RU2811254C1 - Method of treating erythematotelangiectatic subtype of rosacea by points - Google Patents

Abstract

FIELD: medicine; dermatology and cosmetology.

SUBSTANCE: method can be used to treat the erythematotelangiectatic subtype of rosacea. 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 nine acupuncture points. Then, after 15 minutes, 15% azelaic acid is applied to the skin and left for 4 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

Field of technology 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 clinics for the treatment of erythematotelangiectatic subtype of rosacea.

The erythematotelangiectatic subtype of rosacea is characterized by the appearance of first transient, aggravated by hot flashes, and then turning into persistent erythema, localized mainly on the cheeks and lateral surfaces of the nose. The color of the erythema can vary from bright pink to bluish-red depending on the duration of the disease. Against the background of erythema, single telangiectasia are formed. Manifestations of the disease intensify when exposed to low and high temperatures, alcohol, spicy food and psycho-emotional stress. Characterized by increased sensitivity of the skin to external medications and ultraviolet radiation. Even indifferent creams and sunscreens can cause increased inflammatory manifestations.

Rosacea is difficult to treat, and therefore there are a large number of them, but most of the schemes and methods do not provide a stable remission of the process.

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 μg/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 2321399 C1, 06/01/2006).

Another well-known method of treatment, recorded in the patent RU 351355 C1, 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 the speed of 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 2583559 C2, 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.

A common drawback of all of these methods is the lack of an integrated approach to treating the disease. All existing methods do not simultaneously affect the totality of the pathogenesis of rosacea (xerosis, disruption of the sebaceous glands, inflammatory process of blood vessels, disruption of the lipid mantle, lymphostasis). In addition, the use of moisturizers on the surface of the skin does not allow achieving hydration at a deep level of the skin, which does not solve the issue of xerosis, an important pathogenetic aspect of rosacea.

Disclosure of the invention

The goal of the claimed method of treatment is to achieve sustainable remission in patients with the erythematotelangiectatic subtype of 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 the erythematotelangiectatic subtype of rosacea and increasing the effectiveness of therapy for the erythematotelangiectatic subtype of 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 1 time per week, during each of which injections of 1% hyaluronic acid are performed without local anesthesia at nine 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 15% azelaic acid is applied to the skin and left for 4 minutes, then the said azelaic acid is washed off with a 0.05% chlorhexidine solution, with injections performed at the following acupuncture points and in the following quantities:

first and second points (0.3 ml of 1% hyaluronic acid): 0.5 cm laterally from the lateral corner of the eye on both sides,

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

fifth and sixth 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,

seventh and eighth points (0.4 ml of 1% hyaluronic acid): 1 cm down from the lateral corner of the eye, from the indicated point 1 cm laterally (from the lateral corner of the eye, draw a conditional line down, step back 1 cm, from the indicated points 1 cm laterally),

ninth point (0.2 ml of 1% hyaluronic acid): 2.5 cm down from the middle of the lower lip (draw a conditional line down the middle of the lower lip, step back 2.5 cm down).

Carrying out the invention

The claimed method for treating the erythematotelangiectatic subtype of 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 claimed 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. Relieving 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 azelaic 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. Has a pronounced lymphatic drainage effect, relieves 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 the erythematotelangiectatic subtype of rosacea. You need to activate 9 points. 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:

- gallbladder meridian points. Localization: 0.5 cm laterally from the lateral canthus on both sides (first and second points);

- points of relief of vascular inflammation I. Localization: 1.5 cm down from the lateral corner of each eye (third and fourth points);

- points of relief of vascular inflammation II. Localization: 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 (the fifth and sixth points);

- liver meridian points. Localization: from the lateral corner of the eye, draw a conditional line down, step back 1 cm, from the indicated point 1 cm laterally (seventh and eighth points);

- point of the pancreas meridian. Localization: draw a conditional line down the middle of the lower lip, retreat 2.5 cm down (ninth point).

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 the erythematotelangiectatic subtype of rosacea, 0.3 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 the eighth point - 0.4 ml; the ninth point - 0.2 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 15% azelaic 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 15% azelaic acid, exposure time, number and duration of procedures, intervals between them were 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.

15% azelaic acid has an antibacterial, anti-inflammatory local effect, which is important in patients with erythematotelangiectatic rosacea, normalizes demodex titer, and restores the lipid mantle.

Application of 15% 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 the erythematotelangiectatic subtype of rosacea.

Examples of implementation of the invention

Clinical example 1

Patient E., 38 years old, complained of redness in the face, located mainly in the central part, burning, hot flashes after physical activity, and drinking alcohol. Over the past year, I sought medical help for a skin disease 2 times; treatment was carried out by a general practitioner, a gynecologist and a dermatologist with low effectiveness.

Status localis: the inflammatory skin process is localized in the facial area, characterized by severe erythema and telangiectasia, in the cheek area there are hemispherical lesions, red in color, active peeling.

Subjectively: no pain, burning, itching, high sensitivity of the skin to wind, notes a chronic course of the disease with a pronounced staged clinical manifestations.

Ds: Rosacea, erythematotelangiectatic subtype.

Associated diseases: gastritis.

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, followed by the application of 15% azelaic acid. The procedures were performed once a week. After 6 weeks of therapy, the erythematous lesions regressed, the patient began to react significantly less to the wind, peeling and itching of the facial skin disappeared, which indicates a significant clinical improvement.

Clinical example 2

Patient K., 52 years old, complained of severe redness on the skin of the face, hot flashes, facial swelling, and enlarged pores. Over the past year, she sought medical help for a skin disease 3 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 forehead, cheeks on both sides, chin, diffuse erythema of a congestive pink color without clear boundaries, weak fine-plate peeling, pasty soft tissues of the face.

Subjective: burning sensation, burning of the skin, hot flashes after stress, alcohol, before the menstrual cycle.

Ds: Rosacea, erythematotelangiectatic subtype.

Associated diseases: chronic gastritis, chronic sinusitis.

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, followed by the application of 15% azelaic acid. The procedures were performed once a week. After 6 weeks of therapy, the erythematous lesions regressed, the patient began to react significantly less to stress, alcohol and the menstrual cycle, peeling and discomfort of the facial skin disappeared, which indicates significant clinical improvement.

Clinical Case 3

Patient V., 46 years old, complained of changes in the facial area (red congestive red spots), burning at rest, in the sun, lack of sleep - the patient feels pulsation on the skin of the face. 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 cheeks and lateral surfaces of the nose in the form of centrofacial erythema of moderate severity with a bluish-reddish color; on the chin, the lesion had an oval shape with a telangiectatic component.

Subjective: severe pain, pulsation of the facial skin, a feeling of skin tightness, sleep disturbance, labile psycho-emotional background.

Ds: Rosacea, erythematotelangiectatic subtype.

Concomitant diseases: chronic tonsillitis, history of appendectomy.

The patient underwent a course of therapy (6 procedures) with the introduction of 1% hyaluronic acid at the specified points, in the specified sequence, with the specified volume, followed by the application of 15% azelaic acid. The patient tolerated the treatment very well. The procedures were performed once a week. After 6 weeks of therapy, the erythematous lesions regressed, tissue swelling went away, pores narrowed, pulsation of the soft tissues of the face went away, the patient’s sleep normalized, peeling and a feeling of tightness of the facial skin leveled out, which indicates a significant clinical improvement.

Claims (6)

A method for treating the erythematotelangiectatic subtype of 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 in nine points to a depth of 2 mm, after completion of which the skin is treated with a solution of 0.05% chlorhexidine, after which after 15 minutes 15% azelaic acid is applied to the skin and left for 4 minutes, then the said azelaic acid is washed off with a 0.05% solution of chlorhexidine, while injection performed at the following acupuncture points and in the following volumes: determine the first and second points 0.5 cm laterally from the lateral corner of each eye and inject 0.3 ml of 1% hyaluronic acid into them; determine the third and fourth 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 fifth and sixth 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 0.4 ml of 1% into them hyaluronic acid; the seventh and eighth points are determined 1 cm down and 1 cm laterally from the lateral corner of each eye and 0.4 ml of 1% hyaluronic acid is injected into them; The ninth point is determined 2.5 cm down from the middle of the lower lip and 0.2 ml of 1% hyaluronic acid is injected.