ART OF MEDICINE 2017

 

HEPATOPROTECTIVE THERAPY RELEVANCE FOR PATIENTS SUFFERING FROM ECZEMA

 

I.O. Buianova

          SHEI «Ivano-Frankivsk National Medical University», Department of Dermatology and Venerology, Ivano-Frankivsk, Ukraine, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

  

Abstract

Abstract. One of the burning problems in dermatology is pathogenetic units research of allergic skin diseases with the aim to optimize its treatment. The importance is defined by increased number of cases of these diseases, and severe clinical processes defined by frequent relapses, resistance to the approved methods of treatment and long-term patient’s incapacity.

Eczema is a chronic relapsing allergic skin disease that occurs on the background of a polyvalent sensibilization of the body and manifests through the inflammatory processes in the superficial layers of skin with the appearance of polymorphic rash and intense itching. Eczema is one of the most common dermatitis, share of eczema in the structure of dermatological disease is 15 to 40%. Both men and women suffer

from eczema most often at the age of 30-60 years. Eczema is considered to be a polyetiological allergic disease, which is caused by the impact of a complex set of exogenous and endogenous etiologic and pathogenetic factors. Among the exogenous causes of eczema they distinguish exogenous allergens of chemical and biological, and environmental factors - risk factors of environmental, climatic, physical, occupational, psychological, hygienic, social plan. Endogenous pathogenic factors are crucial in the development and course of eczema - family history, changes in immune responsiveness, disorder of the nervous and endocrine regulation, impaired microcirculation, concomitant diseases of the digestive system, metabolic disorders, etc. They contribute to the formation of endo and autoallergens. According to statistics, up to 80% of cases of allergic skin diseases are associated with various lesions of the gastrointestinal tract.

The purpose of our work was to analyze existing approaches to eczema treatment identifying perspective ways to improve treatment of such patients. The treatment program includes a hypoallergenic diet, systemic and topical treatment of dermatosis, and correction of neural and neuroendocrine disorders, sanitation of foci of chronic infection. Systemic therapy of patients with eczema includes antihistamines, glucocorticoids, sedatives drugs, vitamins. The external treatment should be administered differentially, it depends on stage of disease. In the acute stage – cold lotions or solutions, in subacute and chronic stage – ointments with corticosteroids.

At present, patients with eczema have metabolic processes disorder associated with chronic inflammatory processes of hepatobiliary system. Signs of abnormal proteometabolism are often determined. According to research data on eczema hypoalbuminemia is observed in almost half of the patients especially within the period of exacerbation and in case of widespread forms. Most authors believe that the nature of dysproteinemia in case of eczema depends more on the severity, prevalence and other features of eczematous process, than on the form of the disease. Although the total amount of protein in blood is not disturbed, in case of eczema acute form, protein cleavage in tissues increases and leads to increase of sulphur-bearing substances in blood. As a rule, changes in protein fractions are characterized by decrease of albumins content, an increase of alpha and gamma-globulins concentration, post albumin glucoproteins, proteins of the hapto-globulin zone, fast and slow post-transferrins. In patients with eczema a significant increase in serum alaninaminotranspherase activity is observed at a moderate increase in the activity of aspartataminotranspherase and lactatedehydrogenase, indicating a change in the function of hepatocytes or the presence of chronic hepatitis requiring the necessary corrective therapy. A moderate increase in the activity of alkaline phosphatase in the blood serum of such patients can confirm the presence of concomitant chronic hepatitis.

Thus, modern research data related to the eczema pathogenesis convincingly indicate the need to apply hepatotropic agents during complex treatment of this dermatosis. In our opinion, it is pathogenetically approved to use hepatoprotectors in treatment, not only for reparative effect, but also with the ability to influence metabolic disorders and changes in the ratio of lipid peroxidation systems and antioxidant defense systems that accompany inflammatory process in liver of any kind etiology, especially taking into consideration the factors of non-alcoholic steatohepatitis observed in many patients with eczema.

 

Key words: eczema, treatment, hepatoprotective therapy.

 

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