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DERMATOVENEREOLOGY
INVENTION
Patent of the Russian Federation RU2139116

METHOD OF TREATMENT OF THE CIRCULAR GRANULEM

METHOD OF TREATMENT OF THE CIRCULAR GRANULEM

The name of the inventor: Volnukhin VA; Grebenyuk V.N .; Kochetkov M.A.
The name of the patent holder: Central Research Institute of Dermatology and Venereology
Address for correspondence: 107076, Moscow, Korolenko St. 3, building 4, Kozhvininstitute of VA Volnukhin.
Date of commencement of the patent: 1999.03.31

The invention relates to dermatology and is intended for the treatment of an annular granuloma. Laser therapy is carried out in two stages. At the first stage, blood is irradiated percutaneously in the region of the projection of the cubital vein. The wavelength is 0.633 μm. The power at the end of the fiber is 20-25 mW. The duration of the session is 20-25 minutes. Sessions are held daily or every other day. On the course of 7-10 sessions. At the distal end of the light guide, a reflector that contacts the surface of the skin is fixed. The second stage is carried out in 3-4 weeks. Irradiated lesions are contact. The wavelength is 0.89 μm. Use a radiating matrix consisting of 10 diodes. The power of each diode is 7-8 W / imp. The pulse repetition rate is 80 Hz. The pulse duration is 100 ns. The average power density is 0.047-0.053 mW / cm 2 . Exposition on the field 2 min. The duration of the session is 10-12 minutes. Sessions are held daily or every other day. 7-10 sessions per course. The method makes it possible to influence the various links in the pathogenesis of the disease, leading to a normalization of the state of hemocirculation in the skin of patients.

DESCRIPTION OF THE INVENTION

The invention relates to medicine, namely to the field of dermatology, and can be used to treat patients with ring-shaped granuloma.

To treat the ring-shaped granuloma, many different methods have been proposed: systemic use of salicylates, corticosteroids, cytostatics, antimicrobial, antitubercular, anti-leukemia, antidiabetic, antimalarial, antihistamines, vitamins; But also X-ray therapy, cryodestruction, electrocoagulation, scarification of lesions, local injections of corticosteroids and gold preparations. Unfortunately, they do not have the proper effect and have a number of adverse reactions.

A method for treating an annular granuloma with a helium-neon laser is described using an LGN-111 apparatus with a specific power density of 1 mW / cm 2 , an exposure of 3-7 minutes, daily, for a course of 15-20 procedures, only 1-3 cycles (Goncharova YA Comparative effectiveness of laser therapy and local negative pressure in the complex treatment of annular granuloma. "Scientific and practical collection" Actual questions of dermatovenerology ", Dnepropetrovsk-Khmelnitsky, 1996, p. 82). However, this method is not effective enough, since the radiation generated by the helium-neon laser penetrates the skin to a small depth, and a significant part of it (up to 40-60%) is reflected from the surface of the skin. Such an effect does not ensure sufficient irradiation of the lower parts of the dermis and deep vascular plexus of the skin.

The invention is aimed at increasing the effectiveness of treatment of annular granuloma by combined application of low-intensity laser radiation of red and near infrared ranges in the form of influences on blood and lesions.

This result is achieved due to the fact that the distinctive feature of the proposed method of treatment of the annular granuloma is that laser therapy is carried out in two stages, the first of which is performed by percutaneous irradiation of the blood with laser light at a wavelength of 0.633 μm through a fiber optic lightguide at the distal end of which The reflector contacting the surface of the skin in the region of the projection of the cubital vein is fixed, with the power at the end of the fiber 20-25 mW, the duration of the session 20-25 min, daily or every other day, for the course of 7 sessions, and in the second stage, 4 weeks after the end of the first one, local irradiation of the lesion centers with pulsed laser light with a wavelength of 0.89 μm is carried out by a contact method using a radiating array consisting of 10 laser diodes with a power of each diode of 7-8 W / imp, a repetition rate of 80 Hz, Pulse duration 100 ns, average power density 0.047-0.053 mW / cm 2 , field exposure 2 min, duration of the session 10-12 min, daily or every other day, for a course of 7-10 sessions.

Depending on the dynamics of the process, at the first stage, two courses of percutaneous laser irradiation of the blood can be performed with an interval between courses of 3-4 weeks.

If necessary, in the second stage, two courses of local laser irradiation of lesions with an interval between courses of 3-4 weeks can be conducted.

The proposed method pursues the implementation of the following principles, which optimize the laser therapy of the annular granuloma.

1. Complex effect on venous blood and skin, and a combination of red and infrared ranges allow to obtain a wider range of therapeutic effects of low-intensity laser radiation, and thereby influence the different links in the pathogenesis of the disease.

2. Laser light in the near infrared range, in contrast to the waves in the red region of the spectrum, has a greater penetrating power, so its use in deep-lying skin formations is more appropriate.

3. Irradiation of blood, in comparison with local irradiation, leads to a more pronounced systemic action on the patient's body, which is especially important in the treatment of multiple rashes.

The method for treating the annular granuloma is as follows. At the first stage of treatment of the annular granuloma, percutaneous laser irradiation of blood with a helium-neon laser (wavelength 0.633 μm) is prescribed. For this purpose, a laser physiotherapeutic unit ULF-01 ("Anod", Russia) or other equipment with similar technical characteristics that can be used in medical practice can be used. Radiation is applied to the skin by means of a fiber optic fiber with a diameter of 400 μm, at the end of which a reflector is fixed, fixed to the body with an adhesive plaster. The presence of a reflector and a slight compression, which occurs when fixing it to the skin with an adhesive plaster, increases the amount of light absorbed by the biotissues. The procedures are performed in the prone position, the projection of the cubital vein is exposed to the contact stable method, under continuous conditions, the radiation power at the end of the light guide is 20-25 mW, the duration of the session is 20-25 min; For a course of 7 sessions, conducted daily or every other day. With a mildly pronounced dynamics of the skin process in 3-4 weeks, a second course of percutaneous laser irradiation of the blood is recommended.

At the second stage, which is carried out 3-4 weeks after the end of the first stage, the effects on the lesion centers with pulsed laser radiation of the infrared range (wavelength 0.89 μm) are assigned. For this purpose, a laser therapeutic device of the Mustang series (Firma Tekhnika, Russia) or other laser equipment with the same technical characteristics that can be used in medical practice can be used. Irradiation is carried out using a radiating array consisting of 10 laser diodes, a contact stable method, with a pulsed power of each diode of 7-8 W, a frequency of 80 Hz, a pulse duration of 100 ns, an average power density of 0.047-0.053 mW / cm 2 , exposure 2 Min on the field, the duration of the session is 10-12 minutes, daily or every other day, for a total of 7-10 sessions. Depending on the dynamics of the clinical picture, a repeated course of local irradiation with an interval of 3-4 weeks is recommended.

In the treatment of annular granuloma, 84.7% of patients showed positive results in the proposed method, a pronounced therapeutic effect was found in 69.3% of patients (remission in 30.8%, significant improvement in 38.5%).

Combined laser therapy, along with the resolution of clinical symptoms, leads to the normalization of hemocirculation in the skin of patients.

When studying the initial parameters of blood perfusion in the foci of the annular granuloma by laser Doppler flowmetry on the capillary blood flow analyzer LAKK-01 (NPP LAZMA, Russia), a violation of the blood microcirculation processes is observed, characterized by an increase in basal blood flow, by an average of 49.1% And the amplitude of vasomotions - by 39.8%, compared with apparently healthy skin. The average level of basal blood flow in the affected skin is 2.73 ± 0.37 perfusion units, in apparently healthy - 1.83 ± 0.30 perfusion units, the amplitude of vasomotions - 1.3 ± 0.24 and 0.93 ± 0.11 respectively. In addition, a decrease in the reactivity of microvessels is recorded in the area of ​​rashes: the maximum posthypermic increment in a thermal test is 40-80% of that in healthy skin.

After laser therapy, the values ​​of basal blood flow and vasomotions in the region of resolved foci (1.83 ± 0.63 and 1.13 ± 0.27, respectively) are close to those in apparently healthy skin (1.83 ± 0.6 and 1.16 ± 0.15 respectively). Normalization of the thermoproducts is slower - within 1-2 months after the end of treatment.

We present clinical examples demonstrating the possibilities of the proposed method of treatment.

Example 1 . Patient P., 10 years old. Diagnosis: annular granuloma, localized form. I'm sick for about a year. Previously conducted treatment (corticosteroid ointments for occlusive dressing, phonophoresis 1% hydrocortisone ointment) had no effect. On examination: on the skin of the back surface of the right foot, there is a ring-shaped focal point, 7x5 cm in size, consisting of separate hemispherical pink knots 3-5 mm in diameter. In the central part of the hearth, the skin is cyanotic-red. On the left buttock there are two foci of bright pink color, 3x1 cm and 3x1.5 cm, surrounded by a roller consisting of densely located small nodules.

The diagnosis was confirmed histologically: in the epidermis - hyperkeratosis, in the dermis - foci of destruction of collagen, surrounded by palisad-like lymphohistiocytic infiltrates; When coloring with toluidine blue at the sites of destruction, metachromatic staining is observed. Clinical and biochemical analyzes of blood and urine within the limits of the age norm. Consulted by a gastroenterologist: diagnosed compensated dysbacteriosis of the intestine 1 degree. In the study of microcirculation in the lesions, a significant increase (almost 3-fold) in the level of basal blood flow and amplitude of vasomotions, a lack of post-hyperemic increase in response to a normalized heat test was revealed.

At the first stage of the patient, a course of percutaneous laser irradiation of blood with a helium-neon laser with a power of 25 mW at the end of the fiber, a duration of the session of 20 min, in the number of 7 sessions conducted every other day was performed. A month after the treatment, the skin in the foci turned pale, the infiltration of the peripheral cushion decreased. In the second stage (4 weeks after the end of the first stage), irradiation of the lesion sites with infrared laser light (wavelength 0.89 μm) was assigned: the exposures were carried out by a radiating array consisting of 10 laser diodes, with a power of 7 W / , A pulse duration of 100 ns, an average power density of 0.047 mW / cm 2 , an exposure of 2 minutes per field, a session duration of 12 minutes, a day, a course of seven sessions. At the end of the local irradiation course, part of the nodules was resolved. The level of basal blood flow and the amplitude of vasomotions in the affected skin decreased to normal values; During the thermal test, the appearance of post-hyperemic growth (155%) was noted in response to the standard normalized effect.

A month after the treatment, the state of clinical remission was established: the skin of the buttocks and the right foot is free from rashes, normal color. In the region of resolved foci, the basal blood flow and vasomotion values ​​did not differ from those in healthy skin; When carrying out the thermal test both in the outbreaks and apparently healthy skin, the post-hyperimic increase in response to the standard normalized exposure was 240-300%, which corresponds to its level in healthy children of the same sex and age.

Example 2 . Patient X., 9 years old. Diagnosis: annular granuloma, generalized form. She is sick for 2 years. She received several courses of drug therapy, including antihistamines, hydrocortisone phonophoresis, external agents (occlusive dressings with steroid and nonsteroidal anti-inflammatory ointments, gels of troxevasin gel, heparin ointment). Against the background of the treatment, there was no improvement, new elements continued to appear. On examination: on the skin of the left shoulder, forearms, lower third of the abdomen, lower limbs - 11 ring-shaped foci of cyanotic red color, ranging from 3x3 to 8x8 cm; On the periphery of the foci there is a roller consisting of densely-elastic nodules 3-5 mm in diameter. Clinical and biochemical analyzes of blood and urine within the age limit. In the study of microcirculation in the area of ​​rashes, there was an increase in the level of basal blood flow by 2.4 times, the presence of high-amplitude vasomotions, a decrease in post-hyperemic increase in response to a standardized heat test by 54%, compared with that in healthy skin.

At the first stage of the patient, a percutaneous laser irradiation of blood was performed with a helium-neon laser with a power of 25 mW at the end of the fiber, a session duration of 20 minutes, daily, for a course of 7 sessions. Three weeks after the treatment, the appearance of new rashes stopped, the intensity of erythema decreased, and a partial normalization of hemodynamic parameters was observed: basal blood flow and vasomotion amplitude remained 1.1 times higher than in healthy skin. At the second stage (3 weeks after the end of the first stage), irradiation of the laser lesion foci of the infrared band (0.89 μm wavelength) was assigned: they were exposed to a radiating array consisting of 10 laser diodes, with a diode power of 8 W / imp, a frequency of 80 Hz , A pulse duration of 100 ns, an average power density of 0.053 mW / cm 2 , an exposure of 2 minutes per field, a session time of 10 minutes, and a course of 10 sessions conducted every other day. After the course of irradiation, rashes on the shoulder, forearms and abdomen were resolved. On the hips and legs, foci of the same size, but the rim around their periphery is fragmented. Four weeks after the indicated treatment, a second course of infrared laser therapy was performed according to the method described above. A month after the treatment, the dermatosis was resolved completely; In the region of the foci - weakly expressed secondary pigmentation. The condition is regarded as clinical remission. The level of basal blood flow and the amplitude of vasomotions in the region of resolved rashes did not differ from normal values. When carrying out the thermal test, the post-hyperemic increase in the foci and apparently healthy skin was 250-300% (variant of the norm).

Example 3 . Patient P, 12 years old. Diagnosis: annular granuloma, generalized form. She is sick for 4 years. She was treated at the place of residence: she received several courses of drug therapy, including anti-tuberculosis and antihistamines, vitamins, external agents (occlusive dressings with steroidal and non-steroidal anti-inflammatory ointments). Against the background of the treatment, there was no improvement, new elements continued to appear. On examination: on the skin of the back surface of the right foot and ankle is a foci of cyanotic red color, round in shape, measuring 10x8 cm, surrounded by peripheral small hemispherical knots of pink color. On the skin of the left and right lower leg, thighs, lower third of back and abdomen, upper limbs - 15 ring-shaped foci from bluish-red to pale pink, ranging from 3x3 to 6x6 cm with a peripheral roller consisting of densely-elastic nodules, 3 -5 mm. Clinical and biochemical analyzes of blood and urine within the age limit. In the study of microcirculation in the area of ​​rashes, an increase in the level of basal blood flow was observed in 2.0 times, amplitude of vasomotions was 2.2 times, a decrease in post-hyperemic increase in response to a normalized heat test by 70%, compared with that in healthy skin.

At the first stage of the patient, two courses of percutaneous laser blood irradiation were performed with a helium-neon laser with a power of 20 mW at the end of the fiber, a duration of the session of 25 min, and a course of 7 daily sessions, with an interval between courses of 3 weeks. After the therapy, the appearance of new rashes ceased, the intensity of erythema decreased, a partial normalization of hemodynamic parameters was observed; But the level of basal blood flow and the amplitude of vasomotions remained 1.6 times higher than the values ​​of healthy skin.

After 4 weeks, the second stage of treatment was performed: the patient was assigned to irradiation of lesions of laser light in the infrared range (wavelength 0.89 μm). The effects were carried out by a radiating array consisting of 10 laser diodes, with a power of each diode of 8 W / imp, a frequency of 80 Hz, a pulse duration of 100 ns, an average power density of 0.053 mW / cm 2 , an exposure of 2 minutes per field, a session time of 12 minutes, Course of 10 daily procedures. When examined in a month: on the upper limbs and stomach, the rashes were resolved; On the hips and legs the foci of the former size, but the roller along the periphery of them is fragmented. After 3 weeks a repeated course of infrared laser therapy was carried out according to the method described above. A month after the treatment the foci on the hips and lower legs were completely resolved, leaving behind a secondary pigmentation; The condition is regarded as clinical remission. The level of basal blood flow and the amplitude of vasomotions in the region of resolved rashes did not differ from normal values. When carrying out the thermal test, the post-hyperemic increase in the resolved foci and apparently healthy skin was 240-280% (variant of the norm).

CLAIM

1. A method for treating annular granules by low-intensity laser therapy, characterized in that laser therapy is performed in two stages, the first of which is performed by percutaneous irradiation of blood with laser light at a wavelength of 0.633 μm through a fiber optic lightguide, at the distal end of which a reflector is contacted, The skin surface in the area of ​​the projection of the cubital vein, with the power at the end of the light guide 20-25 mW, the duration of the session 20-25 minutes, daily or every other day, for a course of 7 sessions, and in the second stage, which is carried out 3 to 4 weeks after the end of the first , Local irradiation of the foci of damage by pulsed laser light with a wavelength of 0.89 μm by a contact method using a radiating array consisting of 10 laser diodes with the power of each disc 7-8 W / imp, pulse repetition rate 80 Hz, pulse duration 100 ns, The average power density is 0.047-0.053 mW / cm 2 , the exposure on the field is 2 minutes, the duration of the session is 10-12 minutes daily or every other day, for a course of 7-10 sessions.

2. The method of claim 1, wherein in the first step two courses of percutaneous laser irradiation of the blood are carried out with an interval between courses of 3 to 4 weeks.

3. The method of claim 1 or 2, characterized in that in the second stage two courses of local irradiation of lesions with an interval between courses of 3 to 4 weeks are carried out.

print version
Date of publication 01.04.2007гг