CLINICAL SIGNIFICANCE OF EXTRACORPOREAL PHOTOCHEMOTHERAPY IN COMPLEX TREATMENT OF LOCALIZED SCLERODERMA

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Abstract

Background: Scleroderma is an autoimmune disease with progressing lesions of connective tissue where fibrosclerotic and vascular disturbances prevail. Lacking of the united concept of its pathogenesis significantly hampers elaboration of pathogenetic methods of treatment. Conventional methods of treatment of localized scleroderma have insufficient clinical effectiveness, lead to remission of short duration, have a series of side effects and complications. Aim: To raise the efficiency of the focal scleroderma treatment with a complex therapy including a method of extracorporeal photochemotherapy (EPCT). Materials and methods: A total of 19 patients with plaque or linear types of localized scleroderma underwent complex treatment including EPCT. All patients had a steadfast progressing course of the disease with generalized lesions, the signs of early systemic scleroderma being revealed in 3 of them. EPCT-method is based on the photo-sensitizing effect of 8-methoxypsoralene and ultraviolet А radiation of mononuclear cells which were separated using cytopheresis further followed with reinfusion. Every course included 4 exposures implemented every other day. Repeated therapeutic course was set in 3 months. Results: All patients satisfactorily tolerated EPCT procedure without side effects and complications. After 3 therapeutic courses, the disease progression was arrested in all patients, the density of scleroderma foci was diminished, approximately, by 50% as compared to the initial level. The crown of the peripheral growth completely disappeared, and the sizes of the disease foci decreased. The more pronounced clinical effect was achieved in patients with disease duration not exceeding 3 years. Conclusion: The proposed method was efficient in treatment of localized scleroderma and might be applied as an adjuvant therapy.

About the authors

O. A. Fomina

Moscow Regional Research and Clinical Institute (MONIKI)

Author for correspondence.
Email: dr.fominaoa@gmail.com
postgraduate student, MONIKI Russian Federation

A. V. Molochkov

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru
MD, PhD, Professor, Deputy Director on science, educational work and international communications, MONIKI Russian Federation

A. V. Kil’dyushevsky

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru
MD, PhD, Professor, leading scientific worker, Department of Surgical Hemocorrection and Detoxification, MONIKI Russian Federation

References

  1. Гусева Н.Г. Системная склеродермия: клиника, диагностика, лечение. Российский журнал кожных и венерических болезней 2002;(4):5-15. [Guseva N.G. Systemic scleroderma: clinic, diagnostics, therapy. Rossiyskiy zhurnal kozhnykh i venericheskikh bolezney 2002;(4):5-15 (in Russian)].
  2. Дворников А.С., Хамаганова И.В., Скрипкин Ю.К., Богуш П.Г. Современные подходы к терапии пациентов с ограниченной склеродермией. Вестник дерматологии и венерологии 2006;(5):17-8. [Dvornikov A.S., Khamaganova I.V., Skripkin Yu.K., Bogush P.G. Contemporary approaches to treatment of localized scleroderma patients. Vestnik dermatologii i venerologii 2006; (5):17-8 (in Russian)].
  3. Бутов Ю.С., Тогузов Р.Т. Некоторые аспекты патогенеза, клиника и терапия склеродермии. Российский журнал кожных и венерических болезней 2002;(4):15-9. [Butov Yu.S., Toguzov R.T. Some features of scleroderma pathogenesis, its clinic and therapy. Rossiyskiy zhurnal kozhnykh i venericheskikh bolezney 2002;(4):15-9 (in Russian)].
  4. Chung L., Lin J., Furst D.E., Fiorentino D. Systemic and localized scleroderma. Clin Dermatol 2006;24(5):374-92.
  5. Волнухин В.А., Мурадян Н.Л., Выборнова О.В., Боровая О.В. Фотохимиотерапия склеродермии и склеродермоподобных заболеваний кожи. Вестник дерматологии и венерологии 2008;(4):39-48. [Volnukhin V.A., Muradyan N.L., Vybornova O.V., Borovaya O.V. Photochemotherapy of scleroderma and scleroderma-like cutaneous diseases. Vestnik dermatologii i venerologii 2008;(4):39-48 (in Russian)].
  6. Leitenberger J.J., Cayce R.L., Haley R.W., Adams-Huet B., Bergstresser P.R., Jacobe H.T. Distinct autoimmune syndromes in morphea: a review of 245 adult and pediatric cases. Arch Dermatol 2009;145(5):545-50.
  7. Zulian F. Systemic manifestations in localized scleroderma. Curr Rheumatol Rep 2004;6(6):417-24.
  8. Gabrielli A., Avvedimento E.V., Krieg T. Scleroderma. N Engl J Med 2009;360(19):1989-2003.
  9. Kräling B.M., Maul G.G., Jimenez S.A. Mononuclear cellular infiltrates in clinically involved skin from patients with systemic sclerosis of recent onset predominantly consist of mono - cytes/macrophages. Pathobiology 1995;63(1):48-56.
  10. Mavalia C., Scaletti C., Romagnani P., Carossino A.M., Pignone A., Emmi L., Pupilli C., Pizzolo G., Maggi E., Romagnani S. Type 2 helper T-cell predominance and high CD30 expression in systemic sclerosis. Am J Pathol 1997;151(6):1751-8.
  11. Whitfield M.L., Finlay D.R., Murray J.I., Troyanskaya O.G., Chi J.T., Pergamenschikov A., McCalmont T.H., Brown P.O., Botstein D., Connolly M.K. Systemic and cell type-specific gene expression patterns in scleroderma skin. Proc Natl Acad Sci USA 2003; 100(21):12319-24.
  12. Корсун В.Ф., Суворов А.П., Морозова И.С. Фитотерапия больных очаговой склеродермией. Вестник последипломного медицинского образования 2006;(2):37-40. [Korsun V.F., Suvorov A.P., Morozova I.S. Phytotherapy of the localized scleroderma patients. Vestnik poslediplomnogo meditsinskogo obrazovaniya 2006;(2):37-40 (in Russian)].
  13. Rook A.H., Suchin K.R., Kao D.M., Yoo E.K., Macey W.H., DeNardo B.J., Bromely P.G., Geng Y., Junkins-Hopkins J.M., Lessin S.R. Photopheresis: clinical applications and mechanism of action. J Investig Dermatol Symp Proc 1999;4(1):85-90.
  14. Song P.S., Tapley K.J. Jr. Photochemistry and photobiology of psoralens. Photochem Photobiol 1979;29(6):1177-97.
  15. Кильдюшевский А.В., Молочков В.А., Ольшанский А.Я., Молочков А.В., Фомин А.М., Гордиевская М.С., Карзанов О.В., Петренко Е.В. Адаптивная иммунотерапия Т-клеточных лимфом кожи на основе экстракорпорального фотофереза. Российский журнал кожных и венерических болезней 2010; (1):4-10. [Kil’dyushevskiy A.V., Molochkov V.A., Ol’shanskiy A.Ya., Molochkov A.V., Fomin A.M., Gordievskaya M.S., Karzanov O.V., Petrenko E.V. Adaptive immunotherapy of T-cell skin lymphomas based on extracorporeal photopheresis. Rossiyskiy zhurnal kozhnykh i venericheskikh bolezney 2010;(1):4-10 (in Russian)].
  16. Молочков В.А., Кильдюшевский А.В., Карзанов О.В., Альбау З. Динамика межклеточных взаимодействий у больных атопическим дерматитом в процессе экстракорпоральной фотохимиотерапии. Российский журнал кожных и венерических болезней 2007;(6):20-2. [Molochkov V.A., Kil’dyushevskiy A.V., Karzanov O.V., Al’-bau Z. Dynamics of cellular interactions in atopic dermatitis patients during extracorporeal photochemo-therapy. Rossiyskiy zhurnal kozhnykh i venericheskikh bolezney 2007;(6):20-2 (in Russian)].
  17. Молочков В.А., Кильдюшевский А.В., Карзанов О.В. Динамика клеточного иммунитета в процессе экстракорпоральной фотохимиотерапии у больных истинной пузырчаткой. Российский журнал кожных и венерических болезней 2008;(4):71-6. [Molochkov V.A., Kil’dyushevskiy A.V., Karzanov O.V. Dynamics of cellular immunity during extracorpo-real photo chemotherapy in true pemphigus patients. Rossiyskiy zhurnal kozhnykh i venericheskikh bolezney 2008;(4):71-6 (in Russian)].
  18. Малиновская В.В., Молочков В.А., Молочков А.В., Кильдюшевский А.В., Карташова М.Г. Комплексное лечение идиопатического типа саркомы Капоши фотоферезом и интерфероном. Российский журнал кожных и венерических болезней 2008;(1):6-11. [Malinovskaya V.V., Molochkov V.A., Molochkov A.V., Kil'dyushevskiy A.V., Kartashova M.G. Complex treatment of idiopathic type of Kaposi’s sarcoma using photopheresis and interferon. Rossiyskiy zhurnal kozhnykh i venericheskikh bolezney 2008;(1):6-11 (in Russian)].
  19. Молочков В.А., Кильдюшевский А.В., Карзанов О.В., Якубовская Е.С. Эффективность экстракорпоральной фотохимиотерапии при псориазе и псориатическом артрите. Экспериментальная и клиническая дерматокосметология 2013;(4):57-64. [Molochkov V.A., Kil'dyushevskiy A.V., Karza - nov O.V., Yakubovskaya E.S. Efficiency of extracorporeal photo-chemotherapy for psoriasis and pso riatic arthritis. Eksperimental'naya i klinicheskaya dermatokosmetologiya 2013; (4):57-64 (in Russian)].
  20. Pérez-Carmona L., Harto-Castaño A., Díez-Recio E., Jaén-Olasolo P. Extracorporeal photopheresis in dermatology. Actas Dermosifiliogr 2009;100(6):459-71.
  21. LeRoy E.C., Medsger T.A. Jr. Criteria for the classification of early systemic sclerosis. J Rheumatol 2001;28(7):1573-6.
  22. Peterson L.S., Nelson A.M., Su W.P. Classification of morphea (localized scleroderma). Mayo Clin Proc 1995;70(11):1068-76.
  23. Krasagakis K., Dippel E., Ramaker J., Owsianowski M., Orfanos C.E. Management of severe scleroderma with long-term extracorporeal photopheresis. Dermatology 1998;196(3): 309-15.
  24. Rook A.H., Freundlich B., Jegasothy B.V., Perez M.I., Barr W.G., Jimenez S.A., Rietschel R.L., Wintroub B., Kahaleh M.B., Varga J. Treatment of systemic sclerosis with extracorporeal photo-chemotherapy. Results of a multicenter trial. Arch Dermatol 1992;128(3):337-46.
  25. Knobler R.M., French L.E., Kim Y., Bisaccia E., Graninger W., Nahavandi H., Strobl F.J., Keystone E., Mehlmauer M., Rook A.H., Braverman I.; Systemic Sclerosis Study Group. A randomized, double-blind, placebo-controlled trial of photopheresis in systemic sclerosis. J Am Acad Dermatol 2006;54(5):793-9.
  26. Zachariae H., Bjerring P., Heickendorff L., Møller B., Wallevik K. Photopheresis and systemic sclerosis. Arch Dermatol 1992; 128(12):1651-3.

Copyright (c) 2014 Fomina O.A., Molochkov A.V., Kil’dyushevsky A.V.

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