BACKGROUND: Taking into account the role of angiogenesis processes in the zone of development of immature scar tissue, it seems pathogenetically justified to use a vascular laser for the correction of hypertrophic skin scars that are at the maturation stage. In this regard, we used a pulsed dye laser, the effect of which is perceived by the patient without pronounced pain, and the technology itself is quite safe and leads to a rapid recovery of the skin after the procedure. Fermencol phonophoresis supplementation of laser therapy with pulsed dye laser has the potential to enhance the therapeutic efficacy of a vascular laser, since Fermenkol is a preparation of collagenases of hydrobiont origin that can destroy the components of the extracellular matrix, the formation of which exceeds in intensity its degradation by matrix metalloproteinases at the stage of formation scar. The use of ultrasound in this case not only accelerates the delivery of proteolytic enzymes, but also exhibits independent fibromodulatory activity. AIM: comparative evaluation of the effectiveness of the use of physiotherapeutic factors (Fermenkol phonophoresis, pulsed dye laser therapy and their combination) in patients with immature hypertrophic skin scars, taking into account clinical research methods. MATERIAL AND METHODS: The study was performed on 125 patients aged 19 to 50 years with immature (less than 6 months) hypertrophic skin scars. All patients were divided into 4 groups according to the simple fixed randomization procedure. The first group (control, 32 patients) received course local compression therapy using silicone plates for two months. The second group (31 patients) was treated with phonophoresis of 0.01% Fermencol gel. The third group (31 patients) was treated with pulsed dye laser. The fourth group (31 patients) received complex treatment, including a combination of two pulsed dye laser procedures and two cycles of Fermencol phonophoresis. Patients were examined twice: before the start of treatment and 2 weeks after the end of the course of treatment. The assessment of the clinical condition of patients was carried out according to the modified Vancouver scale for assessing the signs of cicatricial deformity. RESULTS: Conducting a course of treatment of patients with immature hypertrophic skin scars made it possible to establish a good tolerability of the effects of physiotherapeutic factors. At the same time, the positive dynamics of clinical manifestations of cicatricial changes in the skin, assessed by Vancouver scar scale, in the control and main groups was not the same and increased in the following order: Control Fermencol phonophoresis pulsed dye laser pulsed dye laser + Fermencol phonophoresis. The use of the correlation adaptometry technique, which makes it possible to objectify the obtained clinical data, evaluating them using the category of functional reserves of the body, confirmed that the best clinical result was achieved in the group recieved combined use of pulsed dye laser and Fermencol phonophoresis. CONCLUSION: The conclusion was made about the maximum therapeutic effect in the group of complex use of pulsed dye laser and ultrasound administration of an enzyme preparation, which manifested itself due to the synergistic type of interaction between two physiotherapeutic factors that have different modalities, points of application and mechanisms for implementing their therapeutic activity.

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The article analyzes the role of matrix metalloproteinases (MMP) in the pathogenesis of immature hypertrophic scars. The revealed decrease in the MMP level in the patients’ initial state against the background of an increased content of TIMP1 indicates a disorder in the mechanisms of regulation of collagen formation in a hypertrophic scar, as a result of which its synthesis significantly predominates over decay, contributing to the formation of a fibrous process. The obtained results convincingly prove that reduced expression of MMP against the background of an increased TIMP1 level is an important pathogenetic mechanism providing excessive deposition of extracellular matrix components in pathological skin scarring. The use of a pulsed dye laser (PDL) in combination with Fermencol phonophoresis promotes an increase in the MMP content in the blood serum of patients with immature hypertrophic scars. The reliable dynamics of the studied biomarkers indicates an increase in the processes of catabolism of the extracellular matrix components and an increase in the regenerative potential of the skin defect, which determine the intensity of the clinical effect during the treatment of immature hypertrophic scars. The correlation analysis between the level of membrane metalloproteinases and the parameters of the Vancouver Scar Scale revealed a set of significant relationships that confirm the clinical and pathogenetic significance of these biochemical variables in the development of fibroplastic processes and also act as informative criteria for the effectiveness of the therapy.

BACKGROUND: An imbalance between matrix metalloproteinases (MMPs) expression and tissue inhibitors of MMP is considered as a possible mechanism for impaired collagen synthesis and degradation, which leads to the development of hypertrophic scars. The use of a vascular laser, in particular a pulsed dye laser, leads to coagulation of the vascular locus that feeds the hypertrophic skin scar, resulting in a decrease in extracellular matrix synthesis. The use of collagenase phonophoresis increases the effectiveness of laser therapy due to the destruction of the extracellular matrix. AIM: To study the role of matrix metalloproteinases and their tissue inhibitors in the pathogenesis of immature hypertrophic skin scars and to evaluate the dynamics of enzymes during the combined use of a pulsed dye laser and Fermenkol phonophoresis. MATERIAL AND METHODS: The study was performed with the participation of 125 patients aged 22 to 55 years with immature (up to 6 months) hypertrophic skin scars. All patients were divided into 4 groups according to the simple fixed randomization procedure. The first group (control, n=32) received course local compression therapy using silicone plates for 2 months. The second group (main group I, n=31) underwent two courses of Fermencol phonophoresis (5 daily procedures lasting 10 minutes each with a break of 34 weeks). The third group (main group II, n=31) underwent two pulsed dye laser procedures with an interval of 4 weeks. The fourth group (main III, n=31) received complex treatment, which included a combination of two pulsed dye laser procedures and two cycles of Fermenkol phonophoresis. The study of the clinical condition of patients was carried out according to the modified Vancouver scar scale (VSS). The content of MMP and tissue inhibitor of metalloproteinase-1 in blood serum was determined by enzyme immunoassay. Patients were examined twice: before the start and 2 weeks after the end of the course of treatment. To form a sample of reference values of MMPs and tissue inhibitors of metalloproteinases (TIMPs), a group of 20 somatically healthy individuals was used. RESULTS: Initially reduced levels of MMP-1 and MMP-9 were found in the blood serum of patients with immature hypertrophic skin scars, with high values of TIMP-1, which allows us to consider reduced expression as an important link in the pathogenesis of the fibroproliferative process in the skin, which causes excessive deposition of extracellular matrix components. The use of pulsed dye laser in combination with Fermencol phonophoresis was accompanied by an increase in the content of MMP in the blood serum of patients with immature hypertrophic skin scars, which positively correlated with the severity of the clinical result of treatment, assessed by VSS. CONCLUSION: A conclusion was made about the clinical and pathogenetic significance of MMPs and TIMPs in the development of fibroplastic processes, which allows us to consider these biochemical parameters as informative criteria for the effectiveness of the therapy.

BACKGROUND: The effectiveness of physiotherapy treatment of scarring of the skin is reduced in patients with impaired carbohydrate and lipid metabolism and the use of drinking mineral water is proposed for their correction of metabolic reactions, but the long-term results of using this technology have not been studied. AIMS: To study the long-term results of treatment of patients with scarring of the skin after the use of photothermolysis, fermencol ultraphonophoresis and internal intake of mineral water, taking into account the presence or absence of metabolic syndrome. MATERIALS AND METHODS: We observed 120 patients with scarring of the skin, 60 of them with metabolic syndrome. The patients were randomly selected into 2 groups: with and without metabolic syndrome, each of which was further subdivided into 2 subgroups according to the treatment method: the first was standard therapy, fractional photothermolysis, fermencol ultraphonophoresis, the second was a similar complex supplemented with internal intake of Essentuki No. 17 mineral water. Glucose, insulin, body mass index, malondialdehyde were determined in the blood of all patients RESULTS: It was found that in patients with metabolic syndrome, the duration of maintaining the achieved therapeutic effects decreases after 6 months of observation, whereas against the background of taking mineral water, this period is extended by 34 months. An additional course of mineral water to physiotherapy treatment effectively corrects metabolic reactions and helps to reduce insulin resistance. CONCLUSION: The use of drinking mineral waters, which have a pronounced activating effect on the insulin regulation of metabolic reactions by reducing resistance to this hormone, allows you to maintain favorable changes in metabolism and energy for at least six months, which contributes to the consolidation of the therapeutic effects of complex physiotherapy and to a certain extent has a preventive potential.