311 NM NARROW SPECTRUM ULTRAVIOLET MEDIUM-WAVE PHOTO THERAPY IN THE TREATMENT OF PSORIASIS
E. A. Batkaev Department of Clinical Mycology and Dermatovenereology, Peoples' Friendship University of Russia
Summary: phototherapy is one of the main methods of psoriasis treatment and it is carried out only in health facilities. a technique of narrow-wave UVB therapy with a wavelength of 311 nm using the Dermalight RU apparatus was developed. In terms of efficiency, the method is comparable to the methods of UV therapy used, but is devoid of side effects. The method is mobile, can be used at home under the supervision of a doctor.
Key words: psoriasis, narrow-wavelength 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 epitheliocytes, 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, causes a serious medical and social problem. Our study of more than 500 outpatient cards and case histories of patients with psoriasis made it possible to determine the structure of the clinical forms of this disease in terms of the severity index and the area of skin lesions (1). So, 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%). Therapy of psoriasis continues to be a far unsolved problem. In this regard, further study of the etiopathogenesis of this disease and the development of new more effective methods of therapy based on the results of scientific research is important. In the last decade, it has been established that successful treatment of mild 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, ointments containing active antiproliferative components (topical steroids, calciumpotriol, zinc peritone, 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 has long been known (heliotherapy, general UVR). For the treatment of psoriasis, long-wave ultraviolet rays of the A range (320-400 nm) are used for a long time. Currently, one of the most effective modern methods of phototherapy for psoriasis, which gives 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 against the background of taking photosensitizers with 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 a medical facility. Selective phototherapy, which is also used only in health care facilities, is carried out using combined UVB + UVA radiation without the ingestion of photosensitizers. The method is non-toxic, but less effective than PUVA therapy (3). At the same time, cases of exceeding the dose of ultraviolet radiation are not uncommon, 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 technique for narrow-wave UVB therapy with a wavelength of 311 nm using the Dermalight RU device has been developed. Philips (Holland) created ultraviolet lamps TL-01, the maximum radiation of which falls on a wavelength of 311 nm, which allowed them to be further called medium-wave ultraviolet rays of a narrow spectrum of 311 nm (Narrow-band UVB 311 nm). Studies have proven the high efficacy of narrow wavelength UVB therapy at 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) evaluated the therapeutic efficacy of narrow wavelength UVB therapy for psoriasis. The procedures were carried out on UV-7001K and UV-1000K units (Waldmann Medicintechnik, Germany) with F85/100W - TL01 lamps, giving an emission spectrum of 310-315 nm with a maximum emission at a wavelength of 311 nm. Studies have shown that clinical cure with PUVA is observed in 96% of cases, while with UVB therapy at 311 nm - in 80-83%. However, in terms of tolerability and safety, narrow-wave UVB 311 nm therapy is superior to PUVA, and in this regard, narrow-wave UVB 311 nm radiation with a frequency of visits 3 times a week was recommended as the safest and most effective modern treatment option for chronic plaque psoriasis. Thus, in terms of efficiency, the method of narrow-wavelength UVB therapy 311 nm with the Dermalight RU device is comparable to the methods of UV therapy used, but is devoid of side effects. The method is mobile, can be used at home under the supervision of a physician. At present, the method is widely used for the treatment of psoriasis and a number of other diseases in the Venera Center polyclinic, the results of the observations will be published.
REFERENCES 1. Batkaev E. A., Chistyakova I. A., Shakhova A. S. Ammifurin in psoriasis phototherapy. 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. Bulletin of Dermatology and Venereology, 2004.4, 29-32)
3. Vladimirov V. V., Panichkina G. S., Molchanova T. V., Zakharova O. Yu. Immediate and long-term results of treatment of patients with psoriasis by 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 efficacy 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) conventional versus broadband UVB with and without dithranol in phototherapy for psoriasis. J. Am. Acad. Dermatol. Feb 1993; 28 (2pt 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 eff ective than conventional UVB in 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 effect of solar radiation on the skin.
The spectrum of sunlight consists of 10% ultraviolet radiation, 40% visible spectrum rays and 50% infrared rays. These types of electromagnetic radiation are widely used in medicine. Today, narrow-spectrum phototherapy is the most effective method of treatment using ultraviolet radiation.
In the 1950s, methoquartz (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 psoralen preparations (they have hepatotoxic and nephrotoxic effects) and ultraviolet radiation of spectrum A, without taking the drugs, the effect of the treatment did not occur. In the 1980s, the so-called Broadband Phototherapy was invented, but due to adverse reactions, it was not widely used.
Narrow band phototherapy
Today, all modern clinics in the world use the most effective and popular method (developed in the 90s) - narrow spectrum phototherapy (Narrow band UVB 311 nm). On a wide spectrum of ultraviolet, one narrow spectrum is "cut out", which has a therapeutic effect.
The spectrum of ultraviolet radiation (peak - 311 nm) has no side effects, and the treatment is not contraindicated for both pregnant women and children from 5 years old, clearly indicates the safety of this method. UVB 311 nm phototherapy for some skin diseases (psoriasis, parapsoriasis, atopic dermatitis) eliminates 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 total 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 for treatment in the inpatient department.
According to world recommendations, depending on the patient's condition and the stage of the disease, the method of narrow-spectrum phototherapy is recommended only 2-3 times a week. With psoriasis - the optimal number of procedures - 20-30 / course; with parapsoriasis - 5-7; with 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 treatments that can be successfully combined with phototherapy, which allows you to achieve a faster effect in the treatment.
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 mediation.
In our medical institution you will be given the opportunity to use the following modern phototherapy methods:
Local Narrow Band Phototherapy (Daavlin 7 Series X 311-10, 2011), which allows phototherapy to be applied to exposed areas of the skin.
Local narrow-spectrum phototherapy (Dermalight 80 UVB-311 nm, 2012) - allows for treatment on the scalp and, if necessary, to increase the dose of radiation in areas where there is insufficient access to ultraviolet light during local phototherapy.
Recently, medium-wave ultraviolet radiation of a narrow spectrum of 311 nm, or another name for this technique, narrow-spectrum phototherapy of 311 nm (UVB 311 nm), has been increasingly used in the treatment of skin diseases.
- Narrow spectrum phototherapy at 311 nm causes fewer side effects than PUVA therapy and selective phototherapy (skin redness, skin itching, pigmentation disorders).
- Narrow spectrum phototherapy at 311 nm uses lower doses of ultraviolet light, thereby minimizing the risk of developing skin neoplasms.
- NO reception of photosensitizers, and as a result - the treatment is tolerated very easily.
- Studies have shown a significantly higher efficacy of UVB 311 compared to selective phototherapy.
Abroad, 311 nm narrow spectrum phototherapy has almost completely replaced selective phototherapy
Narrow spectrum phototherapy 311 nm, efficiency:
This technique is one of the most effective in the treatment of psoriasis, slightly inferior to PUVA therapy. In terms of the ratio of safety and efficacy 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. At the same time, as in the case of PUVA therapy, excessive cell division is inhibited. Rashes gradually turn pale, become less dense, peeling disappears. This is due to a decrease in the number of cellular elements in the foci of psoriasis. There is also a pronounced antipruritic effect.
The source of UVB rays are Philips TL-01 lamps installed in special booths.
Narrow spectrum phototherapy sessions of 311 nm are held 3-5 times a week. In general, the course of treatment takes 25-30 procedures - it depends on the prevalence and severity of the disease. To increase the period of remission, gradual withdrawal and maintenance treatment is recommended.
Narrow spectrum phototherapy 311 nm, indications:
Psoriasis, vitiligo, atopic dermatitis, lichen planus, alopecia areata, pruritus, lymphomatoid papulosis, chronic urticaria, granuloma annulare, prurigo, Gibert's lichen, severe seborrheic dermatitis, scleroderma, mild cutaneous T-cell lymphoma (TSCL), photodermatosis , eczema and other skin diseases.
Narrow spectrum phototherapy 311 nm, contraindications:
History of melanoma or skin cancer, age up to 14 years, skin diseases with impaired DNA repair mechanisms and the risk of developing neoplasms (xeroderma pigmentosa, Bloom's syndrome, familial dysplastic nevus syndrome); diseases that worsen when exposed to ultraviolet radiation (lupus erythematosus, autoimmune thyroiditis), eye diseases (cataracts, lack of the lens).
Early side effects:
Because treatment takes place without the use of photosensitizers, side effects are minimal and are associated only with the action of ultraviolet radiation - skin itching, dry skin, redness and skin burns (with an excessively high dosage of UV rays). To prevent them, it is necessary to correctly determine the phototype of the skin, to select the dosages 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, sunscreen, protective regimen) are symptoms of skin aging. In numerous domestic and foreign studies, the development of skin neoplasms has not been proven.
Selective phototherapy
The method of selective phototherapy (SFT) 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 excessive DNA synthesis, a decrease in the proliferation of epidermal cells. UV-B rays normalize the state of the immune system, reduce inflammation in the skin.
As a source of UVB rays, fluorescent lamps are used, installed in special booths.
The design of the cabins used for SFT may be different.
Typically, the lamps are placed vertically in the cabin and the patient receives the procedure while standing. But in some settings, the lamps are located horizontally, and then the procedure takes place in a horizontal position (lying on the couch). Devices for isolated treatment of hands and feet, scalp (ultraviolet comb) are also produced.
The ultraviolet comb is equipped with a comb made of transparent plastic, which will allow ultraviolet rays to most effectively penetrate the scalp. This device can also be used to treat limited areas of the skin that are difficult to reach during general phototherapy (inguinal, axillary and anogenital areas).
The UV comb is 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, it is necessary to use sunglasses equipped with UVA and UVB filters. After the procedures, it is advisable to use moisturizing body lotions.
SFT has a pleasant "side" effect, since as a result of this method of treatment, in addition to cleansing the skin, patients get a tan.
SFT can be combined with other methods of treatment, which increases the effectiveness of treatment, prolongs the time of remission and reduces the duration of the course of treatment.
If you find an error on this page, highlight it and press Ctrl+Enter.
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 venerology. 2014; (6): 9-21. (in English)
4. Dovzhansky S.I., Slesarenko N.A., Yudin S.V. Communication planus with diabetes and ulcerative colitis. In: System Bitter Medicine. Gorky; 1985: 123-5. (in English)
5. Gomes M., Schmitt D., Southeyrand P. et al. Lichen plfnus and chronic graft-versus host reaction. J. Cutan. Pathol. 1982; 9(4): 249-57.
DOI: htpp://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.
8. Blinkov I.L., Khazin L.V Biological Basis of Structural Resonance of Electric and Electromagnetic Therapy. . Moscow: Pulse; 2010. (in Russian)
© 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 PALMAR-PLANT PSORIASIS IN CHILDREN
1CJSC European Medical Center, 123104, Moscow;
2FGBU DPO "Central State Medical Academy" of the Office of the President of the Russian Federation, 121359, Moscow
The article presents data on the local application of narrow-band 311 nm phototherapy in the treatment of children with palmoplantar psoriasis. Local phototherapy with narrow-band ultraviolet radiation at a wavelength of 311 nm is an effective treatment for this disease in children.
Key words: medium wave ultraviolet radiation; phototherapy; narrowband 311 nm phototherapy; palmoplantar psoriasis.
For citation: Turbovskaya S.N., Kotenko K.V. Local narrow-band (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: Turbovskaya Svetlana Nikolaevna, Ph.D. honey. Sci., dermatovenereologist, CJSC 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 Centre", 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 urgent problems is children's psoriasis, the incidence of which has a clear upward trend. At the same time, the palmar-plantar localization of the psoriatic process in children occurs in about 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 the treatment of pediatric patients with psoriasis is a serious medical and social problem, the significance of which is determined primarily by the unreliability of existing medical methods for treating children. Therefore, despite the available arsenal of modern methods of treating psoriasis, the issue of developing safe and highly effective methods of treatment for pediatric patients, as well as long-term control of this disease, remains a cardinal problem. Currently, immunosuppressive drugs are the most effective in the treatment of psoriasis, including palmoplantar forms, but
RUSSWN JOURNAL of the PHYSICAL THERAPY, BALNEOTHERAPY and REHABILITATION. 2016; 15(6)
DOI: htpp://dx.doi.org/10.18821/1681-3456-2016-15-6-308-310_
original investigations
Rice. Fig. 1. Dynamics of PASI values (in points) and GSS (in points) in patients after the use of local UVB 311 nm therapy
4 weeks after its onset.
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 radiation spectrum is increasingly being used, which selectively acts on skin structures and produces less pronounced side effects. Scientific studies show that 311 nm wavelengths 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 treatments are required to achieve results, longer remission is achieved, observed less pronounced side effects 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
Under our observation there were 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 narrow-band mid-wave ultraviolet (UVB 311 nm) therapy.
UVB therapy procedures were performed using a UV 181 BL apparatus (Herbert Waldmann GmbH & Co.) equipped with Th01 lamps emitting a narrow UVB spectrum with an emission maximum at 311 nm. The protocol of UVB therapy included the determination of the skin phototype in accordance with the classification of Thomas B. Fitzpatrick (1975), the determination of the initiating dose without determining the equivalent dose rate (EDR) and dose increments, and procedures. With phototype I, the initial dose of UVB 311 nm radiation was 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. Stepwise (each subsequent procedure) increase in UVB dose was 0.05 J/cm2 for phototype I and 0.1 J/cm2 for other skin phototypes. Irradiation 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, slightly affects calcium metabolism in the body (100 times weaker than vitamin D3), What allow
Palmar-plantar 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-lymphocyte activation and regulates immune processes in the skin. For children, the ointment is applied in a thin layer to the affected areas of the skin 2 times a day. The maximum weekly dose at the age of over 12 years - no more than 75 g, at the age of 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.
Exclusion 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, we used clinical methods based on the determination of dermatological status indices with the study of objective and subjective symptoms of diseases: GSS (Global Severity Score). Monitoring the safety of the combined method was carried out according to the clinical analysis of blood and urine, biochemical analysis of blood. Statistical data were analyzed and processed 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 the treatment was assessed using PASI, which can range from 0 to 72 points, GSS - from 0 (no skin manifestations) to 5 (very severe psoriasis) points.
Clinical remission was noted with a decrease in PASI, GSS by 95% or more, a significant improvement - a decrease in PASI by 70-94%, improvement - by 30-69%, no dynamics (regression) - less than 29%.
In most patients, there was a pronounced positive trend in relation to the clinical symptoms of the disease. PASI 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 efficacy 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 no clinical case, after the application of this method, there was no
PHYSIOTHERAPY, BALNEOLOGY and REHABILITATION. 2016; 15(6)
DOI: htpp://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 maintained clinical remission after the use of pulse therapy.
side effects. According to the results of clinical blood and urine tests, as well as a biochemical blood test, 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 in patients with clinical remission and significant improvement, UVB 311 nm pulse therapy was used for 2 months, the procedures were performed 2 times a week with an irradiation dose equal to 50% of the maximum. The results of long-term follow-up showed that in the majority of patients on the background of the use of pulse therapy (83.3%), it was possible 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 with maintenance therapy were noted in 8.3% of patients. However, these symptoms did not require medical 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 topical preparation with calcipotriol in children with palmoplantar psoriasis is a highly effective technique. This method allows achieving clinical remission and significant improvement in the vast majority of patients (96%) with this form of psoriasis. The use of pulse therapy UVB 311 nm after the main course of treatment allows you 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 in REFERENCES)
2. Potekaev N.N., Kruglova L.S. Psoriatic disease. M.: MDF; 2014.
3. Murashkin N.N., Gluzmin M.I. Rare forms of psoriasis in children. Kuban Scientific Medical Bulletin. 2011; (2): 107-11.
6. Turbovskaya S.N., Ponic E.S., Kruglova L.S., Levshin R.N., Korchazhkina N.B., Elfimov M.A. Approaches to phototherapy in children with chronic dermatosis. Occupational medicine and industrial ecology. 2016; (2): 24-9.
R E F E R E N C E S
1. Griffiths C.E., Barker J.N. The Pathogenesis and clinical features of psoriasis. Lancet. 2007; 370(9583): 263-71.
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 English)
4. Dogra S., Kaur I. Childhood psoriasis. Indian J. Dermatol. Venereol. Leprol. 2010; 76:357-65.
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 English)
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.
8 Laws P.M., Young H.S. Topical treatment of psoriasis. Expert Opin. Pharmacother. 2010; 11(12): 1999-2009.
Serov D.N.1, Kruglova L.S.1, Ponic 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 for Dermatovenereology and Cosmetology, DZ, Moscow, 123104, Moscow; 2BU KhMAO-Yugra "Khanty-Mansiysk Clinical Dermatovenerological Dispensary", 628012, Khanty-Mansiysk
The article presents data on the effectiveness of the use of narrow-band 311 nm phototherapy and low doses of cyclosporine in patients receiving biological therapy with TNF-a blockers with the “escape” effect (PASI 50). The study showed that the inclusion of narrow-band phototherapy and cyclosporine in the complex makes it possible to achieve PASI 75 and PASI 100. As a result of monitoring the safety of the combined method, no undesirable effects were noted in the short term (1 year).
Key words: severe psoriasis; narrowband 311 nm phototherapy; cyclosporine; TNF blockers, PASI 75, PASI 100.
For citation: Serov D.N., Kruglova L.S., Ponic E.S. Efficacy of UVB 311 nm therapy and cyclosporine in patients with poor response to TNF-a blockers. 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. otd. provision of specialized assistance; Moscow Scientific and Practical Center for Dermatovenereology and Cosmetology of the Department of Health, 123104, Moscow. Email: [email protected]
Loading...