For citation: Davidovich M.I. Experience of using UVB 311 nm in the treatment of seborrheic dermatitis // BC. 2015. No. 9. P. 525

Seborrheic dermatitis (DM) is a multifactorial chronic recurrent inflammatory skin disease. Rashes of diabetes are localized, as a rule, in 88% of cases in the face, in 70% on the scalp, in 27% in the chest, in 10% in the back, on the groin and axillary folds, i.e. in those places where the sebaceous glands are most developed. Diabetes mellitus is characterized by erythematous-squamous foci on the skin, often accompanied by itching.

Currently, there are discrepancies in terminology: many authors confuse the concepts of "seborrhea" and "seborrheic dermatitis". Seborrhea is a skin condition caused by a sebum production disorder that can be a background for the development of acne. Diabetes mellitus is a disease in its own right, which some dermatologists call "seborrheic eczema" and "seborrhea".

DM is a common disease; according to various authors, the frequency of its distribution is 1–5%. The share of DM accounts for about 10% of all dermatoses.

Men get sick more often than women. The disease is observed in infants ("seborrheic cap"), it occurs on the 12th week. life of the child and disappears on its own by 8-9 months. Diabetes mellitus develops in 20–25% of boys during puberty and in young people aged 19–20 years; the next peak in incidence occurs at 50 years.

Clinical manifestations and the frequent recurrent course of diabetes lead to psychoemotional experiences of patients, reduce their social activity and quality of life, and contribute to the development of an inferiority complex in them. The idea of ​​one's own external unattractiveness leads to the development of dysmorphophobia - a morbid state of the psyche, accompanied by fears or beliefs about an imaginary external deformity. Patients become withdrawn, easily irritated, they have difficulties in adaptation in the social and intimate spheres.

Despite the large selection of therapeutic methods, diabetes is characterized by a tendency to relapse and resistance to treatment.

Phototherapy is currently the treatment of choice for many dermatoses, and since many diabetic patients improve in the summer, this treatment is justified.

In the world literature, there are isolated works devoted to the use of UVB therapy in diabetes mellitus.

Despite the accumulated experience in the use of narrow-wave UVB therapy, the mechanism of its action has not yet been fully elucidated. T. Wrone-Smith, B. J. Nickoloff (1996) determined that narrow-band UVB radiation is more conducive to T-cell apoptosis than broadband SFT. J. C. Viac et al. believe that narrow-band UVB therapy at a wavelength of 311 nm has a selective effect on skin immunity. Other researchers have convincingly shown the immunosuppressive effect of narrow-band UVB on tumor necrosis factor (TNFα), the concentration of which in the blood serum of patients with psoriasis before treatment exceeded the control values ​​(1.89 ± 0.3 ng / ml with a norm of 1.48 ± 0.43 ng / ml, p<0,05), при этом PASI коррелировало с показателями TNFα (r=0,52, р<0,05). Снижение концентрации TNFα в результате фототерапии 311 нм сопровождалось также снижением PASI .

H. Sigmundsdottir et al. (2005) observed in patients with psoriasis treated with narrow-band UVB, a significant decrease in the production of IL, 1β, IL2, IL5 and IL6 in the blood serum compared with these parameters before treatment. In addition, the concentration of INFγ, IL 8 and IL12p70 also decreased, but did not reach a statistical value.

D. Pirkhammer et al. (2000) studied the effectiveness of UVB therapy (311 nm). The open study involved 18 patients with lesions of the skin of the face, scalp, interscapular region and chest region. The treatment was carried out 3 times a week (on average 23 procedures) with an average cumulative dose of 9.8 J / cm2. The authors did not observe any side effects. Clinical remission was achieved within a maximum of 8 weeks. ... The authors noted the high efficiency of this method in diabetes mellitus.

T. Gambichler et al. (2005) in 28 articles, including 6 randomized controlled, 16 open prospective and 6 retrospective studies, which included 719 patients with atopic dermatitis, 305 patients with advanced vitiligo, 25 patients with polymorphic photodermatosis, 108 patients with early stage T-cell lymphoma, 88 patients chronic urticaria, 15 patients with lichen planus, 10 patients with prurigo associated with polycythemia, 18 patients with seborrheic dermatitis, 6 patients with prurigo and 5 patients with perforating dermatitis, showed that the best result of narrow spectrum UVB therapy was observed in the treatment of atopic dermatitis and vitiligo.

Considering all of the above, we conducted our own study to study the efficacy and safety of phototherapy with UVB rays of 311 nm in 40 patients with diabetes. We cite our clinical observation as an example.

Patient M., 50 years old, in December 2013 turned to the Clinic of Skin and Venereal Diseases of the I.M.Sechenov First Moscow State Medical University with complaints of rashes on the scalp, face, chest and back. Itching subjectively worried. Allergic history is not burdened.

Anamnesis of life: grew and developed according to age, in a prosperous family. In childhood, he suffered from chickenpox, often had ARVI. He is currently unemployed, married and has a healthy child. Allergic history is not burdened. Bad habits: does not smoke, does not abuse alcohol.

Medical history: sick for 10 years. The first rashes appeared on the scalp. I used anti-seborrheic shampoos on my own. Gradually, the rash spread to the face and trunk. I went to a doctor in 2010 and was diagnosed with seborrheic dermatitis. He used antihistamines, vitamins, ointments with glucocorticosteroids and anti-seborrheic shampoos with a temporary positive effect. Received systemic and local antifungal drugs, but there was no improvement. A real exacerbation within 1 month, developed after a stressful situation. I contacted our clinic for the selection of therapy.

On examination: rashes of a chronic inflammatory nature, localized on the scalp, face, chest and back. The rash is monomorphic, represented by erythematous-squamous foci of pinkish-yellow color with a diameter of about 2-4 cm, with clear boundaries of irregular outlines. On the scalp there are grayish-yellow scales on an erythematous background. Hair and nails are not changed. The lymph nodes are not enlarged. Subjectively, the rash is accompanied by periodic itching (Fig. 1).

Clinically diagnosed with seborrheic dermatitis.

Concomitant diseases: chronic gastritis and biliary dyskinesia.

Examination in the clinical and biochemical analysis of blood did not reveal any changes, with the exception of an increased ALT content - 53 U / L.

A course of phototherapy with UVB rays of 311 nm was carried out, consisting of 11 procedures with a mode of 4 irradiation per week with an initial dose of 0.05 J / cm2 and its gradual increase by 0.1 J / cm2 every two procedures. The maximum single dose was 0.6 J / cm2, the total dose was 4.1 J / cm2. Against the background of the therapy, regression of the rash was noted after the 5th procedure, the itching was stopped after the 3rd procedure. No side effects were noted. Locally, we applied only Node DS shampoo with a frequency of 2-3 times a week.

As a result of phototherapy with UVB rays of 311 nm, clinical remission was achieved (Fig. 2). For concomitant pathology, consultation and examination by a gastroenterologist was recommended.

After the therapy, the patient was followed up for 12 months. During this period, clinical remission was maintained.

Thus, phototherapy now rightfully occupies a worthy place in the treatment of dermatoses. The use of UVB 311 nm in diabetes mellitus gives a quick and stable effect, and also increases the duration of remission.

Literature

1. Patnaik R., Choudary T. N., Shashikiran B. Nutrition and skin / Valia R. G., Valia A. R., ed. // IADVL textbook and atlas of dermatology. 2nd edn. Bombay: Bhalani Publishing House, 1999. P. 974-1001.
2. Arabiyskaya E.R., Krasnoselskikh G.V., Mikheev G.N. Seborrhea and its complications. Recommendations for dermatologists, interns, clinical residents and medical students. M., 2000.38 p.
3. Carr M.M., Pryce D.M., Ive F.A. Treatment of seborrhoeic dermatitis with ketoconazole: I. Response of seborrhoeic dermatitis of the scalp to topical ketoconazole // Br. J. Dermatol. 1987. Vol. 116. P. 213-216.
4. Smith K. J., Skelton H. G., Yeager J. et al. Cutaneous findings in HIV1-positive patients: a 42-month prospective study. Military Medical Consortium for the Advancement of Retroviral Research // J. Am. Acad. Dermatol. 1994. No. 31. P. 746-754.
5. Monakhov S.A. A modern approach to the treatment of seborrheic dermatitis // Consilium medicum. Dermatology. 2010. no. 1.S. 7-9.
6. Novoselov V.S., Bogadelnikova A.E., Novoselov A.V., Savenkov V.V. Rational therapy of seborrheic dermatitis // Clinical Dermatology and Venereology. 2011. No. 2. S. 90-95.
7. Snarskaya E.S., Surikova N.S., Chubatova S.V. Liposomal line "Isida" in complex care for combination and oily skin // Ros. zhurn. leather. and venus. bol. 2012. No. 5. S. 55-55.
8. Mayser P., Haze P., Papavassilis C. et al. Differentation of Malassezia species: selectivity of cremophor EL, castor oil and ricinoleic acid for M. furfur // Br. J. Dermatol. 1997. Vol. 137. P. 208-213.
9. Clinical dermatovenerology: in 2 volumes / Ed. Yu. K. Skripkina, Yu.S. Butova. M .: GEOTAR-Media, 2009.Vol. II. S. 469-475.
10. Wolfe K., Johnson R., Surmond D. Dermatology according to Thomas Fitzpatrick. Atlas reference. 2nd Russian edition. Per. from English M .: "Practice", 2007. 1248 p.
11. Novikova L.A., Buravkova A.G., Demyanova O.B. On the treatment of seborrheic dermatitis // Problems of medical mycology. 2010. T 12.No. 2.P. 121.
12. Khlebnikova A.N. On the treatment of seborrheic dermatitis // Clinical Dermatology and Venereology. 2009. No. 3. S. 50-54.
13. Gupta A.K. Ciclopirox: an overview // Int. J. Dermatol. 2001. Vol. 40. P. 305-310.
14. N.V. Bakonina Clinical features, course and immunomorphological parameters in patients with seborrheic dermatitis. Abstract dissertation. candidate honey. sciences. M., 2007.
15. Yakovlev A.B., Suvorova K.N. Mallasesia is an infection of the human skin. Study guide. M., 2005.46 p.
16. Chren M.M., Lasek R.J., Quinn L.M. et al. Skindex, a quality-of-life measure for patients with skin disease: reliability, validity, and responsiveness // J. Invest. Dermatol. 1996. Vol. 107 (5). P. 707-713.
17. Wrone-Smith T., Nickoloff B.J. Dermal injection of immunocytes induces psoriasis // J. Clin. Invest. 1996. Vol. 98. P. 1878-1887.
18. Viac J., Goujon C, Misery L. et al. Effect of UVB 311 nm irradiation on normal human skin // Photodermatol. Photoimmunol. Photomed. 1997. Vol. 13, No. 03. P. 103-108.
19. Serwin A.B., Sokolowska M., Сhodynicka B. Soluble tumor necrosis factor alpha receptor type 1 in psoriasis patients treated with narrowband ultraviolet B // Photodermatol. Photoimmunol. Photomed. 2005. Vol. 21, No. 4. P. 210-211.
20. Sigmundsdottir H., Johnston A., Gudjonsson J.E. et al. Narrowband-UVB irradiation decreases the production of pro-inflammatory cytokines by stimulated T cells // Arch. Dermatol. Res. 2005. Vol. 297, No. 1. P. 39-42.
21. Pirkhammer D., Seeber A., ​​Honigsmann H., Tanew A. Narrow-band ultraviolet B (ATL-01) phototherapy is an effective and safe treatment for patients with severe seborrheic dermatitis // Br. Dermatol. 2000. Vol. 143. P. 130-133.
22. Gambichler T., Breuckmann F., Boms S. Narrowband UVB phototherapy in skin conditions beyond psoriasis // J. Am. Acad. Dermatol. 2005. Vol. 52, No. 4. P. 660-670.

Hand-held medical ultraviolet lamp for psoriasis, vitiligo, atopic dermatitis - UVBNB-311nm

(on the market since 2007. All information is current as of 31.01.2020).

based on the original emitter

Philips (narrow-band UV-B therapy, made in Poland, "For medical use only")

with a resource increased 2-3 times in comparison with any "kernels" and "dermalites", stable switching on and constant UV flux - the only offer in Russia of a narrow-band medical UV lamp 311 nm with !

Not expensive, convenient, safe and effective phototherapy for psoriasis, vitiligo, eczema, dermatitis, alopecia, urticaria -

Price 8200 rubles- includes qualified and free medical and technical consultations during the entire life of the lamp (5-10 years) - no other competitor has!

Both devices, like all other narrow-band lamps, emit the same healing ultraviolet 311nm, but the UVBNB-311 lamp has significant functional advantages ( stable switching on without flickering in any network, stable UV flux and increased service life 2-3 times), which will be illustrated by the following video:

IMPORTANT: the UVBNB-311 lamp (with electronic power supply) has the same advantages over by all the rest of the 311nm medical lamps presented in the Russian Federation ( Kernel, Dermalight, Psoriasis, Provit ...), because ALL of them, like the Alpha-311 lamp, have a primitive choke in the starting circuit.

1. Phototherapy is practically. The only contraindication may be an increased risk of skin neoplasms, primarily melanoma. But the medical fact is that any dermatosis is, as it were, a protection against skin cancer, and the blood plasma of vitilisers even stops the development of melanoma at the 3rd stage! Some contraindications, such as leukemia, anticancer chemotherapy, or profound mental disorders, are simply irrelevant. Others, because in any phototherapy just one or another piece of ordinary sunlight is used, and nothing more.

2. For the same reasons for this type of skin exposure there is no addiction ... Those. after six months of continuous procedures, the skin can develop its own resource of reaction, or some kind of counteraction mechanisms develop in it. One way or another, and after prolonged use, the effect of phototherapy also weakens a little - this is normal, and after a short break, the effect is restored. But you can be absolutely sure that after the termination of the procedures (temporary or permanent), you will never have any aggravation!

3. Method not has no negative consequences , as, for example, after mechanical effects on the skin (relevant for acne, melanocyte transplantation for vitiligo). All autoinflammatory processes (which in fact are ALL dermatoses!) End naturally (dry out) without any scars. Those. No "post-acne" after using the 311nm lamp threatens you in any case!

4. How it differs from the usual mini tanning bed ? This is a completely different piece of equipment! Suffice it to say that lamps of equal power for tanning salons are 10-15 times cheaper than special medical lamps for phototherapy. Solarium lamps emit mainly in the UV-A range with a very low (1-4%) percentage of curative UV-B. At the same time, the UV-A range itself in the entire solar spectrum is the most carcinogenic, and it is for this reason that the UV-B range also causes tanning, but it is already less carcinogenic than radiation in tanning beds. And most importantly, it is he who causes that series of rather poorly studied reactions that suppress the development of excessive inflammation in the skin and stimulate its recovery mechanisms.

5. With what ? ALL !!! This does not require taking photosensitizers destroying metabolism (killing the liver and kidneys); the total irradiation time is ten times less - the skin does not deteriorate, it is more difficult to get a burn; does not give a contrasting stain of vitiligo tan; just more effective - the result comes faster.

As mentioned above, this UV-B range (as opposed to the hard UV-C range of germicidal lamps!) Is an integral part of the normal solar spectrum on a bright summer day. So why, in order to achieve at least some result, it takes more than one day, or even a week, to sunbathe under the sun, and the effect of phototherapy with narrow-band UV-B 311 nm occurs in some cases the very next day and after literally a few minutes of exposure? Apparently, different areas of sunlight stimulate different, often mutually compensating, balancing processes in the skin. For example, in another part of the light spectrum, infrared, with frequencies of 755 and 1060 nm, reverse procedures are performed - they eliminate hyperpigmentation, discolor large moles. In nature, this is all too often: everything is on counterweights, on feedbacks (trust the old biologist!) - it's just more reliable and easier to control. And it is for this reason that a narrow range cut from the general natural spectrum works so effectively - its effect is simply not compensated for!

(Introductory articles on light therapy for skin diseases - they are all almost the same):
Phototherapy of chronic dermatoses with narrow-band 311 nm ultraviolet radiation
http://www.mednovosti.by/journal.aspx?article=314

7. Why then dermatologists do not treat this ? Why isn't it being treated? In Europe, for thirty years already, they have been very much treated, and even included in the insurance. And today we have enough 311nm booths (Eurolab, TsNIKVI), and (in total there are 25 such lasers in the Russian Federation), quite a few devices of the type (this is based on an excimer lamp, the same 308nm, only the light is not coherent) - all this equipment it costs tens of thousands of euros, which is why their sessions are so expensive. And small hand lamps .. - why would a doctor recommend them to you? So that you never come to him again and bring your money?

*************

So, the most wonderful in the treatment of the vast majority of dermatoses has established itself in the range of UV-B radiation, and here they found the most-most - the range of 310-312 nm. It is not carcinogenic at all! You don't get burned from it. And he is the most healing! Therefore, it is at this frequency (308 nm) that excimer lasers and excimer lamps (for example, XTRAC and Exilight) work - who knows, each procedure on them, of which up to a hundred is needed, costs from 5000 to 15000 (!) rubles.

But at exactly the same frequency, the much more affordable special medical bulbs developed by the Dutch company Philips color code 01... Moreover, according to reviews of those who have experienced both, light bulbs are not only cheaper and more convenient, but also much more efficient and safer than laser light sources. These lamps are available in various designs - from hand-held 9-watt, to long 100-watt, like for a solarium. For many reasons, including safety, you should not chase a large area of ​​simultaneous irradiation, it is much better to consistently harass small, but most interfering with life areas of dermatosis (face, hands). This is the purpose of the offered here light hand lamps with Philips medical emitters, the cost of procedures with which is cheaper than procedures in medical offices by about 1500 (!) Times - 3000 hours of procedures for 8200 rubles (after 3000 hours of operation, the radiation of 311nm in the lamps drops by only 25%).

It is rather strange to come across heated debates on the Internet on the topic "I do not believe in the benefit of therapy-311nm". Who needs faith here? Phillips? Brand number 1 in Europe for the production of medical equipment on the one hand, and it is also for the production of light sources? After all, this is not Karp or some other crook who developed the technology and established the production of such lamps. This was done by Philips specialists - especially for the treatment of dermatoses! And not at all so that someone could "profit from suffering"! All packages of these lamps bear the inscription: "FOR MEDICAL USE ONLY". And for those who doubt it, Phillips sent me his own personally - read and draw conclusions.

Lamp UVBNB-311nm as a product - production and comparison with analogues

1. The devices operate exactly the same PL-S 9W / 01 / 2P bulbs that are used by most manufacturers - Dermalight-80 and Dermalight-ru, Dermapal, Kernel and others. Similar bulbs manufactured by the German company Saalmann are quite rare, but in terms of price, quality and characteristics they are no different from Philips. That is, whoever sells such equipment to you and at what price, the emitters themselves in it will always be the same and, as a rule, manufactured by Philips - the plant is located in Poland, they are sold only in packages, only by bank transfer, they are not in warehouses. The manufacturer's website is often altered, but the description there you can find something like this: Philips.ru/ light solutions / lamps / UV / Fluorescent Medical / Medical Therapy-01 / PL-S 9W-01-2P. in 2019 a description from Phillips is here: http://www.lighting.philips.ru/prof/lamps/special-lamps/medical-lamps/medical-therapy-uvb-narrow-band/xum01pl/927901700121_EU/product

Briefly description of the precious emitting glasses themselves and the device as a whole:

Typical gratitude from the buyer (letter to mail.ru):
24 Re: Vitiligo today, 12:43 Good afternoon) Thank you for your articles and for the lamp, a month and a week has passed, and the results (freckles) have appeared and there are more and more of them, and they are growing in size) thank you for everything. (24.06.2018)

Or:
Mikhail Yurievich, hello! I received the parcel, everything arrived safe and sound. The product works, it is done neatly. Thank you, Best regards, Du..ev V.F. (18.05.2018)

Feedback from buyers, alas, is not a frequent occurrence, but, thank God, all of it is in the same spirit).

Note that a similar, but heavier one, without a handle and a fixer for the distance to the skin with an unstable UV flux and a shorter service life, a homemade product on Provitiligo.com costs about 9000 (fluctuates with the euro rate))) rubles, and the notorious Dermalight-ru ( exactly the same low-functional Chinese hack) - 9900 (!). And this is the price even before the euro almost doubled! IMPORTANT: the cheap Psoriasis-UFIK device sold by Medtekhnika, described as 311nm, is actually equipped with 10th and 12th color bulbs. This is UV-A - as in tanning salons, and broadband UV-B - cancer and burn hazard. But they only write about it at the very end of the page: " Characteristics of the UVIK device (Psoriasis): Lamp in the device - model Philips PL-S 9W / 12 / PL- S 11W / 10 (luminescent, compact) ". A 311nm lamp (color code 01) is offered to buy from them separately (4000 rubles!) And a Chinese one. So be careful, don't get fooled by the price!

Delivery cost within the Russian Federation by Russian Post - 300 rubles.

Payment only in cash. I send to cities and towns by mail - cash on delivery ( 8900 RUB) or after prepayment (by transfer to a card ( Sberbank, VTB-24) or through payment systems Kolibri, Zolotaya Korona - 8500 rub - this is already with delivery in Russia. Specify the cost of delivery abroad by letter separately! Who needs insurance - this is in addition to the cost; who does not need it, the mail will not return money in case of loss. (From practice: the search requires only 0.2% of parcels, and more often they are found, for the entire time (more than 13 years, 1700 parcels), only one was irretrievably lost by mail.) If delivery is absolutely necessary by the CDEK transport company, then delivery always comes out much more expensive and always a different amount.

It is extremely useful to combine irradiation with a lamp with antioxidant protection of the skin: cream SODERM-Forte(0.07% - 4 times more than in Vitiskin for 3000 rubles from France - Superoxide dismutase with cluster silver) - 800 rubles. (15gr).

Lotion with metals, protecting from burns and generally strengthening the skin (there are no analogues in the world!) - 600 rubles (with delivery abroad - 750).

You can read more about all these things on the page

How to pay and get UVBNB-311 skin curing lamp

HOW TO PAY

Delivery by Russian Post across the Russian Federation - 300 rubles. CDEK - much more expensive and not much faster, we specify individually.

Prepayment for residents of the Russian Federation (EXCEPT Muscovites! - see below) comes out about 750 rubles cheaper than cash on delivery:
translate into Sberbank card or Sberbank transfer Kolibri, or payment systems Western Union, Unistream, Zolotaya Korona (the most profitable from Kazakhstan is Zolotaya Korona) the required amount.

If the card does not work, then for payment systems the recipient: Churaev Mikhail Yurievich (127224, Moscow, Grekova st., 11, apt. 51.

M In this case, you immediately inform me by e-mail the full name of the sender, the exact amount of the transfer, its date and the CHECK NUMBER.

I repeat: the most preferred prepayment method (convenient for both me and the buyer) - transfer money to a Sberbank card(or VTB-24 - whoever is more comfortable. Details - by letter).

C.O.D. This is when you pay for the parcel already upon receipt of it at the post office. It looks more reliable, however, it comes out significantly more expensive than prepayment, because you have to fully insure the parcel (4% - these are the rules of the Post), plus pay about 250 rubles for the transfer of this cash on delivery. In connection with the sharply increased number of cases when parcels with cash on delivery are not picked up by the addressees, I send such parcels only after an insurance advance of 1000 rubles - this amount is deducted from the cash on delivery, of course.

Cash on delivery is not accepted abroad, so that only IOO% prepayment remains.

No electronic money, Qiwi, Yandex-wallets and others will be able to pay - I don't have all this and never will.

HOW I SEND: the next morning after receiving the prepayment, by Russian Post. From transport companies I send CDEK (there is no cash on delivery in CDEK for a private person!), In extreme cases - EMC (more expensive by 400 rubles to the Urals, 500 - Siberia, 600 - the Far East). To the Far North (Sakha, Kamchatka, Norilsk), except for summer, only air is also 300-400 rubles more expensive. A regular parcel goes around the Russian Federation for about a week, to Belarus and Ukraine - 9-11 days, to Kazakhstan - 12-14 days. I check all devices before shipment, the glass is already in the cartridge, protected for shipment. Upon receipt, everything is completely ready to use.

You can track the movement of the parcel sent to you on the page:
"Postage tracking" on the Russian Post server
To do this, you just need to enter in the field the number of the postal identifier, which I will send you to your e-mail immediately after sending the parcel.
, because I have been sending commercial parcels on a regular basis since 1992, I have sent more than one or two thousand of them, I know very well what "Russian Post" is, and how what needs to be packed for 100% safety. Not a single lamp was ever damaged in transit.

HOW TO ORDER BULB UVBNB-311nm:

Orders are accepted ONLY by e-mail [email protected]

Write without further ado: zip code, detailed address, surname, name, patronymic, phone number (preferably), method of payment, type of dermatosis, do you need anything else - EVERYTHING !!! (The words of greeting and "goodbye" are actually not superfluous, we will be people!))) Who does not have e-mail, there is only one way out: send a prepayment by postal order, in which write your return postal address in as much detail as possible - with a zip code, with a full name ; do not write "Nizhnevartovsk, Tyumenskaya 1-2-5", but write, please: "Tyumen region, Nizhnevartovsk, Tyumenskaya st., 1, building 2, apt. 5". Well, as a last resort, just call ...

CONNECTION

e-mail: [email protected]
mobile: 8-985-985-4451

Muscovites!

After a preliminary agreement, come for the lamp from 10-00 to 21-00 (no lunch, no holidays and weekends) at the address Grekova st., 11, apt. 52: metro Medvedkovo, HEAD carriage from the center, there is only one exit (one door!) - to Grekov Street. Without crossing the street, look to the left, slightly up the hill and obliquely see new red houses. Ours is the smallest - 14 floors, the third in a row. Entrances - from the courtyard, the first entrance (from the metro is distant), 14th floor. Press "5 2 V" on the intercom. Walking from the metro for 4 minutes. By car: from the Moscow Ring Road -1 min, see Yandex. Sm O rub, check, I will answer all your questions. In summer, call a few days in advance, because most often I am at the dacha or away at all.

Comrades Muscovites! I always say: "Call and come." And some hear: "Come and call." They call: "Open the door!" 8-985-985-4451

For Muscovites, it is also possible to buy a lamp for a while- to assess its effectiveness. What if your skin does not react to UV at all? Then the lamp can be returned less depreciation: 1 month - 20%, 2 months - 50%, 3 months - 100%. In principle, due to the congenital immunity of 2-3% of the skin to UFOs, it is possible to return the device for non-Muscovites, but only after deducting the postage in both directions.
In general, this item is relevant only for psoriasis and atopics - in them, after a week, the effect of the application becomes obvious. But for vitilizers it is more difficult - after all, it so happens that a person shines some kind of spot for half a year - and without a visible result. And then spring, summer comes, and it is this spot that quickly becomes covered with pigment. The processes in vitiligo are generally very inhibited, extended. Therefore, with vitiligo, it makes no sense to return the lamp either after a month or three. Yes, in general, no one has ever asked for this, since more often, even with vitiligo, the first pigment becomes noticeable after a month.

WARRANTY for UVBNB-311nm lamp.

The standard warranty is 12 months. If during 12 months from the date of purchase, your lamp will stop switching on by itself, I will replace it for you free of charge minus postage. If it stops turning on after falling off the shelf - sorry, but the bulbs are fragile.

Moreover, due to the consumable nature of the Polish light bulb (glass), NONE of the seller gives any guarantees at all for this light bulb. And I give: a guarantee for the bulb itself - 3 months... I have for this

ATTENTION!!! If something happened to the lamp (it does not matter - during the warranty period or after), do not disassemble anything, do not pick, do not touch. Lamps with tamper marks, like all other manufacturers, I DO NOT SERVICE!

Certificates for Philips 9W-01-2P lamp and its body

BONUSES for buyers of any medical lamps on the website

There are also bonuses .. True, there is only one, but an important one is qualified information and advisory support of the lamp operation process that no one else will offer you. Indeed, most of the sellers of similar devices, portraying themselves on the Internet in medical coats, in fact, judging by their statements, not only are not doctors, not biologists, do not know the problem, but even write in Russian with errors. They do not understand anything either in the physics of UV-B therapy processes, or in physics in general. There is no need to talk about physiology.
Therefore, due to the ever-increasing competition, this bonus applies only to my own customers: at any time they can e-mail me all the questions that have arisen during the procedures and get an answer to them within 24 hours. a biologist with 15 years of experience in the problem, with a huge 13-year statistics from their own (and not anonymous from the Internet!) buyers.

The reaction of the skin to ultraviolet radiation occurs, as a rule, 4–6 hours after exposure and is expressed in the appearance of erythema and a feeling of slight itching. Usually, after 2-3 hours, these phenomena disappear. But if the inflammatory reaction of the skin remains for a longer period, it is recommended to wait for its disappearance and then continue the treatment.

In the course of treatment, all patients develop a slight tan. It should be noted that the formation of pigmentation during therapy with UVB rays of 311 nm occupies an intermediate position between PUVA and broadband medium-wave (selective) phototherapy. Pigmentation is more intense than with broadband medium wavelength phototherapy, but less intense than with PUVA.

Photochemotherapy (PUVA) remains the most effective phototherapy technique. Our data indicate that clinical cure with PUVA is observed in 96% of cases, while with narrow-band 311 nm phototherapy - in 80-83%. However, narrowband 311 nm phototherapy is superior to PUVA in tolerance and safety.

Contraindications for phototherapy

Before starting phototherapy, patients should be examined in order to exclude pathology from the internal organs, since there are a number of contraindications for treatment with ultraviolet rays. The use of phototherapy is contraindicated in eye diseases (glaucoma, cataracts), hypertension (II, III degrees), endocrinopathies, the presence of benign and malignant tumors. For this purpose, before starting treatment, the patient should be examined by the following specialists: therapist, surgeon, ophthalmologist, gynecologist, endocrinologist.

Indications for narrowband 311 nm phototherapy

Psoriasis, atopic dermatitis, pruritus, parapsoriasis, lichen planus, solar urticaria, polymorphic solar dermatosis.

Features of the treatment of psoriasis

With the method of 3 or 4 single irradiation per week, in case of regression of rashes, there is no need to constantly increase the dose of UVB rays. For example, on the 2nd week with a dose of UVB radiation of 0.5 J / sq. cm, there is a disappearance of clinical manifestations on the skin, therefore the dose of UVB radiation is 0.5 J / sq. cm may remain in the following days of treatment. The absence of regression requires an increase in the dose. Subsequently, for example, on the 3rd week, at a dose of 0.7 J / sq. see regression of rashes is observed, and this dose should remain for treatment for subsequent procedures.

Features of the treatment of parapsoriasis

Medium-wave ultraviolet radiation of a narrow spectrum of 311 nm is used to treat plaque and drop-shaped forms of parapsoriasis. The irradiation regime can be from 3 to 4 times a week. During treatment, a patient with a plaque form of parapsoriasis may develop new, previously invisible rashes on the skin of the trunk and extremities. Their appearance does not require the cancellation of the prescribed course of treatment. Treatment is carried out until the complete disappearance of clinical manifestations on the skin.

Features of the treatment of lichen planus

Treatment is carried out, as a rule, according to the method of 3 irradiation times per week. It is recommended to use erythemal doses of UVB radiation for the entire treatment period.

The timing of the end of treatment is determined by the clinical effect - until the complete regression of the rash.

Features of the treatment of atopic dermatitis and pruritus

Since these two diseases have a common nature and sometimes a similar clinical picture, the approach to treatment with medium-wave 311 nm ultraviolet radiation is identical to that of a broad-wave spectrum, however, the radiation regime can be from 3 to 4 times a week. Treatment begins with a minimal (suberythemal) dose of UVB rays until the clinical manifestations on the skin disappear completely. The course of treatment can range from 20 to 30 procedures.

Features of the treatment of vitiligo

Treatment for vitiligo with medium-wave ultraviolet radiation of a wide spectrum is based on the same principles that were developed for the treatment of vitiligo with ultraviolet radiation, that is, treatment is carried out at erythemal doses, when erythema appears on the background of depigmented areas and foci of pigmentation appear.

Features of the treatment of baldness

Treatment of both total and focal forms of baldness is carried out at erythemal doses, that is, when erythema appears on the skin. The radiation regime can be from 2 to 3 procedures per week. It is recommended to carry out no more than 10-15 procedures for the course of treatment. To achieve a positive effect of the therapy, it is necessary to carry out several courses of treatment with an interval of 20-30 days between them.

Literature:

1. Vladimirov V.V. The role of skin phototype classification in choosing rational phototherapy. Bulletin of Dermatology and Venereology 2009, No. 4, pp. 65-67.
2. Vladimirov, V.V. New possibilities of using various types of photochemotherapy of chronic dermatoses in combination with systemic and local drugs. Medical advice. Scientific and practical zhurn. for doctors, 2008, no. 7-8. P. 11-17.
3. Vladimirov V.V. V.V. Vladimirova Medium wavelength ultraviolet radiation of a wide spectrum (selective phototherapy) in phototherapy of chronic dermatoses. Modern problems of dermatovenerology, immunology and medical cosmetology, 2009, No. 1/09 (04), pp. 46-50
4. Parrish J. A., Jaenicke K. F. Action spectrum for phototherapy of psoriasis. J. Invest. Dermatol. 1981; 76: 359.
5. Viac J., Goujou C., Misery L., Staniek V., Faure M., Schmitt D., Claudy A. Effect of UVB 311 nm irradiation on normal human skin. Photodermatol. Photoimmunol. Photomed. 1997 Jun; 13 (3): 103-8.
6.el-Ghorr A.A., Norval M. Biological effects of narrow-band (311 nm TL-01) UVB irradiation: a review. J. Photochem. Photobiol. B. 1997 Apr; 38 (2-3): 99-106.
7. Ozawa M., Ferenczi K., Kikuchi T., Cardinale I., Austin L.M., Coven T.R., Burack L.H., Krueger J.G. 312-nanometer ultraviolet B light (narrow0band UVB) induces apoptosis of T cells within psoriatic lesions. J. Exp. Med. 1999 Feb 15; 189 (4): 711-8.
8. Vladimirov V.V., Menshikova L.V., Cheremukhina I.G., Vladimirova V.V., Kuryanova O.N., Vladimirova E.V. Treatment of psoriasis patients with ultraviolet medium-wave phototherapy of a narrow spectrum of 311 nm. Bulletin of Dermatology and Venereology, 2004, No. 4, pp. 29-32
9.V.Vladimirov, A.Kubanova, M.Butoreva, V. Volnuchin, V.Vladimirova, E.Vladimirova Phototherapy with narrow-band UVB (311nm) in psoriasis. 5 th Congress of the Baltic Association of Dermatoveneorology, September 8-10, 2005, Vilnius, Lithuania, Abstract Book p. 70
10. Goryacheva T.A., Samsonov V.A., Nadgerieva O.V., Volnukhin V.A. Clinical results of narrow-band (311 nm) phototherapy in patients with atopic dermatitis. Russian Journal of Skin and Venereal Diseases, 2009, No. 3, pp. 22-25

Turbovskaya S.N. 1, Kruglova L.S. 1, Korchazhkina N.B.2

NARROWBAND (311 nm) PHOTOTHERAPY OF CHRONIC DERMATOSIS IN CHILDREN

1 Moscow Scientific and Practical Center for Dermatovenerology and Cosmetology of the Moscow Department of Health; 2 FSBI DPO "Central State Medical Academy" of the Administrative Department of the President of the Russian Federation

The article presents data on the use of narrow-band 311 nm-phototherapy in the treatment of children with chronic dermatoses. The indications, techniques, safety and effectiveness of the method are described. Phototherapy with narrow-band ultraviolet radiation with a wavelength of 311 nm is an optimal type of treatment in terms of efficiency and tolerance.

Key words: ultraviolet radiation; medium wave ultraviolet radiation; phototherapy; narrowband 311 nm phototherapy; psoriasis; atopic dermatitis; vitiligo. Please cite this paper as: Turbovskaya S.N., Kruglova L.S., Korchazhkina N.B. Narrowband (311nm) phototherapy of chronic dermatoses in children. Physiotherapy, balneology and rehabilitation. 2016; 15 (2): 60-65. DOI 10.18821 / 1681-34562016-15-2-60-65

For correspondence: Turbovskaya Svetlana Nikolaevna, Ph.D. dermatovenerologist, Moscow Scientific and Practical Center for Dermatovenereology and Cosmetology, Department of Health, Moscow, 117497, Moscow, E-mail: [email protected]

Turbovskaya S.N. 1, Kruglova L.S.1, Korchazhkina N.B.2

THE APPLICATION OF NARROW-BAND (311 NM) PHOTOTHERAPY OF CHRONIC DERMATOSES IN THE CHILDREN

"Moscow Research and Practical Center of Dermatovenerology and Cosmetology, Moscow Health Department, 117497, Moscow; 2 Federal state budgetary institution of continuous professional education" Central State Medical Academy ", General Management Department of the Presidential Administration of the Russian Federation

The data concerning the application of narrow-band phototherapy at a wave-length of 311 nm for the treatment of the children suffering from chronic dermatoses are presented. The indications for the use of this method and the relevant technical procedures are described with special reference to their safety and effectiveness. It is concluded that phototherapy with the use of narrow-band ultraviolet radiation with a wave-length of 311 nm provides the optimal (in terms of effectiveness and tolerability) tool for the treatment of the children presenting with chronic dermatoses.

Keywords: ultraviolet radiation; middle wave-length ultraviolet radiation; phototherapy; narrow-band (311 nm) phototherapy; psoriasis; atopic dermatitis; vitiligo.

For citation: Turbovskaya S.N., Kruglova L.S., Korchazhkina N.B. The application of narrow-band (311 nm) phototherapy of chronic dermatoses in the children. Fizioterapiya, bal "neologiya i reabilitatsiya (Russian Journal of Physiotherapy, Balneotherapy, and Rehabilitation) 2016; 15 (2): 60-65. (In Russ.): DOI 10.18821 / 1681-3456- 2016-15-2-60- 65 For correspondence: Turbovskaya Svetlana Nikolayevna MD, dermatologist, Moscow Scientific and Practical Center of dermatology and cosmetology Moscow Health Department, Moscow, 117497, Russian Federation, E-mail: [email protected]

Conflict of interest. The authors declare no conflict of interest.

Funding. The study had no sponsorship.

Received 11 Yanuary 2016 Acceptid 13 Yanuary 2016

Recently, there has been a tendency towards the use of narrow radiation spectra in the treatment of skin diseases in children, which selectively act on skin structures and give less pronounced side effects. Recent scientific studies have shown that 311 nm wavelengths provide maximum therapeutic effect with minimal erythema. There is reason to believe that over time, narrow-band 311 nm phototherapy will completely replace other types of phototherapy in the treatment of skin diseases in children, since its effectiveness (the rate of achieving remission and the duration of maintaining the result) with a minimum of adverse reactions is superior to other types of phototherapy. According to some authors, UVB therapy of 311 nm is comparable in efficiency with PU-VA therapy and is indicated for psoriasis, atopic dermatitis (AD), lichen planus, pruritus, solar urticaria, polymorphic solar

dermatosis. Also, the high efficiency of narrow-wave UVB therapy has been proven in comparison with selective phototherapy.

To date, the high efficiency of the use of ultraviolet radiation of the indicated range in the treatment of skin diseases in children is explained by the fact that to obtain the effect, fewer procedures are required, a longer remission is achieved, less pronounced side reactions are observed, it is possible to combine this therapy with other types of treatment. It is also important that the carcinogenicity of this type of treatment is recognized as minimal in comparison with other types of UV therapy.

Mechanisms of action of UVB 311 nm therapy

UV radiation has anti-inflammatory and immunomodulatory effects. It is important to note that the immunomodulatory effect for different UV spectra is almost identical.

Original articles

Basically, UV radiation has anti-inflammatory, antiproliferative and immunosuppressive effects. The photoimmunological effect is due to the depth of penetration of UV rays. UVB rays mainly affect epidermal keratinocytes and Langerhans cells. It should be noted that narrow-wave UVB therapy at a wavelength of 311 nm selectively affects skin immunity, when exposed to it, the expression of CD1 + cells decreases, HLA-DR + of dermal cells increases in the absence of dermo-epidermal infiltration of CD11b macrophages; in the upper layers of the epidermis, there is an increase in the binding of biotinylated substance P, in the dermis, the expression of ICAM-1 and the induction of E-selectin by endothelial cells increase. It is believed that 311 nm UVB radiation has a more pronounced effect on the systemic immune response than broad-wave UVB radiation, which is reflected in the activity of natural killer cells, lymphoproliferation and cytokine response. There are reports of a suppressive effect of the medium wavelength spectrum on the production of Staphylococcus aureus antigens, which significantly increases the effectiveness of blood pressure therapy. The main mechanism of elimination of psoriatic plaques under the influence of narrow-band 311 nm UVB radiation is the induction of T-cell apoptosis by it.

Indications for narrow-band 311 nm phototherapy in children

In children, narrow-band 311 nm phototherapy is used for psoriasis, blood pressure, lichen planus, pruritus, parapsoriasis, vitiligo, seborrheic dermatitis and other dermatoses. In addition, with the help of UVB-311 nm phototherapy, prevention of polymorphic photodermatosis is possible.

There are clinical observations of the use of UFB-311 in children with scleroderma, in whom a partial positive response was obtained. Single clinical studies confirm the effectiveness of UVB therapy in children with subcorneal pustulosis. Much more research has been devoted to its use in alopecia areata. However, since no controlled randomized trials have yet been conducted and the available information is based on a small number of clinical observations, further research is needed on the effects of narrow-band phototherapy on the above skin conditions.

Phototherapy for acne UFB-311 is currently not performed. For the treatment of this disease, there are now many, both external and systemic highly effective methods. In comparison with them, phototherapy has only a slight, mainly cosmetic effect and only intensifies light damage to the skin of the face, which is already constantly under the influence of sunlight.

Contraindications for UVB 311 nm therapy in children

Contraindications for narrow-band phototherapy in children are acute fever

long-term conditions, benign and malignant neoplasms, active tuberculosis, intolerance to UV radiation, the presence of diseases in which UV radiation can have an undesirable effect (photodermatosis, porphyria, systemic lupus erythematosus, albinism, pigmented xeroderma, hereditary dysplastic nevus syndrome, syndrome Gorlin, dermatomyositis, Blum's syndrome, Cockayne's syndrome), claustrophobia (when using cabins), concomitant immunosuppressive therapy, conditions and diseases in which physiotherapy is contraindicated, low compliance.

Narrow-band phototherapy techniques

Narrow-band medium wave therapy with a wavelength of 311 nm is the most highly effective method in treatment and can be given to children of any age. Techniques for 311 nm UVB therapy vary. Most authors prefer to perform procedures three or four times a week, since less frequent procedures lengthen the treatment time, and more frequent irradiation slightly shortens the treatment time, but increases the cumulative dose of UVB and its erythemogenicity. The increase in the dose of UVB 311 rays can be fixed or be a corrective percentage of the previous dose. Initial doses, depending on the type of skin, vary from 180 to 400 mJ / cm2. Most dermatologists recommend a small increase in UVB dosage between treatments, which can reduce the average cumulative dose by 10% while maintaining positive treatment results.

The effectiveness of phototherapy and the safety of its use depend on determining the reaction of the skin to solar (ultraviolet) radiation, i.e., determining the phototype of the skin, controlling the dose of UV radiation, treatment methods, and controlling the intensity of radiation from ultraviolet lamps in phototherapy devices. Control over the intensity of radiation of ultraviolet lamps is carried out in order to ensure the proper effect of the therapy and the prevention of side effects. A number of phototherapy devices have built-in sensors that measure the radiation intensity and automatically calculate the exposure time using the program, depending on the dose.

Before starting phototherapy, the patient (patient representative) should be informed about the planned treatment method, the need to strictly adhere to the doctor's prescriptions, as well as possible side effects.

Before prescribing treatment, to identify contraindications, a clinical and laboratory examination of the child is carried out: a general blood test, a general urine test, a biochemical blood test, a consultation with a pediatrician, ophthalmologist, endocrinologist. According to the indications, they recommend examination by other specialists.

The minimum (initial) radiation dose is determined based on the individual sensitivity

PHYSIOTHERAPY, BALNEOLOGY and REHABILITATION. 2016; 15 (2)

DOI: 10.18821 / 1681-3456-2016-15-2-60-65

Original articles Table 1

Dosage Scheme for UVB 311nm Therapy

Irradiation sequence

Assessment after 24 hours Actions

Step 1 Determination of the DER Initial dose of therapy 50-70% of the DER

Step 2 Initiation of therapy Absence of erythema Increase in dose by 30%

Step 3 Subsequent therapy sessions 3-5 times a week Minimal erythema Remaining asymptomatic erythema Painful erythema with or without edema or blistering Increase by 20% (15% after 2 sessions) Do not increase Do not administer until symptoms disappear

Step 4 Resumption of therapy After symptoms disappear Decrease the last dose by 50%, then increase by 10%

the child's sensitivity to UV radiation or depending on the skin phototype (according to the classification of TB Fitzpatrick). You can also determine the individual photosensitivity using a Dalfeld-Gorbachev biodosimeter. Phototesting is carried out on areas of unburned skin (on the forearm, lower abdomen, back or buttock) with the determination of the minimum erythemal dose (MED). Phototesting results are evaluated after 24 hours.

The initial dose of total UVB 311 nm therapy is 50-70% of the DER. When dosing irradiation, depending on the type of skin and the degree of sunburn in the child, the irradiation begins with a dose of 0.1-0.2 J / cm2. The procedures are carried out 3-5 times a week. In the absence of erythema, a single dose is increased with each procedure or through the procedure by 5-20%, or 0.05-0.01 J / cm2, with the appearance of mild erythema, the dose is no longer changed. 15-35 procedures are prescribed for the course (Table 1).

Phototherapy techniques are divided into general (irradiation of the entire skin) and local (irradiation of skin areas). In general UV therapy, in the case of a slower resolution of the process, for example, with localization on the scalp or lower extremities, total irradiation is combined with subsequent local irradiation. It is desirable to combine treatment with UV radiation of 311 nm with the use of general and local drugs. This increases the effectiveness of therapy, increases the duration of remission of the disease and reduces the total dose of radiation.

Narrowband 311 nm phototherapy for atopic dermatitis

Atopic dermatitis (AD) refers to diseases of a multifactorial nature. The generally recognized causes of the development of the disease are the participation of hereditary factors, disorders of the central and autonomic nervous system, and the endocrine system. The role of immediate allergic reactions, non-infectious, bacterial allergens, superantigens and other factors is undeniable.

The leading role in the implementation of clinical manifestations of blood pressure is assigned to cell-mediated reactions (delayed-type hypersensitivity), which is confirmed by numerous studies of domestic and foreign authors. Genetically determined "atopic" immune response in conditions of constant

antigenic stimulation leads to the development of an inflammatory reaction in the skin of patients with AD. According to foreign authors, this is determined by long-term persistence in the body of activated CD45RO + T-lymphocytes or CLA + T-lymphocytes. There is no consensus on this issue.

It is believed that these cells, regardless of their CD4 / CD8 phenotype, play a key role in the pathogenesis of AD. As a result of the research, a statistically significant (p< 0,001) увеличение по сравнению с аналогичными показателями группы здоровых лиц содержания в дерме и эпидермисе больных кожно-ассоциированных CD45RO+T-лимфоцитов и CLA+T-лимфоцитов, а также статистически достоверное (p < 0,001) снижение этих показателей после курса узкополосной (311 нм) фототерапии .

These changes in the immunological parameters in the skin of patients with AD under the influence of narrow-band (311 nm) phototherapy, apparently, are not the only ones, the spectrum of its action is undoubtedly wider. It is assumed that narrow-band (311 nm) medium-wave UV therapy also affects other links in the complex chain of migration of T-lymphocytes from the vascular bed into the skin of patients with AD. Also, data were obtained on the effectiveness and good tolerance of complex treatment with the use of UVB 311 nm-therapy and medicinal cosmetics in both adults and children with AD.

Narrowband 311 nm phototherapy for viti ligo

For the first time, the effectiveness of the use of UVB-therapy 311 nm in children with vitiligo was demonstrated in the work of foreign authors. In the group of patients (n = 51) aged 4 to 16 years who suffered from generalized forms of vitiligo and received a course of narrow-band UV-therapy 311 nm for 6-12 months, 53% of patients developed repigmentation of more than 75% of the lesion area. These results are consistent with reports from other researchers. According to G. Chen et al. , narrow-band medium-wave UV therapy of 311 nm was effective in more than 70% of patients with vitiligo. Repigmentation of 50-75% of the lesion area was achieved in 33% of patients. The duration of treatment was at least 12 months.

Original articles

vitiligo. Patients received radiation 2-3 times a week for 12 months. As a result, all patients showed a positive effect in the form of repigmentation of more than 50% of the area of ​​the lesions. The maximum effect was achieved with prolonged courses of phototherapy (50 procedures or more per course).

Narrowband 311nm phototherapy for psoriasis

Narrowband UVB therapy has an optimal therapeutic range. In adult patients and children, the experience gained allows us to recommend narrow-wave UVB 311 nm radiation with a frequency of visits 3 times a week as the safest and most effective modern treatment for chronic plaque psoriasis. Local UVB 311 nm therapy is indicated for psoriasis of the scalp and limited psoriasis vulgaris of smooth skin. In some cases (delayed resolution of rashes on the lower extremities), local narrow-band therapy is prescribed during general UVB 311 nm therapy, procedures are added after 5-7 sessions of general UVB therapy. As with AD, phototherapy in children is recommended to be combined with topical treatment to increase its effectiveness and shorten the course of treatment as much as possible. Phototherapy and systemic immunosuppressive drugs, or retinoids, are not recommended to be combined in children due to the possible development of severe side effects.

Side Effects of UVB 311nm Phototherapy (Table 2)

UVB tolerance of 311 nm is generally rated very good. Adverse reactions in the form of transient erythema are observed in 10% of patients, in the form of dry skin - in 15%. In connection with the appearance of erythema, treatment is interrupted for 1-2 days. When the procedures are resumed, the radiation dose is reduced by 50% of the available dose and after 1-2 sessions it is gradually increased by 0.5 of the initial dose. A slight increase in dryness is temporary; in this case, patients are advised to additionally apply softening and / or hydrating creams.

The most serious side effect of therapy is erythema. Small manifestations pass quickly and are not dangerous, although they cause a burning sensation. Second degree burns must be avoided. During the treatment period, the patient should use emollient and moisturizing neutral creams.

Before starting the procedure, creams, ointments, cosmetics, etc. should be removed from the irradiated area. To prevent keratitis and conjunctivitis developing when ultraviolet radiation gets into the eyes, it is necessary to use protective glasses.

Prevention and treatment of adverse reactions to UVB 311 nm therapy in children

The most common side effect of UVB 311 nm therapy is the development of erythema of varying severity resulting from an overdose of radiation. In this regard, patients during the course of phototherapy should be under the close supervision of a medical

table 2

Risk Factors and Side Effects of UVB 311nm Phototherapy

Side effects

Sunburn or phototoxic reaction in overdose

Phototoxic reaction with unintentional use of a photosensitizer

Conjunctivitis and keratitis (with inadequate eye protection)

Provocation of photodermatosis (polymorphic photodermatosis)

UV lentigo

Skin changes caused by exposure to light

Precancerous conditions and squamous cell carcinomas

Melanomas

Note. ++ - high risk; + - significant risk; ± - small risk; ? - possible in principle, but no data available.

staff. Moderate erythema usually resolves within a few days after dose reduction or temporary discontinuation of procedures, after which treatment is resumed at the dose reduced by half. In the presence of severe erythema, edema and blistering, symptomatic treatment is carried out, including cooling the affected skin, the use of antipruritic, pain relievers and moisturizers. To prevent the development and treatment of severe phototoxic reactions in some cases, external and systemic corticosteroids, antihistamine, non-steroidal anti-inflammatory and antioxidant drugs can be used.

To reduce itching and dryness of the skin, patients are advised to use emollients or moisturizers during the course of treatment. In cases of persistent itching, antihistamines and sedatives are prescribed.

When skin hyperpigmentation appears, a photoprotective cream is applied to the pigmented areas to protect the skin from further radiation.

When carrying out phototherapy, the following precautions should be observed: during the entire course of treatment, patients should avoid exposure to the sun and protect the skin of exposed areas of the body from the sun's rays with clothing or photoprotective cream; during a phototherapy session, it is necessary to protect the eyes with photoprotective glasses with lateral protection, the use of which will avoid the development of keratitis, conjunctivitis and cataracts; lips, ears, nipples, as well as areas exposed to chronic solar radiation (face, neck, back of the hands), in the absence of rashes on them, it is recommended to protect them during procedures with clothing or photoprotective agents; the use of other photosensitizing agents should be avoided

drugs and cosmetics: tetracycline, griseofulvin, sulfonamides, thiazide diuretics, nalidixic acid, phenothiazines, coumarin anticoagulants, sulfonylurea derivatives, methylene blue, toluidine blue, bengal rosea, methyl orange and anticorbid aromatic oils, etc .; during the course of treatment, as well as within 1-2 months after its completion, it is advisable to intensively moisturize the skin with external agents; it is not recommended to prescribe more than 1-2 courses per year or a large number of sessions in a short period, irradiation of the genitals in males.

All of the above gives grounds to assert with confidence that the use of UVB 311 nm phototherapy is a highly effective and safe method of treating skin diseases in children, which allows it to be more widely used in pediatric dermatological practice.

Financing. The study was not sponsored. LITERATURE

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Original articles

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Among chronic dermatological diseases, psoriasis ranks first in terms of prevalence. Methods for treating psoriasis are constantly being supplemented and improved, however, it is currently not possible to completely get rid of the disease. Phototherapy for psoriasis, a method based on light exposure to the affected epidermis, can significantly alleviate the course of the disease and prolong remission. There are several types of phototherapy, each of which is characterized by a number of features.

In psoriasis, there is a process of excessive division of epidermal cells. This leads to the formation of a dense keratinized area with scaling - psoriatic plaque. Skin DNA cells are responsible for cell division, the whole process of plaque formation is characterized by excessive immunity.

One of the ways to reduce the clinical manifestations of the disease is the effect of suppressing the immune system. This is done with the help of special drugs - immunosuppressants. The principle of action of phototherapy for psoriasis is similar to taking such drugs and consists in stimulating the production of substances that suppress the activity of the immune system, and therefore stop the excessive division of skin cells.

For treatment, ultraviolet rays of a certain wavelength are used. The longer the wavelength, the deeper the ultraviolet ray penetrates into the skin. Under UV exposure, the production of cytokines is stimulated. They suppress local immunity by preventing plaque formation. In addition, UV irradiation of the inflamed skin stimulates the activity of melanocytes, thereby increasing the protective function of the epidermis and accelerating regeneration. The use of phototherapy in the treatment of psoriasis allows you to stop the progression of the disease, avoid the development of complications and prolong the duration of remission. Correctly selected effect helps to reduce the frequency of exacerbations of the disease and improve the general well-being of the patient.

Benefits of phototherapy

Phototherapy can improve skin condition without taking strong drugs. The peculiarity of such an effect is the relative safety and the rapid achievement of a therapeutic effect.

In the course of UV exposure, the processes occurring in the skin cells are activated. UV irradiation triggers the skin renewal mechanism and is not perceived by the immune system as a third-party effect, since it is an absolute analogue of the natural process of skin stimulation by the sun's rays. The difference lies only in the intensity of radiation and the depth of penetration of the rays into the epidermis, which depends on the selected wavelength and the method used.

The rays used in phototherapy are analogous to solar

Phototherapy for psoriasis allows you to:

• improve skin regeneration;
• reduce psoriatic plaques;
• normalize cellular metabolic processes in the epidermis;
• stop the progression of the disease.

According to statistics, phototherapy in 85% of cases helps to significantly prolong the period of remission and avoid complications. UV exposure is indicated to prevent damage to the nail plates and inflammation of the joints against the background of psoriasis. Stimulating melanin production by UV exposure accelerates skin regeneration, resulting in plaque softening and healing faster.

The advantages of the method of treatment are good tolerance and quick efficacy. The therapeutic effect of the course of treatment lasts a long time. After exposure to photo, the duration of remission is about 6-9 months.

Types of phototherapy

Phototherapy is carried out with ultraviolet rays of different wavelengths. In the treatment of psoriasis, the effect is used in two spectra - long-wave therapy (wavelength 320-400 nm), and narrow-wave therapy (311 nm, UVB).

The wavelength determines the depth of penetration of UV radiation into the skin. The higher this value, the deeper the beam penetrates, affecting the deep layers of the epidermis. The choice of a method for the treatment of psoriasis is carried out depending on the severity of the symptoms and the depth of the spread of the pathological process.

The depth of skin penetration depends on the wavelength

Selective phototherapy

The method of selective phototherapy involves the effect on the skin in two spectra - long-wave and medium-wave. The wavelength in this case is from 290 to 330 nm.

The method is indicated for mild to moderate psoriasis. Selective phototherapy for psoriasis (SFT) can achieve a stable therapeutic effect in almost 90% of cases. SFT is used for localized eruptions, but not for generalized psoriasis. The exposure is carried out in a special booth using a fluorescent lamp. The duration of exposure to ultraviolet light and the intensity of radiation are determined individually for each patient. Usually, minimal exposure is practiced during the first procedure, with a gradual increase in power with each subsequent session.

The method of selective phototherapy for psoriasis has proven itself well in the treatment of scalp lesions. In this case, a special comb is used that produces ultraviolet waves directly to the affected area. When small areas of the skin are irradiated, there are no side effects and good tolerance of the procedure. Nevertheless, slight discomfort after the procedure is possible, which is manifested by dryness and itching. As the skin becomes accustomed to phototherapy, the side effects diminish.

Ultraviolet comb is used for psoriasis of the scalp

The course of treatment for psoriasis consists of an average of 30 treatments. The cost of one session ranges from 500 to 2000 rubles, depending on the pricing policy of the chosen clinic. No more than five sessions are allowed per week.

Narrow band phototherapy

Narrow-band phototherapy or UVB is rightfully considered the most gentle and safe. Due to the exposure to rays of the same spectrum (wavelength 311 nm), the likelihood of dryness, burns, pigmentation and itching is minimized. Stimulation of the skin in a narrow-wavelength spectrum ensures that there are no risks of developing oncology.

A feature of UVB therapy for psoriasis is a pronounced immunostimulating effect. Ultraviolet exposure suppresses the activity of skin cells, while at the same time helping to strengthen the entire immune system in general. As a result, there is a decrease in plaque eruptions with a simultaneous improvement in skin regeneration and relief of the inflammatory process.

The disadvantage of the UVB method for psoriasis is considered to be insufficient prevalence, due to the lack of the necessary equipment in most medical institutions. According to the forecasts of doctors, over time, UFB will completely replace SFT, since this method is more gentle, and at the same time is not inferior in efficiency to the selective method. In addition, negative reactions with narrow-band phototherapy treatment are observed three times less often than with other methods.

Due to insufficient equipment of medical institutions, the treatment of UFB is often difficult. The cost of this method is lower, the maximum price of a session does not exceed 1,500 rubles in Moscow. Clinics in other cities offer UVB therapy at a price of 400 rubles per session. The duration of treatment is up to 40 procedures, depending on the severity of symptoms, 2-3 times a week.

Photochemotherapy

The method is a combination of drug treatment and phototherapy. Photochemotherapy, known as PUVA therapy, is indicated for the treatment of psoriasis of any form and severity, and is considered one of the most effective treatments for this disease.

The effectiveness of the treatment is due to the use of photosensitizers (psoralen) - special drugs that increase the sensitivity of epidermal cells to ultraviolet radiation. The drug is taken one hour before irradiation. The combination of medicines and ultraviolet radiation allows you to achieve a pronounced therapeutic effect in a short time. As a rule, psoriasis symptoms subside after the third session.

Varieties of PUVA therapy are baths and the use of retinoids instead of sensitizers. PUVA baths are indicated for the development of side effects in response to taking photoactive drugs. In this case, the medicine is dissolved in water. The patient lies in the bath for half an hour and then goes to the UV booth. In this case, the photosensitivity of the skin increases, but there is no systemic effect on the body.

An effective alternative to the use of sensitizers is the PE-PUVA method, which involves taking retinoids for psoriasis. This treatment of psoriasis with phototherapy allows you to quickly improve the condition of the epidermis by stimulating skin renewal.

PUVA therapy is the most widespread and available. The cost of a session rarely exceeds 1000 rubles. On average, you will have to pay about 600 rubles for one procedure. The course of treatment consists of 20-40 procedures. A repeated course is shown no earlier than six months later.

As practice shows, two courses of phototherapy are enough, the interval between which is 6-12 months, so that the frequency of exacerbations of psoriasis is reduced by 2-3 times.

PUVA therapy has proven to be effective in the treatment of psoriasis and vitiligo

Contraindications for phototherapy

Before starting treatment, you should inform your doctor about all chronic diseases and medications taken. Despite the seeming safety, the method has a number of contraindications, including:

• malignant neoplasms;
• renal and hepatic impairment;
• pathology of the cardiovascular system;
• endocrine disorders;
• diabetes;
• lupus erythematosus;
• arterial hypertension;
• photodermatosis, allergic eczema;
• cataract.

The method is not used to treat patients with epilepsy and neurological disorders, which are accompanied by increased excitability.

An absolute contraindication to UV treatment is tuberculosis.

In the presence of nevi, papillomas, birthmarks in the affected area, it is necessary to inform the doctor about this. Excessive UV irradiation of moles can lead to a change from a benign neoplasm to a malignant one. In rare cases, exposure to ultraviolet light causes the development of melanoma - a malignant transformation of melanocytes.

The side effects of phototherapy depend on the method of exposure. Selective light therapy is accompanied by itching, burns, and pigmentation disorders. With UVB exposure, there are minimal side effects, but skin irritation is possible. Adverse reactions of PUVA therapy in most cases are associated with taking photosensitizing drugs, and are manifested by nausea and vomiting.