Aim. To evaluate the effectiveness of complex therapy using the regulatory polypeptide selank and combined narrow-band medium-wave and wide-band long-wave ultraviolet (UV) radiation in the correction of the cytokine blood profile and immunoglobulin E (IgE) level in patients with atopic dermatitis (AD).Material and methods. In a group of 124 patients with medium-heavy AD (61 men, 63 women; average age 23.7 ± 6.06 years), a comparative analysis of the effect of therapy on the interleukins (IL) -1β,-4,-10,-13, immunoglobulin E (IgE) blood levels was performed. We compared the results of basic drug treatment (BT), additional prescription of selank (S), combined UV phototherapy (CFT) in the range of 311 nm and 320–400 nm, as well as complex therapy (S + CFT + BT).Results. The immune status of AD patients is characterized by high blood levels of IL‑1β,-4,-10,-13 and IgE in comparison with healthy individuals. Standard drug therapy had the least effect on the cytokine profile and level IgE blood of patients. The use of selank increases the anti-inflammatory effect of BT. The regulatory effect on cytokine activity and level IgE is even more significantly enhanced with the use of CFT. The most pronounced immunocorrective effect was demonstrated by complex therapy with the use of combined UV radiation techniques and selank.Conclusions. The use of a combined narrow-band medium-wave (311 nm) and wide-band long-wave (320–400 nm) UV radiation and regulatory polypeptide drug (selank) causes the most pronounced positive effect on the cytokine blood profile and IgE level in patients with AD, which indicates a greater anti-inflammatory activity of this treatment method (p < 0.001) compared to the monotherapy groups and basic therapy (p < 0.001).
The review represents the analysis of modern data on the pathogenesis and methods of treatment of atopic dermatitis (AtD). The literature search was carried out using the Scopus, Web of Science, MedLine, The Cochrane Library, EMBASE, e-library databases. AtD is one of the most common skin diseases, aff ecting about 20% of children and 5% of adults in advanced countries. The disease is multifactorial by its etiology. Among the genetic factors, the main attention is paid to the mutation of the gene encoding the synthesis of fi laggrin-protein involved in the functioning of the skin barrier. The role of cytokines regulating the synthesis of IgE — interleukins (IL) -4, -5, -12, -13, -31 is studied in the genesis of immune disorders in AtD. Steady-state stress accompanying pruritic dermatitis contributes to the development of anxiodepressive сonditions degrades quality of life, and stress-related increase of cortisol level may be essential in impairing the barrier function of the skin. Among the new approaches to the treatment of patients with AtD, the possibilities of using Selank, which represents the group of regulatory peptides and narrow-band phototherapy of the 311 nm range, are discussed.
Целью исследования было изучить взаимосвязи клинических проявлений среднетяжелой формы атопического дерматита (АтД) с цитокиновым профилем крови, психонейрогормональным статусом и качеством жизни пациентов. В исследование включено 124 больных с АтД (61 мужчина и 63 женщины) в возрасте от 18 до 40 лет. Контрольную группу составили 30 здоровых лиц. Индекс SCORAD у больных составил 39,8±3,25 балла, что соответствует среднетяжелой форме АтД, а значение дерматологического индекса качества жизни (ДИКЖ), равное 23,2±5,1 балла, свидетельствовало низкому его уровню. В результате корреляционного анализа было установлено наличие прямой связи средней силы между индексом SCORAD и уровнями циркулирующих цитокинов крови (ИЛ-1β, ИЛ-4, ИЛ-10, ИЛ-13), выраженностью личностной и реактивной тревожностей и качеством жизни пациентов по индексу ДИКЖ. Прямая слабая связь обнаружена с уровнями IgE, γ- ИНФ, АКТГ, кортизола и алекситимией. Обратная корреляция клинических проявлений АтД слабой степени найдена с уровнем в крови β-эндорфина. Таким образом, для больных АтД средней степени тяжести характерно повышение в крови антител класса IgE, цитокинов (ИЛ-1β, ИЛ-4, ИЛ-10 ИЛ-13, γ-ИНФ), отражающих активность воспалительного процесса, а также повышенная активность гормонов гипоталамо-гипофизарной оси (АКТГ, кортизол), снижение уровня эндогенного β-эндорфина, повышение уровней личностной, реактивной тревожностей и алекситимии, выраженность которых коррелирует со значением индекса SCORAD The aim of the study was to assess the relationship of the clinical manifestations of moderate atopic dermatitis (AD) with the cytokine blood profile, psycho-neuro-hormonal status and patient’s quality of life. The study included 124 patients with AD (61 men and 63 women) aged 18 to 40 years. The control group consisted of 30 healthy individuals. The SCORAD index in patients was 39.8 ± 3.25 points, which corresponds to the moderate form of AD, and the value of the dermatological index of quality of life (DQL), equal to 23.2 ± 5.1 points, indicated its low level. As a result of the correlation analysis, it was established that there was a direct relationship of average strength between the SCORAD index and the levels of circulating blood cytokines (IL-1β, IL-4, IL-10, IL-13), the severity of personal and reactive anxiety and the quality of life of patients according to the DQL index. A weak direct link was found with the levels of IgE, INF-γ, ACTH, cortisol and alexithymia. An inverse correlation of the mild AD clinical manifestations was found with the level of β-endorphin in the blood. Thus, patients with moderate AD are characterized by an increase of antibodies of the IgE class, cytokines (IL-1β, IL-4, IL-10 IL-13, INFγ), reflecting the activity of the inflammatory process, as well as increased activity of hypothalamic-pituitary hormones axes (ACTH, cortisol), a decrease in the level of endogenous β-endorphin, an increase in the levels of personal, reactive anxiety and alexithymia, the severity of which correlates with the value of the SCORAD index
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