Background: Eczema is one of the most common skin diseases. Despite the success of systemic and local pharmacotherapy, effective treatment of patients with eczema is hampered by the lack of clear ideas about the etiology and the multifactorial nature of the disease pathogenesis. The research results available to date indicate that it is possible to increase the effectiveness of treatment of eczema patients using phototherapy methods. Aim: To evaluate the possibilities of narrow-band phototherapy with a wavelength of 311 nm (UVB-311 nm) in increasing the effectiveness of drug therapy in patients with eczema. Methods: The dermatological index of the symptom scale (DISS) was used to assess the clinical manifestations of eczema. Serum levels of cytokines – interleukins (IL) -1β, -2, -6, -10, interferon gamma (INF-γ), tumor necrosis factor alpha (TNF-α) were determined by solid-phase enzyme immunoassay. UVB-311 nm therapy procedures (25 sessions) were performed with the Dermalight®1000 device (Germany). The results of the treatment were evaluated after 2 and 4 months from the beginning of treatment. Results: The study included 66 patients with eczema (mean age 58.6±3.4 years, 44 males, 22 females), randomized into 2 groups. Group 1 included 33 patients who received only basic drug therapy (BDT). In the 2nd group, there were 33 patients who, in addition to BDT, received narrow-band phototherapy UVB-311 nm (РT+BDT). In the BDT group, the indicators of DISS after 2 months decreased by 1.33 times (p=0.01), while in the РT+BDT group - by 1.95 times (p<0.001). The level of cytokines in the BDT group did not change significantly (p>0.05) after 2 months. In the РT+BDT group, after 2 months, the level of IL-1ß decreased by 1.25 times (p=0.001), IL-2 - by 1.44 times (p<0.001), IL-6 - by 1.69 times (p=0.001), INF-γ – by 1.28 times (p=0.001), TNF-α – by 1.29 times (p=0.002);the level of IL-10 increased by 1.22 times (p=0.002). Conclusions: Basic drug therapy contributes to a moderate decrease in the DISS by 1.33 times, but does not provide a significant decline in the pro-inflammatory cytokine potential of the blood. The use of UVB-311 nm phototherapy contributes to a more significant decrease in the levels of the complex of proinflammatory cytokines (IL-1β, -2, -6, TNF-α, INF-γ) and an increase in anti-inflammatory IL-10, which favorably affects the clinical course of dermatosis, manifesting by a decrease in the DISS by 1.95 times.
Objective: to study changes in immunological parameters in patients with true eczema during complex therapy with the use of upadacitinib. Materials and methods. The work was performed with the participation of 131 patients aged 18 to 70 years (average age 58.7±3.6 years) with a diagnosis of true eczema, who were on inpatient treatment. The patients were divided into 4 groups: the first group received basic drug therapy (BMT), the second - phototherapy (FT) and BMT (BMT+FT), the third - upadacitinib (UPA) and BMT (BMT+ UPA), the fourth - BMT+FT+UPA. The content of IL-1ß, IL-2, IL-6, IL-10, INF-γ, TNF-α in the blood serum of patients was determined by enzyme immunoassay before the start of treatment and 2 and 4 months after its start. Results. Before the start of treatment, the values of IL-1ß, IL-2, IL-6, IL-10, INF-γ, TNF-α in the blood serum of patients in comparison with healthy individuals were significantly increased (3.7-4.2 times) against the background of a decrease in the level of IL-10 (2 times). In patients of the first group, the cytokine level did not change significantly after 2 and 4 months from the start of treatment in comparison with the indicators before the start of treatment. In the second group, at all follow-up periods, the content of IL-10 significantly increased with a decrease in the levels of IL-1ß, IL-2 and IL-6. When using UPA in the third group, the content of IL-10 increased against the background of a marked decrease in all other cytokines studied. The greatest changes were noted in the fourth group during the complex treatment of UPA with FT and BMT: a significantly significant decrease in the levels of IL-1, IL-2, IL-6, INF-γ, TNF-α (by 53-67%, p<0.001) against the background of an increase in the content of IL-10 (by 69%, p<0.001). The preservation of the orientation and severity of the identified shifts after 4 months indicates their stability. Conclusion. In patients with true eczema, the use of upadacitinib as part of complex treatment in combination with basic drug therapy and phototherapy causes a pronounced and prolonged correction of the cytokine profile in the blood.
Introduction. Modern complex treatment of atopic dermatitis (AD) in children involves not only drug treatment, but also the use of physiotherapy techniques. Purpose: to develop an effective complex method for the treatment of children with AD with the combined use of hydrotherapy (HT), non-selective chromotherapy (NCT) and low-intensity laser blood irradiation (NLBI), which reduces the severity of the disease and improves the children and their families’ quality of life. Material and methods. We examined 164 children diagnosed with AD from 4 to 15 years old (mean age 8±2.9 years). For a comparative study of the effectiveness of various treatment methods, 5 groups of patients were formed who received: basic drug therapy (BMT), GT+BMT, NHT+BMT, NLBI+BMT, GT+NHT+NLBI+BMT. Before the start of treatment, after 1 month and 3 months. assessed the severity of clinical manifestations of AD using the SCORAD scale, children’s dermatological quality of life index (DQLI), family DQLI (FDQLI), Results. After 1 month from the beginning of treatment in the groups of BMT, GT+BMT, NHT+BMT, NLBI+BMT, GT+NHT+NLBI+BM, the values of the SCORAD indices decreased by 1.5; 2; 2.5; 3.4; 4.6 times (respectively), the DQLI index — 1,5 times; 1.9; 2.3; 2.9; 4.6 times (respectively), the FDQLI index of 1.3; 1.5; 2.1; 2.7; 4.5 times (respectively). Conclusion. The developed method of combined use of HT, NCT, NLBI and basic drug therapy in the treatment of children with AD is more effective than the use of these methods in isolation. This is confirmed by a decrease in the DQLI and FDQLI indices by 78.3% and 71.7%, respectively, and a decrease in the SCORAD index by 78.3% with the transition from a moderate to mild form of the disease.
Aim. To evaluate the effectiveness of low-intensity laser blood irradiation for the correction of the cytokine profle and violations of the skin barrier function in the complex treatment of children with atopic dermatitis.Material and methods. The study included 65 children with atopic dermatitis (AtD) (mean age 8 ± 2,9 years) and 30 healthy children (control group). The patients were divided into two groups depending on the treatment: group 1 – basic drug therapy (BDT), group 2 – BDT in combination with supravenous laser blood irradiation (NLBI). Blood cytokine status indicators were assessed – levels of interleukins (IL) -4,-10,-13,-18, tumor necrosis factor-alpha (TNF-α), indicators of skin barrier function (skin pH, skin moisture, transepidermal water loss – TEWL) before treatment, after 1 and 3 months from the start of treatment.Results. Basic drug therapy had the least effect on the cytokine profle of the blood of patients and parameters characterizing the barrier function of the skin. The inclusion of NLBI was accompanied by an anti-inflammatory effect, signifcantly enhanced the regulatory effect on blood cytokine activity, signifcantly improved the barrier function parameters studied (skin pH, skin moisture, TEWL) and reduced the frequency of disease relapses.Conclusions. Basic drug therapy did not have a statistically signifcant corrective effect on the parameters of the immune status and skin barrier function in children with AtD. The combined use of NLBI and BDT increases the effciency of correction of the blood cytokine profle and violations of the skin barrier function in children with AtD, leads to a decrease in the frequency of disease relapses, which indicates the advantage of this method compared to monotherapy with basic drugs.
The aim of this study was to evaluate changes in immunological parameters in children with atopic dermatitis when using hydrotherapy, non-selective chromotherapy, and intravenous laser irradiation of blood against the background of basic drug therapy. Materials and methods. The work was performed with the participation of 164 patients with moderate lichenoid and erythematous-squamous forms of atopic dermatitis aged 4 to 15 years with a frequency of exacerbations from 3 to 4 times a year with a tendency to increase their duration. The patients were divided into 5 groups: the first group received basic drug therapy (BDT), the second - hydrotherapy and BDT, the third - non-selective chromotherapy and BDT, the fourth - low-intensity laser irradiation of blood and BDT, the fifth - hydrotherapy, non-selective chromotherapy, low-intensity laser irradiation of blood and BDT. The content of total IgE, IL-4, IL-10, IL-13, IL-18 and TNF-α in the blood serum of patients was determined by enzyme immunoassay before treatment, as well as 1 and 3 months after its start. Results. Before the start of treatment, the values of all the studied indicators in comparison with healthy individuals were significantly increased (by 2.1-3.1 times). In patients of the first and second groups, the level of IgE and cytokines did not change significantly after 1 and 3 months from the start of treatment in comparison with the indicators before the start of treatment. In the third group, after 1 month from the start of treatment, the group experienced a significant (by 11-20%) decrease in IgE and cytokine levels, which persisted after 3 months of follow-up. In the fourth group, the decrease in the studied indicators after 1 month was even more significant and did not change significantly. The greatest decrease in indicators after 1 and 3 months was observed in the fifth group of patients (by 40-62%) who received basic drug therapy in combination with hydrotherapy, non-selective chromotherapy and intravenous laser irradiation of blood. Conclusion. In children with moderate atopic dermatitis, drug-based basic treatment combined with non-selective chromotherapy and intravenous laser irradiation of blood contributes to the effective correction of immunological reactivity for a long period of time.
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