RU2814362C1 - Method of treating rosacea with solid persistent oedema by points - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to dermatology and cosmetology, and can be used for treating rosacea with solid persistent oedema. Six procedures are performed for 20 minutes each with interval of 1 time a month, during each of which 1% hyaluronic acid is injected without local anaesthesia into twenty-four acupuncture points. After that, 15 minutes later, 12% ferulic acid is applied on the skin and held for 8 minutes.

EFFECT: method makes it possible to arrest xerosis, to carry out sebum regulation, to restore work in a vascular component, to restore protective properties of skin due to combination of injection therapy with 1% hyaluronic acid on acupuncture points with application of peeling.

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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 clinics for the treatment of rosacea with solid persistent swelling (rosacea-lymphedema).

Rosacea with solid persistent edema (Morbighan disease or rosacea-lymphedema) is a difficult diagnostic variant of the disease. Bacterial infection and allergic conditions in patients (increased IgE, bronchial asthma, allergic rhinitis and others) may play a role in the development of this form of rosacea. The swelling is located mainly on the upper parts of the face: on the forehead, bridge of the nose, eyelids, cheeks. At the same time, the traditional symptoms of rosacea are also observed. In a chronic persistent course, the swelling of the upper half of the face becomes persistent and becomes significantly thicker. The color of the skin in the affected areas becomes dark red or bluish-purple. With prolonged existence, swelling can be replaced by persistent infiltration and fibrosis. The histological picture is similar to that of classic rosacea, however, a large number of mast cells are detected.

With rosacea with solid persistent edema, the fifth link of pathogenesis comes to the fore, chronic lymphostasis, which leads to the formation of fibrosis in the subcutaneous fatty tissue and disruption of the skin texture, respectively. This form of atypical rosacea is complex and difficult to treat.

State of the art

There is a known method of treating rosacea with solid persistent edema using glucocorticosteroid hormones, radiotherapy, anti-inflammatory external therapy, antibiotics, interferon gamma cannot be called satisfactory, and in the early stages - the use of isotretinoin in a dosage of 0.2-0.5 per 1 mg/kg body weight body daily in combination with ketotifen 2 mg daily for several months (Jansen Th., Plewig G. Morbus Morbihan // Akt. Dermatol. 1996. Vol. 22. P. 161–164, Potekaev N.N. Rosacea (monograph) . M.-SPb; CJSC "Publishing House BINOM" - "Nevsky Dialect", 2000. 144 p.).

There is also a known method for the treatment of 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, metronidazole 500 mg 3 times a day orally, traditionally used for the treatment of rosacea, 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.

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 links in the pathogenesis of rosacea (xerosis, disruption of the sebaceous glands, vascular inflammation, 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 treatment method is to achieve sustained remission in patients with rosacea with solid, persistent edema within six months.

When creating the invention, a technical problem is solved, consisting in expanding the range of technical means for treating rosacea with solid persistent edema and increasing the effectiveness of therapy for rosacea with solid persistent edema; 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 month, during each of which injections of 1% hyaluronic acid are performed without local anesthesia at twenty-four points to a depth of 2 mm, after which the skin is immediately treated a solution of 0.05% chlorhexidine, after which after 15 minutes 12% ferulic acid is applied to the skin, left for 8 minutes, then the said ferulic acid is washed off with a 0.05% solution of chlorhexidine, with injections performed at the following acupuncture points and in the following amounts:

first and second points (0.2 ml of 1% hyaluronic acid): 4 cm down from the angle of the lower jaw along a line running from the angle of the lower jaw to the collarbone on both sides,

third and fourth points (0.2 ml of 1% hyaluronic acid): 2 cm down from the first and second points along the indicated line on both sides,

fifth and sixth points (0.2 ml of 1% hyaluronic acid): 2 cm down from the third and fourth points along the indicated line on both sides,

seventh and eighth points (0.2 ml of 1% hyaluronic acid): 2 cm down from the fifth and sixth points along the indicated line on both sides,

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

eleventh and twelfth points (0.4 ml of 1% hyaluronic acid): 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,

thirteenth and fourteenth points (0.2 ml of 1% hyaluronic acid): the place where the body of the eyebrow transitions into its tail along the lower border of hair growth on both sides,

fifteenth and sixteenth points (0.2 ml of 1% hyaluronic acid): 1 cm down and laterally diagonally from the medial corner of the eye on both sides,

seventeenth and eighteenth points (0.3 ml of 1% hyaluronic acid): 1.5 cm medial from the point located 1.5 cm above the lateral corner of the eye on both sides,

nineteenth and twentieth points (0.2 ml of 1% hyaluronic acid): 3 cm back from the earlobe on each side,

twenty-first and twenty-second points (0.4 ml of 1% hyaluronic acid): 1.5 cm diagonally medial from the earlobe on each side,

twenty-third and twenty-fourth points (0.2 ml of 1% hyaluronic acid): projection point on the skin of the angle of the lower jaw on both sides.

Carrying out the invention

The claimed method for treating rosacea with solid persistent edema 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 ferulic acid, which has an antibacterial, absorbable, defibrosing, keratolytic and anti-inflammatory effect on the skin (applied topically after the injection part, 15 minutes later, upon the onset of hemostasis).

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 month. In total, the course of treatment takes six 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. Peeling is large-plate in nature. 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 rosacea with solid persistent edema. Twenty-four points must 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:

– kidney activation points I. Localization: from the angle of the lower jaw, draw a line down to the collarbone, retreat 4 cm down from the angle of the lower jaw, activate the points symmetrically on both sides (first and second points). We go down from the active points by 1 cm, activate the points on both sides (third and fourth points), perform the specified algorithm 2 more times, activate the points on both sides (fifth - eighth 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 and prevents the development of fibrous tissue in lymphedema rosacea. We perform it symmetrically, on both sides (ninth and tenth 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 (the eleventh and twelfth points);

– kidney activation points II. Localization: the place where the body of the eyebrow transitions into its tail, we activate the points along the lower hairline, symmetrically on both sides (the thirteenth and fourteenth points);

– kidney activation points III. Localization: from the medial corner of the eye we retreat diagonally downward and outward 1 cm, activate the points symmetrically, on both sides (fifteenth and sixteenth points);

– points of the kidney meridian. Localization: draw a line upward from the lateral corner of the eye, retreat 1.5 cm, then draw a perpendicular medially, retreat 1.5 cm, activate the points symmetrically on both sides (seventeenth and eighteenth points);

– lymphatic drainage active points. Localization: draw a line back from the earlobe, retreat 3 cm, activate points on both sides, symmetrically (nineteenth and twentieth points). From the earlobe we draw a diagonal downward to the commissure of the lips, we retreat 1.5 cm from the earlobe, we activate the points on both sides (the twenty-first and twenty-second points). We find the angle of the lower jaw by palpation, activate the points symmetrically on both sides (twenty-third and twenty-fourth 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 rosacea with solid persistent edema, 0.2 ml of 1% hyaluronic acid is injected into the first and second points, 0.2 ml into the third and fourth points, 0.2 ml into the fifth and sixth points, and 0.2 ml into the seventh. and the eighth point - 0.2 ml each, the ninth and tenth points - 0.2 ml each, the eleventh and twelfth points - 0.4 ml each, the thirteenth and fourteenth - 0.2 ml each, the fifteenth and sixteenth - each 0.2 ml, in the seventeenth and eighteenth - 0.3 ml each, in the nineteenth and twentieth - 0.2 ml each, in the twenty-first and twenty-second - 0.4 ml each, in the twenty-third and twenty-fourth - 0. 2 ml.

In 80% of cases, after the fifth procedure, patients note a marked decrease in tissue swelling, a decrease in itching and skin irritation, the skin reacts less to external environmental factors, and narrowing of pores, 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 12% ferulic acid is applied to the skin. The exposure time is 8 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 12% ferulic 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.

12% ferulic acid has a resolving, defibrosing, antioxidant, protects the skin from free radicals, has a pro-apoptotic effect in skin cancer cells, has an antibacterial, anti-inflammatory local effect, normalizes demodex titer, and restores the lipid mantle.

Applying 12% ferulic 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 rosacea with solid persistent edema.

Examples of implementation of the invention

Clinical example 1

Patient R., 40 years old, complained of severe dense swelling on the forehead and cheeks, impaired skin texture, redness of the face with a bluish tint, and hot flashes after drinking alcohol. Over the past 2 years, she sought medical help for a skin disease 2 times; she was treated by a general practitioner, a gynecologist and a dermatologist with low effectiveness.

Status localis: the inflammatory skin process is localized in the forehead and cheeks, tissue swelling, dense on palpation, enlarged pores, disturbed skin texture.

Subjectively: a feeling of a “heavy face”, burning, high sensitivity of the skin after drinking alcohol, marks the chronic course of the disease with a pronounced staged clinical manifestations.

Ds: Rosacea with solid persistent swelling.

Concomitant diseases: allergic rhinitis.

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 12% ferulic acid. The procedures were performed every 4 weeks. After 6 months of therapy, tissue swelling was leveled out, facial tissues became soft to the touch, pores narrowed, skin texture evened out, the patient began to react significantly less to alcohol intake, which indicates a significant clinical improvement.

Clinical example 2

Patient O., 42 years old, complained of swelling on the forehead, cheeks, chin, red-blue face, hot flashes, fever, enlarged pores, impaired relief of the facial skin in the cheeks and nose, and sebum. Over the past year, she sought medical help for a skin disease 2 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 (dense swelling) is localized in the forehead, cheeks on both sides, chin, diffuse congestive cyanotic erythema, impaired skin texture, enlarged pores, oily sheen on the face.

Subjective: unpleasant on palpation, burning sensation, burning of the skin, hot flashes after nervous tension, with lack of sleep.

Ds: Rosacea with solid persistent swelling.

Concomitant diseases: bronchial asthma.

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 12% ferulic acid. The procedures were performed once a month. After 6 months of therapy, the inflammatory foci (dense swelling) regressed, the patient began to react significantly less to nervous tension, the pores narrowed, the face became “lighter”, the skin texture evened out, the skin became soft, elastic, the pain syndrome on palpation of the facial skin was relieved, which suggests of significant clinical improvement.

Clinical Case 3

Patient Zh., 46 years old, complained of changes in the forehead, cheeks, eyelids (dense infiltrative swelling of the soft tissues of the face), burning at rest, in the sun, in case of eating disorders - the patient feels pulsation on the skin of the face. Marked disturbance of the skin texture, the skin is dense, diffuse erythema with a bluish tint. 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 on the forehead, cheeks and eyelids in the form of constant swelling, the skin has a bluish-red color, a violation of the skin texture, and cicatricial deformities.

Subjective: pulsation of the facial skin, sleep disturbance, loss of appetite, labile psycho-emotional background.

Ds: Rosacea with solid persistent swelling.

Concomitant diseases: polynosis.

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 12% ferulic acid. The patient tolerated the treatment very well. The procedures were performed once a month. After 6 months of therapy, persistent swelling of the soft tissues of the face regressed, the pores narrowed, the skin texture leveled out, the erythema resolved, the pulsation of the soft tissues of the face went away, the patient’s sleep and appetite normalized, the patient’s psycho-emotional background improved, which indicates a significant clinical improvement.

Claims (13)

A method for treating rosacea with solid persistent swelling at points, consisting of six procedures of 20 minutes each with an interval of 1 time per month, during each of which injections of 1% hyaluronic acid are performed without local anesthesia at twenty-four 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 12% ferulic acid is applied to the affected skin, left for 8 minutes, then the said ferulic acid is washed off with a 0.05% solution of chlorhexidine, with In this case, injections are performed at the following acupuncture points and in the following volumes: determine the first and second points 4 cm down from the angle of the lower jaw along a line running from the angle of the lower jaw to the collarbone on both sides, and inject 0.2 ml of 1% hyaluronic acid into them, determine the third and fourth points 2 cm down from the first and second points along the indicated line on both sides and inject 0.2 ml of 1% hyaluronic acid into them, determine the fifth and sixth points 2 cm down from the third and fourth points along the indicated line on both sides and inject 0.2 ml of 1% hyaluronic acid into them, determine the seventh and eighth points 2 cm down from the fifth and sixth points along the indicated line on both sides and inject 0.2 ml of 1% hyaluronic acid into them, determine the ninth and tenth points 1.5 cm diagonally down from the commissure of the lips to the lower jaw and inject 0.2 ml of 1% hyaluronic acid into them, determine the eleventh and twelfth points 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 inject 0.4 ml of 1% hyaluronic acid into them, determine the thirteenth and fourteenth points at the place of transition of the body of the eyebrow into its tail along the lower border of hair growth on both sides and inject 0.2 ml of 1% hyaluronic acid into them, determine the fifteenth and sixteenth points 1 cm down and laterally diagonally from the medial corner of the eye on both sides and inject 0.2 ml of 1% hyaluronic acid into them, determine the seventeenth and eighteenth points 1.5 cm medially from a point located 1.5 cm above the lateral corner of the eye on both sides, and inject 0.3 ml of 1% hyaluronic acid into them, determine the nineteenth and twentieth points 3 cm back from the earlobe on each side and inject 0.2 ml of 1% hyaluronic acid into them, determine the twenty-first and twenty-second points 1.5 cm diagonally medial from the earlobe to the commissure of the lips on each side and inject 0.4 ml of 1% hyaluronic acid into them, The twenty-third and twenty-fourth points are determined as projection points on the skin of the angle of the lower jaw on both sides and 0.2 ml of 1% hyaluronic acid is injected into them.