The total result of the research contains a rational approach to solving the problem, which involves studying the impact of acne vulgaris (AV) and comorbid conditions (demodecosis and gallbladder dyskinesia) on the severity of the clinical course, morphology of erythrocytes (degree of poikilocytosis), quality of life combination therapy using laser therapy.
The prevalence of acne among 378 young people aged 19–36 years with different phototypes (PT) were studied, of which AV was detected in 82.7 % of II–III PT and 68.5 % of V–VI PT.
In order to increase the informativeness of the diagnosis of demodex skin lesions and reduce the time of the study, an epithelial scotch test was developed and patented, which was used to establish the comorbidity of AV with demodectic mange in 305 people (268 from II–III / 37 from V–VI PT). The presence of ticks was found in 67.1 % of people with II–III and 27.02 % of people with V–VI PT.
Comorbidity of acne with gallbladder dyskinesia (GBD) was studied among 268 people with II–III PT, who underwent a two-stage ultrasound study using a choleretic stimulant. Hypokinetic dysfunction was found among 44 % of subjects.
To assess the risks of demodex skin lesions in people with acne, 132 people were involved: 56 without acne elements and 76 with acne elements. A re-examination 12 months later revealed the presence of ticks in 3.57 % of people without AV and in 21.05 % of AV. The odds ratio (OR) was 7.2 (CI 95 %: 1.582, 32.765), which reliably confirms the impact of acne on the risk of demodicosis (p = 0.00533).
The influence of comorbid pathologies on the severity of the clinical picture of acne was established using the international scale Global Acne Grading System GAGS. The severity of the clinical picture in patients with acne was lower by 6.9 % than in people with acne and demodicosis, and 13.8% lower than in the group with acne, demodicosis and GBD. The association between the severity of clinical manifestations of acne and the presence of comorbidity with demodicosis and GBD was confirmed by a strong direct relationship r = +0.91 (p < 0.001). When assessing the intensity of itching on the visual analog scale VAS (Visual analogue scale) in the group with comorbidity acne with demodecosis mange was 9.3 %, and in the group AV + D + GBD – 20.9 % higher than in patients with AV (p ˂ 0.05). The area of post-inflammatory erythema calculated using the Image J program and the Clinician Erythema Assessment Scale showed a significant difference between patients with acne and study groups with comorbid conditions.
The study of morphological characteristics of blood cells on the basis of data obtained by light and scanning electron microscopy, found a significant increase in the relative number of altered forms of erythrocytes to 17.8 % ± 8.94 % (p˂0.05). The association between the presence of GBD and the level of poikilocytosis in patients with acne was confirmed by the establishment of a direct relationship of medium strength during Pearson's correlation analysis r = +0.75 (p < 0.05).
The impact of acne on quality of life, determined by the DLQI questionnaire, shows a significant difference between the groups: among patients with comorbidity of acne with demodicosis and GBD the average overall score was 8.88 points compared to 5.97 in patients with acne. The association of the burden of acne with comorbid pathology and the quality of life of patients with acne was proved by calculating the correlations r = +0.71 (p <0.005).
In order to improve the treatment of acne in comorbidity with demodicosis and gallbladder dyskinesia, an algorithm of combination therapy with the gradual use of topical and systemic laser therapy was developed.
To reduce the manifestations of inflammation and elimination of ticks of the genus Demodex, patients underwent a course of laser procedures using a laser device with a wavelength of 1064 nm with remote treatment of the skin on the following parameters: wave length (λ) = 1064 nm; spot diameter (Ø) – 6 mm; fluence – 35 J/cm2; pulse length – 0.6 ms.
Normalization of gallbladder function in 100 % of patients of the group with
AV + D + GBD (48.0 % ± 7.9 %) and a decrease in the number of echinocytes to 8.89 ± 1.36 % with an increase in the number of discocytes to 88.11 % ± 5.78 % (p˂ 0.05 ) confirmed the effectiveness of the LLT course.
The use of a long-wave neodymium laser (λ = 1 064 nm) to eliminate the Demodex mites and reduce inflammation in the group of patients with V–VI phototype ensured the elimination of mites in 70 % of patients and reduced clinical manifestations by 58.9 % (p ˂ 0.05) , which proves the effectiveness and validity of the use of laser therapy for patients with V–VI phototype.
Key words: acne, acne vulgaris, demodicosis, gallbladder dyskinesia, comorbidity, life quality, Nd: YAG 1064 laser, laser therapy, intravenous low level laser therapy, photodynamic therapy.
