Gel-ultraphonophoresis for patients with scarring on the skin: results of comparative prospective intervention study

INTRODUCTION. In modern realities of peace and military trauma there are an increasing number of scar skin defects, often accompanied by pronounced subjective sensations and tissue functional limitations. An urgent task is the scientific substantiation of effective methods of their correction.

OBJECTIVE. To determine healing effects and safety of using ultraphonophoresis of enzyme gel with high transcutaneous and proteolytic activity in patients with scarring on the skin.

MATERIALS AND METHODS. There was examination of 82 patients with emerging (N=21 study group, N=16 comparison group) and mature (N=25 study group, N=20 comparison group) scar skin of different localizations at the rehabilitation stage after various injuries, burns, removal of skin neoplasms. The study applied clinical and functional methods in the assessment of scar tissue, medical and sociological methods in evaluating patients’ quality of life and safety profile.

RESULTS. There were improved clinical indicators and functional skin properties in the scar area, a significant regression of subjective sensations, an increased quality of life score, more pronounced in the study groups. Dynamics of clinical indicators is more expressed in group 1 and group 3. Vascularization values before and after treatment in the groups were: in group 1 and 3 before treatment - 6,4±0,93 and 5,8±0,25, after - 3,0±0,24 and 2,7±0,31, respectively; in group 2 the values before and after treatment were 5,6±0,26 и 4,2±0,62, respectively, in group 4 – before treatment 4,9±0,53, after - 4,1±0,48. As a result of dynamics of the quality of life indicators, a more significant improvement was found in the study groups with respect to the comparison groups. In the group with emerging scars the sum of points before treatment was 20,4±0,3, after treatment - 12,4±0,3; in the comparison group - 18,7±0,5 and 13,4±0,5 before and after treatment, respectively; in the group with mature scars: before treatment - 23,6±0,3, after - 13,7±0,4; in the comparison group - 21,3±0,4 и 16,2±0,5 before and after treatment, respectively. A favorable safety profile of treatment was defined: adverse events (tingling, burning) were transient and fully cupped after the procedure.

DISCUSSION. Ultraphonophoresis, one of the man methods in the transdermal delivery, contributes to changing the epidermal barrier permeability for molecules of various drugs as well as potentiation for actions of anti-scarring agents at different stages of emerging and existing scar skin defects.

CONCLUSION. Ultraphonophoresis of the enzyme gel with a high transcutaneous and proteolytic activity has fibromodulating and sedative curative effects in patients with scarring skin of different genesis and duration.

marine medicine, skin scar, ultraphonophoresis of the enzyme gel with a high transcutaneous and proteolytic activity, rehabilitation

1. Shen W., Chen L., Tian F. Research progress of scar repair and its influence on physical and mental health // Int J Burns Trauma. – 2021. – Vol. 11, № 6. – P.442-446.

2. Adaskevich V.P. Diagnostic index in dermatology (Diagnosticheskiye indeksy v dermatologii). Moscow: Med Science, 2004.- P.165.

3. Surkichin, S.I. The influence of foresis methods on the therapy of scar deformities of the skin // Medical Alphabet – 2020. – № 4.

4. Stenko A.G. [et al.]. Clinical experience of the use of electrode pharmacophoresis in the treatment and prevention of scarring of the skin. // Clinical dermatology and venereology. - 2014. – Vol.12, No. 1. – Р.63-67.

5. Kruglova L.S., Techieva S.G., Stenko A.G., Shmatova A.A. Modern view on innovative methods of therapy of pathological scar deformities. // Clinical dermatology and venereology. - 2014. – Vol.12, No. 5. – Р.105‑116.

6. Y. Xue, C. Qi, Y. Dong. Poly (γ-glutamic acid)/chitooligo-saccharide/papain hydrogel prevents hypertrophic scar during skin wound healing // J Biomed Mater Res B Appl Biomater. – 2021. – Vol. 109, № 11.

7. Ogawa R., Dohi T., Tosa M. et al. The Latest Strategy for Keloid and Hypertrophic Scar Prevention and Treatment: The Nippon Medical School (NMS) Protocol // Journal of Nippon Medical School. 2020. – P. JNMS. 2021-88-106

8. Clinical guidelines of the Ministry of Health of the Russian Federation: rubricator of clinical guidelines on the website http://cnikvi.ru/clinical guidelines for the management of acne patients. ICD-10 class: L91. Diseases of the skin and subcutaneous tissue. (Klinicheskiye rekomendatsii)- 2022.

9. Vercelli S. et al. Clinimetric properties and clinical utility in rehabilitation of postsurgical scar rating scales: a systematic review // International Journal of Rehabilitation Research. – 2015. – V. 38. – №. 4. – P. 279-286. doi: 10.1097/MRR.0000000000000134.

10. Minaev S.V., Vladimirova O.V. Multicenter study of the effectiveness of anti-scar therapy in patients of different age groups // Surgery. Journal named after N.I. Pirogov. – 2020. – No. 9. – Р. 51-58.

11. Salisty P.V., Saidgalin G.Z., Biktashev V.S., Faizyanov A.A., Prikhodko I.G., Emelyanov A.A., Makhotina M.V. Experience with the use of the drug "Karipain Scar" in the children's burn department. Children's surgery. - 2021. - V.25, No. 5. - P.346-351.

12. Kurganskaya I.G. Complex correction of pathological skin scars: disse. …candidate of medical sciences: 14.01.10: defended 12.09.11: approved. 06.10.11. St. Petersburg., 2011. 149 p.

13. Karpova T.N. Fermenkol electro- and ultraphonophoresis in the correction of skin scars: abstract for the competition an academic degree candidate medical science: 14.00.51 - St. Petersburg, 2009. 18 p.

14. Sorokina KI, Ufimtseva MA, Simonova NV, Beresneva TA, Paskevich PV. Topical enzymatic therapy of atrophic acne scars. Klinicheskaya Dermatologiya i Venerologiya. - 2022. - V.21(6). – P.840‑848.

15. Prikhodko E.V. The use of drugs "Karipain" for conservative therapy of intervertebral hernias, osteochondrosis and diseases of the joints // Practical medicine. - 2013. - V.1, No. 66. - S.202-203.

16. Zhanturina A.A. Аpplication of electrophoresis with the enzyme preparation "Кaripain" in the treatment of patients with herniated intervertebral disks //Medicine. - 2014. - V.2, No. 20. - P.12-13.

17. Salisty P.V., Biktashev V.S., Saidgalin G.Z., Faizyanov A.A. Experience in the treatment of scars with caripain scar. // Russian Bulletin of Pediatric Surgery, Anesthesiology and Resuscitation. - 2022. - T.12, No.S. - P.125.

18. Admakin, A.L. Burn scars: features of development, diagnosis and correction by conservative methods // Clinical Medicine. - 2018. - T. 96, No. 1.

19. Ogawa R., Dohi T., Tosa M. et al. The Latest Strategy for Keloid and Hypertrophic Scar Prevention and Treatment: The Nippon Medical School (NMS) Protocol. Journal of Nippon Medical School. 2020. – P. JNMS. 2021-88-106

20. Huang C., Ogawa R. Systemic factors that shape cutaneous pathological scarring. // The FASEB Journal. – 2020. - V. 34. https://doi.org/10.1096/fj.202001157R

21. Obraztsova A.E. Morphological and functional features of the reparative process in the healing of skin wounds, taking into account possible cicatricial deformities // Bulletin of new medical technologies. - 2021. - No. 1.