main diagnosis is papulopustular or erythematous subtype of rosacea, and steroid rosacea in these cases represents a complication of long-term therapy with topical corticosteroids. In addition to the erythematotelangiectatic and papulopustular subtypes of rosacea, the main diseases in patients with steroid rosacea are atopic dermatitis and seborrheic dermatitis, since for these diseases topical corticosteroids are often used on the facial skin. According to the researchers, the duration of use of topical corticosteroids associated with the development of steroid rosacea in most cases was 1-2 years (Del Rosso J. Management of Papulopustular Rosacea and Perioral Dermatitis with Emphasis on Iatrogenic Causation or Exacerbation of Inflammatory Facial Dermatoses. Use of Doxycycline- modified Release 40mg Capsule Once Daily in Combination with Properly Selected Skin Care as an Effective Therapeutic Approach // J Clin Aesthet Dermatol. 2011 August; 4(8): 20–30).

State of the art.

There is a known method of treating rosacea, when a patient with an established diagnosis of rosacea is prescribed local injections of an ozone-oxygen mixture with a concentration of 3000 mcg/l subcutaneously into lesions on the facial skin, 1-2 ml with a total volume of 15 ml 3 times a week for 4 weeks. At the same time, the patient receives daily administration of sodium thiosulfate 30%, 10 ml intravenously, traditionally used for the treatment of rosacea, metronidazole 500 mg 3 times a day orally, and external treatment with 1% metronidazole gel (patent RU 2321399C1, 06/01/2006).

Another well-known method of treatment, recorded in the patent RU 351355C1, 04/28/2008, is to conduct a microcurrent effect on the skin affected by the disease, in which an additional Doppler examination of the microcirculation of the facial skin is carried out, the background volumetric velocity of tissue blood flow in the affected areas of the facial skin is determined, the background volumetric velocity tissue blood flow in unaffected areas of facial skin. The results obtained are compared. Depending on the detected percentage of deviation, basic facial skin care with cleansing and moisturizing agents is prescribed; microcurrent therapy in lymphatic drainage mode with a course of varying duration; administration of Sulodexide 250 LE in a course of varying duration.

Another treatment method is presented in patent RU 2583559C2, 04/09/2014. It consists of detoxification therapy, including antihistamines and sedatives in combination with local pharmacotherapy. Local therapy is carried out after a certain time interval with the use of 5% sulfur ointment, 10% sulfur ointment, 20% sulfur ointment, Azelik gel 15% on the affected areas according to the scheme. Throughout the course, Cetaphil® Dermacontrol™ and facial moisturizer SPF30 are used for washing in the volume and manner stated in the specified patent.

The main difficulty with steroid rosacea, in addition to the active inflammatory process of blood vessels, is the development of skin atrophy, severe disruption of the lipid mantle, and a decrease in the protective properties of the skin. It is these pathogenetic aspects that must be taken into account when choosing points while simultaneously carrying out moisturizing, sebum-regulating, drainage, anti-inflammatory therapy for rosacea as the main disease. There are many problems, they are complex, but solvable. A common drawback of all existing methods is the lack of an integrated approach to treating the disease, especially to its complications, because steroid rosacea, in fact, is a complication of the underlying disease due to incorrect tactics and strategies for patient management.

Disclosure of the invention.

The goal of the claimed treatment method is to achieve sustainable remission in patients with steroid rosacea within three months.

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

The technical result is achieved by performing six procedures of 20 minutes each with an interval of once every two weeks, during each of which injections of 1% hyaluronic acid are performed without local anesthesia at twenty-two points to a depth of 2 mm, after which the skin is immediately treated with a solution of 0.05% chlorhexidine, after which after 15 minutes 20% lactic acid and 20% arginine are applied to the skin, left for 2 minutes, then the specified lactic acid and 20% arginine are washed off with 0.05% chlorhexidine solution, with injections performed at the following acupuncture points and in the following volumes:

first, second, third, fourth, fifth, sixth, seventh, eighth points (0.2 ml of 1% hyaluronic acid from left to right): 1 cm towards the scalp from the hair growth line, active points are located in increments of 2 cm from each other, the center points are located 1 cm lateral from the center line,

ninth and tenth points (0.4 ml of 1% hyaluronic acid): 1 cm laterally from the foramen infraorbitale on both sides,

eleventh and twelfth points (0.2 ml of 1% hyaluronic acid): 1 cm lateral from the foramen supraorbitale on both sides,

thirteenth and fourteenth points (0.2 ml of 1% hyaluronic acid): 1 cm laterally from the foramen mentale on both sides,

fifteenth and sixteenth points (0.2 ml of 1% hyaluronic acid): 1.5 cm diagonally down from the commissure of the lips to the lower jaw,

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

nineteenth and twentieth points (0.4 ml of 1% hyaluronic acid): 1 cm above the point of intersection 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,

twenty-first and twenty-second points (0.4 ml of 1% hyaluronic acid each): 2 cm down from the wing of the nose along a line running from the wing of the nose to the commissure of the lips.

Implementation of the invention.

The claimed method of treating steroid 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. Relief 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 and arginine, which have a moisturizing, soothing, trophic 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 every two weeks. In total, the course of treatment takes three 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 steroid rosacea. Nine 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 fibroblast accumulation. Localization: we retreat along the hair growth line towards the scalp 1 cm, carry out a series of activation of points symmetrically retreating from the central line of the head 1 cm. The horizontal distance between the points is 2 cm. Activate 4 points on each side of the head (first, second, third, fourth, fifth, sixth, seventh, eighth points);

– activation points for the outputs of the main neurovascular bundles. Localization: we retreat from the foramen infraorbitale laterally 1 cm, activate the point on both sides (the ninth and tenth points);

– activation points for the outputs of the main neurovascular bundles. Localization: we retreat from the foramen supraorbitale laterally 1 cm, activate the point on both sides (the eleventh and twelfth points);

– activation points for the outputs of the main neurovascular bundles. Localization: we retreat from the foramen mentale laterally 1 cm, activate a point on both sides (the thirteenth and fourteenth points);

– activation points of the lymphatic system of the iliac region. Localization: we draw a line from the commissure of the lips to the line of the lower jaw diagonally, 1.5 cm down there is an important activation point for the lymphatic system, which, when activated, gives a pronounced anti-inflammatory effect. Restoring lymphatic drainage in the area of inflammation increases the regenerative abilities of the skin, which is a key link in the pathogenesis of the steroid form of rosacea. We perform it symmetrically, on both sides (fifteenth and sixteenth points);

– points for relieving vascular inflammation I. Localization: step back 1.5 cm from the lateral corner of the eye, activate the points symmetrically on both sides (seventeenth and eighteenth points).

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

– points of activation of the venous system. Localization: draw a line from the wing of the nose to the commissure of the lips, retreat 2 cm from the wing of the nose along the drawn line, activate on both sides (twenty-first and twenty-second 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 steroid rosacea, 0.2 ml of 1% hyaluronic acid is injected into the first to eighth points, 0.4 ml into the ninth and tenth points, 0.2 ml into the eleventh and twelfth points, and 0.2 ml into the thirteenth and fourteenth points. - 0.2 ml at the fifteenth and sixteenth points - 0.2 ml, at the seventeenth and eighteenth points - 0.4 ml, at the nineteenth and twentieth points - 0.4 ml, at the twenty-first and twenty-second points - at 0.4 ml.

In 80% of cases, after the fourth procedure, patients note a decrease in itching and irritation of the skin, the skin reacts less to external environmental factors, the skin becomes pleasant to the touch, stagnant spots disappear, the skin begins to “breathe”, becomes “alive”, which has a positive effect on the overall health of the skin. 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 and 20% arginine are applied to the skin. The exposure time is 2 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 and arginine, 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 an anti-inflammatory, regenerating effect, restores the lipid mantle, and affects the main links in the pathogenesis of steroid rosacea.

Application of 20% lactic acid and 20% arginine 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 remission of neurogenic inflammation in steroid rosacea.

Examples of implementation of the invention.

Clinical example 1.

Patient T., 42 years old, complained of redness in the face, burning, hot flashes after physical activity, drinking alcohol, and psycho-emotional stress. Applies Akriderm GK cream to the skin of the face every day; a dependence has formed; upon withdrawal, severe swelling of the facial skin develops, unbearable itching, redness, and the inflammatory process progresses sharply. Over the past year, I sought medical help for a skin disease 2 times; treatment was carried out by a therapist, a psychiatrist, a psychologist and a dermatologist with low effectiveness.

Status localis: the inflammatory skin process is localized in the facial area, characterized by severe atrophy (thinning) of the skin, erythema and multiple telangiectasias, the patient experiences pain when performing palpation tests to determine the level of skin sensitivity.

Subjectively: pain when touching the skin, burning, itching, high sensitivity of the skin to wind, sun, “everything”, marks the chronic course of the disease with a pronounced staged clinical manifestations.

Ds: Rosacea, steroid subtype.

Concomitant diseases: chronic migraine.

The patient underwent a course of therapy (6 procedures) with the introduction of 1% hyaluronic acid at the indicated points, in the indicated sequence, with the indicated volume and subsequent application of 20% lactic acid and arginine. The procedures were performed every 2 weeks. After 12 weeks of therapy, the erythematous lesions regressed, skin atrophy and the telangiectatic component decreased, the patient began to react significantly less to wind and sun, itching of the facial skin, pain on palpation disappeared, and complete refusal of hormonal cream, which indicates a significant clinical improvement.

Clinical example 2.

Patient O., 56 years old, complained of severe redness on the skin of the face, hot flashes, swelling of the face, multiple telangiectasia, high sensitivity of the skin to all environmental factors, cannot choose a cream for home care, constantly uses Fluorocort cream, attempts to refuse were ineffective, dependence was formed. Over the past year, she sought medical help for a skin disease 4 times, but complete resolution of the skin process was not observed. There was no effect against standard methods of therapy.

Status localis: upon examination, the inflammatory skin process is localized in the area of the entire face, diffuse erythema of a congestive cyanotic color, multiple telangiectasia located throughout the face, the face resembles a “web” of blood vessels, pronounced skin atrophy, pastiness of the soft tissues of the face.

Subjective: burning sensation, burning of the skin, hot flashes after stress, alcohol, all meteorological environmental factors.

Ds: Rosacea, steroid subtype.

Concomitant diseases: adenomyosis.

The patient underwent a course of therapy (6 procedures) with the introduction of 1% hyaluronic acid at the indicated points, in the indicated sequence, with the indicated volume and subsequent application of 20% lactic acid, 20% arginine. The procedures were performed every 2 weeks. After 12 weeks of therapy, the erythematous lesions regressed, the patient began to react significantly less to stress, alcohol, external environmental factors, the skin became thicker, the number of telangiectasia decreased, the discomfort of the facial skin went away, and the hormonal cream was completely abandoned, which indicates a significant clinical improvement.

Clinical example 3.

Patient D., 36 years old, complained of changes in the facial area (red congestive red spots), burning at rest, in the sun, lack of sleep, thinning of the skin, dependence on Celestoderm cream. Despite the therapy, relapses of the disease occurred with a frequency of 4-5 times a year. Standard methods without positive dynamics.

Objectively: upon examination, the skin process was localized on the face, pronounced skin atrophy, isolated telangiectasia, swelling of the soft tissues of the face.

Subjectively: a feeling of constant tightness of the skin, a feeling that the skin will “crack”, severe sensitivity to all factors of the external and internal environment, unbearable itching when trying to stop hormonal cream, sleep disturbance, labile psycho-emotional background.

Ds: Rosacea, steroid subtype.

Concomitant diseases: chronic pyelonephritis.

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, 20% arginine. The patient tolerated the treatment very well. The procedures were performed every 2 weeks. After 12 weeks of therapy, the erythematous lesions regressed, tissue swelling went away, the turgor and elasticity of the facial skin improved, high sensitivity to external and internal environmental factors leveled out, the patient’s sleep normalized, the feeling of tightness in the facial skin was relieved, and a complete refusal of hormonal cream was achieved, which indicates a significant clinical benefit. improvement.

Claims (9)

A method for treating steroid rosacea by points, consisting of six procedures of 20 minutes each with an interval of 1 time every two weeks, during each of which injections of 1% hyaluronic acid are performed without local anesthesia into twenty-two points to a depth of 2 mm, after at the end of which the skin is treated with a solution of 0.05% chlorhexidine, after which after 15 minutes 20% lactic acid and 20% arginine are applied to the skin, left for 2 minutes, then the specified lactic acid and 20% arginine are washed off 0 .05% chlorhexidine solution, with injections performed at the following acupuncture points and in the following volumes: determine the first, second, third, fourth, fifth, sixth, seventh, eighth points 1 cm towards the scalp from the hair growth line in increments of 2 cm from each other and inject 0.2 ml of 1% hyaluronic acid into them acids from left to right, with the central points located 1 cm lateral from the center line, the ninth and tenth points are determined 1 cm laterally from the foramen infraorbitale on both sides and 0.4 ml of 1% hyaluronic acid is injected into them, determine the eleventh and twelfth points 1 cm lateral from the foramen supraorbitale on both sides and inject 0.2 ml of 1% hyaluronic acid into them, determine the thirteenth and fourteenth points 1 cm lateral from the foramen mentale on both sides and inject 0.2 ml of 1% hyaluronic acid into them, the fifteenth and sixteenth points are determined 1.5 cm diagonally down from the commissure of the lips to the lower jaw and 0.2 ml of 1% hyaluronic acid is injected into them, determine the seventeenth and eighteenth points 1.5 cm down from the lateral corner of each eye and inject 0.4 ml of 1% hyaluronic acid into them, determine the nineteenth and twentieth 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 twenty-first and twenty-second points are determined 2 cm down from the wing of the nose along a line running from the wing of the nose to the commissure of the lips and 0.4 ml of 1% hyaluronic acid is injected into them.