medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2024-9-91-94medalphabet-3784Research ArticleСтатьиИнтенсивный импульсный свет как перспективный метод коррекции ретикулярного варикоза и телеангиэктазий: от патогенетической обусловленности до выраженного клинического результатаIntense pulsed light is a promising way for telangiectasias / reticular veins treatment: from pathogenesis to pronounced clinical outcomeshttps://orcid.org/0000-0002-5901-4250ДемидионД. В.DemidionD. V.

Демидион Диана Витальевна - к.м.н., врач-дерматолог, косметолог, физиотерапевт, кафедра физической и реабилитационной медицины с курсом клинической психологии и педагогики.

Москва

Diana V. Demidion - PhD Med, dermatologist, cosmetologist, physiotherapist at Dept of Physical and Rehabilitation Medicine with a course in Clinical Psychology and Pedagogy.

Moscow

diana@premium-a.ruhttps://orcid.org/0000-0003-3619-206XКорякинД. А.KoryakinD. A.

Корякин Данила Алексеевич – студент.

Москва

Danila A. Koryakin – student.

Moscow

danila110920021@gmail.comФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента РоссииРоссияCentral State Medical Academy of the Administrative Department of the President of RussiaRussian FederationФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian Federation20242107202409Дерматология (1)9194Copyright © Демидион Д.В., Корякин Д.А., 20242024Демидион Д.В., Корякин Д.А.Demidion D.V., Koryakin D.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/3784

Варикозная болезнь нижних конечностей представляет собой наиболее распространенную патологию периферических сосудов, встречающуюся у трети взрослого населения. Более широким понятием является термин хронические заболевания вен нижних конечностей (ХЗВНК), которое помимо собственно варикозной болезни включает в себя изолированный ретикулярный варикоз и/или телеангиэктазии. Основой лечения ретикулярного варикоза считается склеротерапия. Однако данная процедура не лишена недостатков и побочных эффектов, что свидетельствует о важности поиска более безопасных методов терапии. Альтернативным лечением ретикулярного варикоза является интенсивный импульсный свет. Для иллюстрации эффективности и безопасности лечения ретикулярного варикоза методом IPL приводим описание клинического случая пациентки 73 лет с жалобами на видимую сеть сосудов темно-фиолетового и синеватого оттенков. После клинической оценки был выставлен диагноз ретикулярного варикоза / телеангиэктазий. На протяжении 3 лет пациентке ежегодно проводилось по 3 процедуры терапии интенсивным импульсным светом (IPL М22, Lumenis) с интервалом 1,5 месяца. Ретикулярный варикоз и телеангиэктазии пациентки практически полностью нивелировались уже после первого года приминения метода IPL терапии, прогрессии ХЗВНК обнаружено не было. Никаких побочных эффектов лечения не отмечалось, пациентка планирует продолжать терапию. Патогенетически применение интенсивного импульсного света в отношении терапии ретикулярного варикоза объясняется влиянием IPL на воспалительный процесс, синтез компонентов внеклеточного матрикса, а также дегрануляцию мастоцитов.

Varicose veins are the most common pathology of peripheral vessels. A broader concept is the term chronic venous insufficiency (CVI), which, in addition to varicose veins, includes telangiectasias and reticular veins. Sclerotherapy is considered as the basis of treatment for reticular veins. However, the procedure has its drawbacks and side effects, which indicates the importance of implementing safer treatment methods. An alternative treatment for reticular veins is intense pulsed light. To illustrate the effectiveness and safety of IPL treatment for reticular veins, we present a clinical case of a patient aged 73 years with complaints of dark purple and bluish vessels. After clinical evaluation, diagnosis of reticular veins/telangiectasias was made (C 1 according to the CEAP 2020 classification). Due to the patients’ refusal to undergo sclerotherapy, it was decided to perform IPL procedures (M22, Lumenis). The patient’s reticular veins and telangiectasias were almost completely leveled out after the second session of IPL therapy; there was also no progress of CVI. No side effects were noted. The pathogenetic application of intense pulsed light in the treatment of reticular veins can be explained by decreasing the inflammatory process, integrating extracellular matrix, as well as inhibition of mast cell degranulation.

ретикулярный варикозинтенсивный импульсный светварикозная болезньтелеангиэктазииreticular veinsintense pulsed lightvaricose veinstelangiectasiasReferencesАверьянов М.Ю. Хронические заболевания вен нижних конечностей: учебное пособие / М. Ю. Аверьянов, С. Г. Измайлов, Г. А. Измайлов.– Н. Новгород. ФГУИПП «Нижполиграф», 2002. 124 с.Averyanov M. Yu. Chronic diseases of the veins of the lower extremities: textbook / M. Yu. Averyanov, S. G. Izmailov, G. A. Izmailov.– N. Novgorod. FGUIPP «Nizhpoligraf», 2002. 124 p. (In Russ.).Evans CJ, Fowkes FG, Ruckley CV, Lee AJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J Epidemiol Community Health. 1999;53(3):149–153.Evans CJ, Fowkes FG, Ruckley CV, Lee AJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J Epidemiol Community Health. 1999;53(3):149–153.Савельев В. С. Флебология: руководство для врачей/ В. С. Савельев, В. А. Гологорский, А. И. Кириенко: под общ. ред. В. С. Савельева – М.: Медицина. 2001. 664с.Savelyev V. S. Phlebology: a guide for doctors / V. S. Savelyev, V. A. Gologorsky, A. I. Kiriyenko: under general. ed. V. S. Savelyeva – M.: Medicine. 2001. 664 p. (In Russ.).Nakano L. C., Cacione D. G., Baptista-Silva J.C., Flumignan R. L. Treatment for telangiectasias and reticular veins. Cochrane Database Syst Rev. 2017;2017: CD 012723.Nakano L. C., Cacione D. G., Baptista-Silva J.C., Flumignan R. L. Treatment for telangiectasias and reticular veins. Cochrane Database Syst Rev. 2017;2017: CD 012723.Porter J. M., Moneta G. L., on Chronic AICC, Disease V. Reporting standards in venous disease: an update. J Vasc Surg. 1995; 21: 635–645.Porter J. M., Moneta G. L., on Chronic AICC, Disease V. Reporting standards in venous disease: an update. J Vasc Surg. 1995; 21: 635–645.Biegeleisen K., Neilsen R. D., O’Shaughnessy A. Inadvertent intra-arterial injection complicating ordinary and ultrasound-guided sclerotherapy. J Dermatol Surg Oncol. 1993;19(10):953–958.Biegeleisen K., Neilsen R. D., O’Shaughnessy A. Inadvertent intra-arterial injection complicating ordinary and ultrasound-guided sclerotherapy. J Dermatol Surg Oncol. 1993;19(10):953–958.Круглова Л. С., Тарасова О. В., Ржевская Л. В. Применение лазеротерапии у пациентов с инволютивными изменениями кожи на фоне сахарного диабета 2 типа. Физиотерапевт. 2019. No 4. С. 30–37.Kruglova L. S., Tarasova O. V., Rzhevskaya L. V. Application of laser therapy in patients with involutive skin changes due to type 2 diabetes mellitus. Physiotherapist. 2019. No. 4. pp. 30–37. (In Russ.).Круглова Л. С., Котенко К. В., Корчажкина Н. Б., Турбовская С. Н. Физиотерапия в дерматологии. Москва, 2016.Kruglova L.S., Kotenko K.V., Korchazhkina N. B., Turbovskaya S. N. Physiotherapy in dermatology. Moscow, 2016. (In Russ.).Потекаев Н. Н., Круглова Л. С. Лазер в дерматологии и косметологии. Москва. МДВ. 2018. 280с.Potekaev N. N., Kruglova L. S. Laser in dermatology and cosmetology. Moscow. MDV. 2018. 280p. (In Russ.).Демидион Д. В., Юсова Ж. Ю., Круглова Л. С., Грекова Е. В., Корякин Д. А. Интенсивный импульсный свет в восстановлении сосудистого компонента в комбинированном протоколе с плазмаферезом как перспективный метод лечения редкого случая эритромелалгии в области лица. Физиотерапевт. 2023; 4.Demidion D. V., Yusova Zh. Yu., Kruglova L.S., Grekova E.V., Koryakin D.A. Intense pulsed light in the restoration of the vascular component in a combined protocol with plasmapheresis as a promising method for treating a rare case of erythromelalgia in the facial area. Physiotherapist. 2023; 4. (In Russ.).Юсова Ж.Ю., Круглова Л.С. Низкоинтенсивное лазерное излучение в комплексном лечении трофических нарушений. Физиотерапевт. 2015. № 2. С. 40–51.Yusova Zh. Yu., Kruglova L. S. Low-intensity laser radiation in the complex treatment of trophic disorders. Physiotherapist. 2015. No. 2. P. 40–51. (In Russ.).Micali G., Gerber P. A., Lacarrubba F., Schafer G. Improving treatment of erythemato-telangiectatic rosacea with laser and/or topical therapy through enhanced discrimination of its clinical features. Journal of Clinical and Aesthetic Dermatology 2016;9(7):30–39.Micali G., Gerber P. A., Lacarrubba F., Schafer G. Improving treatment of erythematotelangiectatic rosacea with laser and/or topical therapy through enhanced discrimination of its clinical features. Journal of Clinical and Aesthetic Dermatology 2016;9(7):30–39.Meesters A. A., Pitassi LHU, Campos V., Wolkerstorfer A., Dierickx C. C. Transcutaneous laser treatment of leg veins. Lasers Med Sci. 2014; 29(2):481–492.Meesters A. A., Pitassi LHU, Campos V., Wolkerstorfer A., Dierickx C. C. Transcutaneous laser treatment of leg veins. Lasers Med Sci. 2014; 29(2):481–492.Goldman M. P., Eckhouse S. Photothermal sclerosis of leg veins. Dermatol Surg. 1996;22(4):323–330.Goldman M. P., Eckhouse S. Photothermal sclerosis of leg veins. Dermatol Surg. 1996;22(4):323–330.Schroeter C. A., Wilder D., Reineke T, Thuerlimann W, Raulin C, Neumann HAM. Clinical significance of an intense, pulsed light source on leg telangiectasias of up to 1 mm diameter. Eur J Dermatol. 2000;7(1):38–42.Schroeter C. A., Wilder D., Reineke T, Thuerlimann W, Raulin C, Neumann HAM. Clinical significance of an intense, pulsed light source on leg telangiectasias of up to 1 mm diameter. Eur J Dermatol. 2000;7(1):38–42.Castro-Ferreira, R.; Cardoso, R.; Leite-Moreira, A.; Mansilha, A. The Role of Endothelial Dysfunction and Inflammation in Chronic Venous Disease. Ann. Vasc. Surg. 2018; (46): 380–393.Castro-Ferreira, R.; Cardoso, R.; Leite-Moreira, A.; Mansilha, A. The Role of Endothelial Dysfunction and Inflammation in Chronic Venous Disease. Ann. Vasc. Surg. 2018; (46): 380–393.Mosmiller, L.T.; Steele, K.N.; Shrader, C.D.; Petrone, A. B. Evaluation of inflammatory cell biomarkers in chronic venous insufficiency. Phlebology 2017; (32): 634–640.Mosmiller, L.T.; Steele, K.N.; Shrader, C.D.; Petrone, A. B. Evaluation of inflammatory cell biomarkers in chronic venous insufficiency. Phlebology 2017; (32): 634–640.Ojdana, D.; Safiejko, K.; Lipska, A.; Sacha, P.; Wieczorek, P.; Radziwon, P.; Dadan, J.; Tryniszewska, E. The inflammatory reaction during chronic venous disease of lower limbs. Folia Histochem. Cytobiol. 2009; (47): 185–189.Ojdana, D.; Safiejko, K.; Lipska, A.; Sacha, P.; Wieczorek, P.; Radziwon, P.; Dadan, J.; Tryniszewska, E. The inflammatory reaction during chronic venous disease of lower limbs. Folia Histochem. Cytobiol. 2009; (47): 185–189.Ono, T.; Bergan, J.J.; Schmid-Schonbein, G.W.; Takase, S. Monocyte infiltration into venous valves. J. Vasc. Surg. 1998; (27): 158–166.Ono, T.; Bergan, J.J.; Schmid-Schonbein, G.W.; Takase, S. Monocyte infiltration into venous valves. J. Vasc. Surg. 1998; (27): 158–166.Gao Y. F., Liu R. J., Li Y. X., Huang C., Liu Y. Y., Hu C. X., Qi H. Comparison of anti-inflammatory effects of intense pulsed light with tobramycin/dexamethasone plus warm compress on dry eye associated meibomian gland dysfunction. Int J Ophthalmol. 2019; 12 (11): 1708–1713.Gao Y. F., Liu R. J., Li Y. X., Huang C., Liu Y. Y., Hu C. X., Qi H. Comparison of anti-inflammatory effects of intense pulsed light with tobramycin/dexamethasone plus warm compress on dry eye associated meibomian gland dysfunction. Int J Ophthalmol. 2019; 12 (11): 1708–1713.Zeng H., Gong L. A Review of Applications and Intracellular Mechanisms of Intense Pulsed Light in Eyelid Inflammatory Diseases. Photobiomodul Photomed Laser Surg. 2023; 41 (3): 104–119.Zeng H., Gong L. A Review of Applications and Intracellular Mechanisms of Intense Pulsed Light in Eyelid Inflammatory Diseases. Photobiomodul Photomed Laser Surg. 2023; 41 (3): 104–119.Cai Y., Zhu Y., Wang Y., Xiang W. Intense pulsed light treatment for inflammatory skin diseases: a review. Lasers Med Sci. 2022; 37 (8): 3085–3105.Cai Y., Zhu Y., Wang Y., Xiang W. Intense pulsed light treatment for inflammatory skin diseases: a review. Lasers Med Sci. 2022; 37 (8): 3085–3105.Xie L., Song W., Dong W., et al. Indirect Application of Intense Pulsed Light Induces Therapeutic Effects on Experimental Murine Meibomian Gland Dysfunction. Front Med (Lausanne). 2022; 9: 923280.Xie L., Song W., Dong W., et al. Indirect Application of Intense Pulsed Light Induces Therapeutic Effects on Experimental Murine Meibomian Gland Dysfunction. Front Med (Lausanne). 2022; 9: 923280.Buján J., Jurado F., Gimeno M. J., et al: Changes in metalloproteinase (MMP-1, MMP-2) expression in the proximal region of the varicose saphenous vein in young subjects. Phlebology. 2000; 15: 64–70.Buján J., Jurado F., Gimeno M. J., et al: Changes in metalloproteinase (MMP-1, MMP-2) expression in the proximal region of the varicose saphenous vein in young subjects. Phlebology. 2000; 15: 64–70.Cao Y., Huo R., Feng Y., et al. Effects of intense pulsed light on the biological properties and ultrastructure of skin dermal fibroblasts: potential roles in photoaging. Photomed Laser Surg. 2011; 29 (5): 327–332.Cao Y., Huo R., Feng Y., et al. Effects of intense pulsed light on the biological properties and ultrastructure of skin dermal fibroblasts: potential roles in photoaging. Photomed Laser Surg. 2011; 29 (5): 327–332.Prieto V.G., Diwan A.H., Shea C.R., Zhang P., Sadick N.S. Effects of intense pulsed light and the 1,064 nm Nd: YAG laser on sun-damaged human skin: histologic and immunohistochemical analysis. Dermatol Surg. 2005; 31 (5): 522–525.Prieto V.G., Diwan A.H., Shea C.R., Zhang P., Sadick N.S. Effects of intense pulsed light and the 1,064 nm Nd: YAG laser on sun-damaged human skin: histologic and immunohistochemical analysis. Dermatol Surg. 2005; 31 (5): 522–525.Kakkos S. K., Zolota V. G., Peristeropoulou P., Apostolopoulou A., Geroukalos G., Tsolakis I.A. Increased mast cell infiltration in familial varicose veins: pathogenetic implications? Int Angiol. 2003 Mar; 22 (1): 43–49.Kakkos S. K., Zolota V. G., Peristeropoulou P., Apostolopoulou A., Geroukalos G., Tsolakis I.A. Increased mast cell infiltration in familial varicose veins: pathogenetic implications? Int Angiol. 2003 Mar; 22 (1): 43–49.Jiang P., Liu Y., Zhang J., Liu Y., Li M., Tao M., Zhang Y., Tang Z., Liu W., Xu Y. Mast cell stabilization: new mechanism underlying the therapeutic effect of intense pulsed light on rosacea. Inflamm Res. 2023; 72 (1): 75–88.Jiang P., Liu Y., Zhang J., Liu Y., Li M., Tao M., Zhang Y., Tang Z., Liu W., Xu Y. Mast cell stabilization: new mechanism underlying the therapeutic effect of intense pulsed light on rosacea. Inflamm Res. 2023; 72 (1): 75–88.Pimentel C.L., Rodriguez-Salido M.J. Pigmentation due to stasis dermatitis treated successfully with a noncoherent intense pulsed light source. Dermatol Surg. 2008; 34 (7): 950–951.Pimentel C.L., Rodriguez-Salido M.J. Pigmentation due to stasis dermatitis treated successfully with a noncoherent intense pulsed light source. Dermatol Surg. 2008; 34 (7): 950–951.Kim H. J., Lee G. W., Son J. W., Shin K., Kim H. S., Ko H. C., Kim B. S., Kim M. B. Venous Insufficiency is a Clear Provoker of Pigmented Purpuric Dermatosis. Ann Dermatol. 2022; 34 (1): 34–39.Kim H. J., Lee G. W., Son J. W., Shin K., Kim H. S., Ko H. C., Kim B. S., Kim M. B. Venous Insufficiency is a Clear Provoker of Pigmented Purpuric Dermatosis. Ann Dermatol. 2022; 34 (1): 34–39.Demidion D.V., Olisova O.Y., Kostenko A.Y., Koriakin D.A., Grekova E.V. Complete clearance of Schamberg disease lesions with intense pulsed light. Photodermatol Photoimmunol Photomed. 2023; 39 (1): 78–81.Demidion D.V., Olisova O.Y., Kostenko A.Y., Koriakin D.A., Grekova E.V. Complete clearance of Schamberg disease lesions with intense pulsed light. Photodermatol Photoimmunol Photomed. 2023; 39 (1): 78–81.National Institute for Health and Care Excellence. Ultrasound-guided foam sclerotherapy for varicose veins. https://www.nice.org.uk/guidance/ipg440 (accessed 14 March 2024).National Institute for Health and Care Excellence. Ultrasound-guided foam sclerotherapy for varicose veins. https://www.nice.org.uk/guidance/ipg440 (accessed 14 March 2024).

The authors declare that there are no conflicts of interest present.