Scars can adversely affect the physical, mental and social well-being of the patient. Common treatments for scar removal include external treatments, chemical peels, mechanical resurfacing, laser resurfacing, injection techniques, physiotherapy, and surgical excision. The search for combined treatment methods is an urgent and priority direction. Methods of phoresis are in demand in the correction of scars, when changes in the structures of the dermis and hypoderm significantly reduce the penetration of topical drugs and allow to achieve a greater therapeutic effect.
Many years of experience in using fixed combinations of topical glucocorticosteroids in dermatology today seem to be justified not only theoretically (the pathogenesis of immuno-inflammatory and infectious dermatoses), but also from the perspective of optimizing therapeutic measures in this category of patients. From this position, the innovative combination drug Tetraderm® can be regarded as the drug of choice for dermatoses of combined etiology. The composition of the drug includes highly effective components that allow you to affect the inflammatory component, infection and trophic tissue in the lesions. The components of the drug show a favorable profile of antibacterial and antimycotic activity. Highly potent corticosteroid can effectively stop inflammation. The drug has prospects for use in various dermatoses of combined etiology (atopic dermatitis, eczema), in clinical situations when mycoses or pyoderma have signs of eczematization of the process, rashes in large folds, cystic dermatoses and diskeratoses.
One of the challenging problems for modern cosmetology is the cosmetic correction of the cutaneous scars of the skin that arises in the first place from the high prevalence of this condition and the lack of reliable and safe methods for its treatment The application of laser technologies including selective laser therapy as the method of fractional photothermolysis and the use of a neodymium (1064 nm) laser is considered to be a promising approach to address this problem. The present study included 18 patients presenting with hormone-dependent atrophic scars. All the patients were assigned for the treatment by selective photothermolysis (at the rate of 2 sessions per each treatment course performed with a 4 week interval) and irradiation by the neodymium laser (at the rate of 6-8 sessions conducted after fractional photothermolysis). The use of combined laser therapy in patients with hormone-dependent atrophic scars produced a pronounced effect as evidenced by the improvement of the clinical picture and was accompanied by the 78.1% reduction of the symptom index according to the DISC symptom scale and the 76.5% improvement of the dermatology life quality index (DLQI). The use of the combined method for the correction of atrophic cutaneous scars helps to restore the epidermal-dermal and epidermal structures of the skin in the association with the 1.4-fold, 1.7-fold, and 1.6-fold increase in the thickness of the epidermis, dermis, and hypodermis respectively; simultaneously, the acoustic density of the tissues increased by 1.8 times which corresponded to the improvement of the ultrasound picture by almost 75% when estimated in accordance with the Vancouver scar scale.
Bipolar radio-frequency devices have all the theoretical prerequisites for use in combination with phototechnologies, while the properties of electro-optical synergy are manifested. Material and method. The study included 125 patients aged 40 to 50 years. Depending on the therapy, patients were divided into 4 groups and subgroups A and B, depending on the identified predictors of the effectiveness of laser therapy. The results of the study. After applying the combined methods, a more significant improvement in the quality characteristics of the skin was noted: an increase in skin moisture in the 1A group, the corneometry index increased by 24.6%, in the 1st group by 28.3%, in the 2A group by 38.9%, in the 2B group by 37.3%, in the 3A group by 29.1%, in the 3B group by 27.5%, in the 4A group by 38.8%, in the 4B group by 38.8%; an increase in skin elasticity in group 1A, the Ua/Uf indicator increased by 13.2%, in group 1B by 13.9%, in group 2A by 27.9%, in group 2B by 29.0%, in group 3A by 14.9%, in the 3B group by 14.6%, in the 4A group by 28.2%, in the 4B group by 28.2%, which was accompanied by a more pronounced decrease in the severity of wrinkles according to profilometry. The use of laser therapy (an erbium or neodymium laser) and microneedle RF therapy contributes to a more significant restoration of the epidermal-dermal structure of the skin, which is confirmed by ultrasound data: the microrelief has improved by more than 3 times compared with monotherapy, the thickness of the dermis is 2.2 times and acoustic density 1.7 times. Conclusions. Combined methods, to a greater extent than mono-laser therapy, contribute to improving the quality of life of patients according to the dynamics of the LHC index, which decreased in groups 1 and 3 by an average of 47.1% and 44.4% versus 57.8% and 64.3% in 2 and 4 groups, while there was a significant difference in the values of the index of HSCI in groups A and B (p 0.01). In accordance with the VAS and GAIS indicators, the optimal effect after a course of therapy with preservation of the results after 1 year was achieved in 25/12.5% of patients in group 1A, in 46.7/33.3% in group 1B, 7/37.5% of patients of group 2A, 78.6/71.4% of patients of group 2B, 33.3/20.0% of patients of group 3A, 50.0/25% of patients 3B groups, 58.8/58.8% and 75.0/75.0% in patients 4A and 4B of the group, respectively, which indicates the high efficiency of the combined methods and the persistence of the results.
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