Method of treating psoriasis vulgaris

FIELD: medicine.

SUBSTANCE: method relates to medicine, particularly to dermatology, and may be applied in treating psoriasis vulgaris. For this purpose, a patient is exposed to narrow-band medium-wave ultraviolet (UV therapy) at wave length 311 nm. It is combined with introducing liptonorm 10 mg once a day for 21-28 days. The UV therapeutic course makes 10 procedures.

EFFECT: method provides fast and prolonged clinical remission of the disease, as well as reduced side effects of the therapy due to the specified UV exposure mode and liptonorm introduction ensuring high photosensitising effect.

1 tbl, 2 ex

 

The invention relates to medicine, namely to dermatology, and can be used for the treatment of patients vulgar psoriasis.

Currently, researchers consider psoriasis as a systemic chronic multifactorial disease with a primary lesion of skin and leading an autoimmune component in the pathogenesis. Of great importance in the pathogenesis of psoriasis is attached to the disturbances in the immune system: an imbalance of T-cell system, the increase in the content of circulating immune complexes, and activation of macrophages and proinflammatory cytokines (TNF-α, IL-1α, IL-2, IL-6, IL-8). Currently, it is known that patients with psoriasis are significantly more likely than the average in the population identify hyperlipidemia caused by increased concentrations of triglycerides, cholesterol and low density lipoprotein. Using the method of immunofluorescence is shown that oxidized low-density lipoprotein in large quantities accumulate in psoriatic plaques ("Clinical Dermatology" guidelines for physicians edited Skripkin J.K. and Butova YU.S., M., 2009, s).

The traditional method of treatment of psoriasis, including detoxifying, antisense, antihistamines, vitamin preparations and tools for external therapy. The effectiveness of traditional therapy is low, especially when ucah common, heavy, long-term course of the disease and remains an actual problem of dermatology ("Modern methods of treatment of psoriasis" methodical recommendations under the editorship of Prof. Skripkin J.K., M., 1995, p.3; Yakubovich A.I., Korepanov, A.R., Novitskaya N.N., Chuprin AU Clinical efficacy of gamma Parian in treatment and care of psoriasis patients // journal of dermatology and venereology. - 2009. No. 10(1). - p.31).

Also known is a method of treatment of the sick vulgar psoriasis by applying a hepatoprotector (Essentiale) and photochemotherapy (FHT). The method is based on the purpose essenziale (parenteral and oral administration) in combination with the use of photosensitizers and ultraviolet rays (320-400 nm) (Mackillican A.L., Dmitriev GA, Bukhvalov IB, Bocharova, E.N., Dunaevsky H., Zavalishina LA the Rationale for the use of Essentiale in photochemotherapy of psoriasis // journal of dermatology and venereology. - 1991. No. 12 - pp. 40, 42).

Experience in the application of hepatoprotectors in combination with photochemotherapy (FHT) allowed to mention its high efficiency, but also demonstrated mixed effects on the lipid metabolism, the possibility of development of a number of side effects and complications caused by the action of hepatoprotector, a photosensitizer and a total dose of ultraviolet radiation length is navalnogo range (UFA).

Closest to the proposed method of treatment is the treatment of patients with psoriasis narrow-band mid-wave ultraviolet radiation (UVR) with a wavelength of 311 nm (Kubanova A.A., Gusev V.A., volnuhin VA et al. "The treatment of patients with psoriasis, atopic dermatitis and vitiligo narrow band medium wave UV radiation with a wavelength of 311 nm", Moscow, 2005 - P.7-8).

Suppressive effect of radio spectrum for the production of antigens of Staphylococcus aureus can significantly improve the effectiveness of treatment of psoriasis, reduce the expression of receptors for substance P (elevated before treatment) and to reduce inflammation through possible modulation of receptor - 1 after exposure to radiation.

However, its disadvantages are a longer duration of therapy - irradiation is conducted 4 times per week and the number of procedures per course ranges from 15 to 35 (average 21 procedure), rapid recurrence after treatment.

The objective of the invention is to increase the efficiency of treatment of patients vulgar psoriasis.

The technical result that will be achieved from the use of this invention is to reduce the side effects, complications, faster achievement of clinical remission.

The technical result is achieved in that in the method of treatment of vulgar psoriasis, including primenenia.nebolshie medium-wave UV radiation with a wavelength of 311 nm, it is also prescribed lipid-lowering drug - liponorm 10 mg 1 time per day rate 21-28 days.

The invention consists in the appointment of a drug from the group of lipid atorvastatin in combination with the course of UFOs.

Liponorm - diabetic drug from the group of statins (Register of medicines of Russia, 1999). The main mechanism of action of atorvastatin is inhibition of the activity of 3-hydroxy-3-methylglutarylcoenzyme And-(HMG-COA) reductase, the enzyme that catalyzes the conversion of HMG-COA to mevalonic acid, which is one of the earliest stages in the chain of cholesterol synthesis in the body. This mechanism leads to increased reactivity of the LDL receptor (low density lipoprotein) in the liver and in extrahepatic tissues that bind LDL particles and removes them from the blood plasma, which leads to reduction of LDL cholesterol in the blood. Anti-sclerotic effect of atorvastatin is a consequence of the impact of the drug on blood vessels and blood components. The drug inhibits the synthesis of isoprenoids, which are growth factors, cells of the inner lining of blood vessels. Atorvastatin lowers cholesterol, low-density lipoprotein, apolipoprotein b, triglycerides. Causes an increase in cholesterol HDL (high density lipoprotein high the Oh density) and apolipoprotein A.

The use of leptonema oral 1 mg 1 time per day in combination with ultraviolet irradiation wavelength of 311 nm course 21-28 days provides lipid-lowering effect, which represents a therapeutic effect on a number of important components in the pathogenesis of vulgar psoriasis and identified comorbidity.

From the analysis of scientific-technical and patent literature inventive combination of properties, leading to a significant increase in therapeutic efficacy by reducing the dose narrow-band (311 nm), medium-wave ultraviolet radiation in combination with leptonema, comprehensively affect the basic mechanisms of disease pathogenesis and lead to a reduction in the duration of exacerbation, to prevent side effects and longer remission periods, we have not identified that allows to make a conclusion on the conformity of the proposed technical solution the criteria of "novelty" and "inventive level".

The method is as follows.

Patients with psoriasis vulgaris, the duration of the disease or aggravation of not less than 1 month, the size of PASI 10-50 points is carried out physical examination, lipid profile serum, consultation of the ophthalmologist, endocrinologist, gynecologist for detection of diseases in which the conduct of narrowband medium-wave ultraviolet irradiation p is olivepomace.

Identify contraindications to UFO recommended for traditional therapy in accordance with clinical guidelines "Dermatovenereology 2007" (edited by ABB). Patients of this group is desintoxicacion-hormonal, hypoinsulinaemia, antihistamine therapy, is assigned a complex of vitamins, topical therapy, physiotherapy.

Liponorm appointed after oral lipid spectrum of blood serum in a dose of 10 mg 1 time per day within 21-28 days. Narrowband medium-wave ultraviolet irradiation with a wavelength of 311 nm is performed in conjunction with a course of lipid-lowering therapy 5 times a week.

The proposed method of treatment easily reproducible, affordable and feasible in health care institutions.

Example 1. Patient B., 53, entered the dermatology Department, FSU Arnieboy" health Ministry of Russia with complaints common rashes, flaking and mild itching during the day. History: ill for 15 years, increasing to 2 times a year in fall and spring. Inpatient treatment was given 1 year ago, remission within 3 months. Therapy with lipid-lowering drugs have not been conducted. Self-treatment for external funds - with a slight positive dynamics. The traditional laboratory examination, PASI-13,5, BSA-42%, ICE-19, the anxiety level average is 22 points. In the study of lipid spectrum of blood serum detected type IIb dyslipidemia.

Treatment according to the developed scheme: liponorm oral 10 mg 1 time a day for 28 days in combination with narrow-band mid-wave ultraviolet irradiation with a wavelength of 311 nm, 5 days a week 10, externally of rash - ointment daivobet 1 time per day.

On the background of the treatment on the 15th day of treatment showed reduction of hyperemia elements, residual light infiltration in the lower extremities and slight desquamation. PASI-5,5, DICE-2, clinical assessment of itching - no significant violations. Control studies of lipid - indices within the normal range.

Example 2. Patient B., 42, was admitted to the hospital with complaints of widespread rash, dry skin, mild itching during the day and mild peeling. History: for the first time got sick 4 years ago, the debut connected with emotional stress. Inpatient treatment is not received. Therapy with lipid-lowering drugs have not been conducted. Traditional treatment with a small positive effect. The traditional clinical examination, PASI-16,9, BSA 55%, DIKE 16, level alarm low - 9 points. In the study of lipid spectrum of blood serum revealed a type III dyslipidemia.

Applied the proposed method of treatment:within 21 days of liponorm oral dose of 10 mg of 1 times a day and narrowband medium-wave ultraviolet irradiation with a wavelength of 311 nm, 5 days a week 10. Externally - scraptiidae 5% ointment with topical corticosteriod (Akriderm cream).

As a result of therapy hyperemia, infiltration, desquamation elements decreased, PASI-4,8, DICE-1, when you study the lipid spectrum of blood serum normalization parameters.

Tolerability was satisfactory, no adverse events were observed.

This scheme was applied in the treatment of 40 patients vulgar psoriasis.

Recurrence of the disease in the observation within 24 months were not recorded.

A comparison group of 40 patients who received conventional therapy. Comparative data of the invention is shown in the table.

tr>
The proposed methodThe known method
1. The period of treatment, weeks21-28 days4-5 weeks
2. The effectiveness of treatment:
- clinical recovery98,8%49,4%
- significant improvement1,2%21,3%
- improvement-29,3%
3. The duration of the remission period12-18 months1-2 months
4. Side effectsnoToxic-allergic reactions (data Arnieboy), pruritus

As can be seen from the table, the proposed course of treatment can reduce the duration of stay of the patient in hospital, in a non-invasive route of administration of drug liponorm with carrying narrowband medium-wave ultraviolet irradiation with a wavelength of 311 nm, to achieve a lengthening of the period of remission due to the impact on pathogenetically significant factor vulgar psoriasis. In addition, the proposed method of treatment allows for the treatment of psoriasis patients in inpatient and outpatient settings, with obvious clinical effect, supported by clinical indicators, preventing complications, reducing length of stay of patients in hospital and increasing the length of remission compared with existing treatment methods.

The method of treatment of vulgar psoriasis, including the use of narrow-band mid-wave UV radiation with a wavelength of 311 nm, characterized in that the UFO out curse the 10 treatments and additionally prescribed lipid-lowering drug liponorm 10 mg 1 time per day 21-28 days.



 

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