Systemic enzyme therapy in the treatment of neurodermitis (atopic
dermatitis) patients
Abstract: Combined hydrolytic enzymes are used for different
diseases treatment for years. Before more than 25 years M. Wolf and
K. Ransberger successfully introduced the method of systemic
enzymotherapy. However there are not publications in Russian and
foreign medical sources devoted to application of the method in
dermatology, in particular for neurodermitis (also known as atopic
dermatitis — AtD) treatment. Because the course of many dermatosi
has chronic and relapsing character and traditional basic therapy
schema have not the desirable clincal effects, the new drugs and
treatment methods development is of great importance. These new
drugs and methods have to control successfully the course of the
illnesses, preventing complications and having minimal side effects.
We decided to test the therapeutical effectiveness and properties of
Wobenzym drug (the first in the line of systemic enzymotherapy
drugs) at AtD patients treatment.
The study was conducted at Skin Diseases Clinic of Military Medicine
Academy (Sankt-Petersburg, Russia) for 12 months as open test. There
was 18 patients with AtD in the treatment groups. The patients
received a monotherapy with Wobenzym as well as combined treatment
with basic treatment schema. The control group of 15 patients of
similar age and clinical characteristics was formed for the clinical
results evaluation and comparative analysis.
Our study demonstrated, that Wobenzym application positively
influence all the AtD manifestations and allows the more stable
remission. All the patients endured the drug well.
Introduction: The Wobenzym is known as antitumor, immunomodulative,
thrombolytic and secondary analgetical agent. It is known also that
systemic enzymotherapy drugs can decompose and eleminate circulating
immunocomplexes, stopping by the fact the development of autoimmune
diseases. It allowed to conduct a study of its therapeutical
activity on AtD patients treatment at the Skin Diseases Clinic of
Military Medicine Academy (may 1997 - may 1998) with due regard to
the comprehensive therapeutical principle — reliability and
effectiveness with good its endurance by the patients.
The problem of AtD is still actual in dermatology due to the extent
to which the dermatosis has been disseminated (from 5 to 30% in the
whole spectrum of skin pathology according to the different data)
and insufficient effectiveness of existing treatment methods6, 12.
It is known that AtD is a chronic dermatosis with tendencies to
acute conditions at spring and autumn. Its etiology is polyfactoral,
and its pathogenesis is not clear yet. At present times the opinion
is often heard that the neurogen disfunctions may have secondary
character. The studies of Toropova and Sinyavskaya (1986) have shown
the role of inborn genetically mediated fermentopathy of alimentary
canal (AC) in children, which causes the state of manifested endogen
intoxication14,15.
Ferment insufficiency of the stomach and intestine with
disbacteriosis and diskinesy of gall ducts is apparent by failure of
important food ingedients assimilation and by the synthesis of
autoaggressive complexes of toxic and autoallergen character —
circulating immune complexes (CIC). Neuroendocrine disfunctions,
pathological state of the callicrein-chinine system, break of the
cateholamines production and their activity occur at these
conditions.
Immunodeficit state peculiar to the AtD patients is manifesting by
cell and humoral immunity factors disfunction and is accompanied by
reducing the whole quantity of T-lymfocytes, especially of T-suppresors,
by increasing of the quantity eusinofils, by reducing of IgM and IgA
levels and increasing of IgG-level, and increasing of IgE in many
times. The latter is mainly caused by reagins (IgE-AT) having a
leading role in development of the allergic atopic process.
Having in mind all the above mentioned and the fact that any of
applied basic therapy schemes does not able to provide a stable
clinical effect, we suggest that aprobation of the systemic
enzymotherapy method and Wobenzym drug may by expedient and logical.
Criteria for patients
A reliable AtD
diagnosis.
Different deviations in
the AC functions in anamnesis.
Anamnesis excluding a
respiratory atopy (bronchial asthma, vasomotor cattarh).
According to B. T.
Gluhenky and S. A. Grando these conditions have place at
25% of AtD patients and
their treatment using ferments in form of active
proteinases is inexpedient according to their studies.
Our study was 12-month open test and there was 18 AtD patients (12
men and 6 women) in the age from 15 to 62 years (an average age was
24,7 years old) In almost all the patients the illness has developed
in childhood (before the 7 years old).
According to patients’ complaints, anamnesis study and results of
examining fulfilled there was evident the alimentary disfunction in
all the patients (in forms of cholecystitis, pancreatitis,
gastritis, colitis with disbacteriosis etc.).
The patients were divided into two groups. The first one consisted
of 6 patients (4 men and 2 women) who received monotherapy with
Wobenzym; the second group included 12 patients (8 men and 4 women)
who combined receiving Wobenzym with traditionally used schemes of
basic therapy. There was also a control group of 15 patients (10 men
and 5 women) who received the basic AtD therapy for comparative
study of the clinical study results.
All the patients from experimental groups received the drug
according to the equal scheme: at first two days of treatment — 2
dragee x 3 times a day, after that — 5 dragee x 3 times a day (30-40
min. before a meal with substantial quantity of water (more than 200
ml.). The course of systemic enzymotherapy continued 1, 5-2 months
depending on the time of approaching of desirable clinical effect.
As all the patients were in an acute period of the disease when
symptoms are most manifestating, the time of the acute period
transition to the period of stabilization and further improvement
were of great interest.
The criteria of effectiveness were following:
The dynamics of local
symtoms: a level of marked skin itching,
lichenification,
erythema, skin driedness and it’s turgor.
The labor data:
leucocytes formula, ESR (Erythrocyte Sedimentation Rate),
blood proteins,
C-reacted protein, lipid metabolism state, quantity and
quality evaluation of
immune T- and B-cells, CIC, immunoglobulins. We also
took into account the
levels of ALT and ACT for the aim of the study results
evaluation.
The subjective
evaluation of the treatment results by the patient using
three-degree scale:
”good”, ”moderate manifestation” and ”weak”.
A comparative analysis
of the treatment results in experimental groups and in
the control one taking
into account the stability of the remission attained.
Results
Fig 1. Dynamics of the skin itching manifestation depending on the
type of treatment
As shown on the fig.1 there was more intensive skin itching in the
experimental patients groups during the first 3-4 days of treatment
(in the monotherapy group — 50% of patients, in the combined therapy
group — 30% of patients), however in further days the intensity of
itching became rapidly decrease. Thus up on the 10th day in average
the intensity of skin itching became insignificant or disappeared at
all in the group with combined treatment, on the 15th day — in the
control group and on the 18th day — in the group with monotherapy.
Consequently the systemic enzymotherapy even by the monotherapy
scheme is able to reduce skin itching manifestations, and its
combination with basic treatment provided an accelaration of the
desirable effect to 5 days (x 1,5).
Fig 2. Dynamics of the erythema-lichenoid state manifestation
depending on the type of treatment
An initial skin itching intensity increasing (short-term, during 3-4
days) could be explained by the Wobenzym’s ability to stimulate
inflammatory processes by activation the callicrein-chinin system
and by further its transition to the settling stage.
Results (fig.2) show the durable and rather manifestated effect in the combined treatment group of patients (erythema-lichenoid skin manifestations became insignificant or practically settled in average up to the end of the 4th week, and in control group the same effect was 2 weeks later). In the Wobenzym-monotherapy group of patients the effect was also evident, but it was less manifestated. The facts are indicative, at first, that the Wobenzym is effective even as monotreatment drug and, secondly, that additional basic AtD treatment is necessary. The latter leads to the desirable results in significantly shorter terms.
An evident confirmation of greater effectiveness of combined
systemic enzymotherapy with basic AtD treatment is the fact that
remission terms are significantly longer (according to our data up
to 2,5-3 months in average) and the relapse duration and its
manifestation is shorter. Five patients (4 men and 1 woman) which
were under our examination in 6 and more months had not relapses at
all. It must be also noted that 10 from 18 patients treated by
Wobenzym continued its taking (2 dragee x 3 times a day) during 3
months after our experiment as supporting preventive treatment. They
are those patients who demonstrate the most prolonged time of
relapse manifestation or its absence during the time of observation.
Fig.3. The subjective evaluation of the treatment applied by the
patients themselves after 1 month.
Among the labor showing it must be noted reducing the total quantity
leucocytes up to the normal values including eozynofils,
normalization of the total blood protein level due to globulins
fractions reducing, increasing of activity of T-cells immunity,
reducing of the ratio T-helpers/T-supressors due to increasing of
the T-supressors quantity, a reliable CIC reducing as well as IgG
and IgE. The labor analysis dynamics of the patients, taking
Wobenzym combined with basic treatment, also was more manifestating.
In conclusion
The open 12-month study conducted at Skin and Venereal Diseases
Clinic of Military Medicine Academy (Sankt-Petersburg, Russia) and
devoted to analysis of therapeutical effectiveness of Wobenzym drug
(Mucos-Pharma, Germany) has clearly demonstarted its influence on
the AtD course. As a rule the realization of the drug’s treatment
potential begins from the first days of the treatment applied and
continues during all the time of treatment. There is not reducing of
the drug effectiveness and accustomization to it eventually — on the
contrary, it is evident clearly manifested increasing of the
positive effects.
Applying Wobenzym combined with traditional for the dermatosis
treatment methods allows reaching better results.
Taking Wobenzym in
supporting doses (2 dragees x 3 times a day) in remission period
provides more stable remission. In case of relapse its course has
less manifestated character.
There were not side effects due to Wobenzym treatment in any of
patients excluding the fact that in first 4-5 days there was
insignificantly increase of skin itching and more manifestated
erythema in some patients. It may be explained by the drug’s
pharmacological properties to speed up and modulate inflammatory
processes as well as by local microcirculation improvement7, 8, 10.
The results of our study support the fact that systemic
enzymotherapy method (with Wobenzym) which was successfully applied
in medical practice, may be also successfully applied in combined
therapy of the Atd patients.
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