Pathogenetic justification of the use of simvastatin in the complex therapy of vitiligo

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Abstract

BACKGROUND: Vitiligo is a chronic acquired disease with a genetic predisposition to pigmentation disorder caused by the destruction of skin melanocytes, leading to hypopigmentation. The effectiveness of currently available methods of treatment of vitiligo, on average, is about 40%. Therefore, it is necessary to search for new effective and safe methods of vitiligo therapy, characterized by minimal risk of side effects, and financial costs of the patient. Simvastatin inhibits cholesterol biosynthesis by inhibiting HMC-CoA reductase. In addition to lowering cholesterol, statins have pleiotropic effects, namely, they inhibit various inflammatory mediators and cytokines, activate the antioxidant system, and reduce the level of active forms of oxygen in melanocytes.

AIMS: To develop a pathogenetic therapeutic complex using simvastatin for patients with vitiligo.

MATERIALS AND METODS: To participate in the study, 81 patients with vitiligo were examined. Each patient was determined by the form and stage of the disease. The effectiveness of therapy in the groups was evaluated by assessing the area of repigmentation. The first group received treatment ― simvastatin in combination with UVB therapy 311 nm, the second group-UVB therapy 311 nm. Studies of cytokines were carried out using enzyme immunoassay. Study of the oxidative status using high-performance liquid chromatography-mass spectrometry. Statistical processing of the research materials was carried out using the SPSS Statistics software package.

RESAULTS: The combined method of therapy with the inclusion of simvastatin showed the following clinical results: 6 (12%) had a pronounced positive effect; improvement ― in 34 (69%) patients. Dynamics of the immune profile: decrease in IL-6 from 10±1 to 8.1±0.6; TNF-α from 18.8±2.1 to 12.9±1.1; increase in IL-10 from 3.2±0.4 to 7.3±0.3. Dynamics of the oxidative profile: malondialdehyde 1.7±0.12 to 1.48±0.11, 8-oxo-DG 0.30±0.03 to 0.23±0.02, SOD 170±3 to 207±7, glutathione 697±36 to 942±32.

CONCLUSION: The combined method of vitiligo therapy with the inclusion of simvastatin is effective and safe, leading to stabilization of the process, clinical improvement and a pronounced effect of therapy in 82% of patients. It also has an immune-correcting effect and normalizes the indicators of the oxidative profile.

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About the authors

Alina Yu. Davletshina

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: alina-mitrakova@yandex.ru
ORCID iD: 0000-0002-7496-7551
Russian Federation, 8 buil. 2 Trubetskaya street, 119991, Moscow

Konstantin M. Lomonosov

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: lamclinic@yandex.ru
ORCID iD: 0000-0002-4580-6193
SPIN-code: 4784-9730
Russian Federation, 8 buil. 2 Trubetskaya street, 119991, Moscow

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Supplementary files

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2. Fig. 1. Immunomodulatory effect of statins.

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3. Fig. 2. Oxidative stress in vitiligo.

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4. Fig. 3. Distribution of patients by age. UVB-311 nm ― ultraviolet rays of the B spectrum with a wavelength of 311 nm.

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5. Fig. 4. Box diagrams of the age of the process by individual stages with division into groups according to the type of treatment (a) and without division into groups (б). UVB ― ultraviolet rays of the B spectrum with a wavelength of 311 nm.

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24. Fig. 5. Comparison of clinical results of therapy in groups.

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