Method of selecting tactics of treating actinic keratosis

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to dermatooncology, and can be used in treatment of actinic keratosis. For this purpose foci of disease are identified with further carrying out their US-examination and derma analysis. In case if hypoechogenic zone, occupying from 5% to 30% of entire derma thickness, is present in derma, applications with liquid nitrogen with textile tip are performed. In case if hypoechogenic zone, occupying from 30% to 70% of entire derma thickness, is detected, applications with liquid nitrogen with copper tip or photodynamic therapy with application of photosensitiser are performed. In case if hypoechogenic zone, occupying from 70% to entire derma thickness, is detected, photodynamic therapy with application of photosensitiser is carried out.

EFFECT: method makes it possible to select tactics of treating said pathology in the most accurate way basing not only on clinical manifestations of disease, but also due to taking into account proliferative abilities of cells, which excludes necessity of carrying out tissue biopsy.

3 dwg, 4 ex

 

The invention relates to medicine, namely to dermatooncology.

There is a method of treatment of actinic keratosis, including clinical examination, and when the detection unit, small foci, it is proposed the use of electrocautery or cryosurgery. When multiple lesions actinic keratosis use of appliqués with 5% ferracioli ointment 2 times a day for 3-4 weeks. At solar keratosis, accompanied by flaking and redness, apply a 0.05 to 0.1% tretinoin cream 1 times a day for 2-4 months, sometimes in combination with cryotherapy or applications with 5% ferracioli cream. (Molochkov VA, V.N. Shabalin., Kryazheva S., Romanenko GP Manual of geriatric dermatology, MONIKI, Moscow 2004, p.71-72).

The disadvantage of this method is the choice of treatment on clinical manifestations of the disease, is not considered proliferative capacity of cells, determining their ability to infestations that may lead to recurrence of pathological lesions.

There is a method of treatment of actinic keratosis, including clinical examination, and upon detection of small size and thickness lesions actinic keratosis proposed use to which iotherapy. When the presence of a single, with clear boundaries, but without signs of invasion lesions actinic keratosis use of curettage or electrodessication. In case of detection of large areas of the lesion with multiple lesions actinic keratosis, it is recommended the use of dermabrasion or chemical peels, and mild or moderate forms of the disease located on the skin of the face and head features the use of photodynamic therapy. (Berman C., L. Bienstock, Kuritzky L., Mayeaux EJ Jr., Tyring SK, Actinic keratoses: sequelae and treatments. Recommendations from a consensus panel. J Fam Pract. 2006 May; 55 (5): suppl 1-8., the prototype).

The disadvantage of these methods is that the choice of treatment is based only on the clinical manifestations of the disease, is not considered proliferative capacity of cells, determining their ability to infestations that may lead to recurrence of pathological lesions.

Object of the present invention is to eliminate the above disadvantages, improving the treatment of actinic keratosis, reducing the number of relapses at the expense of an individual choice of treatment.

For this proposed after clinical studies with the definition of disease, further ULTRASONIC study of pathological lesions with an analysis of the dermis, and if it HIPAA agendas zone occupying from 5% to 30% of the entire thickness of the dermis, be treated with applications of liquid nitrogen with textile tip, the detection hypoechoic zone occupies from 30% to 70% of the entire thickness of the dermis, recommend treatment applications of liquid nitrogen with a copper tip or photodynamic therapy application the application of the photosensitizer by the decision of the physician, depending on the clinical indications, and in identifying hypoechoic zone occupying 70% to the entire thickness of the dermis, to recommend only photodynamic therapy with application the application of the photosensitizer.

The proposed method of treatment of actinic keratosis is simple in execution, allows you to take an individual approach to the treatment taking into account the proliferative activity of the cells, which increases the effectiveness of therapy, reduces the number of relapses.

Figure 1 shows the scanogram hypoechoic zone, occupying 28% (from 5% to 30%) of the entire thickness of the dermis (example 1); figure 2 - scanogram presents hypoechoic area, occupying 61% (from 30% to 70%) of the entire thickness of the dermis; figure 3 presents scanogram hypoechoic zone, occupying the entire thickness of the dermis.

The implementation of the method is demonstrated on specific clinical examples.

Example 1

Patient M., 62, was admitted to the Department of Dermatovenereology and dermatooncology diagnosed with actinic is eratos. When viewed on the face marked spots, bright pink color, round shape, diameter from 5 mm to 9 mm, with fuzzy boundaries, the surface of which is rendered the cortical-scales.

The patient has to lie down on the couch with a slightly raised head. Before the examination from the surface of one of the foci removed the cortical-scales, then struck at least 5 mm conductive gel at room temperature. Ultrasound examination was performed without mechanical compression applied by the sensor. For studies used a specialized digital ultrasound system high resolution DUB (firm "TPM GmbH, Germany), ULTRASONIC sensor 75 MHz, registration number 2005/1123. Assess the extent of hypoechoic areas in the dermis. Depending on the thickness of the hypoechoic zone choose tactics of treatment.

Revealed hypoechoic zone 1 (figure 1), occupying 28% of the entire thickness of the dermis, therefore, examined the hearth of the low proliferative activity of cells and proliferating cells are located in the basal or parabasal layers of the epidermis. Was prescribed treatment with application of liquid nitrogen with textile tip a known schema.

After a month in the field of cryosurgery was noted pinkish normotrophic scar. One year after treatment signs of recurrence is not detecting the woman.

Example 2

Patient N., 58 years old, was admitted to the Department of dermatology and dermatooncology diagnosed with actinic keratosis. When viewed on the face there are several foci of irregular shape, with clear boundaries on surfaces which are rendered yellowish-brown crust. Similar to the description of example 1 is carried out ultrasound examination of one of the pathological lesions. Assess the extent of hypoechoic areas in the dermis.

Revealed hypoechoic zone 2 (figure 2), occupying 61% of the entire thickness of the dermis, therefore, examined the hearth there is a medium proliferative activity of cells and proliferating cells are located in the spinous layer of the epidermis.

Was prescribed treatment with application of liquid nitrogen with copper tip, once.

After a month in the field of cryosurgery was noted pinkish normotrophic scar. One year after treatment signs of recurrence was not found.

Example 3

Patient K., 68 years old, was admitted to the Department of dermatology and dermatooncology diagnosed with actinic keratosis. When viewed on the face marked the hearth of irregular shape, with sharp edges, the surface of which is rendered yellowish-brown crust. Similar to the description of example 1 is carried out ultrasound examination. Assess the degree of als is ravennati hypoechoic areas in the dermis.

Revealed hypoechoic zone 3 (figure 3), occupying the entire dermis, the conclusion is that in the survey of the hearth there is a medium proliferative activity and proliferating cells are located throughout the epidermis. For treatment was assigned photodynamic therapy with application applying the photosensitizer photoditazine gel.

After a month in the field of photodynamic therapy was observed pinkish normotrophic scar. One year after treatment signs of recurrence was not found.

Example 4

Patient K., 52 years old, was admitted to the Department of Dermatovenereology and dermatooncology diagnosed with actinic keratosis. When viewed on the face and neckline observed several foci of irregular shape, with clear boundaries on surfaces which are rendered yellowish-brown crust. Similar to the description of example 1 was carried out ultrasound examination of one of the pathological lesions. Assessed the prevalence of hypoechoic areas in the dermis: the revealed hypoechoic area, occupying 65% of the entire thickness of the dermis, therefore, examined the hearth there is a medium proliferative activity of cells and proliferating cells are located in the spinous layer of the epidermis. For treatment was assigned photodynamic therapy with application application fo is sensibilitate.

After a month in the field of photodynamic therapy was observed pinkish normotrophic scar. One year after treatment signs of recurrence was not found.

The proposed method was chosen tactics of treatment in 45 patients. To confirm the correctness of the chosen parameters for the proposed method, allowing adequate treatment, a comparative study of these same patients using immunohistochemical method, which was carried out in accordance with the methodology C.R. Taylor., R. Cote. and L.A. Stemberger.

For this purpose, 20 patients of lesions actinic keratosis immediately after the ultrasound scan was taken of biopsy material for immunohistochemical studies.

Immunohistochemical study investigated the level of proliferation in the epidermis and extent of elastosis in the dermis. In centers with elastosis, extending to the upper parts of the reticular dermis, noted the low index of cell proliferation, and expression of Ki 67 was visualized mainly in the basal and parabasal departments of the epidermis. In tumors with elastosis, extending to deep divisions reticular dermis, noted the average index of proliferation, the distribution of Ki 67 were recorded in basically the over the spinous layer of the epidermis. In centers with a total area of elastosis also noted the average index of proliferation, however, the expression of Ki 67 was visualized throughout the entire thickness of the epidermis.

Studies have shown that immunohistochemical study localization elasticeski changes in the different departments of the dermis coincided with the location of the stripe-shaped hypoechoic zones at ultrasonography.

The proposed method allows to carry out the treatment according to the results of noninvasive studies, which eliminates the need for a biopsy, prevents the appearance of skin imperfections on the face and exposed parts of the body, and provides sufficient information content for choice of treatment.

The selection method of treatment of actinic keratosis, including conducting clinical studies with detection of disease outbreaks, characterized in that it further conduct ULTRASOUND examination revealed pathological lesions with an analysis of the dermis and if it hypoechoic zone, occupying from 5 to 30% of the entire thickness of the dermis, offer to treat applications of liquid nitrogen with textile tip, the detection hypoechoic zone, which occupies from 30 to 70% of the entire thickness of the dermis, recommend treatment applications of liquid nitrogen with a copper tip or photodynamic therapy application application photosensibilisation is a, and when identifying hypoechoic zone, occupying 70% to the entire thickness of the dermis, recommend photodynamic therapy with application the application of the photosensitizer.



 

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