The dissertation is devoted to theoretical generalization and new approach to the scientific problem of improving the effectiveness of treatment of patients with seborrheic dermatitis by complex differentiated therapy of patients with seborrheic dermatitis, taking into account the microbiota of the skin and gastrointestinal system.
General clinical, biochemical, bacteriological, statistical methods of research were used in the dissertation to solve the tasks. Under our supervision there were 78 patients with seborrheic dermatitis, most of them were patients aged 25 - 50 years. Among patients with seborrheic dermatitis, the majority of the examined were men - 53 people (67.95%), the rest were women - 25 people (32.05%), which corresponds to the gender epidemiological features of the disease. The control group for comparison of laboratory parameters was represented by 30 healthy volunteers aged 22-52 years. Social origin of patients with seborrheic dermatitis was: employees (32 - 41.0%), workers (12 - 15.4%), students (15 - 19.2%), temporarily unemployed (19 - 24.4%).
Clinical manifestations of seborrheic dermatitis started with lesions of the scalp in 56 (71.8%) and other skin areas in 22 (28.2%). Subsequently, the pathological process in 30 (38.5%) patients spread to the skin of the face, in 26 (33.3%) to other areas of the skin. Anamnestic data allowed to establish the dependence of seborrheic dermatitis recurrence on the season. Thus, in most patients (58) exacerbations of the disease were associated with seasonality: in 41 patients (52.6%) they occurred in autumn and winter, in 17 patients (21.8%) in spring and summer, in 20 patients (25.4%) they did not depend on the season.
Microbiological examination of patients with seborrheic dermatitis of the main group revealed both saprophytic and pathogenic microorganisms. Thus, Malassezia spp. were found in 90% of patients with seborrheic dermatitis of the main group, S. capitis in 82.00%, S. epidermidis - 50.00%, S. hominis - 32.14%, Micrococcus spp. haemolyticus - 8,00%, S. saprophyticus - 6,00%.
Patients with seborrheic dermatitis in the comparison group were prescribed clotrimazole 1% cream. Clotrimazole has antimycotic activity and also acts on gram-positive and gram-negative microorganisms.
Regarding the assessment of the effectiveness of therapy by the duration of treatment, it showed a significant advantage of the approaches used in the main group, as the duration of treatment in the main group was 2.0 (95% CI 2.0 - 4.0) days shorter (p<0.001) compared to the comparison group and averaged 11.0 (10.0; 14.0) days.
Indicators of the dermatological quality of life index showed that the average score among all subjects before treatment was 18.0 (14.0; 22.0) points; in the main group - 18.5 (15.0; 22.0) points, which was not statistically different (p = 0.093) compared to the control group - 16.0 (11.5; 21.5) points.
Evaluation of the dermatological index of quality of life in the groups after treatment showed that it significantly decreased (p<0.001) among all patients - on average by 16.0 (13.0; 19.0) points, and among patients of the main group - by 16.0 (14.0; 19.0) points and the comparison group - by 14.5 (10.5; 19.5) points.
In terms of adequate use of topical therapy in patients with seborrheic dermatitis, a scientifically based composition of a soft dosage form with piroctone olamine and naphthalene desalted for external use in the complex therapy and prevention of seborrheic dermatitis was used. It represents scientific and practical interest and allows to expand the pharmacotherapeutic arsenal of drugs for practical dermatology.
A rational approach to diet and careful selection of skin and hair care products provided long-term maintenance of a favorable treatment result.
Keywords: seborrheic dermatitis, skin microbiota, intestinal microbiocenosis, antimicrobial activity, treatment, efficacy, probiotics.
