Psoriasis, commonly known as psoriasis, is a chronic inflammatory skin disease characterized by common scaly erythema. The disease is easy to diagnose and difficult to treat, causing great distress to patients’ daily lives and psychological well-being. Because the cause of the disease is unknown and the pathogenesis is complex, there are many treatment methods, but most of them can only achieve recent clinical results and can only temporarily relieve symptoms but are difficult to cure, and are prone to relapse within a short period of time.
In the current study, ultraviolet light therapy can clinically cure the disease and delay the relapse time as much as possible, especially for drippy psoriasis, which is more effective and has a very low relapse rate. Our hospital adopts narrow-spectrum medium-wave ultraviolet light combined with Chinese medicine fumigation to treat psoriasis vulgaris, and achieves satisfactory efficacy, which is reported as follows.
1.Clinical data
Seventy-six patients came from the dermatology outpatient clinic and ward of our hospital, including 32 cases of punctate, 44 cases of plaque and 35 cases of female, with the disease duration ranging from 3 months to 42 years, with an average of 6.3 years.
Prior to treatment, medical history, systematic physical examination, dermatological examination and improvement of auxiliary examinations were performed. Inclusion criteria.
1. those aged between 15 and 60 years;
2. No systematic treatment within 3 months and no glucocorticoid preparation applied to the affected area within 1 month;
3. No abnormalities in blood and urine routine, liver and kidney function tests;
4. No active cardiopulmonary disease;
5. No significant photosensitive skin disease;
6. No glaucoma or cataract;
7. No basal cell nevus syndrome;
8. No pregnancy or breastfeeding. Patients sign the informed consent form for UV light therapy before treatment.
2.Treatment methods
2.1 Chinese medicine fumigator: DXZ-3 Chinese medicine fumigator produced by Jilin Liangda Medical Equipment Co.
2.2 NB-UVB light source: KN-4001 whole-body ultraviolet light therapy instrument manufactured by Jiangsu Xuzhou Kono Medical Instruments and Equipment Co., Ltd. with lamp model 40 TL 100W01, manufactured by Philips of the Netherlands, with a wavelength of 311 nm.
2.3 Treatment process: The Chinese medicine fumigation instrument was heated by adding 30g of Chinese medicine Phellodendron leaf, 30g of alum, 30g of manganese, 20g of bitter ginseng, 20g of wild chrysanthemum, 15g of honeysuckle, 20g of white fresh bark, 20g of ground bone bark, and the patient entered the fumigation chamber wearing a disposable fumigation suit, with the head and neck exposed outside the chamber, and was fumigated once every other day for 20-30 minutes, and the temperature control should be 38-40℃ (time, temperature control depends on the climate and physical condition). Temperature control depends on the climate, physical condition and other factors).
After fumigation, clean the skin with warm water shower, remove scales, then enter the UV light therapy instrument treatment cabin, according to the operation routine (cover the eyes, breasts, external genitalia) for phototherapy, the starting dose of 0.5J/cm2, every other day irradiation 1 time, each increment of 0.3J-0.5J, each time the highest single dose is not more than 5.0J; if there is a slight erythema, continue to increase the dose of irradiation, if there is moderate erythema If there is heavy erythema, wait for the erythema to fade and use the original dose, if the disease does not improve significantly for 2 weeks to terminate the treatment, if the lesion is completely cured, apply the final dose of irradiation once a week for 4 times to consolidate the treatment.
3.Efficacy assessment criteria
Before treatment, after treatment, according to pruritus, erythema infiltration, scaling and area as psoriasis area and severity, and refer to PASI score to assess the treatment results. Clinical cure: all lesions disappear or only a few small inconspicuous lesions remain, and PASI decreases by more than 90% compared with that before treatment; effective: lesions disappear by 60%~89%, and PASI decreases by 69%~90% compared with that before treatment; effective: lesions disappear by 30%~59%, and PASI decreases by 31%~69% compared with that before treatment; ineffective: lesions disappear by 30% or less, and PASI decreases by <30% compared with that before treatment. The total effective rate is the clinical cure rate plus the significant rate. The total effective rate is the clinical cure rate plus the apparent rate.
4. Statistical methods
The data were expressed as mean ± standard deviation, and the x2 test was used for statistical analysis.
5.Results
All 76 patients completed the treatment, among which there were 32 cases of punctate, 28 cases of cure, 3 cases of apparent effect, with a total effective rate of 96.9%; there were 44 cases of plaque, 30 cases of cure, 7 cases of apparent effect, with a total effective rate of 84.1%. It can be seen that the efficacy of this therapy in the treatment of common psoriasis is better than that of plaque (Table 1). There was a significant difference (P<0.01) in the comparison of the mean values of PASI scores before and after treatment between the two groups, indicating that this therapy had good efficacy in treating two different clinical types of psoriasis vulgaris (Table 2).
Table 1 Comparison of treatment effects between two groups of patients Example
Group
Number of cases
Cured
Effective
Effective
Ineffective
Total effective rate(%)
Dotted
32
28
3
1
0
96.9
Patchy
44
30
7
5
2
84.1
Table 2 Comparison of mean values of PASI scores before and after treatment between two groups (x±s)
Group
Number of cases
Before treatment
After treatment
Spotted
32
16.13±4.67
2.58±1.06
Plaque-like
44
19.37±5.45
5.42±3.23
There was a significant difference between the two groups of patients after treatment compared with the PASI score before treatment (P<0.01).
Adverse reactions Both groups of patients had diffuse skin pigmentation of varying degrees of severity after application of NB-UVB irradiation, with 2 cases of erythema, 6 cases of mild skin itching, and 3 cases of dry skin, and the erythema and itching disappeared after stopping irradiation, and the pigmentation was relieved 2 months after stopping treatment.
6. Discussion
Psoriasis is an inflammatory skin disease with excessive proliferation of keratin-forming cells. The etiology of psoriasis is complex and is currently believed to be related to genetics, metabolism and cellular immunity, especially closely related to T cells. UV irradiation can inhibit DNA synthesis in epidermal cells of psoriasis lesions, slow down the reproduction of epidermal cells, and cause apoptosis of T cells, thus causing lesions to fade. Clinical research also confirms that narrow-spectrum medium-wave ultraviolet radiation with a wavelength of about 311 nm is a therapeutic measure with good efficacy and few adverse effects.
According to traditional Chinese medicine, the internal cause of psoriasis is the dryness and heat of the blood, and the external cause is the wind evil guest in the skin, and the evil heat is prolonged, the two wrestle with each other, the heat and toxicity are contained in the muscle surface, the blood stasis turns into dryness, the blood deficiency produces wind and the disease.
Treatment is to clear heat and detoxify, cool the blood and invigorate the blood, dispel wind and stop itching. In the fumigation formula, honeysuckle, dandelion, bitter ginseng and wild chrysanthemum are bitter and cold in nature, which have the effect of clearing heat and detoxifying the blood, dispelling swelling and dispersing knots; white fresh bark and ground bone bark are bitter and cool in nature, which can clear heat and cool the blood, dispel wind and relieve itching; alum and manganese are salty and cold in nature, which can soften and disperse knots, so the combination of all the medicines can play the effect of clearing heat and cooling the blood, dispelling wind and relieving itching, and also help to clear the scales of skin lesions.
Chinese medicine fumigation takes effect through the synergistic effect between heat, pressure and medicine, using the physiological characteristics of the skin, so that the medicine is absorbed through the skin surface, penetrated by the stratum corneum and transferred by the dermis into the blood circulation to exert its medicinal effect, and can also avoid the stimulation of the drug on the digestive system and reduce the burden on the liver and kidneys, thus improving the utilization of the drug, and can also more thoroughly remove the scales attached to the skin lesions.
Chinese medicine fumigation integrates medicine and physical therapy, and the warming effect of the medicine vapor causes the blood vessels to expand and the sweat glands to open, which promotes blood circulation and metabolism, allowing the “evil toxins” in the body to be discharged with sweat, which is conducive to supporting the root of the problem. It is also found that the penetrating power of narrow-spectrum medium-wave ultraviolet light is weak, and it cannot even penetrate a piece of white paper. If ultraviolet light is irradiated after removing the scales of skin lesions, it can make the light work directly on the skin lesions, so that the effect of ultraviolet light can be better exerted and the effect can be doubled with half the effort.
In this paper, through the observation of 76 patients with common psoriasis treated with narrow-spectrum medium-wave ultraviolet light combined with Chinese medicine fumigation, we believe that its efficacy is remarkable and the side effects of applying drug treatment are reduced, especially for punctate psoriasis, the efficacy is better and it is worthy of clinical promotion and application.