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Íîâûå ñòðàòåãèè ëå÷åíèÿ äåìîäåêîçà
Ïîñêîëüêó òåìà àêòóàëüíà ïðèâîæó ñòàòüþ Michelle Dalton ðåäàêòîð æóðíàëà Eyeworld (ðóñ.) äåêàáðü, 2008.
Íîâûå ñòðàòåãèè ëå÷åíèÿ äåìîäåêîçà Ëèøü íåäàâíî îôòàëüìîëîãè ñòàëè ïðèõîäèòü ê ïîíèìàíèþ òîãî, êàêèì îáðàçîì êëåù ïðîâîöèðóåò ðåöèäèâèðóþùåå âîñïàëåíèå âåê Íà ïðîòÿæåíèè ìíîãèõ äåñÿòèëåòèé ðåôðàêòåðíûé ê ëå÷åíèþ áëåôàðèò áûë íàñòîÿùåé ïðîáëåìîé äëÿ îôòàëüìîëîãîâ.  íåêîòîðûõ ñëó÷àÿõ ïîìîãàþò îòøåëóøèâàþùèå ñðåäñòâà. Èíîãäà áëåôàðèò ñîïóòñòâóåò ïòåðèãèóìó. Ó îäíèõ áîëüíûõ áëåôàðèò âûðàæåí â áîëüøåé ñòåïåíè, ó äðóãèõ — â ìåíüøåé. Ïðè÷èíà áëåôàðèòà ìîæåò áûòü ïðîñòà — êëåù Demodex. Ïðè äåìîäåêîçíîé èíâàçèè âåê ó ïàöèåíòîâ íàáëþäàåòñÿ ðàçíîîáðàçíàÿ êëèíè÷åñêàÿ ñèìïòîìàòèêà, â òîì ÷èñëå ïðèçíàêè âîñïàëèòåëüíîãî ïðîöåññà â êîíúþíêòèâå. Òå æå ñàìûå ñèìïòîìû îòìå÷àþòñÿ ïðè ïîðàæåíèè ãëàç â ñëó÷àå ðîçàöåà. «Åñëè òðàäèöèîííîå ëå÷åíèå ðîçàöåà îêàçûâàåòñÿ íåýôôåêòèâíûì, òî, ïî âñåé âåðîÿòíîñòè, ýëèìèíèðîâàòü êëåùà ìîæíî ñ ïîìîùüþ ñêðàáà äëÿ âåê íà îñíîâå ìàñëà ÷àéíîãî äåðåâà. Ïðè âñåõ ðàçíîâèäíîñòÿõ ðåôðàêòåðíîãî ê òåðàïèè èíòðàîêóëÿðíîãî âîñïàëåíèÿ íåîáõîäèìî èñêëþ÷èòü Demodex êàê ýòèîëîãè÷åñêîãî àãåíòà. Èçâåñòíî, ÷òî ðåöèäèâèðóþùèé ïòåðèãèóì ìîæåò âîçíèêàòü íà ôîíå âîñïàëèòåëüíîãî ïðîöåññà, ïðè÷èíîé êîòîðîãî ìîæåò áûòü íåâûëå÷åííûé äåìîäåêîç», — çàÿâëÿåò ä-ð Schffer C.G. Òsång, äèðåêòîð Öåíòðà ïî ëå÷åíèþ çàáîëåâàíèé ïîâåðõíîñòè ãëàçà è ìåäèöèíñêèé äèðåêòîð Èññëåäîâàòåëüñêîãî è îáðàçîâàòåëüíîãî ôîíäà ïî èçó÷åíèþ çàáîëåâàíèé ïîâåðõíîñòè ãëàçà. Ñèìïòîìàòèêà äåìîäåêîçà Ïî ñëîâàì ä-ðà Steven Safran, äëÿ äåìîäåêîçà âåñüìà õàðàêòåðíû çóä âåê ïî óòðàì è èõ ïîêðàñíåíèå, ÷òî îáúÿñíÿåòñÿ ÷óâñòâèòåëüíîñòüþ êëåùåé ê ñâåòó. Íî÷üþ êëåùè âûõîäÿò íà ïîâåðõíîñòü, ñïàðèâàþòñÿ, îòêëàäûâàþò ÿéöà íà ðåñíèöàõ, à óòðîì çàïîëçàþò îáðàòíî â ôîëëèêóëû ðåñíèö, ïðîâîöèðóÿ òåì ñàìûì çóä. Ïîñòàíîâêó äèàãíîçà çàòðóäíÿåò òîò ôàêò, ÷òî ó íåêîòîðûõ ïàöèåíòîâ ñèìïòîìàòèêà îòñóòñòâóåò.  äðóãèõ ñëó÷àÿõ êëèíè÷åñêàÿ êàðòèíà íàïîìèíàåò àëëåðãèþ íà êëåùåé, gðîâîöèðóþùóþ âûðàæåííûé çóä è âîñïàëåíèå êðàåâ âåê. Îïàòàíîë (Àlñîn, ÑØÀ) ïîìîãàåò òàêèì áîëüíûì, íî çàáîëåâàíèå íå èçëå÷èâàåò. Ñóùåñòâóåò ìíåíèå, ÷òî ïîÿâëåíèå ðîçîâûõ óãðåé íà êîæå ëèöà îáóñëîâëåíî óâåëè÷åíèåì ïëîòíîñòè êëåùåé, êîòîðûå çàïóñêàþò âîñïàëèòåëüíûé ïðîöåññ èëè ñïåöèôè÷åñêèå èììóííûå ðåàêöèè, ìåõàíè÷åñêè áëîêèðóþò ôîëëèêóëû èëè äåéñòâóþò â êà÷åñòâå ïåðåíîñ÷èêîâ äëÿ áàêòåðèé. Ëå÷åíèå ìàñëîì ÷àéíîãî äåðåâà Ä-ð Safran ñ÷èòàåò, ÷òî òåðàïåâòè÷åñêèå ñâîéñòâà ìàñëà ÷àéíîãî äåðåâà â îòíîøåíèè Demodex, îïèñàííûå ä-ðîì Òsång, ìîãóò ñòàòü íîâûì íàïðàâëåíèåì â ëå÷åíèè ýòîãî çàáîëåâàíèÿ; îí ïðåäëàãàåò íåñêîëüêî ìîäèôèöèðîâàòü ïðîïèñü ëåêàðñòâåííîãî ïðåïàðàòà. Ìàñëî ÷àéíîãî äåðåâà ìîæíî íàéòè â îòäåëàõ çäîðîâîãî ïèòàíèÿ ìíîãèõ ìàãàçèíîâ, íî êðîìå òîãî, ä-ð Safran òàêæå èñïîëüçîâàë è ìàçü, ïðåäëîæåííóþ ä-ðîì Òsång. Ïîëîâèíó ìàñëà ÷àéíîãî äåðåâà ìîæíî çàìåíèòü íà ìàñëî îðåõà ìàêàäàìèè. «ß ââîæó ïðåïàðàò âàòíûì àïïëèêàòîðîì ïîñëå çàêàïûâàíèÿ îäíîé êàïëè òåòðàêàèíà, ïîýòîìó äîïîëíèòåëüíîãî ëåêàðñòâåííîãî ïðèêðûòèÿ íå òðåáóåòñÿ. ß ñòàðàþñü ïîäâåñòè ïðåïàðàò íåïîñðåäñòâåííî ê êîðíÿì ðåñíèö è ðàñïðîñòðàíÿþ åãî íà ðåñíèöàõ, ÷òîáû óíè÷òîæèòü âñå ÿéöà. Òàêèì æå îáðàçîì ÿ îáðàáàòûâàþ è áðîâè. Ïðåïàðàò íå äîëæåí ñòåêàòü ñ àïïëèêàòîðà, íî àïïëèêàòîð äîëæåí áûòü íàñòîëüêî âëàæíûì, ÷òîáû ÿ ìîã âèäåòü, êàê ïðåïàðàò ïîïàäàåò íà êîæó, êîãäà ÿ ïðèêàñàþñü ê íåé. Âíà÷àëå ÿ îáðàáàòûâàþ áðîâè, çàòåì âåêè, ÷òî ïîçâîëÿåò èçáàâèòüñÿ îò èçëèøêà ìàñëà, êîòîðîå ìîæåò âûçâàòü ðàçäðàæåíèå. Çà îäíó ïðîöåäóðó ÿ ïðîèçâîæó òðè àïïëèêàöèè äëèòåëüíîñòüþ îêîëî 10 ìèíóò êàæäàÿ, à çàòåì íàíîøó 20% ìàçü ìàñëà ÷àéíîãî äåðåâà, êîòîðóþ ãîòîâÿò ïî ìîåé ïðîïèñè â ðåöåïòóðíîì îòäåëå àïòåêè. Îáû÷íî òðåáóåòñÿ òðè ïðîöåäóðû ñ ïðîìåæóòêîì â íåäåëþ», — ðàññêàçûâàåò ä-ð Safran, ïðåäóïðåæäàÿ, ÷òî íå ñëåäóåò ïðèìåíÿòü íàòèâíîå ìàñëî ÷àéíîãî äåðåâà. «ß ïîïðîáîâàë òàêîå ñðåäñòâî íà ñåáå, è ó ìåíÿ îñòàëèñü íå ñàìûå ïðèÿòíûå îùóùåíèÿ», — ãîâîðèò îí. Ñâîèì ïàöèåíòàì ä-ð Safran ðåêîìåíäóåò ñëåäóþùóþ ñõåìó ëå÷åíèÿ è ïîâåäåíèÿ: • åæåäíåâíîå èñïîëüçîâàíèå øàìïóíÿ äëÿ âîëîñ è äëÿ ðåñíèö íà îñíîâå ÷àéíîãî äåðåâà; • åæåäíåâíîå èñïîëüçîâàíèå ìûëà èëè ñðåäñòâà äëÿ óìûâàíèÿ íà îñíîâå ÷àéíîãî äåðåâà; • æåíùèíàì ñëåäóåò ïåðåñòàòü ïîëüçîâàòüñÿ ìàêèÿæåì; • âûñòèðàòü ïîñòåëüíîå áåëüå è/èëè êóïèòü íîâûå ïîäóøêè; • ïðîâåðèòü íà íîñèòåëüñòâî Demodex ïàðòíåðà ïî áðàêó; • ïðîâåðèòü íà íîñèòåëüñòâî Demodex äîìàøíèõ æèâîòíûõ; • â ïåðâûå íåäåëè ïîñëå èñïîëüçîâàíèÿ äîìà ñêðàáà-øàìïóíÿ ñëåäóåò íàíîñèòü íà íî÷ü ìàçü íà îñíîâå ìàñëà ÷àéíîãî äåðåâà. Ïðè íàëè÷èè ÿðêî âûðàæåííîãî âîñïàëèòåëüíîãî ïðîöåññà öåëåñîîáðàçíî íàçíà÷èòü òîáðàäåêñ èëè òîáðàìèöèíà 0,3% è ðàñòâîð äåêñàçîíà0,1%, (Àlñîn, ÑØÀ), ÷åðåç íåäåëþ åãî ñëåäóåò çàìåíèòü íà áàöèòðàöèí èëè ýðèòðîìèöèí. Áîëüøèíñòâî ïàöèåíòîâ ñ÷èòàåò, ÷òî ïîêðàñíåíèå ãëàç è ææåíèå ñâÿçàíî ñ ïëîõèì ñàìî÷óâñòâèåì, íåäîñûïàíèåì è òàê äàëåå. Ïðè âîçíèêíîâåíèè òàêèõ ñèìïòîìîâ íà íèõ ñðàçó æå îáðàùàåòñÿ âíèìàíèå. Íà ôîíå ïðèìåíåíèÿ ïðåïàðàòîâ ìàñëà ÷àéíîãî äåðåâà áîëüíûå îöåíèâàþò ýòó ñèìïòîìàòèêó ïî 10-áàëëüíîé øêàëå íà «2 «1», à íå íà «9» èëè «8», êàê äî íà÷àëà ëå÷åíèÿ. |
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Îðèãèíàë ñòàòüè çäåñü
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#3
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Èç îáñóæäåíèÿ íà ÀéÌýéë
""Ñòàòüÿ â ìàéñêîì ÀìÆÎ çà 2007 äîïóñêàåò ê âîçìîæíîñòü ýôôåêòà ïëàöåáî (íå ðàíäîìèçèðîâàíîå èññëåäîâàíèå) è äðóãèå âàðèàíòû äéñòâèÿ ìàñëà ÷àéíîãî äåðåâà, à íå óíè÷òîæåíèå Demodex. Òåì íå ìåíåå, ß ñîáèðàþñü ïðîáîâàòü ýòî; òåðÿòü íå÷åãî, è êàæåòñÿ âåðîÿòíûì, ÷òî êëåùè, èìåþùèå ñåêñ, èñïðàæíÿþùèåñÿ è èãðàþùèå ïîêåð â âàøèõ ðåñíèöàõ, õîòü êàê òî îò ýòîãî ìàñëà ïîñòðàäàëè áû. Mitchell Gossman, M.D. St. Cloud, Minn.""" Ýìîöèîíàëüíîäîêàçàòåëüíàÿ ìåäèöèíà. |
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èçâèíèòå, ÷òî âñòðåâàþ, âîò ýòî ëå÷èòå? [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Ìàñëî ÷àéíîãî äåðåâà ñòàíîâèòñÿ ïîïóëÿðíûì
Çäåñü òîæå ïðî íåãî: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Lid scrub with TTO (Tea Tree Oil) In the office, after we administered a drop of 0.5% oxybuprocaine (proparacaine), a cotton tip wetted in 50% TTO was used to scrub the lash roots from one end to the other as one stroke. A total of six strokes were applied to each lid. A dry cotton tip was then used to remove excess TTO from the lid margin. Because TTO scrub not only loosened CD but also stimulated Demodex to move out to the skin (see Results), a dry cotton tip was used to remove CD 5 minutes later. After another 5 minutes, the second lid scrub with TTO was applied in the same manner. Following 10 minutes of rest, the third TTO lid scrub was applied. If there was any irritation, the eye was rinsed with non-preserved saline. This office scrub was repeated weekly until the Demodex count reached 0 for two consecutive visits. Home lid scrub and other instructions At home, the patient was asked to mix 0.5 ml of TT shampoo with tap water in both middle fingers. With eyes closed, the lids were massaged with a medium pressure for 3–5 minutes. The skin was then rinsed with clean water and dried with a towel. Such home lid scrub was practised twice daily for 1 month and then once daily thereafter. In addition, the patient was also instructed to discard used facial make-up, and wash the hair, the face, nostrils, the external ear and the neck with TT shampoo daily. The bedding and pillow cases were washed with hot water and dried in a heated dryer immediately after the first office scrub, and once a week thereafter. If the spouse also complained of similar eye irritation, the same home lid scrub was also practised. Consistent with our earlier report,19 we noted that the Demodex count in all seven patients receiving daily lid hygiene with baby shampoo never reached zero in a period between 40 and 350 days—that is, beyond one life cycle (fig 2 ). These results, together with those published earlier,2,4 strongly imply that the conventional treatment cannot eradicate Demodex, a notion also supported by the finding that 50% baby shampoo did not kill Demodex in vitro (table 1 ). It should also be noted that 75% alcohol and 10% povidone-iodine, agents known to kill most microbes, could not kill Demodex in vitro (table 1 ). Because previous incubation with 50% baby shampoo or 10% SDS, detergents dissolving oil, before 10% povidone-iodine still could not kill Demodex (table 1 ), we suspect that Demodex is resistant to povidone-iodine. Although 4% pilocarpine gel was used to treat Demodex,4 it did not kill Demodex in 150 minutes Results: Demodex folliculorum survived for more than 150 minutes in 10% povidone-iodine, 75% alcohol, 50% baby shampoo, and 4% pilocarpine. However, the survival time was significantly shortened to within 15 minutes in 100% alcohol, 100% TTO, 100% caraway oil, or 100% dill weed oil. TTO’s in vitro killing effect was dose dependent. Lid scrub with 50% TTO, but not with 50% baby shampoo, can further stimulate Demodex to move out to the skin. The Demodex count did not reach zero in any of the seven patients receiving daily lid scrub with baby shampoo for 40–350 days. In contrast, the Demodex count dropped to zero in seven of nine patients receiving TTO scrub in 4 weeks without recurrence. |
#6
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Èçâèíèòå, ÷òî âñòðåâàþ, õîòü è íå ñïåöèàëèñò. Ìàñëî ÷àéíîãî äåðåâà, äàæå ðàçâåäåííîå 1:10, î÷åíü ñèëüíî ðàçäðàæàåò ñëèçèñòûå. Ìíå êàæåòñÿ, ÷òî âñå ñëåäû ìàñëà ñ âåêà òóò æå áóäóò ñìûòû ïîòîêîì ñëåç. ß íà íåñêîëüêèõ ñâîèõ çíàêîìûõ (ïðî óðîâåíü äîêàçàòåëüíîñòè çíàþ ) ïîïðîáîâàëà ìåòîä, ïðèäóìàííûé ìíîþ è îñíîâàííûé íà áèîëîãèè äåìîäåêñîâ. Íóæíî â òå÷åíèå íåñêîëüêèõ íî÷åé ïîäðÿä ïî ÷àñàì âñòàâàòü è ïðîìûâàòü âåêè âîäîé. Äåëî â òîì, ÷òî èç ôîëëèêóëîâ âûõîäÿò òîëüêî áðîäÿ÷èå ñàìöû â ïîèñêàõ ñàìîê. Åñëè èõ óïîðíî ýëèìèíèðîâàòü, ïðåðûâàåòñÿ ðåïðîäóêòèâíûé öèêë.
Äðóãàÿ ñòîðîíà ïðîáëåìû â òîì, ÷òî ýòè æå ëþäè î÷åíü áûñòðî çàðàæàþòñÿ äåìîäåêñîì âíîâü.
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Åëåíà Åâãåíüåâíà Êîðíàêîâà, ïàðàçèòîëîã. |
#7
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Öèòàòà:
Öèòàòà:
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#8
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Äîáðîãî âðåìåíè ñóòîê!  ñòàòüå ( ïîñò 1, îò óâàæàåìîãî Ñåðãåÿ Íèêîëàåâè÷à) ñêàçàíî, ÷òî ä-ð Safran ïîëîâèíó ìàñëà ÷àéíîãî äåðåâà çàìåíèë íà ìàñëîì ìàêàäàìèè, à ÷åì åùå ìîæíî ðàçâåñòè, ÷òî 50% ìàñëî ïîëó÷èëîñü? Î÷åíü õî÷åòñÿ ïðèìåíèòü â ïðàêòèêå òàêîé ñïîñîá
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#9
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îõ, óæ ýòè "ñàìöû, âûõîäÿùèå íà ïîèñê ñàìîê" - îò íèõ âñåãäà îäíè íåäîðàçóìåíèÿ+àëëåðãèÿ. Ìîæåò, ìû ñôîðìóëèðóåì âìåñòå ðåêîìåíäàöèè? Ýòî ðåàëüíàÿ ïðîáëåìà....
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#10
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×òîáû ìû òóò íå ïðèäóìàëè - ëå÷åíèå äîëæíî áûòü äîñòóïíî ïàöèåíòó äîìà. À îïèñàííîå ëå÷åíèå "â îôèñå" - íå âåðõ ìå÷òàíèé.
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#11
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Íó ïî÷åìó áû è íå â îôèñå? ß âîò òîæå äóìàþ: ñ ÷åì ìîæíî ðàçìåøàòü, ìîæåò ñ áàíàëüíûì âàçåëèíîì? Îí æå âðîäå äëÿ ãëàç íåéòðàëüíûé. È åñëè ñíà÷àëà îáåçáîëèòü âåêè ìåñòíîé àïïëèêàöèåé ëèäîêàèíà, à ïîòîì îáðàáîòàòü...
Òîëüêî íà ïàöèåíòàõ ÿ íå ýêñïåðèìåíòèðóþ... |
#12
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ß ÷åñòíî ãîâîðÿ íàçíà÷àë áåç ðàçáàâëåíèé (ìåäñêåéï ìíå ïðî íèõ íè÷åãî íå ãîâîðèë èáî) Ïàðå ÷åëîâåê, ïðàâäà âñåãî. Ïðèõîäèëè ÷èñòåíüêèìè.
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