Method of treating patients with acne vulgaris and connective tissue dysplasia

FIELD: medicine.

SUBSTANCE: method involves administering Aevit, Unidox as a background therapy of degree I and II, and Isotretinoin and Cynovit gel as a background therapy of degree III and IV. Besides, Magnerot® 3.0 g is taken once a day (1.0 g three times a day) throughout the all background therapy.

EFFECT: invention enables providing higher clinical effectiveness in the patients with acne and connective tissue dysplasia.

1 tbl, 4 dwg

 

The invention relates to medicine, namely to dermatology and cosmetology.

The problem of acne is one of the most important in modern dermatology. Acne occurs in 85% of persons aged 12 to 25 years old, have a tendency to higher incidence of illness among patients of working age and an increase in the frequency of severe forms[1, 2, 3].

The high prevalence, high rate of complications and refractory forms of acne, frequent psycho-emotional manifestations of the disease make it a social problem of dermatology and cosmetology.

Acne is a polymorphic multifactorial chronic disease of the hair follicles and sebaceous glands, manifested by comedones and inflammatory lesions of the skin in the form of papules, pustules, nodes.

Numerous studies have shown that the causes of acne are varied. Have the value of nature and the properties of microorganisms in the lesions, the immune and neuroendocrine systems of the vascular wall skin[4, 5, 6].

However, some aspects of the pathogenesis of acne remain to date largely unexplored. In particular, have not been studied genetically-determined value of connective tissue dysplasia (CTD) is a syndrome manifested external stigmata of disambiguate in combination with dysfunction of internal organs, and its influence on the clinical form �knye and the effectiveness of treatment.

Connective tissue dysplasia includes more than 20 syndromes associated with dysplasia dependent changes and pathological conditions, reflected in the International classification of diseases X revision (ICD-X).

For many variants of undifferentiated CTD characteristic changes in the skin: the thinness, weakness, low elongation, thinning of the subcutaneous fat layer, petechiae, scars, keloid scars, multiple pigmented spots, etc. [7, 8].

During embryogenesis connective tissue (CT) is involved in the formation of hair follicles and sebaceous glands - the leading factors in the pathogenesis of acne [9].

Thus, a high incidence of PT in the human body in General, and including in the skin, its importance in embryogenesis and functioning of the structural components of the skin (hair follicles, sebaceous glands) suggests a possible relationship of the development of the DST and acne.

The task of determining the effect of DST on the development of acne and the development of a plan of treatment.

The task is achieved by the analysis of CTD in patients with acne further course of treatment, depending on the I-II degree, III-IV degree of acne, additionally Magnerot® at a dose of 3.0 g per day (1.0 g three times daily).

In accordance with the guidelines National guidelines for the diagnosis of hereditary disorders of PT analyze the phenotype is�die signs of connective tissue dysplasia. They are divided into main (hyperactivity skin, flat feet, disturbances of the organ of vision, dilatation, deformation of the spine and thorax) and secondary (anomalies of the ears, abnormal development and growth of the teeth, transient joint pain, dislocations and subluxations of the joints, arachnodactyly, slender fingers, etc.). Classification of the degree of DST: under the norm implies the absence or permits the presence of 1-2 signs; cervical dysplasia characterized by 3-5 signs; severe dysplasia 6 and more signs. Patients included in the study provided that they have at least 3 external stigmas of disambiguate in accordance with the diagnostic criteria of the DST [8].

Was studied 250 patients with different severity of acne (one HUNDRED), of which 175 acne with CTD. In accordance with modern approaches to the diagnosis of DST according to the analysis of external mortality from 175 115 patients (67.7 percent), there was a moderate degree of DST, 60 (34.3 percent) others - various dysplastic syndromes and phenotypes, including marfanoid habitus in 7 (11,7%), joint hypermobility syndrome - 4 (6,7%), unclassifiable phenotype - 49 (81,6%).

Table 1 depicts the classification of acne severity of lesions [10, 11].

A quantitative analysis of the frequency of occurrence of CTD among patients with RA�governmental options course acne has revealed a statistically significant differences (criteria for t-test, Mann-Whitney, Wilcoxon, Pearson) symptom severity of dysplasia for patients with mild, moderate and severe disease. So, the patients I HUNDRED on average revealed a 3.7±0.96 symptom of, II STA - 4,3±0,78, III HUNDRED - 4,8 ±0.45 and IV one HUNDRED and 5.4±1.57 symptom of DST. Differences in the frequency of occurrence of CTD between groups of variants of the course of acne is statistically significant (p<0,05).

Assessment of somatotype was performed in 175 patients with acne DST and a control group of 75 patients with acne.

Among 75 patients of acne (control group - 1) in 52% of patients were predominant component of mesomorphy. Component of endomorphin had 21.3% of persons, a component of ectomorphy - 20,0% . Not determined the predominance of the somatotype scores in 6.7% of patients.

The somatotypes acne patients in Association with DST differ from those in acne without DST, indicating the adverse effect of DST on the development of acne (p<0,05). From the point of view of the clinical manifestations of acne in conjunction with CTD can talk about the influence of somatotype on their variability. The most pronounced on the severity of the acne symptoms identified in patients with uncertain somatotype. So, somatotype of the patient even in the long course of the disease had no significant effect on acne. At the same time when DST up to equality somatotype was more often identified in patients with more severe acne p� than mesomorphic, but lighter than in patients with ectomorphic and unspecified type.

Examined 250 patients with acne who were divided into 3 groups. The core group (CG) included 100 patients with acne were combined with CTD; in the first control group of 75 patients with acne, a second control group of 75 persons who have acne combined with CTD.

76 acne patients with CTD and only 37 with acne determined the content of magnesium in blood plasma and erythrocytes using a diagnostic kit Cormey-Mg-250.

In patients with acne DST magnesium deficiency in plasma was detected in 39 (51.3%) of 76, in erythrocytes - 46 (56,6%). In patients of acne without DST indices were close to those of a healthy person (normal 0.7 to 1.1 µmol/l) is statistically significant difference between groups (p<0,05).

Therapy patients of I and II degree of acne include aevitum 1 caps. 2 times a day inside one month, one dose (Solutab®) 100 mg per day orally 6-8 weeks; externally recommended to wash the gel Zinovich evening 6-8 weeks, the night gel clinit once daily for 4 weeks

Therapy for patients with III-IV degree of acne were of isotretinoin (Roaccutane®) at the rate of 0.75 mg per kg of body weight once a day for 5-6 months and gel Zinovich once in the evening throughout the course of treatment.

The main group of patients (with acne DST) in addition to therapy (at any degree of acne) received �magnerot® (magnesium salt of orotic acid) at a dose of 3.0 g per day (1.0 g three times daily) throughout the course of treatment.

Magnesium is a trace element, which is part of over 300 enzymes in the body, participates in intra - and extracellular maturation of collagen and other structural elements of connective tissue. A deficiency of magnesium ions contributes to the development of the DST [12].

In the first control group with acne and in the second control group - acne with CTD, prescribed therapy, taking into account only the severity of acne (I-IV class).

For the purpose of studying the results of treatment of patients of acne developed criteria for its evaluation. Clinical recovery is considered the absence of clinical manifestations, the disappearance or significant decrease in the total number of inflammatory cells due to the regression of papules and/or pustules. Clinical improvement - signs of regression of the vast number of papules and/or pustules, even with a slight increase of the total number of inflammatory cells is not more than 10%. No changes - no changes of cutaneous manifestations; deterioration - increase the total number of inflammatory cells at the expense of papules and/or pustules more than 10%, no signs of regression of previous eruptions. "The positive result of the" treatment consider clinical recovery + clinical improvement.

In Fig. 1 shows the results of treatment of patients with OG supplementary prescribing the drug, Magnerot®. As can be seen from the figure,the clinical recovery occurred in 34% of persons clinical improvement - 49,0%, the result, no change was documented in 17.0% of patients.

Magnesium content determined in plasma and erythrocytes in patients with acne and DST before treatment, revealed a reliable decrease (p<0.05) in the months after the end of therapy with the appointment of Magnerot, had a tendency to normalization of the indicators close to those of a healthy person (normal is 0.7-1.1 mmol/l).

In a remote period, there were problems in 7.0% of patients of the main group, but to a lesser intensity than before therapy.

Patients had a long history of the disease and the number of external stigmas of disambiguate more than five. The somatotype patients belonged mostly to uncertain and ectomorphic and up to equality types.

In Fig. 2 presents the early results of treatment of patients with acne in the absence of connective tissue dysplasia. As can be seen from the figure, the clinical recovery was achieved in 48,0% of patients, clinical improvement is at 34.7 per cent, the result of treatment, no change - 17,3%.

Summary the effectiveness of therapy of patients in the second group (control acne with CTD), which Magnerot® advanced is not assigned to therapy is presented in Fig. 3.

As can be seen from the figure, the clinical recovery was observed in 33.3% of individuals, clinical improvement - 30,7%, results� treatment was no change in 26.7% of patients and 9.3 per cent occurred in the course of therapy.

In Fig. 4 presents a comparison of immediate results of treatment of patients in three groups according to the "positive results" (clinical recovery + clinical improvement). As can be seen from figure 4, the proposed method of treatment is with the connection of the drug Magnerot® - the core group appointed by acne patients with CTD, were close in positive outcomes for persons who had only acne - p<0,05 (first control group) and exceeded the effectiveness of therapy in the group with acne DST 19.0% - p<0,05 (second control group) who were not appointed Magnerot®.

The proposed scheme of treatment of acne patients with connective tissue dysplasia, depending on the degree of acne (I-IV) and the appointment of the drug Magnerot®, allows to increase the effectiveness of therapy in persons of this category 19.0%.

Sources of information

1. Arabian E. A. Modern view of the treatment of acne: status challenges and new opportunities / E. A. Arabian // Attending physician. - 2003. - No. 4. - S. 20-25.

2. Monakhov S. A. psycho-Emotional disorders in patients suffering from acne / S. A. Monks, A. L. Ivanov, M. A. Samgin // ROS. Journal of skin and generic. diseases. - 2003. - No. 4. - S. 45-52.

3. Cargnello A. Acne: what's new? / A. Cargnello // MJA. - 1996. - Vol. 165. - P. 153-158.

4. Adaskevich V. P. Acne vulgaris and pink / VP adaskevich. - M.: Medical book, N. Novgorod the ngma, 2003. - 160 p.

5. Males A.V. Acne and AK�ifornia dermatoses / V. A. Males // M., 2009. - 288 p.

6. Goodmann G. Acne. Natural history, facts and myths / G. Goodmann // Aust. Fam. Physician. - 2006. - Vol. 35. - No. 9. - P. 613-616.

7. Nechaev G. I. connective tissue Dysplasia: terminology, diagnosis, clinical management of patients / G. I. Nechaeva, I. A. V. // Omsk. - 2007. - 188 S.

8. Heath B. Modern methods of somatotyping. Modernized method of determining somatotype / B. Heath, J. E. Carter // Questions of anthropology. - M., 1969. - Vol. 33 - 19 C.

9. Cerides G. S. Histopathology and clinical characteristics of dermatoses / G. S. Cerides, V. P. Fedotov, A. D. Dudun, V. A. Tumansky // 1st ed. - D., 2004. - P. 11-67.

10. Acne (ed Kubanova A. A.). - M.: DEX, 2010. - 28 S. - (Clinical guidelines) Russian society of dermatovenerologists.

11. Consensus on Acne Classification / AAD, 2006.

12. Nechaev G. I. Efficacy of magnesium in patients with connective tissue dysplasia / G. N. Nechaev, S. M. Yudin, O. V. Tikhanova // Aktual. Vopr. internal pathology. Connective tissue dysplasia. - Omsk. - 2005. - S. 209-214.

Method of treatment of patients with acne vulgaris (acne) with dysplasia of connective tissue, including the acceptance of Evita, one dose in the treatment of I and II degree of acne and the intake of isotretinoin and gel Zinovia in the treatment of III and IV degree of acne, characterized by one time per day 3.0 g Magnerot® (1.0 g three times daily) throughout the course of basic therapy.



 

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