mvjrМедицинский вестник Юга РоссииMedical Herald of the South of Russia2219-80752618-7876The Rostov State Medical University10.21886/2219-8075-2023-14-1-5-12mvjr-1746Research ArticleАКУШЕРСТВО И ГИНЕКОЛОГИЯOBSTETRICS AND GYNECOLOGYВлияние комбинированной антиоксидантной и фотодинамической терапии на эмоциональное состояние пациенток с краурозом вульвыEffect of combined antioxidant and photodynamic therapy on the emotional state of patients with vulvar craurosishttps://orcid.org/0000-0003-1129-6639КиселеваЕ. А.KiselevaE. A.

Киселева Екатерина Александровна, ассистент кафедры акушерства и гинекологии 

Томск

Ekaterina A. Kiseleva, Assistant of the Department of Obstetrics and Gynecology 

Tomsk

rhapsody@t-sk.ruhttps://orcid.org/0000-0002-7541-0317МахмутходжаевА. Ш.MakhmutkhodzhaevA. Sh.

Махмутходжаев Алишер Шавкатович, д.м.н., профессор кафедры акушерства и гинекологии 

Томск

Alisher Sh. Makhmutkhodzhaev, Dr. Sci. (Med.), Professor of the Department of Obstetrics and Gynecology 

Tomsk

alisher_sh_m@mail.ruhttps://orcid.org/0000-0002-3869-1906МихеенкоГ. А.MikheenkoG. A.

Михеенко Галина Александровна, д.м.н., профессор кафедры акушерства и гинекологии 

Томск

Galina A. Mikheenko, Dr. Sci. (Med.), Professor of the Department of Obstetrics and Gynecology 

Tomsk

gmikheenko@gmail.comСибирский государственный медицинский университетРоссияSiberian State Medical UniversityRussian Federation202327032023141512Copyright © Киселева Е.А., Махмутходжаев А.Ш., Михеенко Г.А., 20232023Киселева Е.А., Махмутходжаев А.Ш., Михеенко Г.А.Kiseleva E.A., Makhmutkhodzhaev A.S., Mikheenko G.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.medicalherald.ru/jour/article/view/1746

Цель: изучение влияния комбинированной антиоксидантной и фотодинамической терапии (ФДТ) на эмоциональное состояние пациенток с краурозом вульвы. Материалы и методы: в исследовании участвовали 90 женщин с краурозом вульвы, которые были рандомизированы на три группы по 30 участниц. В первой группе лечение включало фотодинамическую терапию (ФДТ) с последующим назначением антиоксиданта Этилметилгидроксипиридина сукцината в течение одного месяца. Участницы второй группы получали только ФДТ. Пациенткам третьей группы проводился курс лазеротерапии на область промежности. Оценка эмоционального состояния участниц осуществлялась посредством Госпитальной шкалы тревоги и депрессии (HADS) до начала и в завершении лечения, через 1, 6 и 12 месяцев после окончания терапии. Результаты: до начала лечения участницы из трёх групп набрали сходное количество баллов по HADS. В ходе наблюдений наилучший результат по шкалам тревоги и депрессии был зафиксирован у пациенток, получавших комбинированную антиоксидантную и фотодинамическую терапию. Через месяц приёма Этилметилгидроксипиридина сукцината сумма баллов по HADS у этих женщин была значимо ниже, чем в группах сравнения. Далее эти пациентки продолжали демонстрировать лучшие показатели по шкале депрессии. Суммы баллов по шкале тревоги в данной группе были сопоставимы с таковыми у пациенток, получавших только ФДТ. Заключение: комбинированная антиоксидантная и фотодинамическая терапия, включающая Этилметилгидроксипиридина сукцинат, оказывает более выраженное позитивное влияние на эмоциональный фон пациенток с краурозом вульвы в сравнении с ФДТ и лазеротерапией. 

Objective: studying of the effect of combined antioxidant and photodynamic therapy (PDT) on the emotional state of patients with vulvar kraurosis. Materials and methods: the study involved 90 women with vulvar kraurosis who were randomized into three groups of 30 participants. In the first group, treatment included photodynamic therapy (PDT) followed by administration of the antioxidant Ethylmethylhydroxypyridine succinate for one month. Participants in the second group received only PDT. Patients of the third group underwent a course of laser therapy on the perineal region. The emotional state of the participants was assessed using the Hospital Anxiety and Depression Scale (HADS) before and at the end of treatment, 1, 6 and 12 months after the end of therapy. Results: before treatment, participants from the three groups scored a similar number of HADS scores. In the course of observations, the best result on the scales of anxiety and depression was recorded in patients who received combined antioxidant and photodynamic therapy. After a month of taking Ethylmethylhydroxypyridine succinate, the HADS score in these women was significantly lower than in the comparison groups. Further, these patients continued to show better scores on the depression scale. The total scores on the anxiety scale in this group were comparable to those in patients who received only PDT. Conclusion: combined antioxidant and photodynamic therapy, including Ethylmethylhydroxypyridine succinate, has a more pronounced positive effect on the emotional background of patients with vulvar kraurosis in comparison with PDT and laser therapy.

крауроз вульвысклероатрофический лихен вульвыфотодинамическая терапияантиоксидантная терапияvulvar kraurosisvulvar lichen sclerosusphotodynamic therapyantioxidant therapyИсследование не имело спонсорской поддержки.The study did not have sponsorship.ReferencesGagne H, Dalton V, Haefner H, Patel DA. Vulvar pain and sexual function in patients with lichen sclerosus. J Reprod Med. 2007;52:121-122.Gagne H, Dalton V, Haefner H, Patel DA. Vulvar pain and sexual function in patients with lichen sclerosus. J Reprod Med. 2007;52:121-122.Haefner HK, Aldrich NZ, Dalton VK, Gagné HM, Marcus SB, et al. The impact of vulvar lichen sclerosus on sexual dysfunction. J Womens Health (Larchmt). 2014;23(9):765-70. https://doi.org/10.1089/jwh.2014.4805Haefner HK, Aldrich NZ, Dalton VK, Gagné HM, Marcus SB, et al. The impact of vulvar lichen sclerosus on sexual dysfunction. J Womens Health (Larchmt). 2014;23(9):765-70. https://doi.org/10.1089/jwh.2014.4805Krapf JM, Mitchell L, Holton MA, Goldstein AT. Vulvar Lichen Sclerosus: Current Perspectives. Int J Womens Health. 2020;12:11-20. https://doi.org/10.2147/IJWH.S191200Krapf JM, Mitchell L, Holton MA, Goldstein AT. Vulvar Lichen Sclerosus: Current Perspectives. Int J Womens Health. 2020;12:11-20. https://doi.org/10.2147/IJWH.S191200Lee A, Bradford J, Fischer G. Long-term Management of Adult Vulvar Lichen Sclerosus: A Prospective Cohort Study of 507 Women. JAMA Dermatol. 2015;151(10):1061-7. https://doi.org/10.1001/jamadermatol.2015.0643Lee A, Bradford J, Fischer G. Long-term Management of Adult Vulvar Lichen Sclerosus: A Prospective Cohort Study of 507 Women. JAMA Dermatol. 2015;151(10):1061-7. https://doi.org/10.1001/jamadermatol.2015.0643Джангишиева Е.К., Уварова Е.В., Батырова З.К. Склерозирующий лихен вульвы: современный взгляд на клинические проявления, диагностику и методы лечения (аналитический обзор). Репродуктивное здоровье детей и подростков. 2018;14(3):34-50. https://doi.org/10.24411/1816-2134-2018-13003Dzhangishieva A.K., Uvarova E.V., Batyrova Z.K. Lichen sclerosus: modern view on clinical manifestations, diagnosis and treatment methods (analytical review). Pediatric and Adolescent Reproductive Health. 2018;14(3):34-50. (In Russ.) https://doi.org/10.24411/1816-2134-2018-13003Зароченцева Н.В., Джиджихия Л.К. Склероатрофический лихен вульвы: современный взгляд на проблему. Российский вестник акушера-гинеколога. 2018;18(6):41-50. https://doi.org/10.17116/rosakush20181806141Zarochentseva N.V., Dzhidzhikhia L.K. Lichen sclerosus et atrophicus: modern view on the problem. Russian bulletin of obstetrician-gynaecologist. 2018;18(6):41-50. (In Russ.) https://doi.org/10.17116/rosakush20181806141Солопова А.Г., Ачкасов Е.Е., Макацария А.Д., Москвичёва В.С., Иванов А.Е. Психоэмоциональный портрет пациенток со склерозирующим лихеном вульвы. Акушерство, Гинекология и Репродукция. 2020;14(2):203-210. https://doi.org/10.17749/2313-7347/ob.gyn.rep.2020.106Solopova A.G., Achkasov E.E., Makatsariya A.D., Moskvichyova V.S., Ivanov A.E. Psycho-emotional profile of patients with vulvar lichen sclerosus. Obstetrics, Gynecology and Reproduction. 2020;14(2):203-210. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2020.106Iannaccone AM, Verrusio G, Iurassich S. Female lichen sclerosus genitalis: discomfort and adaptation. Clin Ter. 2016;167(4):113-20. https://doi.org/10.7417/CT.2016.1940Iannaccone AM, Verrusio G, Iurassich S. Female lichen sclerosus genitalis: discomfort and adaptation. Clin Ter. 2016;167(4):113-20. https://doi.org/10.7417/CT.2016.1940Nair PA. Vulvar Lichen Sclerosus et Atrophicus. J Midlife Health. 2017;8(2):55-62. https://doi.org/10.4103/jmh.JMH_13_17Nair PA. Vulvar Lichen Sclerosus et Atrophicus. J Midlife Health. 2017;8(2):55-62. https://doi.org/10.4103/jmh.JMH_13_17Шарапова Л.Е., Шульдяков А.А., Ляпина Е.П., Филлипов А.Г. Параметры качества жизни у больных хроническими дистрофическими заболеваниями вульвы, совершенствование комплексной терапии. Фундаментальные исследования. 2011;9-3:570-574. eLIBRARY ID: 16754716Sharapova L.E., Shuldyakov A.A., Lyapina E.P., Filippov A.G. Life quality parameters in patients with chronic degenerative disease of the vulva, the improvement of treatment. Fundamental research. 2011;9-3:570-574. (in Russ.) eLIBRARY ID: 16754716Kolitz E, Gammon L, Mauskar M. Vulvar lichen sclerosus in women of reproductive age. Proc (Bayl Univ Med Cent). 2021;34(3):349-351. https://doi.org/10.1080/08998280.2021.1885093Kolitz E, Gammon L, Mauskar M. Vulvar lichen sclerosus in women of reproductive age. Proc (Bayl Univ Med Cent). 2021;34(3):349-351. https://doi.org/10.1080/08998280.2021.1885093Rees S. Living with vulval lichen sclerosus: Unheard stories and silenced voices. Case Rep Womens Health. 2020;29:e00271. https://doi.org/10.1016/j.crwh.2020.e00271Rees S. Living with vulval lichen sclerosus: Unheard stories and silenced voices. Case Rep Womens Health. 2020;29:e00271. https://doi.org/10.1016/j.crwh.2020.e00271Brauer M, van Lunsen R, Burger M, Laan E. Motives for Vulvar Surgery of Women with Lichen Sclerosus. J Sex Med. 2015;12(12):2462-73. https://doi.org/10.1111/jsm.13052Brauer M, van Lunsen R, Burger M, Laan E. Motives for Vulvar Surgery of Women with Lichen Sclerosus. J Sex Med. 2015;12(12):2462-73. https://doi.org/10.1111/jsm.13052Burrows LJ, Creasey A, Goldstein AT. The treatment of vulvar lichen sclerosus and female sexual dysfunction. J Sex Med. 2011;8(1):219-22. https://doi.org/10.1111/j.1743-6109.2010.02077.xBurrows LJ, Creasey A, Goldstein AT. The treatment of vulvar lichen sclerosus and female sexual dysfunction. J Sex Med. 2011;8(1):219-22. https://doi.org/10.1111/j.1743-6109.2010.02077.xLansdorp CA, van den Hondel KE, Korfage IJ, van Gestel MJ, van der Meijden WI. Quality of life in Dutch women with lichen sclerosus. Br J Dermatol. 2013;168(4):787-93. https://doi.org/10.1111/bjd.12137Lansdorp CA, van den Hondel KE, Korfage IJ, van Gestel MJ, van der Meijden WI. Quality of life in Dutch women with lichen sclerosus. Br J Dermatol. 2013;168(4):787-93. https://doi.org/10.1111/bjd.12137Pinelli S, D’Erme AM, Lotti T. Management of sexual dysfunction due to vulvar lichen sclerosus in postmenopausal women. Dermatol Ther. 2013;26(1):79-82. https://doi.org/10.1111/j.1529-8019.2012.01536.xPinelli S, D’Erme AM, Lotti T. Management of sexual dysfunction due to vulvar lichen sclerosus in postmenopausal women. Dermatol Ther. 2013;26(1):79-82. https://doi.org/10.1111/j.1529-8019.2012.01536.xvan Cranenburgh OD, Nijland SBW, Lindeboom R, de Korte J, de Rie MA, et al. Patients with lichen sclerosus experience moderate satisfaction with treatment and impairment of quality of life: results of a cross-sectional study. Br J Dermatol. 2017;176(6):1508-1515. https://doi.org/10.1111/bjd.15125van Cranenburgh OD, Nijland SBW, Lindeboom R, de Korte J, de Rie MA, et al. Patients with lichen sclerosus experience moderate satisfaction with treatment and impairment of quality of life: results of a cross-sectional study. Br J Dermatol. 2017;176(6):1508-1515. https://doi.org/10.1111/bjd.15125Murphy R. Lichen sclerosus. Dermatol Clin. 2010;28(4):707-15. https://doi.org/10.1016/j.det.2010.07.006Murphy R. Lichen sclerosus. Dermatol Clin. 2010;28(4):707-15. https://doi.org/10.1016/j.det.2010.07.006Pérez-López FR, Vieira-Baptista P. Lichen sclerosus in women: a review. Climacteric. 2017;20(4):339-347. https://doi.org/10.1080/13697137.2017.1343295Pérez-López FR, Vieira-Baptista P. Lichen sclerosus in women: a review. Climacteric. 2017;20(4):339-347. https://doi.org/10.1080/13697137.2017.1343295Borghi A, Corazza M. Novel Therapeutic Approaches and Targets for Treatment of Vulvar Lichen Sclerosus. Curr Pharm Biotechnol. 2021;22(1):99-114. https://doi.org/10.2174/1389201021666200516154310Borghi A, Corazza M. Novel Therapeutic Approaches and Targets for Treatment of Vulvar Lichen Sclerosus. Curr Pharm Biotechnol. 2021;22(1):99-114. https://doi.org/10.2174/1389201021666200516154310Criscuolo AA, Schipani C, Cannizzaro MV, Messinese S, Chimenti S, et al. New therapeutic approaches in the treatment of anogenital lichen sclerosus: does photodynamic therapy represent a novel option? G Ital Dermatol Venereol. 2017;152(2):117-121. https://doi.org/10.23736/S0392-0488.16.05272-XCriscuolo AA, Schipani C, Cannizzaro MV, Messinese S, Chimenti S, et al. New therapeutic approaches in the treatment of anogenital lichen sclerosus: does photodynamic therapy represent a novel option? G Ital Dermatol Venereol. 2017;152(2):117-121. https://doi.org/10.23736/S0392-0488.16.05272-XKing M, Rubin R, Goldstein AT. Current uses of surgery in the treatment of genital pain. Current Sexual Health Rep. 2014;6(4):252-258. https://doi.org/10.1007/s11930-014-0032-8King M, Rubin R, Goldstein AT. Current uses of surgery in the treatment of genital pain. Current Sexual Health Rep. 2014;6(4):252-258. https://doi.org/10.1007/s11930-014-0032-8Lewis FM, Tatnall FM, Velangi SS, Bunker CB, Kumar A, et al. British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018. Br J Dermatol. 2018;178(4):839-853. https://doi.org/10.1111/bjd.16241. PMID: 29313888.Lewis FM, Tatnall FM, Velangi SS, Bunker CB, Kumar A, et al. British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018. Br J Dermatol. 2018;178(4):839-853. https://doi.org/10.1111/bjd.16241. PMID: 29313888.Maździarz A, Osuch B, Kowalska M, Nalewczyńska A, Śpiewankiewicz B. Photodynamic therapy in the treatment of vulvar lichen sclerosus. Photodiagnosis Photodyn Ther. 2017;19:135-139. https://doi.org/10.1016/j.pdpdt.2017.05.011Maździarz A, Osuch B, Kowalska M, Nalewczyńska A, Śpiewankiewicz B. Photodynamic therapy in the treatment of vulvar lichen sclerosus. Photodiagnosis Photodyn Ther. 2017;19:135-139. https://doi.org/10.1016/j.pdpdt.2017.05.011Osiecka BJ, Jurczyszyn K, Nockowski P, Murawski M, Ziółkowski P. Photodynamic therapy with green light for the treatment of vulvar lichen sclerosus - Preliminary results. Photodiagnosis Photodyn Ther. 2017;17:185-187. https://doi.org/10.1016/j.pdpdt.2016.11.015Osiecka BJ, Jurczyszyn K, Nockowski P, Murawski M, Ziółkowski P. Photodynamic therapy with green light for the treatment of vulvar lichen sclerosus - Preliminary results. Photodiagnosis Photodyn Ther. 2017;17:185-187. https://doi.org/10.1016/j.pdpdt.2016.11.015Ozog DM, Rkein AM, Fabi SG, Gold MH, Goldman MP, et al. Photodynamic Therapy: A Clinical Consensus Guide. Dermatol Surg. 2016;42(7):804-27. Erratum in: Dermatol Surg. 2017;43(2):319. PMID: 27336945. https://doi.org/10.1097/DSS.0000000000000800Ozog DM, Rkein AM, Fabi SG, Gold MH, Goldman MP, et al. Photodynamic Therapy: A Clinical Consensus Guide. Dermatol Surg. 2016;42(7):804-27. Erratum in: Dermatol Surg. 2017;43(2):319. PMID: 27336945. https://doi.org/10.1097/DSS.0000000000000800Tasker F, Kirby L, Grindlay DJC, Lewis F, Simpson RC. Laser therapy for genital lichen sclerosus: A systematic review of the current evidence base. Skin Health Dis. 2021;1(3):e52. https://doi.org/10.1002/ski2.52Tasker F, Kirby L, Grindlay DJC, Lewis F, Simpson RC. Laser therapy for genital lichen sclerosus: A systematic review of the current evidence base. Skin Health Dis. 2021;1(3):e52. https://doi.org/10.1002/ski2.52Prodromidou A, Chatziioannou E, Daskalakis G, Stergios K, Pergialiotis V. Photodynamic Therapy for Vulvar Lichen Sclerosus-A Systematic Review. J Low Genit Tract Dis. 2018;22(1):58-65. https://doi.org/10.1097/LGT.0000000000000362Prodromidou A, Chatziioannou E, Daskalakis G, Stergios K, Pergialiotis V. Photodynamic Therapy for Vulvar Lichen Sclerosus-A Systematic Review. J Low Genit Tract Dis. 2018;22(1):58-65. https://doi.org/10.1097/LGT.0000000000000362Pai VV, Shukla P, Kikkeri NN. Antioxidants in dermatology. Indian Dermatol Online J. 2014;5(2):210-4. https://doi.org/10.4103/2229-5178.131127Pai VV, Shukla P, Kikkeri NN. Antioxidants in dermatology. Indian Dermatol Online J. 2014;5(2):210-4. https://doi.org/10.4103/2229-5178.131127Смулевич А.Б. Депрессии в общей медицине. Москва: МИА; 2007.Smulevich A.B. Depressii v obshhej medicine. Moscow: MIA; 2007. (in Russ.)

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