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Vol 27, No 1 (2024)

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DERMATO-ONCOLOGY

Melanocytic nevus: Clinical features and colorimetrial evaluation

Sakharova M.V., Klyuchareva S.V., Kashutin S.L., Levit M.L., Shapchits N.L.

Abstract

BACKGROUND: An increase in the frequency of registration of skin malformations, benign, precancerous and malignant skin neoplasms requires new approaches to their diagnosis and treatment. The different depth of melanocytic nevi in the epidermis and dermis is reflected in the color of the melanocytic nevus.

AIM: to study the localization, size and intensity of pigmentation of melanocytic nevi depending on their color.

MATERIALS AND METHODS: A clinical and instrumental study of 280 people with melanocytic nevi of various localization was conducted using their colorimetric assessment and dermatoscopic diagnosis. If melanoma was suspected, patients were consulted by an oncologist. The diagnosis of "melanoma" was confirmed histologically.

RESULTS: Melanocytic nevi are more localized on the face than on the abdomen, back or chest, which is confirmed statistically. The largest sizes ― 5.5 mm ― are reached by nevi having a dark brown color, and, consequently, localized in the epidermis above the basal layer, and the smallest ― 2.0 mm ― melanocytic nevi with brown color located in the basal layer of the epidermis, which is also statistically confirmed.

CONCLUSION: The largest sizes ― 5.5 mm ― are reached by nevi having a dark brown color, and, consequently, localized in the epidermis above the basal layer, and the smallest ― 2.0 mm ― melanocytic nevi with brown color located in the basal layer of the epidermis.

Russian Journal of Skin and Venereal Diseases. 2024;27(1):5-12
pages 5-12 views

DERMATOLOGY

Clinical and morphological characteristics of patients with urticarian rasches

Olisova O.Y., Teplyakova K.S., Smolyannikova V.A., Kashakanova N.M., Ershov A.V., Andzhelova D.V., Salugina S.O., Torgashina A.V., Fomina D.S., Filatov A.V., Zharkov N.V., Kovalkova E.V., Borzova E.Y.

Abstract

BACKGROUND: The most common diagnosis given to patients with chronic urticarial rashes is chronic spontaneous urticaria (prevalence in the population is 0.1–1.4%). However, similar symptoms can also be observed in other rarer diseases: urticarial vasculitis, hypocomplementemic urticarial vasculitis syndrome, cryopyrine-associated syndromes and Schnitzler's syndrome.

AIM: to analyze the clinical features and histological characteristics of skin biopsies in patients with chronic urticarial rashes to optimize the management and improve differential diagnosis.

MATERIALS AND METHODS: At a retrospective stage, 9 patients with chronic urticarial rashes and a histological examination were selected from the archival data of the Clinic of Skin and venereal fiseases named after V.A. Rakhmanov Sechenov University from January 2019 to April 2022. Prospective patient recruitment was from January 2022 to September 2023 and included 11 patients who underwent skin biopsy. Data obtained from the analysis of demographic characteristics are presented as median and interquartile range. Histological parameters were assessed by qualitative and quantitative methods.

RESULTS: The study included 20 patients (16 women and 4 men) aged 23 to 63 years, 36.5. Depending on the clinical and histological characteristics, the patients were divided into three groups: 9 patients with chronic spontaneous urticaria, disease duration from 2 to 132 months, 24 months [18; 33]; 9 patients were diagnosed with urticarial vasculitis, the duration ranged from 7 to 180 months, 30 [24; 84]. There were 2 patients diagnosed with hypocomplementemic urticarial vasculitis syndrome; the duration of the disease was 24 months. Clinically, chronic spontaneous urticaria was distinguished by a shorter duration of the disease and a shorter duration of existence of individual elements. Standard or increased doses of antihistamines were effective in five patients with chronic spontaneous urticaria. In addition, patients with chronic spontaneous urticaria also had atypical signs of rashes, which indicates a transition group between chronic spontaneous urticaria and urticarial vasculitis. In patients with urticarial vasculitis and hypocomplementemic urticarial vasculitis syndrome, clinical features such as longer duration of blistering, burning and soreness, residual hyperpigmentation, and resistance to antihistamine therapy were more often observed. When conducting a histological examination, the main histological features for urticarial vasculitis were leukocytoclasia, fibrin deposits and damage to the vascular walls with fibrin deposition; fibrinoid necrosis was rarely visualized, which, in combination with the above features, was present in only two patients with hypocomplementemic urticarial vasculitis syndrome.

CONCLUSION: This study presents the results of our own observations, analysis of the clinical and histological characteristics of patients with various diseases (chronic spontaneous urticaria, urticarial vasculitis, hypocomplementemic urticarial vasculitis syndrome). The results obtained may be useful for optimizing the differential diagnosis of diseases accompanied by urticarial rashes.

Russian Journal of Skin and Venereal Diseases. 2024;27(1):13-26
pages 13-26 views

Genetic determinants of atopic dermatitis

Grebennikova I.P., Morrison A.V., Lipatova T.E., Yeremina M.G.

Abstract

Atopic dermatitis is a heterogeneous disease, the pathogenesis of which is associated with mutations of genes encoding structural proteins of the epidermis, barrier enzymes and their inhibitors.

The article analyzes data from the works of various authors on the study of gene expression in atopic dermatitis, and notes the role of genes regulating innate and adaptive immune responses, as well as environmental factors inducing the disease. Recent studies indicate a key role of epigenetic changes in the development of the disease. Epigenetic modifications are mainly mediated by DNA methylation, histone acetylation and the action of specific non-coding RNAs. It has been documented that the profile of epigenetic changes in patients with atopic dermatitis differs from that observed in healthy individuals.

Understanding epigenetic changes is critical for developing personalized treatment strategies.

Russian Journal of Skin and Venereal Diseases. 2024;27(1):27-36
pages 27-36 views

Features of clinical manifestations of secondary syphilis in a HIV infected patient

Serdyukova E.A., Shchava S.N.

Abstract

Syphilis and human immunodeficiency virus (HIV) infection are diseases of an infectious nature with a predominantly sexual route of infection. Despite the decrease in the incidence of syphilis in recent years in Russia, there is an increase in HIV infection.

The combination of several infections in one patient leads to changes in clinical manifestations, which sometimes significantly complicates their diagnosis, leading to a late start of treatment. Syphilis against the background of HIV infection proceeds in stages, but usually it has a malignant, aggressive and severe course, often with the development of atypical forms and complications.

The primary syphilis against the background of HIV infection is characterized by the appearance of ulcerative-necrotic character of the hard chancre, such severe complications as phagedenism and gangrenization, the frequent addition of a secondary infection, severe soreness of the hard chancre. Secondary syphilides in HIV-infected patients are characterized by the appearance of ulceration with the formation of necrotizing vasculitis, extraordinary infectiousness of the elements. The disease progresses rapidly and over a few months from the moment of infection, manifest neurosyphilis or tertiary syphilis may develop due to immunodeficiency.

The authors describe the features of the manifestations of syphilis in its different periods against the background of HIV infection. A clinical case of a 35-year-old woman who was diagnosed with secondary syphilis and HIV infection is presented. The patient had numerous skin rashes, which were interpreted differently by doctors of different specialties for 2 months. The patient was diagnosed with pyoderma, "allergy", infectious exanthema, however, against the background of the treatment, there was a negative dynamics of the skin process. The authors have demonstrated the effectiveness of specific therapy: complete resolution of skin rashes.

Russian Journal of Skin and Venereal Diseases. 2024;27(1):37-44
pages 37-44 views

Studying the relationship between oral lichen planus and periodontal disease: Value on periodontal pathogens and oral hygiene

Svitich O.A., Teplyuk N.P., Stepanov M.A., Vartanova N.O., Damdinova B.S.

Abstract

BACKGROUND: Oral lichen planus is a chronic inflammatory condition of the oral mucosa characterized by white, lacy lesions. The etiology of oral lichen planus is complex and remains unclear, but it is thought to be a T-cell mediated autoimmune disease. Several factors have been implicated in the pathogenesis of oral lichen planus, including genetic predisposition, dental materials, iatrogenic factors, infections, autoimmunity, and bowel disease. The microflora of the oral cavity plays an important role in maintaining oral health and preventing disease. However, its role in the development and progression of oral lichen planus is not yet totally understood. Some studies have shown that there are differences in the microflora of oral lichen planus patients compared to healthy controls. These differences may be related to the inflammatory process in oral lichen planus, or they may be a contributing factor to the disease.

AIM: Identify the prevalence of the detection of periodontopathogenic microorganisms in oral lichen planus patients and compare their prevalence in healthy non-oral lichen planus patients.

MATERIALS AND METHODS: A cross-sectional, single-center study was conducted. A total of 75 patients were recruited, 45 with oral lichen planus and 30 healthy controls. The groups were formed by simple random sampling. The diagnosis of oral lichen planus was confirmed histologically in the main group. The forms and localization of oral lichen planus were determined in the main group based on clinical examination. In the control group, patients were divided into two subgroups depending on the presence of chronic periodontitis or gingivitis. The prevalence of periodontal pathogens was assessed based on the analysis of culture results. Among the 48 bacteria isolated from the oral mucosa of the affected site in the main and control groups, we focused on the microbiota of only periodontal bacteria to study their role and assess their impact on disease progression.

RESULTS: Among the 45 patients with a clinical diagnosis of oral lichen planus, there were 10 (22.22%) men and 35 (77.78%) women, with a mean age of 55.3±13.4 years. The control group included 30 healthy volunteers, 8 (26.67%) men and 22 (73.33%) women, with a mean age of 54.8±12.7 years. In patients with oral lichen planus regardless of their periodontal status the percentage of seropositivity for A. actinomycetemcomitans, V. parvula, P. gingivalis, T. denticola is higher compared to their healthy counterparts with gingivitis and periodontitis.

CONCLUSION: The study found an increased frequency of detection of pathogenic microorganisms, such as A. actinomycetemcomitans, V. parvula, P. gingivalis, and T. denticola, in patients with oral lichen planus, regardless of the presence of periodontitis. These periodontopathogens may be associated with oral lichen planus. However, further studies are needed to clarify their role in the pathogenesis of the disease.

Russian Journal of Skin and Venereal Diseases. 2024;27(1):45-54
pages 45-54 views

Differentiated approach to external acne therapy

Olisova O.Y.

Abstract

Acne is a serious medical and social problem due to the widespread prevalence of the disease. Localized mainly on the face, acne leads to the development of disorders in the psycho-emotional sphere, significantly reducing the quality of life.

The aim of the study was to study the effectiveness and safety of Epiduo/Effezel gel (adapalene 0.1% and benzoyl peroxide 2.5%) in patients with papulopustular acne.

The Clinic of Skin and Sexually Transmitted Diseases of the Clinical Hospital No. 2 of Sechenov University has accumulated extensive experience in the treatment of acne. In the diagnostic and treatment department, patients with mild to moderate acne receive consultations and treatment almost every day. A dermatological examination is carried out visually with a simple count of eruptive elements: papules, pustules and nodes, on the basis of which the degree of severity is determined. Patients with severe forms of acne receive systemic retinoids with corrective therapy until a certain cumulative dose is reached, and then patients receive topical maintenance therapy intermittently for 12 months.

Despite the development of effective methods for treating this dermatosis, patient adherence to treatment remains low. This is due, first of all, to the duration of therapy, not always the rapid achievement of the expected result, and to the development of psycho-emotional disorders in patients. In the latest edition of the Russian Society of Dermatovenerologists and Cosmetologists clinical guidelines for the treatment of mild to moderate acne with a high level of evidence A1, it is recommended to use benzoyl peroxide and a fixed combination of adapalene and benzene peroxide. When prescribing benzene peroxide (Baziron AS), we observed the best results in clearing the skin of rashes in the presence of a few papulopustular elements in the clinical picture due to the triple action of benzoyl peroxide ― antimicrobial, keratolytic and sebostatic. In our experience, it usually took 4 to 6 weeks to achieve clinical remission, and we did not note a single case of the development of bacterial resistance during treatment. For moderately widespread papulopustular acne rashes of moderate severity, as well as in cases of severe forms of the disease, when it is impossible to prescribe systemic isotretinoin or there is a tendency to scarring of the primary elements, we used a fixed combination of adapalene 0.1% and benzoyl peroxide 2.5% (Effezel) with anti-inflammatory, antimicrobial, keratolytic, sebostatic, comedolytic and anticomedogenic effects.

In the arsenal of dermatologists and cosmetologists there are drugs for the external treatment of mild to moderate papulopustular acne with a high level of evidence. Thus, for papulopustular acne with a few inflammatory (papules and pustules) rashes, benzoyl peroxide gel may be recommended. For moderately widespread papulopustular acne with the presence of comedones (moderate severity), a fixed combination of adapalene and benzoyl peroxide can be recommended as the first line of therapy.

Russian Journal of Skin and Venereal Diseases. 2024;27(1):55-68
pages 55-68 views

Prevalence and clinical signs of inflammatory back pain in patients with skin psoriasis and axial involvement

Pereverzina N.O., Kruglova L.S., Korotaeva T.V.

Abstract

BACKGROUND: The incidence of psoriatic arthritis has been increasing in recent years. Moreover the number of severe cases resistant to standard therapy has been increasing as well and leading to a marked deterioration in the quality of life and early disability. There is a need to diagnose the disease at preclinical stages, as well as early therapy and secondary prevention. Therefore, the role of dermatologists in identifying predictors and risk factors for the development and severe course of psoriatic arthritis is increasing. Particularly severe forms of psoriatic arthritis are caused by axial manifestations, which are often clinically asymptomatic in early stage of psoriatic arthritis. Moreover, most often axial manifestations is diagnosed in patients with an already established diagnosis of psoriatic arthritis, and there is practically no data on the prevalence and clinical and instrumental characteristics of axial manifestations in patients with smooth skin psoriasis.

AIM: to assess the prevalence and clinical characteristic of axial manifestations in patients with skin psoriasis using questionnaires, scales and Аssessment of SpondyloArthritis International Society (ASAS) diagnostic criteria.

MATERIALS AND METHODS: The prospective study to assess the prevalence and clinical characteristiс of axial manifestations in patients with skin psoriasis.

RESULTS: The prevalence of axial manifestations in patients with skin psoriasis, according to ASAS criteria, was 36.1%. Early manifestations of axial lesions in patients with skin psoriasis are aching, nagging pain in the back (37.2%) or neck (22.1%), as well as a feeling of stiffness in the back (46.3%) or neck (38.9%). The main risk factors and predictors of the development of psoriatic arthritis were the long duration of skin psoriasis (more than 12 years), pain in any joints, swelling of the fingers, pain/stiffness in the neck, pain/stiffness in the back, pain in the joints at rest/night time, widespread (BSA >18 points), severe (PASI >13 points) process. Having back/neck pain at rest or at night increases the odds of developing inflammatory pain by 132 times and 10 times, respectively, and back/neck stiffness by 10 and 6 times, respectively. Increasing the age of onset of back/neck pain by 1 year increases the chances of developing axial lesions by 1.3 times.

CONCLUSION: There is the first study to identify clinical signs of inflammatory back pain in patient with axial manifestations at early stage of psoriatic arthritis and to determine the prevalence of inflammatory back pain in patients with skin psoriasis and without an established diagnosis of psoriatic arthritis. However, further study of methods for early diagnosis of axial manifestations and other forms of psoriatic arthritis is necessary to optimize treatment and improve the quality of life of patients.

Russian Journal of Skin and Venereal Diseases. 2024;27(1):69-82
pages 69-82 views

Resistin in patients with psoriasis vulgaris during PUVA therapy

Yatskova O.S., Teplyakova K.S., Pritulo O.A.

Abstract

BACKGROUND: Currently, psoriasis represents a serious medical and social problem, and it is one of the most common chronic skin diseases. Over the past decades, special attention has been paid to the association of psoriasis with various diseases, such as cardiovascular diseases, inflammatory bowel diseases, depression, etc. Common comorbidities of psoriasis include metabolic syndrome or obesity. Resistin is one of the hormones produced by adipose tissue, the concentration of which increases markedly in patients with psoriasis. Resistin expression is induced by proinflammatory cytokines such as IL-1, IL-6, IL-12 and TNF-a. In turn, an increase in resistin levels leads to increased production of pro-inflammatory cytokines involved in the development of psoriasis, thereby promoting the recruitment of leukocytes during the inflammatory process leading to chronic inflammation. Taken together, the above changes may contribute to the development of metabolic syndrome in psoriasis. Among the effective methods of treating the disease, phototherapy methods (PUVA and UVB 311 nm) remain relevant. Considering these data, it is of interest to study the level of resistin in the serum of patients with psoriasis and its change after a course of PUVA.

AIM: The aim of our study was to evaluate the serum resistin level in patients with psoriasis vulgaris before and after PUVA.

MATERIALS AND METHODS: The study was conducted at the department of Skin and Venereology diseases at the Sechenov University in the period from June 2022 to November 2023. The study included 30 patients with psoriasis vulgaris of moderate severity (PASI <20), of whom there were 16 men and 14 women. The healthy control group included 20 participants (11 men and 9 women). All patients had blood drawn from a vein during hospitalization and after a course of PUVA. Healthy participants underwent a single blood draw from a vein.

RESULTS: A noticeable decrease in the level of resistin in the blood serum was revealed after a course of PUVA in all patients with psoriasis compared to baseline values. In addition, after treatment, resistin levels approached the values recorded in healthy participants.

CONCLUSION: Thus, our study allows us to consider resistin as a biological marker of the effectiveness of PUVA in the treatment of patients with psoriasis vulgaris, as well as a predictor of the occurrence of concomitant diseases in patients with psoriasis.

Russian Journal of Skin and Venereal Diseases. 2024;27(1):83-90
pages 83-90 views

Deverji's disease after COVID-19: Case report

Olisova O.Y., Teplyuk N.P., Martynenko D.M., Dunaeva E.R., Grekova E.V.

Abstract

Deverji's disease is a rare idiopathic skin disease characterized by keratinization disorder and manifested in follicular hyperkeratosis, orange-red peeling plaques, palmar-plantar keratodermia with the possible development of erythroderma. The etiopathogenesis of this dermatosis is still unknown. There are such possible trigger factors as traumatization, ultraviolet radiation, taking certain medications, autoimmune and oncological diseases, bacterial or viral infection, vaccination. The presence of familial cases is due to a mutation in the CARD14 gene. Diagnosis of the disease is based on characteristic clinical symptoms. The histological picture has no pathognomonic features; however, a biopsy is necessary for differential diagnosis with other papulosquamous dermatoses. Treatment of Deverji's disease remains a difficult task, since the disease pathogenesis has not been fully studied.

The article describes a clinical case of Deverji's disease manifestation in a 64-year-old woman who had suffered COVID-19 infection twice. She was admitted to the Department of Dermatology and Venerology (Sechenov University) with complaints of skin rashes on her face, trunk, upper and lower extremities, accompanied by severe itching. The absence of any distinctive clinical and histological changes, the torpidity of the skin process and resistance to the therapy made it difficult to make a diagnosis. After the emergence of characteristic clinical symptoms (palmar-plantar keratodermia, salmon-tinged rashes with islands of healthy skin), as well as the results of repeated histological examination (alternating areas of ortho- and parakeratosis; uneven granular layer; vacuolization of basal cells; uneven broad acantholytic strands; loosened dermo-epidermal junction; small perivascular lymph-macrophage infiltrates) Deverji's disease was diagnosed.

The use of standard therapies (systemic glucocorticosteroid therapy, methotrexate, topical therapy) did not give any results, and therefore it was decided to initiate the netakimab. After 5 injections, the first positive results were obtained in the form of the color paling and a decrease in the number of rashes, palmar-plantar keratodermia regression and improvement of the patient psychoemotional state. After 11 injections, almost complete remission was achieved, and treatment was continued until all symptoms disappeared completely.

The article provides a literature review of the etiopathogenesis, clinical manifestations and treatment methods of Deverji's disease. The described clinical case is the fifth example in the world of the Deverji's disease manifestation after a COVID-19 infection, and is also the first case of the IL-17 inhibitor netakimab successful use for the disease treatment.

Russian Journal of Skin and Venereal Diseases. 2024;27(1):91-102
pages 91-102 views

CHRONICLES

Chronicles of A.I. Pospelov Moscow Society of Dermatovenerologists and Cosmetologists (MSDС was founded on October 4, 1891) Bulletin of the MSDС № 1155

Yakovlev A.B., Maximov I.S., Petukhova E.V.

Abstract

On December 19th we held our last meeting of Moscow Society of Dermatologists and Cosmetologists named after A.I. Pospelov in person.

There were 137 participants and no applicants.

Professors, teachers and doctors from leading dermatovenerological clinics in Moscow were invited to take part in the anniversary meeting of the MSDС.

Our agenda included two clinical cases. Both of them were based on speakers’ personal experience and included nail and facial skin disorders. This kind of analysis may boost doctors’ experience in diagnosis and management of challenging clinical cases.

There were no scientific reports of the meeting.

Russian Journal of Skin and Venereal Diseases. 2024;27(1):103-108
pages 103-108 views

PHOTO GALLERY

Photogallery. Anogenital herpes due to HIV infection

Prozherin S.V.

Abstract

In patients with HIV infection, especially in the early stages and with preserved immunity, the same clinical manifestations of anogenital herpetic viral infection are observed as in immunocompetent individuals. As human immunodeficiency virus-associated (HIV) immunosuppression worsens in patients not taking antiretroviral therapy, the likelihood of developing atypical, disseminated forms of herpetic lesions increases. In severe immunodeficiency, the course of anogenital herpetic viral infection becomes more persistent, extensive, deep, long-term non-healing erosive and ulcerative rashes often develop, often spreading beyond their typical localization sites. In people living with human immunodeficiency virus with CD4+ T-lymphocyte counts below 50 cells/μl, erosions and ulcers caused by herpes simplex virus types 2 and/or 1 are often detected in the perianal area. In case of an atypical clinical picture, the diagnosis of anogenital herpetic viral infection is made based on the results of laboratory tests. The diagnostic standard is the detection of herpes simplex virus in scrapings from rashes using molecular genetic methods. In hypertrophic, tumor-like forms of the lesion, histological examination may be required.

All patients presented in the photo gallery are human immunodeficiency virus positive. He established the diagnosis of anogenital herpes based on the detection of one or simultaneously two types of herpes simplex virus in biomaterial from lesions using the polymerase chain reaction method. The explanations to the images indicate the stage and phase of human immunodeficiency virus infection in accordance with the Russian clinical classification, as well as the level of CD4+ T-lymphocytes at the time of diagnosis of anogenital herpetic viral infection.

Russian Journal of Skin and Venereal Diseases. 2024;27(1):109-116
pages 109-116 views


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