NARROW SPECTRUM ULTRAVIOLET MEDIUM WAVE PHOTOTHERAPY 311 NM IN THE TREATMENT OF PSORIASIS
E. A. Batkaev Department of Clinical Mycology and Dermatovenereology RUDN University
Summary: phototherapy is one of the main methods of treating psoriasis and it is carried out only in health care facilities. A method of narrow-wave UVB therapy with a wavelength of 311 nm using the Dermalight RU device has been developed. In terms of effectiveness, the method is comparable to the used methods of UVB therapy, but is free of side effects. The method is mobile and can be used at home under the supervision of a doctor.
Key words: psoriasis, narrow-wave phototherapy, wavelength 311 nm, Dermalight RU device.
Psoriasis is a chronic dermatosis predominantly with a genetic determinant of autoimmune reactions, manifested by benign hyperproliferation of epithelial cells, impaired differentiation and keratinization, as well as pathology of organs and systems. The high prevalence of psoriasis, the frequent onset of the disease at a young age, resistance to therapy, reduces the social activity of patients and their quality of life, causing a serious medical and social problem. Our study of more than 500 outpatient records and medical histories of patients with psoriasis allowed us to determine the structure of the clinical forms of this disease based on the severity index and area of skin lesions (1). Thus, a mild form is observed in 80% of cases (PASI<10, S <25%), форма средней тяжести в 15% (PASI <10-30, S <50%) и форма тяжелая в 5% (PASI > 30, S >50%). Treatment of psoriasis continues to remain a far unsolved problem. In this regard, further study of the etiopathogenesis of this disease and the development, based on the results of scientific research, of new, more effective methods of therapy is important. In the last decade, it has been established that successful therapy of mild forms of psoriasis is the key to preventing its transformation into severe forms of the disease. At the same time, correctly selected topical therapy with the use of creams and ointments containing active antiproliferative components (topical steroids, calcium potriol, zinc peryton, urea), as well as detoxifying and anti-inflammatory drugs, antioxidants, hepato- and angioprotectors is of primary importance. A special place is given to UV therapy. The positive effect of sunlight on the course of psoriasis (heliotherapy, general ultraviolet radiation) has long been known. To treat psoriasis, long-wave ultraviolet rays in the A range (320-400 nm) have been used for a long time. Currently, one of the most effective modern methods of phototherapy for psoriasis, giving 75-92% of clinical recovery, is photochemotherapy (PUVA therapy) (Batkaev E. A., Chistyakova I. A., Shakhova A. S., 2012). However, PUVA therapy is carried out while taking photosensitizers that have toxic properties, which limits its widespread use. In addition, this method of treatment is indicated for patients with moderate and severe forms of the disease and is possible only in health care facilities. Selective phototherapy, also used only in medical institutions, is carried out using combined UVB+UVA radiation without ingesting photosensitizers. The method is non-toxic, but less effective than PUVA therapy (3). At the same time, there are frequent cases of exceeding the dose of ultraviolet radiation, provoking an exacerbation of the psoriatic process. Taking into account the prevalence of mild forms of psoriasis (80%) and the fact that patients with limited manifestations of the disease are treated on an outpatient basis, a method of narrow-wave UVB therapy with a wavelength of 311 nm using the Dermalight RU device has been developed. The Philips company (Holland) created ultraviolet lamps TL-01, the maximum radiation of which occurs at a wavelength of 311 nm, which made it possible to later call them medium-wave ultraviolet rays of a narrow spectrum 311 nm (Narrow-band UVB 311 nm). Studies have proven the high effectiveness of narrow-wave UVB therapy at a wavelength of 311 nm (4.5) compared to selective phototherapy (6.7). It is believed that the main mechanism of resolution of psoriatic plaques under the influence of narrow-wave UVB is its induction of T-cell apoptosis (8).
Vladimirov V.V. et al. (2) assessed the therapeutic efficacy of narrow-wave UVB therapy for psoriasis. The procedures were carried out on UV-7001K and UV-1000K units (Waldmann Meditsintechnik, Germany) with F85/100W - TL01 lamps, giving a radiation spectrum of 310-315 nm with a maximum radiation at a wavelength of 311 nm. Studies have shown that clinical cure with PUVA is observed in 96% of cases, while with UVB therapy 311 nm - in 80-83%. However, in terms of tolerability and safety, narrow-wave UVB therapy 311 nm is superior to PUVA, and therefore, narrow-wave UVB 311 nm radiation with a frequency of visits 3 times a week was recommended as the safest and most effective modern option for the treatment of chronic plaque psoriasis. Thus, in terms of effectiveness, the method of narrow-wave UVB therapy with 311 nm using the Dermalight RU device is comparable to the methods of UVB therapy used, but is free of side effects. The method is mobile and can be used at home under the supervision of a doctor. Currently, the method is widely used for the treatment of psoriasis and a number of other diseases in the Venus Center clinic; the results of observations will be published.
LITERATURE 1. Batkaev E. A., Chistyakova I. A., Shakhova A. S. Ammifurin in phototetapy of psoriasis. Bulletin of postgraduate medical education. 2012.4.3-6
2. Vladimirov V.V., Menshikova L.V., Cheremukhina I.G., Vladimirova V.V., Kuryanova O.N., Vladimirova E.V. Treatment of patients with psoriasis with narrow-spectrum ultraviolet medium-wave phototherapy 311 nm. Bulletin of Dermatology and Venereology, 2004,4, 29-32)
3. Vladimirov V.V., Panichkina G.S., Molchanova T.V., Zakharova O.Yu. Short-term and long-term results of treatment of patients with psoriasis using selective phototherapy. Bulletin of Dermatology and Venereology, 1985, 2, 34-36.
4. Ettler K., Vaicova M., Nozickova M. Our experience with UVB 311 nm phototherapy in psoriasis and parapsoriasis. Proc. 11th Congress of the European Academy of Dermatology and Venereology 2002.
5. Gupta G., Long J., Tillman D. M. Th e effi cacy of narrowband ultraviolet in phototherapy in psoriasis using objective and subjective outcome measures. Br. J Dermatol 1999 May; 140 (5):887-90.
6. Storbeck K., Holzle E., Schurer N., Lehmann P., Plewig G. Narrow-band UVB (311 nm) versus conventional broadband UVB with and without dithranol in phototherapy for psoriasis. J. Am. Acad. Dermatol. 1993 Feb; 28 (2 pt 1):227-31.
7. Walters I. B., Burack L. H., Coven T. R., Gilleaudeau P., Krueger J. G. Suberythemogenic narrow-band UVB is markedly more effective than conventional UVB in the treatment of psoriasis vulgaris. J. Am. Acad. Dermatol. 1999 Jun; 40 (6 Pt 1): 893-900.
8. Ozawa M., Ferenczi K., Kikuchi T., Cardinale I., Austin L. M., Coven T. R., Burack L. H., Krueger J. G. 312-nanometer ultraviolet B light (narrow0band UVB) induces apoptosis of T cells within psoriatic lesions. J. Exp. Med. 1999 Feb 15; 189 (4):711-8.
The method of narrow-spectrum phototherapy has been the “gold standard” for the treatment of dermatological diseases for 20 years, such as: psoriasis, atopic dermatitis, neurodermatitis, parapsoriasis, eczema, seborrheic dermatitis, itching, alopecia areata. Since ancient times, people have paid attention to the healing effects of solar radiation on the skin.
The spectrum of sunlight consists of 10% ultraviolet rays, 40% visible rays and 50% infrared rays. These types of electromagnetic radiation are widely used in medicine. Today, narrow-spectrum phototherapy is the most, most effective method of treatment using ultraviolet radiation.
In the 1950s, methquartz (an artificial ultraviolet emitter) was developed. Due to the presence of a large number of adverse reactions on the skin, the search for scientists continued. In the 70s, a new method was proposed - PUVA therapy.
The essence of the method: the patient is forced to take drugs psoralens (which have hepatotoxic and nephrotoxic effects) and ultraviolet radiation of the A spectrum; without taking the drugs, the effect of treatment did not occur. In the 80s, the so-called Broadband Phototherapy was invented, but due to adverse reactions it was never widely used.
Narrow-spectrum phototherapy
Today, all modern clinics in the world use the most effective and popular method (developed in the 90s) - phototherapy of a narrow spectrum of light (Narrow band UVB 311 nm). From the wide spectrum of ultraviolet radiation, one narrow spectrum is “cut out”, which has a therapeutic effect.
The spectrum of ultraviolet radiation (peak - 311 nm) has no side effects, and treatment is not contraindicated for both pregnant women and children over 5 years old, clearly indicating the safety of this method. UVB 311 nm phototherapy for some skin diseases (psoriasis, parapsoriasis, atopic dermatitis) can eliminate the skin manifestations of these diseases, and for vitiligo it is the only treatment method that is recognized by evidence-based medicine.
The main advantage of phototherapy is the overall duration of the procedure, which lasts from 5 minutes (at the beginning of treatment) to 30 minutes (increases over time), which allows you to save a lot of time for yourself, and completely eliminates the need to carry out treatment in an inpatient department.
According to international recommendations, depending on the patient’s condition and stage of the disease, narrow-spectrum phototherapy is recommended only 2-3 times a week. For psoriasis - the optimal number of procedures is 20-30 / course; with parapsoriasis - 5-7; for atopic dermatitis, neurodermatitis and eczema - 10-15; with vitiligo, a positive result is observed after 10 procedures, and for a course of 30-100. Do not forget about the importance of other treatment methods that can be successfully combined with phototherapy, which allows you to achieve faster treatment results.
UVB 311nm - safe phototherapy
Depending on your diagnosis, our doctors will recommend a combination of phototherapy sessions with external treatment - the use of moisturizers, shampoos, creams or other medical media.
In our medical institution you will have the opportunity to use the following modern methods of light therapy:
Local narrow-spectrum phototherapy (Daavlin 7 Series X 311-10, 2011), which allows phototherapy to be carried out on open areas of the skin.
Local narrow-spectrum phototherapy (Dermalight 80 UVB-311 nm, 2012) - allows you to carry out treatment on the scalp and, if necessary, increase the radiation dose in areas where, with local phototherapy, there is insufficient access to ultraviolet light.
Recently, medium-wave ultraviolet radiation of a narrow spectrum of 311 nm, or another name for this technique - phototherapy of a narrow spectrum of 311 nm (UVB 311 nm), has been increasingly used in the treatment of skin diseases.
- Narrow spectrum phototherapy 311 nm causes fewer side effects than PUVA therapy and selective phototherapy (skin redness, skin itching, pigmentation disorders).
- With narrow spectrum phototherapy 311 nm, lower doses of ultraviolet radiation are used, thereby minimizing the risk of developing skin tumors.
- There is NO intake of photosensitizers, and as a result, the treatment is tolerated very easily.
- Studies have shown a significantly higher effectiveness of UVB 311 compared to selective phototherapy.
· Abroad, narrow spectrum phototherapy 311 nm has almost completely replaced selective phototherapy
Narrow spectrum phototherapy 311 nm, effectiveness:
This technique is one of the most effective in the treatment of psoriasis, slightly inferior to PUVA therapy. In terms of safety and effectiveness of therapy, UVB 311 nm has no equal.
Narrow spectrum phototherapy 311 nm, mechanism of action:
In psoriasis, UVB 311 nm has an immunoregulatory effect, normalizing the balance of inflammatory and anti-inflammatory factors in the affected skin. In this case, as with PUVA therapy, excessive cell division is inhibited. The rashes gradually fade, become less dense, and peeling disappears. This occurs due to a decrease in the number of cellular elements in the lesions of psoriasis. A pronounced antipruritic effect is also noted.
The source of UVB rays is Philips TL-01 lamps installed in special booths.
Narrow-spectrum 311 nm phototherapy sessions are carried out 3-5 times a week. In general, the course of treatment takes 25-30 procedures - this depends on the prevalence and severity of the disease. To increase the period of remission, gradual withdrawal and maintenance treatment are recommended.
Narrow spectrum phototherapy 311 nm, indications:
Psoriasis, vitiligo, atopic dermatitis, lichen planus, alopecia areata, pruritus, lymphomatoid papulosis, chronic urticaria, granuloma annulare, prurigo, Giber's rosacea, severe seborrheic dermatitis, scleroderma, mild forms of cutaneous T-cell lymphoma (CTCL), photodermatosis , eczema and other skin diseases.
Narrow spectrum phototherapy 311 nm, contraindications:
A history of melanoma or skin cancer, age under 14 years, skin diseases with impaired DNA repair mechanisms and the risk of developing neoplasms (xeroderma pigmentosum, Bloom's syndrome, familial dysplastic nevus syndrome); diseases the course of which worsens when exposed to ultraviolet radiation (lupus erythematosus, autoimmune thyroiditis), eye diseases (cataracts, lack of lens).
Early side effects:
Because the treatment takes place without taking photosensitizers, side effects are minimal and are associated only with the action of ultraviolet radiation - itching of the skin, dry skin, redness and burns of the skin (with an excessively high dosage of UV rays). To prevent them, it is necessary to correctly determine the skin phototype and select the dosage of ultraviolet radiation.
Long-term side effects:
Associated with prolonged exposure to ultraviolet radiation (with ultra-long, frequent use of UVB 311 nm phototherapy for many years) and neglect of protective measures (glasses, sunscreens, protective regimen) are symptoms of skin aging. In numerous domestic and foreign studies, the development of skin tumors has not been proven.
Selective phototherapy
The method of selective phototherapy (SPT) is based on the use of medium wavelength ultraviolet (UVB, 280-320 nm).
The mechanism of action of SFT is due to a decrease in excess DNA synthesis and a decrease in the proliferation of epidermal cells. UV-B rays normalize the immune system and reduce inflammatory processes in the skin.
Fluorescent lamps installed in special booths are used as a source of UVB rays.
The design of cabins used for SFT may vary.
Typically, the lamps are placed vertically in the booth and the patient receives the procedure while standing. But in some installations, the lamps are located horizontally, and then the procedure is performed in a horizontal position (lying on the couch). Devices for isolated treatment of hands and feet, and scalp (ultraviolet comb) are also produced.
The ultraviolet comb is equipped with a comb made of transparent plastic, which will allow ultraviolet rays to penetrate the scalp most effectively. This device can also be used to treat limited areas of the skin that are difficult to reach during general phototherapy (groin, axillary and anogenital areas).
The UV comb is intended for individual use.
SFT sessions should be carried out 3-4-5 times a week. In general, the course of treatment takes 20-30 procedures, but this depends on the prevalence and severity of the disease.
When receiving procedures, you must use sunglasses equipped with UVA and UVB filters. After procedures, it is advisable to use moisturizing body lotions.
SFT has a pleasant “side” effect, since as a result of this treatment method, in addition to cleansing the skin, patients get a tan.
SFT can be combined with other treatment methods, which increases the effectiveness of treatment, lengthens the time of remission and reduces the duration of treatment.
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3. Fedotova K.U., Zhukova O.V., Kruglov.L.S., Ptashinsky R.I. Lichen planus: etiology, pathogenesis, clinical forms, histology and basic principles of treatment. Clinical Dermatology and Venerologiya. 2014; (6): 9-21. (in Russian)
4. Dovzhansky S.I., Slesarenko N.A., Yudin S.V. Communication plan with diabetes and ulcerative colitis. In: System Bitter Medicine. Gorki; 1985: 123-5. (in Russian)
5. Gomes M., Schmitt D., Souteyrand P. et al. Lichen plfnus and chronic graft-versus host reaction. J. Cutan. Pathol. 1982; 9(4): 249-57.
DOI: http://dx.doi.org/10.18821/1681-3456-2016-15-6-308-310
Original articles
6. Handa S., Sahoo B. Childhood lichen planus. A study of 87 cases. Int. J. Dermatol. 2002; 41: 423-7.
7. Katta R. Lichen planus. Am. J.Fam. Physician. 2000; 61: 3319-24. Kang H., Alzolibani A.A., Otberg N., Shapiro J. Lichen planopilaris. Dermatol. Ther. 2008; 21: 249-56.
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© TURBOVSKAYA S.N., KOTENKO K.V., 2016 UDC 615.831.4.03:616.517-053.2
Turbovskaya S.N.1, Kotenko K.V.2
LOCAL NARROW BAND (311 nm) PHOTOTHERAPY FOR PALMOBLANTA PSORIASIS IN CHILDREN
1JSC "European Medical Center", 123104, Moscow;
2FGBU DPO "Central State Medical Academy" of the Administration of the President of the Russian Federation, 121359, Moscow
The article provides data on the local use of narrowband 311 nm phototherapy in the treatment of children with palmoplantar psoriasis. Local phototherapy with narrow-band ultraviolet radiation with a wavelength of 311 nm is an effective treatment for this disease in children.
Key words: mid-wave ultraviolet radiation; phototherapy; narrowband 311 nm phototherapy; palmoplantar psoriasis.
For citation: Turbovskaya S.N., Kotenko K.V. Local narrowband (311 nm) phototherapy for palmoplantar psoriasis in children. Physiotherapy, balneology and rehabilitation. 2016; 15(6): 308-310. DOI: http://dx.doi.org/10.18821/1681-3456-2016-15-6-308-310
For correspondence: Svetlana Nikolaevna Turbovskaya, Ph.D. honey. Sciences, dermatovenerologist, JSC European Medical Center, 123104, Moscow. Email: [email protected]
Turbovskaya S.N.1, Kotenko K.V.2
LOCAL NARROW-BAND (311 nm) PHOTOTHERAPY OF PALMAR-PLANTAR PSORIASIS IN THE CHILDREN
1Closed joint stock company "European Medical Centre", 123104, Moscow;
2Federal state budgetary institution of additional professional education "Central State Medical
Academy", Presidential Administration of the Russian Federation, 121359, Moscow
The objective of this article was to report the data concerning the local application of narrow-band (311 nm) phototherapy in the children presenting with palmar-plantar psoriasis. It is concluded that local narrow-band phototherapy using ultraviolet radiation with a wavelength of 311 nm is an efficient method for the treatment of this condition in the children.
Keywords: medium-wave ultraviolet radiation; narrow-band phototherapy (311 nm emission); palmar-plantar psoriasis.
For citation: Turbovskaya S.N., Kotenko K.V. Local narrow-band (311 nm) phototherapy of palmar-plantar psoriasis in the children. Fizioterapiya, Bal"mologiya i Reabilitatsiya (Russian Journal of the Physical Therapy, Balneotherapy and Reabili-tation). 2016; 15(6): 308-310. (In Russ.). DOI: http://dx.doi.org /10.18821/1681-3456-2016-15-6-308-310 For correspondence: Turbovskaya Svetlana Nikolaevna, candidate med. sci., dermatologist, Closed joint stock company "European Medical Center", Moscow, 123104. E-mail: [email protected]
Conflict of interest. The authors declare no conflict of interest.
Acknowledgments. The study had no sponsorship.
Psoriasis is one of the most common chronic dermatoses. According to numerous studies, from 1 to 3% of the world's population suffers from this disease. One of the current problems is childhood psoriasis, the incidence of which has a clear upward trend. At the same time, palmoplantar localization of the psoriatic process in children occurs in approximately 1/4 of cases of all clinical forms and, on the one hand, causes inconvenience to patients and reduces the quality of life, and on the other hand, it is characterized by a torpid course and resistance to traditional therapy. To date, improvement
technologies for treating children with psoriasis is a serious medical and social problem, the significance of which is determined primarily by the unreliability of existing drug treatments for children. Therefore, despite the available arsenal of modern methods for treating psoriasis, the cardinal problem remains the development of safe and highly effective treatment methods for pediatric patients, as well as long-term control of this disease. Currently, immunosuppressive drugs are most effective in the treatment of psoriasis, including palmoplantar forms, however
RUSSWN JOURNAL of the PHYSICAL THERAPY, BALNEOTHERAPY and REHABILITATION. 2016; 15(6)
DOI: http://dx.doi.org/10.18821/1681-3456-2016-15-6-308-310_
Original investigations
Rice. 1. Dynamics of PASI (in points) and GSS (in points) values in patients after applying local UVB 311 nm therapy
4 weeks after its start.
the side effects caused by this group of drugs limit their use in pediatric practice. At the same time, it is known that in the treatment of skin diseases in children, phototherapy with a narrow spectrum of radiation is increasingly used, which selectively acts on skin structures and produces less pronounced side effects. Scientific studies show that waves with a length of 311 nm provide maximum therapeutic effect with minimal erythema, carcinogenicity of this type of treatment, which are recognized as minimal compared to other types of UV therapy, while fewer procedures are required to achieve results, longer remission is achieved, and observed less pronounced adverse reactions and it is possible to combine this therapy with other types of treatment. It should also be noted that this type of phototherapy is aimed at restoring immunological reactivity, increasing the adaptive and compensatory capabilities of the body, improving blood circulation and metabolism in the skin. All these facts make this type of phototherapy a priority, especially in pediatric practice.
Material and methods
We observed 25 patients aged 6 to 18 years with diagnosed palmoplantar psoriasis with a torpid course of the pathological process resistant to standard therapy. All patients were prescribed local narrowband mid-wave ultraviolet (UVB 311 nm) therapy.
UVB therapy procedures were carried out using a UV 181 BL device (Herbert Waldmann GmbH and Co.) equipped with TH01 lamps emitting a narrow UVB spectrum with an emission maximum at 311 nm. The UVB therapy protocol included establishing the skin phototype in accordance with the classification of Thomas B. Fitzpatrick (1975), determining the initiating dose without determining the equivalent dose rate (EDR) and step-by-step increasing doses, and carrying out procedures. With phototype I, the initial dose of UVB 311 nm radiation was equal to 0.05 J/cm2, with phototype II - 0.1 J/cm2, with phototype III - 0.2 J/cm2, with phototype IV - 0.3 J/cm2 cm2. The step-by-step (each subsequent procedure) increase in the UVB dose was 0.05 J/cm2 for phototype I and by 0.1 J/cm2 for other skin phototypes. Radiation procedures were prescribed 5 times a week. As an external treatment, patients used the drug calcipotriol (a synthetic analogue of vitamin D), which causes a dose-dependent inhibition of keratinocyte proliferation, accelerates their morphological differentiation, and has a slight effect on calcium metabolism in the body (100 times weaker than vitamin D3), What allow
Palmoplantar psoriasis
Improvement
Significant improvement Clinical remission
Rice. 2. Results of treatment of palmoplantar psoriasis in children using a combined method, including local UVB 311 nm therapy and topical calcipotriol.
use it in pediatric patients (from 6 years of age). Calcipotriol is a potent inhibitor of interleukin 1 (IL-1)-induced T cell activation and regulates immune processes in the skin. For children, apply a thin layer of ointment to the affected areas of the skin 2 times a day. The maximum weekly dose for children over 12 years of age is no more than 75 g, for children aged 6 to 12 years - no more than 50 g.
Inclusion criteria: confirmed diagnosis of psoriasis; moderate forms of psoriasis (Psoriatic Area and Severity Index (PASI) more than 10 points, BSA< 10%), стационарная стадия, возраст больных 6-18 лет, подписание информированного согласия.
Non-inclusion criteria: age less than 6 years, presence of contraindications for phototherapy, pustular psoriasis, advanced stage, low patient compliance.
To objectify the assessment of the effectiveness of the treatment, the work used clinical methods based on determining indices of dermatological status with the study of objective and subjective symptoms of diseases: GSS (Global Severity Score). The safety of using the combined method was monitored according to clinical blood and urine tests and biochemical blood tests. Analysis and processing of statistical data was performed on a personal computer using the Statistica 6.0 and BMDP software package for IBM PC using mathematical statistics methods.
Results and discussion
The effectiveness of treatment was assessed using PASI, which can vary from 0 to 72 points, GSS - from 0 (no skin manifestations) to 5 (very severe psoriasis) points.
Clinical remission was stated when PASI, GSS decreased by 95% or more, significant improvement - PASI decreased by 70-94%, improvement - by 30-69%, no dynamics (regression) - less than 29%.
Most patients showed pronounced positive dynamics in relation to the clinical symptoms of the disease. PASI was reduced by 89.5% from 11.4 (p< 0,01) до 1,2 балла (p < 0,05). GSS в среднем редуцировал на 93,8% с 3,2 (p < 0,05) до 0,2 балла (p < 0,05). Таким образом, у всех пациентов была отмечена клиническая ремиссия и значительное улучшение (рис. 1).
In accordance with the dynamics of dermatological status indices, the overall therapeutic effectiveness of local UVB 311 nm therapy averaged 96%, of which clinical remission and significant improvement were observed in 84% of patients, while only improvement was observed in 4% of patients (Fig. 2).
It should be noted that in not a single clinical case after using this method was there any improvement in
PHYSIOTHERAPY, BALNEOLOGY and REHABILITATION. 2016; 15(6)
DOI: http://dx.doi.org/10.18821/1681-3456-2016-15-6-310-314
25 -| 20 -15 -10 -5 -
3 months 6 months 9 months
Rice. 3. Results of long-term observations: the number of patients with preserved clinical remission after the use of pulse therapy.
side effects. According to the results of clinical blood and urine tests, as well as biochemical blood tests, no significant changes were detected at the end of the course of therapy, which confirms the high safety of the method.
After the main course of therapy, patients with clinical remission and significant improvement were treated with UVB 311 nm pulse therapy for 2 months, procedures were carried out 2 times a week with a radiation dose equal to 50% of the maximum. The results of long-term observations showed that the majority of patients using pulse therapy (83.3%) managed to control the process throughout the year: PASI was 1.9 = 1.2; Q3 = 2.6] points (p< 0,01) (рис. 3).
Side effects in the form of transient erythema and itching during maintenance therapy were noted in 8.3% of patients. However, these symptoms did not require drug treatment, and in these cases the radiation dose was adjusted, which was reduced to 30% of the maximum single main course of phototherapy.
Original articles
Conclusion
Local application of UVB 311 nm therapy and a topical drug with calcipotriol in children with palmoplantar psoriasis is a highly effective technique. This method allows to achieve clinical remission and significant improvement in the vast majority of patients (96%) with this form of psoriasis. The use of UVB 311 nm pulse therapy after the main course of treatment makes it possible to control the process in 83.3% of patients throughout the year.
L I T E R A T U R A (items 1, 4, 5, 7, 8, see REFERENCES)
2. Potekaev N.N., Kruglova L.S. Psoriatic disease. M.: MDF; 2014.
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6. Turbovskaya S.N., Ponich E.S., Kruglova L.S., Levshin R.N., Korchazhkina N.B., Elfimov M.A. and others. Approaches to phototherapy in children with chronic dermatoses. Occupational medicine and industrial ecology. 2016; (2): 24-9.
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2. Potekaev N.N., Kruglova L.S. Psoriatic Disease. Moscow: MDF; 2014. (in Russian)
3. Murashkin N.N., Gluzmen M.I. Rare form of psoriasis in children. Kubanskiy nauchnyi medictsinskiy vestnik. 2011; (2): 107-11. (in Russian)
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5. Pathirana D., Ormerod A.D., Saiag P., Smith C. et al. European S3-guidelines on the systemic treatment of psoriasis vulgaris. J. Eur. Acad. Dermatol. Venerol. 2009; 23(Suppl. 2): S1-70.
6. Turbovskaya S.N., Ponich E.S., Kruglova L.S., Levshin R.N., Korchazhkina N.B., Elfimov M.A. et al. Approaches to phototherapy in children with chronic dermatoses. Meditsina truda i promyshlennaya ekologiya. 2016; (2): 24-9. (in Russian)
7. Vladimirov V., Kubanova A., Butoreva M., Volnuchin V., Vladimirova V., Vladimirova E. Phototherapy with narrow-band UVB (311nm) in psoriasis. In: 5th Congress of the Baltic Association of Dermato-veneorology, September 8-10, 2005, Vilnius: Abstract Book. Vilnius; 2005: 70.
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Serov D.N.1, Kruglova L.S.1, Ponich E.N.2
EFFECTIVENESS OF UVB 311 NM THERAPY AND CYCLOSPORINE IN PATIENTS WITH INSUFFICIENT RESPONSE TO TNF-a BLOCKERS
1GBUZ Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow Healthcare Department, 123104, Moscow; 2BU KHMAO-Yugra “Khanty-Mansiysk Clinical Dermatovenerological Dispensary”, 628012, Khanty-Mansiysk
The article presents data on the effectiveness of narrowband 311 nm phototherapy and low doses of cyclosporine in patients receiving biological therapy with TNF-a blockers with an “escape” effect (PASI 50). The study showed that the inclusion of narrow-band phototherapy and cyclosporine in the complex allows one to achieve PASI 75 and PASI 100. As a result of monitoring the safety of the combined method, the absence of undesirable effects in the short term (1 year) was noted.
Key words: severe psoriasis; narrowband 311 nm phototherapy; cyclosporine; TNF-a blockers, PASI 75, PASI 100.
For citation: Serov D.N., Kruglova L.S., Ponich E.S. Efficacy of UVB 311 nm therapy and cyclosporine in patients with insufficient response to TNF-a blocking drugs. Physiotherapy, balneology and rehabilitation. 2016; 15(6): 310-314. DOI: http://dx.doi.org/10.18821/1681-3456-2016-15-6-310-314
For correspondence: Serov Dmitry Nikolaevich, Ph.D. honey. sciences, head dept. providing specialized assistance; Moscow Scientific and Practical Center for Dermatovenereology and Cosmetology of the Department of Health, 123104, Moscow. Email: [email protected]
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