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.
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