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INVENTION
Russian Federation Patent RU2171121

METHOD OF TREATMENT lipid necrobiosis

METHOD OF TREATMENT lipid necrobiosis

Name of the inventor: Samsonov VA .; Markusheva LI .; Hachukova LM .; Volnukhin VA
The name of the patentee: State Enterprise Central Research Institute for Skin and Venereal Diseases
Address for correspondence: 107076, Moscow, ul. Korolenko, 3, K.4, GU TSNIKVI, V.A.Samsonovu
Starting date of the patent: 2000.12.05

The invention relates to medicine, namely to the field of dermatology. Each session of laser therapy is performed in two stages. In the first of which produce transdermal blood irradiation with laser light with a wavelength of 0.633 microns by optical fibers, the distal end of which is fixed a reflector in contact with the skin surface in the projection cubital vein at the end of the power to 20-25 mW, and the fiber length of exposure 20-25 min. At the second stage, the local lesions irradiation pulsed laser light with a wavelength of 0.89 microns by contact with the radiating matrix consisting of 10 laser diodes with each diode power 8.6 W / pulse, the pulse duration of 100 ns, the pulse repetition frequency of 80 Hz or 150 Hz, the exposure field on 1 or 2 minutes exposure and duration of 8-12 minutes. The pulse repetition frequency is changed every 3-4 sessions, sessions of laser therapy is carried out 5 days a week, all on a course of 10-12 sessions. Such combined effect during each session allows to increase the effectiveness of treatment.

DESCRIPTION OF THE INVENTION

The invention relates to medicine, namely to the field of dermatology, and can be used for treating patients with lipoid necrobiosis.

For the treatment of patients with lipoid necrobiosis used a wide variety of different methods. This hypoglycemic agents, angioprotectors, antibiotics, corticosteroids, acetylsalicylic acid, cytotoxic agents, agents that enhance the metabolic processes in the skin, antioxidants and lipotropic agents.

A method of treating skin lipid necrobiosis helium-neon laser with a power flux density of 0.25 - 5 mW / cm 2 with an exposure of 3-10 minutes, daily on a course of 20-20 sessions (Korepanov VI, Fedorov SM, Shulga VA "Application of low-intensity laser radiation in dermatology" (practical guide), Moscow, 1996, p. 27).

However, this method of treatment is insufficiently effective, as it involves teleirradiation foci, which leads to insufficient penetration of the laser radiation in the lower dermis of the skin and blood vessels. This method of treatment of lipid necrobiosis not take into account the complex causal mechanisms of the disease: changes of lipid peroxidation, microcirculation disorders, changes in carbohydrate metabolism.

The invention aims at improving the efficiency of the treatment of lipid necrobiosis by combining for each session percutaneous low-intensity irradiation of blood helium-neon laser irradiation, and local lesions infrared radiation spectrum.

This result is achieved by a method for the treatment of lipid necrobiosis each session of laser therapy is performed in two stages, the first of which produce a percutaneous blood irradiation with laser light with a wavelength of 0.633 microns by optical fibers, the distal end of which is fixed a reflector in contact with the surface skin in the projection cubital vein at the end with a power of 20-25 mW, and the fiber length of exposure to 20-25 minutes and in the second stage of laser therapy session, which is carried out immediately after the first exercise local lesions irradiation pulsed laser light with a wavelength 0 89 microns by contact with the radiating array consisting of 10 laser diodes with a power of each diode 6-8 watts / pulse, pulse duration of 100 ns, pulse repetition rate of 80 Hz or 150 Hz, exposure on the 1 or 2 minutes, and the duration of exposure 8-12 minutes, with a pulse repetition frequency of change every 3-4 sessions, sessions of laser therapy is carried out 5 days a week, all on a course of 10-12 sessions.

If necessary, carry out additional 1 or 2 courses of laser therapy, similar to the first, with an interval between courses of 6-8 weeks.

The above method of treatment is a fundamentally important aspects:

The combination of venous blood and skin exposure to laser radiation is determined by a wide range of therapeutic effects, thereby adjusting carbohydrate, lipid metabolism, indicators rheology and hemostasis of blood.

Percutaneous blood irradiation results in significant systemic action. Given the frequent combination lipid necrobiosis with diabetes, the method has high practical significance, since It allows to correct metabolic disorders in these patients.

The infrared spectrum of the laser radiation has a high penetrating power, high tropism for vascular skin formations. Laser-infrared light has a normalizing effect on the microcirculatory processes, which are the main pathogenic factor leading to damage of the vascular wall and the emergence of cutaneous manifestations.

The proposed method for the treatment of lipid necrobiosis as follows. For percutaneous laser irradiation of helium-neon laser at the first stage of each session of laser therapy using laser physiotherapy installing vapor recovery units 01 ( "anode", Russia) or other equipment with similar technical characteristics, permitted for use in medical practice. Radiation is applied to the skin with a fiber optic light guide 400 microns in diameter, which is attached to the end reflector, a plaster body seating. Procedures performed in the supine position, the projection is exposed to the effects of the cubital vein at the contact stable method, in continuous mode, the output power at the end of the optical fiber 20-25 mW, exposure time of 20-25 minutes.

In the second stage a session of laser therapy effects on the lesions performed by pulsed laser radiation infrared (wavelength of 0.89 microns). For these purposes, used laser therapeutic device "Mustang" series (manufactured by LLP "Technology", Russia) or other laser equipment with similar technical characteristics, permitted for use in medical practice. Irradiation is carried out by radiating a matrix consisting of laser diodes 10, in stable contact technique, at each pulse power 8.6 W diode 80 Hz or 150 Hz, pulse width of 100 nm, exposure 1 minute or 2 minutes exposure time 8 -12 min. The pulse repetition frequency is changed every 3-4 sessions. Sessions laser therapy carried out 5 days a week for 10-12 sessions per course. Depending on the dynamics of clinical recommended repeat courses of laser therapy with an interval between courses of 6-8 weeks.

In the treatment of patients with lipoid necrobiosis proposed method positive results observed in 75% of patients, a marked effect in 55% of patients.

One of the major pathogenetic mechanisms of lipid necrobiosis is a violation of microcirculation, diabetic angiopathy, hemorheological status and hemostasis system. The proposed method of treatment leads to an improvement of clinical symptoms, normalization of gemomikrotsirkulyatsii in the skin.

Due to the high information content of the method of laser Doppler flowmetry assess the condition of the microcirculation in the skin of patients with lipoid necrobiosis. In the study baseline blood perfusion in the lesions in the capillary blood flow analyzer LAK-01 ( "LAZMA", Russia) revealed increase in basal blood flow, on average, by 49.1% and vasomotions amplitude - by 39.8% compared with apparently healthy skin. The average level of basal blood flow in the affected skin is 3,72 ± 0,31 perfusion units in apparently healthy - 2,25 ± 0,2 perfusion units, the amplitude vasomotions - 1,8 ± 0,22 and 1,1 ± 0,34 respectively. In addition, the area of ​​lesions recorded decrease microvascular reactivity: maximum gain when postgiperemichesky termoprobe is 40-80% of that of a healthy skin.

Following the laser value of basal blood flow and vasomotions allowed in the centers of (2,83 ± 0,63 and 1,13 ± 0,27 respectively) are close to the indicators apparently healthy skin (2,25 ± 0,2 and 1,1 ± 0.34).

The following examples are based on clinical material illustrating described method of treatment.

Example 1. The patient was 59 years old. Diagnosis: lipoid necrobiosis, classic form of Urbach-Oppenheim. Sick for 2 years. Previously, nothing was treated. On examination: on the front surfaces of both shins 2 hearth rounded, presented spotty and patchy elements of the size of 2-3 cm and 5-6 cm in diameter with clear boundaries reddish-brown with a yellowish tinge. In multiple lesions telangiectasia, slightly pronounced atrophy. Diagnosis is confirmed by biopsy: a few thickened epidermis, hyperkeratosis. In the dermis observed extensive necrosis of collagen fibers surrounded by histiocytic infiltrate with admixture of lymphocytes and single giant cells. When stained with Sudan III in the area of ​​necrobiosis marked accumulation of fat in the form of small drops of rusty-brown color. Diabetes is not revealed. Indicators of glucose tolerance test in the normal range. There hyperviscosity and hypercoagulation syndrome. lipid profile are not changed. In the study of microcirculation in the lesions showed a significant increase (by 4 times) the level of the basal blood flow and vasomotions amplitude postgiperemicheskogo lack of growth in response to a standardized thermal test.

The patient had a course of laser therapy, which includes: 12 sessions held 5 times a week. In the first stage irradiation sessions performed transcutaneous blood helium-neon laser with a power at the fiber end 25 mW, 20 min exposure duration. Immediately after that, the second step irradiation was performed every session lesions infrared laser light (wavelength 0.89 um) using the radiating array 10 consisting of laser diodes, each diode at a power of 6 W / pulse, 80 Hz and 150 Hz ( changing the frequency of repetition every three sessions, starting with 80 Hz frequency), pulse duration of 100 ns, exposure for 2 minutes on the field, 4 fields irradiation, 5 days a week, 12 sessions per course. Upon completion of the course of laser foci uplostilis considerably paled. The emergence of new elements have been noted. The level of basal blood flow and the amplitude of the affected skin vasomotions decreased 1.5 times; during termoproby postgiperemicheskogo noted the appearance of growth (170%) in response to standard normalized impact.

Example 2. Patient B., 60 years old. Diagnosis: lipoid necrobiosis, a common form. Sick for 2 years. Previously applied external hormones for 2 months with no positive effect. Quickly there were new elements, and pre-existing lesions increased in size. On examination: lesions were located on the sides of the chest, the front wall of the abdomen, in the elbow, in the front of the leg. Outbreaks presented mottled, nodular and patchy elements light pink color with clear boundaries, in diameter from 2-3 mm to 3-4 cm. The center on the side of the chest to the left accompanied by severe infiltration. Foci localized on the legs and in the joints with telangiectasias, with severe atrophy.

Diabetic patients are not identified, but the blood glucose levels higher than normal. lipid profile (cholesterol, triglycerides, lipoprotein) increased. There hyperviscosity and hypercoagulation syndrome plasma. In investigating microcirculation lesions observed in the basal blood level increase is 3 times, the presence of high-vasomotions, postgiperemicheskogo gain reduction in response to a normalized thermal test by 70% compared with that in healthy skin.

2 patients underwent a course of laser therapy every 8 weeks. Each course consists of 12 sessions held 5 times a week. During each session, the patient was performed transcutaneous laser irradiation of blood helium-neon laser with a power at the fiber end 25 mW, 20 min exposure duration. Immediately thereafter exposed to lesions emitting laser array infrared light (wavelength 0.89 um). The matrix consisted of 10 laser diodes with a power of each diode 7 watts / pulse, a frequency of 150 Hz - the first four sessions, 80 Hz - following four sessions, 150 Hz - the last four sessions. The pulse duration of 100 ns, exposure 1 minute on the field, the total number of exposure fields - 10. To reduce the possible adaptation to the laser action is necessary to change the frequency characteristics of the impact and intensity of the laser radiation.

After 1st course of laser therapy did not appear new centers, noted a slight blanching of the lesions. After 8 weeks was conducted 2nd course laser as described above. One month after treatment showed a significant flattening of the infiltrative plaque cells, reducing the number of telangiectasias. Viscosity parameters were approaching normal. The level of basal blood flow and the amplitude vasomotions in the lesions and approached normal values. During the termoproby posgiperemichesky increase in the outbreak and apparently healthy skin amounted to 220%.

Example 3. Patient N., 19 years. Daignoz: lipoid necrobiosis, classic form of Urbach-Oppenheim with ulceration. Sick for 8 years. Earlier repeatedly applied heparin ointment, jelly "Solkoseril", "Aktovegin" hemostatic sponge. Without the expressed clinical effect. On examination: lesions occupy the front surface of each of the drums with clear boundaries red-brown color with shine. The central zone of foci presented severe atrophy with single telangiectasias. The inner surface of each of the drums in the ankles ulcerative defects 1-2 cm in diameter with a slight discharge. In patients with diabetes mellitus type 1, moderate, step subcompensation, diabetic nephropathy. In analyzes - improving lipid metabolism in a 3-fold increase in serum and plasma viscosity, increased plasma clotting factor of 2-3.

In the study of microcirculation in the eruption was an increase in the basal level of blood flow by 2.5 times, vasomotions amplitude of 2.2 times, the lack of postgiperemicheskogo growth in response to the standardized thermal test.

The patient was conducted 3 courses of laser therapy with an interval of 6 weeks. Each course consisted of 10 sessions carried out 5 times a week. Percutaneous laser irradiation of blood carried a helium-neon laser with a power of at the end of the optical fiber 25 mW, exposure duration of 25 minutes. Immediately thereafter, infrared laser light irradiation is conducted lesions surrounding the ulcer. Impact carried radiating array consisting of 10 laser diodes with a power of each diode 8 W / pulse, 80 Hz and 150 Hz (changing the pulse repetition frequency of every 3 sessions, starting with 80 Hz), pulse duration of 100 ns, exposure for 2 minutes 6 fields exposure. Duration 10 sessions.

Repeated courses of laser therapy were conducted in 6 weeks (total 3 courses). Against the backdrop of courses and the resolution was observed scarring ulcers, pre-existing for a few years. The level of basal blood flow and the amplitude vasomotions in lesions close to normal. During the termoproby postgiperemichesky an increase of 160%. Normalize lipid metabolism, blood rheology and hemostasis.

CLAIM

1. A method for treating lipid necrobiosis by laser, characterized in that each session of laser therapy is performed in two stages, the first of which produce a percutaneous blood irradiation with laser light with a wavelength of 0.633 microns by optical fibers, the distal end of which is fixed a reflector contacting with the skin surface in the projection cubital vein at the end of the fiber to power 20-25 mW and duration of action of 20-25 minutes, and the second laser session stage, which is carried out immediately after the first exercise local lesions irradiation pulsed laser light with a 0.89 microns wavelength by contact with the radiating array consisting of 10 laser diodes with a power of each diode 6-8 watts / pulse, 100 ns pulse duration, pulse repetition rate of 80 Hz or 150 Hz, exposure on the 1 or 2 minutes and duration of exposure 8-12 min, while the pulse repetition frequency change every 3-4 sessions, sessions of laser therapy is carried out 5 days a week, all on a course of 10-12 sessions.

2. A method according to claim 1, characterized in that it further performed one or two laser course, similar to the first, with an interval of 6-8 weeks between courses.

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Publication date 01.04.2007gg