IMPROVEMENT OF COMPLEX TREATMENT OF PATIENTS WITH LOCALIZED SCLERODERMA, ASSOCIATED WITH LYME BORELIOSIS
DOI:
https://doi.org/10.11603/1681-2727.2022.1.13023Keywords:
localized scleroderma, Lyme borreliosis, penicillin, doxycycline hydrochloride, cytokinesAbstract
The aim was to compare the clinical effectiveness of two schemes of complex treatment of patients with associated LB, using penicillin or doxycycline hydrochloride.
Materials and methods. Under the supervision there were 35 patients aged 20 to 64 years with associated LB, including 9 men (25.7 %), 26 women (74.3 %). Patients were treated on an outpatient and inpatient basis at the Ternopil Regional Clinical Dermatological and Venereological Dispensary during 2015–2021. The control group consisted of 25 blood donors, who did not differ significantly in age and sex from the examined patients.
Two schemes of complex treatment of patients with LS associated with LB were used. Accordingly, all patients were divided into two groups. Group 1 included 17 patients who received treatment lasting 21 days: penicillin intramuscularly 1 million IU 1 time per day, plakvenil 0.2 g 2 times a day orally in three five-day courses with three-day intervals, carsil 2 tablets 3 times a day, aevit 100 thousand IU 1 time per day, 2.5 % solution of thiotriazoline 4.0 ml intramuscularly, solcoseryl gel topically. In group 2 (18 patients), intramuscular injections of penicillin were replaced by doxycycline hydrochloride 100 mg twice daily in this treatment regimen. Analysis of the effectiveness of the applied schemes of complex treatment of patients was performed on the 30th day after its completion.
We compared the dynamics of the general clinical manifestations of the disease, local changes and levels of cytokines in the sera of patients: pro-inflammatory IL-6 and anti-inflammatory IL-10. The modified Localized Skin Severity Index (mLoSSI) was used to assess the activity of localized scleroderma.
Results. The use of doxycycline hydrochloride instead of penicillin in the complex treatment of patients with localized scleroderma associated with Lyme borreliosis contributed to the rapid disappearance of general and local manifestations of inflammation of lesions of localized scleroderma, which confirms a decrease in the modified Localized Skin Severity Index in 2.9 versus 1.5 times. Doxycycline hydrochloride ensured faster disappearance of fever and headache in the examined patients, a significant reduction in the percentage of patients with fatigue/general weakness, pain and swelling of the joints, compared with penicillin. The tested scheme of complex treatment with doxycycline hydrochloride in comparison with penicillin, allowed to significantly reduce the concentration of proinflammatory cytokine IL-6 in the blood of patients – 2.3 to 1.1 times and increase the content of anti-inflammatory IL-10 – 2.1 to 1.1 times respectively.
Conclusions. Doxycycline hydrochloride should be used instead of penicillin in the complex treatment of patients with localized scleroderma, associated with Lyme borreliosis.
References
Wenzel, D., Haddadi, N.S., Afshari, K., Richmond, J.M., & Rashighi, M. (2021). Upcoming treatments for morphea. Immunity, Inflammation and Disease, 9 (4), 1101-1145. https://doi.org/10.1002/iid3.475
Arkachaisri, T., Vilaiyuk, S., Torok, K., & Medsger, T. (2009). Development and initial validation of the Localized Scleroderma Skin Damage Index and Physician Global Assessment of disease Damage: a proof-of-concept study. Rheumatology, 49 (2), 373-381. doi: 10.1093/rheumatology/kep361
Abbas, L., Joseph, A., Kunzler, E., & Jacobe, H. (2021). Morphea: progress to date and the road ahead. Annals of Translational Medicine, 9 (5), 437-437. DOI: 10.21037/atm-20-6222
Krasowska, D., Rudnicka, L., Dańczak-Pazdrowska, A., Chodorowska, G., Woźniacka, A., & Lis-Święty, A. et al. (2019). Localized scleroderma (morphea). Diagnostic and therapeutic recommendations of the Polish Dermatological Society. Dermatology Review/Przegląd Dermatologiczny, 106 (4), 333-353. https://doi.org/10.5114/dr.2019.88252
Rodríguez-Salgado, P., & García-Romero, M.T. (2019). Morphea: a practical review of its diagnosis, classification and treatment. Gaceta medica de Mexico, 155 (5), 483-491. https://doi.org/10.24875/GMM.M20000336
Zinchuk, O.M., & Kaliuzhna, L.D. (2016). Skin lesions in patients with late-onset Lyme disease. Dermatolohiia, kosmetolohiia, seksopatolohiia – Dermatology, Cosmetology, Sexopathology, 1-2, 10-14 [in Ukrainian].
Choi, M.S., Seong, G.H., Park, M.J., Park, M., Hong, S.P., Park, B.C., & Kim, M.H. (2020). Rapidly progressing generalized morphea with high Lyme disease titer. Indian Journal of Dermatology, 65 (5), 432-434. Retrieved from: https://doi.org/10.4103/ijd.IJD_279_18
Șandru, F., Popa, A., Petca, A., Miulescu, R.G., Constan-tin, M.M., Petca, R.C., ... & Dumitrașcu, M.C. (2020). Etiologic role of Borrelia burgdorferi in morphea: A case report. Experimental and Therapeutic Medicine, 20(3), 2373-2376. Retrieved from: https://doi.org/10.3892/etm.2020.8815
Bali, G., & Hidvégi, B. (2018). Diagnostic and treatment strategies of dermatologists for treating morphea in Hungary. Acta Dermatovenerol Croat, 26, 21-24
Kreuter, A., Krieg, T., Worm, M., Wenzel, J., Moinzadeh, P., & Kuhn, A. et al. (2016). German guidelines for the diagnosis and therapy of localized scleroderma. JDDG: Journal Der Deutschen Dermatologischen Gesellschaft, 14 (2), 199-216. DOI: 10.1111/ddg.12724
Knobler, R., Moinzadeh, P., Hunzelmann, N., Kreuter, A., Cozzio, A., & Mouthon, L. et al. (2017). European Dermatology Forum S1-guideline on the diagnosis and treatment of sclerosing diseases of the skin, Part 1: localized scleroderma, systemic sclerosis and overlap syndromes. Journal of The European Academy of Dermatology and Venereology, 31 (9), 1401-1424. doi: 10.1111/jdv.14458
Naj, X., & Linder, S. (2017). Actin-dependent regulation of Borrelia burgdorferi phagocytosis by Macrophages. Current Topics in Microbiology and Immunology, 399, 133-154. https://doi.org/10.1007/82_2016_26
Tanaka, T., Narazaki, M., & Kishimoto, T. (2014). IL-6 in inflammation, immunity, and disease. Cold Spring Harbor Perspectives in Biology, 6 (10), a016295. https://doi.org/10.1101/cshperspect.a016295;
Bobe, J., Jutras, B., Horn, E., Embers, M., Bailey, A., & Moritz, R. et al. (2021). Recent Progress in Lyme Disease and Remaining Challenges. Frontiers In Medicine, 8. DOI: 10.3389/fmed.2021.666554
Gautam, A., Dixit, S., Philipp, M., Singh, S., Morici, L., Kaushal, D., & Dennis, V. (2011). Interleukin-10 alters effector functions of multiple genes induced by Borrelia burgdorferi in macrophages to regulate Lyme disease inflammation. Infection and Immunity, 79 (12), 4876-4892. DOI: 10.1128/iai.05451-11
Wolska-Gawron, K., & Krasowska, D. (2017). Localized scleroderma – classification and tools used for the evaluation of tissue damage and disease activity/severity. Dermatology Review/Przegląd Dermatologiczny, 104 (3), 269-289. https://doi.org/10.5114/dr.2017.68775
Ata, M.A. (2019). Optimization of diagnosis and treatment of limited scleroderma taking into account the clinical and pathogenetic role of metabolic and immune disorders. Candidate’s thesis. Kharkiv [in Ukrainian].
Diudiun A.D., Romanenko K.V., Horbuntsov V.V. Efficacy of complex pathogenetic treatment of limited scleroderma with the use of narrowband phototherapy. Dermatovenerolohiya. Kosmetolohiia. Seksopatolohiia – Dermatovenereology. Cosmetology. Sexopathology, 1-4, 228-234 [in Ukrainian]
Henehan, M., Montuno, M., & De Benedetto, A. (2017). Doxycycline as an anti-inflammatory agent: updates in dermatology. Journal of the European Academy of Dermatology and Venereology : JEADV, 31 (11), 1800-1808. https://doi.org/10.1111/jdv.14345
Nguyen, C.T., Cifu, A.S., & Pitrak, D. (2022). Prevention and treatment of Lyme Disease. JAMA, 327 (8), 772-773. https://doi.org/10.1001/jama.2021.25302
Szczęch, J., Samotij, D., Jaworecka, K., Tobiasz, A., & Reich, A. (2020). Quality of life in patients with morphea: A cross-sectional study and a review of the current literature. Biomed. Research International, 2020, 1-8. DOI: 10.1155/2020/9186274
Hein, T.M., Sander, P., Giryes, A., Reinhardt, J.O., Hoegel, J., & Schneider, E.M. (2019). Cytokine expression patterns and single nucleotide polymorphisms (SNPs) in patients with chronic Borreliosis. Antibiotics (Basel, Switzerland), 8 (3), 107. https://doi.org/10.3390/antibiotics8030107
Johnson, B., Stevenson, A., Prêle, C., Fear, M., & Wood, F. (2020). The role of IL-6 in skin fibrosis and cutaneous wound healing. Biomedicines, 8 (5), 101. DOI: 10.3390/biomedicines8050101
Savenkova, V.V. (2011). Characteristics of immunological changes in patients with limited scleroderma depending on the stage of the disease. Dermatology and Venereology, 3, 44-51.
Horbuntsov, V.V., Romanenko, K.V., & Diudiun, A.D. (2016). Influence of complex pathogenetic treatment on some indicators of the immune system of patients with limited scleroderma. Dermatovenereology. Cosmetology. Sexopathology, 1-4, 205-208.
Steen, E., Wang, X., Balaji, S., Butte, M., Bollyky, P., & Keswani, S. (2020). The role of the anti-inflammatory cytokine interleukin-10 in tissue bibrosis. Advances In Wound Care, 9 (4), 184-198. DOI: 10.1089/wound.2019.1032
Henehan, M., Montuno, M., & De Benedetto, A. (2017). Doxycycline as an anti-inflammatory agent: updates in dermatology. Journal of the European Academy of Dermatology and Venereology : JEADV, 31(11), 1800–1808. https://doi.org/10.1111/jdv.14345
Nguyen, C. T., Cifu, A. S., & Pitrak, D. (2022). Prevention and Treatment of Lyme Disease. JAMA, 327(8), 772–773. https://doi.org/10.1001/jama.2021.25302
Szczęch, J., Samotij, D., Jaworecka, K., Tobiasz, A., & Reich, A. (2020). Quality of Life in Patients with Morphea: A Cross-Sectional Study and a Review of the Current Literature. Biomed Research International, 2020, 1-8. doi: 10.1155/2020/9186274
Hein, T. M., Sander, P., Giryes, A., Reinhardt, J. O., Hoegel, J., & Schneider, E. M. (2019). Cytokine Expression Patterns and Single Nucleotide Polymorphisms (SNPs) in Patients with Chronic Borreliosis. Antibiotics (Basel, Switzerland), 8(3), 107. https://doi.org/10.3390/antibiotics8030107
Johnson, B., Stevenson, A., Prêle, C., Fear, M., & Wood, F. (2020). The Role of IL-6 in Skin Fibrosis and Cutaneous Wound Healing. Biomedicines, 8(5), 101. doi: 10.3390/biomedicines8050101
Savenkova V. V. (2011). Characteristics of immunological changes in patients with limited scleroderma depending on the stage of the disease. Dermatology and venereology, 3, 44–51.
Horbuntsov V.V., Romanenko K.V., Diudiun A.D. (2016). Influence of complex pathogenetic treatment on some indicators of the immune system of patients with limited scleroderma. Dermatovenereology. Cosmetology. Sexopathology, 1-4, 205-208.
Steen, E., Wang, X., Balaji, S., Butte, M., Bollyky, P., & Keswani, S. (2020). The Role of the Anti-Inflammatory Cytokine Interleukin-10 in Tissue Fibrosis. Advances In Wound Care, 9(4), 184-198. doi: 10.1089/wound.2019.1032
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