No 4S (2018)

Lichen ruber planus (LRP) is an inflammatory dermatosis, often involving the mucous membranes of the oral cavity, esophagus, pharynx, conjunctiva, and also the dermal appendages. Depending on the nature of the lesions, there are typical and atypical forms of LRP of the skin and mucous membranes; and atypical forms are characterized by a more severe course, frequent relapses, torpidity of the treatment and the risk of malignant transformation. The etiology of LRP is not clear, but its development is associated with autoimmune destruction of basal keratinocytes by T cells. Treatment of LRP is not effective enough and is carried out primarily by applications of corticosteroids. In advanced and resistant processes, systemic corticosteroids, retinoids, immunosuppressants and biological agents are prescribed, the use of which is accompanied by a high incidence of side effects and complications, but does not prevent the recurrence of the disease. This review is devoted to modern methods of radiation therapy, used in the complex treatment of LRP of the skin and oral cavity, incl. photodynamic therapy, photochemical and extracorporeal photochemotherapy (photopheresis). A number of methods considered in the review (including photodynamic and extracorporeal photochemotherapy) are very promising and their use can significantly improve the effectiveness of therapy of LRP of the the skin and oral cavity, especially persistent and resistant to drug therapy.

Acne is a multifactorial chronic dermatosis, which predominantly affects children, but adults may also be affected. The disease adversely affects the patient’s physical condition and can be a source of social problems. The review is devoted to the new drug Indoxyl gel (clindamycin 1%+benzoyl peroxide 5%), the use of which once a day was optimal compared with the combination therapy with adapalen 0.1%+benzoyl peroxide 2.5% for both immediate and long-term results.

Background. Psoriatic rashes can be localized on any areas of the skin, while the scalp is involved in the process in 80% of cases. The therapy of psoriasis patients with localization of the process on the scalp is quite difficult for clinicians and includes not only the treatment of exacerbations of dermatosis, but also maintenance therapy aimed at prolonging remission. Objective. To evaluate the efficacy and safety of using betamethasone+calcipotriol (Xamiol) fixed combination in the treatment of exacerbations and as maintenance therapy for patients with scalp psoriasis. Methods. 69 patients were under observation. In case of mild-to-moderate course of the process (Group 1), patients received monotherapy with Xamiol up to 8 weeks. In the severe course of the process (Group 2), patients used keratolytic for 15-20 minutes with occlusive dressing to eliminate the prominent scaly crusts, and after washing the keratolytic, the Xamiol gel was applied. At the second stage of the observation, patients with achieved clinical remission or significant improvement (PASI - Psoriasis Area Severity Index К3 points) either used Xamiol on demand (Group 3) or by intermittent scheme 1-2 times a week (Group 4) until the onset of another exacerbation. Results. In the Group 1, the PASI index was reduced by 82.7%, in the Group 2 - by 80.3%. DLQI (Dermatology Life Quality index) decreased by 80.9%, in the Group 2 - by 76.9%. In the Group 3, maintenance on-demand therapy allowed to control the process in 82.6% of patients. In Group 4, 90.6% of patients using the intermittent scheme had no negative dynamics - the PASI index persisted in the confidence interval Q1=0.2; Q3=4.8 points, which allowed the long-term control of the disease: PASI index <5 points, while 46.9% of patients had no exacerbations for 12 months against the background of intermittent therapy. Conclusion. Calcipotriol / betamethasone dipropionate fixed combination in the form of a gel is an effective and well-tolerated method of therapy of exacerbations and maintenance therapy for psoriasis with the localization of the process on the scalp.

Background. Infantile hemangiomas are the most common tumors among children of the first year of life, characterized by rapid proliferation and the occurrence of various complications. Objective. To develop an algorithm for the selection of patients for treatment by laser radiation based on the assessment of the characteristics of infantile hemangiomas by non-invasive methods with subsequent evaluation of the therapy. Methods. A prospective study including 122 children aged 1 to 24 months with infantile hemangiomas with the use of clinical assessment of hemangiomas, erythemometry and ultrasound examination (ultrasound) was conducted. Results. 132 vascular tumors were detected in 122 children. According to ultrasound dopplerography, superficial hemangiomas were detected in 84 patients (63.6%), combined - in 38 patients (28.8%). Two patients were recommended for observation, 10 patients were referred for surgical treatment. 81 patients with superficial hemangiomas received a short course of laser treatment (1-5 procedures). For the treatment of 38 patients with combined tumors, a long course (6-10 procedures) was used. According to ultrasound after the course of treatment, vascular formation and feeding vessels were not visualized, the dermios and hypodermis - without structural changes. The parameters of erythemometry after the course of treatment corresponded to the values of normal skin and decreased from 110 to 85 units. Conclusion. The authors have developed an algorithm for selecting patients for laser treatment, including erythemometry, assessment of area, depth, diameter of the feeding vessels and excluding dangerous anatomical localizations.

Topical therapy with glucocorticosteroids (GCSs) plays an important role in the treatment of steroid-sensitive dermatoses, including psoriasis and atopic dermatitis, due to the anti-inflammatory, antiproliferative, vasoconstrictive and hyposensitizing effects of these drugs. Dermovate - 0.05% clobetasol propionate is a very strong corticosteroid, allowing to quickly achieve full clinical effect against the background of a low concentration of the active substance, which reduces the risk of systemic side effects and has a favorable safety profile when used correctly. The rational use of topical GCSs in psoriasis and atopic dermatitis is discussed in detail.

Background. Acne is an androgen-dependent dermatosis, characterized by sebum hyperproduction with a chronic recurrent inflammation of the sebaceous glands and hair follicles. Acne treatment is carried out both by external comedonolitic, anti-inflammatory and antibacterial drugs, as well as systemic ones - antibiotics, retinoids and hormonal preparations with good anti-androgenic effect. Description of the clinical case. A clinical case of a patient with long-standing acne vulgaris of II degree of severity with a positive effect from medium-dose isotretinoin therapy is presented. Conclusion. The results obtained make it possible to recommend isotretinoin as a drug of choice for long-standing mild and moderate acne.

Background. The choice of treatment for actinic keratosis (AK) depends on the clinical form, localization of lesion, associated diseases and economic opportunities. Treatment of AK by laser-induced thermotherapy is of great interest. This article discusses the currently used methods of AK treatment. Description of the clinical case. A clinical case of treating a patient with a diagnosis of actinic keratosis, erythematous form is presented. According to the results of a cytological examination, changes in the dermis were represented by keratinocyte dysplasia and hyperkeratosis. Ultrasound of the AK lesion revealed an increase in the thickness of the epidermis in the form of a band of increased echogenicity and hypoechoic zone, which occupies a third of the dermis, corresponding to solar elastosis. The patient received AK treatment using laser-induced thermotherapy with a good clinical and cosmetic results. Conclusion. The prevalence of the disease, risk of malignant transformation, the patient’s awareness of cosmetic unacceptability, the adverse effect on the psycho-emotional sphere and social adaptation determine the relevance of this problem and the need to develop new effective methods and treatment regimens.