Vol 28, No 8 (2021)

Currently, there are no clinical trial data to recommend the use of combinations of genetically engineered biological drugs in the treatment of patients with COVID-19. Clinical data on the sequential use of various genetically engineered biological drugs are contradictory. The combined use of genetically engineered biological drugs may increase the risk of suppression of the immune system. The use of Janus kinase inhibitors in combination with biological disease-modifying antirheumatic drug is not recommended.

A review of the current generalizing data of the neuroimmunological concept of the pathogenesis of atopic dermatitis (AD) is presented. It touches on the aspects of psychoneuroimmunology and stress associated with this pathology, the role of neuropeptides in the development of inflammatory skin reaction. The review reveals the psychosomatic aspects of the pathogenesis of AD, presents the substantiation of the role of neuroimmune factors in the mechanism of its development. Analysis of the literature indicates the need for a comprehensive assessment of the pathogenetic mechanisms of the development of this disease, taking into account the role of neurotransmitters in the development of an inflammatory skin reaction, their relationship with the immune system and their contribution to the development of the main symptoms of dermatosis. The relevance of studying the topic is attributable to the increase in the prevalence of this pathology and often the ineffectiveness of traditional anti-inflammatory therapy. Most researchers consider the current situation as a result of underestimation of stressogenic and neuroimmune factors in the pathogenesis of AD. The search and application of antagonists of neurotransmitters or their receptors will open up new perspectives in the treatment of AD due to an important role of neurogenic inflammation in the mechanism of its development. Further research in this direction is relevant and significant.

The review continues the topic of describing the types of skin rashes associated with the novel coronavirus infection (COVID-19), including against the background of drug treatment, supplementing the information given in the previous publication of the same authors (Farmateka. 2020;27(8):8-17). The article also describes some of the features of the cutaneous manifestations of post-COVID-19 syndrome and presents authors’ own observations of 27 cases of reactive diffuse alopecia that developed after COVID-19. Information on some of the indirect dermatological problems of patients and medical personnel, on the features of the provision of dermatological care and training of dermatologists associated with the COVID-19 pandemic is provided.

The article provides information about the professional erysipeloid of Rosenbach, an acute zoonotic infectious disease characterized primarily by skin lesions and/or inflammation of the joints. The disease is sporadic, epidemic outbreaks are not excluded. There is a possibility of chronization of the disease, immunity is not stable. This infection is seasonal, with most cases occurring in the summer-autumn period. Recently, erysipeloid of Rosenbach has acquired practical significance among workers in the meat and fish processing industries. The prognosis with the cutaneous form is favorable.

Damage to macromolecules, membranes and other subcellular structures by reactive oxygen species plays an important role in the pathogenesis of aging. Improving antioxidant status through the consumption of dietary antioxidants can prevent the onset of chronic disease and premature aging. Biologically active anti-age oral supplement Epi-Oral F199 - «the secret of youth», contains 7 well-studied antioxidants. Daily intake of a biologically active anti-age supplement of epigenetic orientation Epi-Oral F199 allows to stop the insenescence and premature aging of the body in general and the skin in particular, to protect against aggressive environmental factors and restore the correct functioning of the cell.

Currently, psoriasis is considered as a chronic systemic inflammatory disease with an immunogenetic basis. Plaque psoriasis is the most common form, and the tactics of its treatment management depends on the severity of the disease. The discovery of the role of the immune system in the pathogenesis of psoriasis contributed to the initiation of the use of a number of systemic agents characterized by insufficient efficacy and tolerance. The extension of the knowledge base on pathogenesis has made it possible to introduce highly effective and safe drugs into clinical practice. Despite this, less specific drugs are still widely used in the treatment of moderate to severe psoriasis. Chronic course, significant impact on the quality of life and association with a number of comorbid conditions determine high requirements for long-term therapy of psoriasis. Among a wide range of systemic drugs, the greatest compliance with these requirements is demonstrated by genetically engineered biological drugs aimed at suppressing interleukin-17(IL-17) and IL-23. While traditional systemic drugs have many years of experience, there is little information available for IL-17 and IL-23 blockers. Our clinical case shows that the use of ixekizumab in the treatment of severe psoriasis vulgaris for 68 weeks remains a safe and highly effective therapy

Background. Due to modern technologies, in recent decades effective drugs have been developed or are being developed for a number of rare diseases. Neurofibromatosis type I is one of these diseases, for which drug therapy that can improve the quality and life expectancy of patients with this disease is being actively developed. So, doctors must know well the debut of the clinical picture. Only a timely diagnosis will make it possible to get the maximum effect from therapy. All this together makes the evaluation of the prevalence and features of the course of neurofibromatosis type I in the population of residents of the Novosibirsk region an urgent problem. Objective. Evaluation of the prevalence of the disease, features of the clinical manifestations of neurofibromatosis type I in the population of the Novosibirsk region, including Novosibirsk. Methods. Retrospective analysis of the medical records of probands in the clinical medico-genetic department (hereinafter MGD) of the City Clinical Hospital № 1 for 10 years (from 2010 to 2020) with the established clinical diagnosis «neurofibromatosis type I» was performed. The diagnostic criteria recommended by the International Expert Committee on Neurofibromatosis Type I were used to diagnose disease. Results. Over the past 10 years, 111 patients with neurofibromatosis type I have been followed-up at the MGD. Taking into account sick relatives (81 people), there were 192 patients with neurofibromatosis type I. Thus, the prevalence of type I neurofibromatosis in Novosibirsk and the region was 1: 14,500. The relatively low prevalence of the disease and its slow progression can be explained by the climate pattern: the in the autumn-winter-spring period, population constantly wears clothes that isolate the skin from the sun’s rays. This is beneficial for the course of neurofibromatosis. In 28% of patients, there were changes in the musculoskeletal system (scoliosis, kyphosis, flat foot). 6 patients had optic nerve gliomas; and Lish nodules were found in 2 patients. Conclusion. The prevalence of neurofibromatosis type I in Novosibirsk and the region is 1:14,500. Neurofibromatosis requires a systematic approach to diagnosis and correction.

Background. Until quite recently, bacterial vaginosis (BV) was considered a «mild» disease that occurs as an isolated process in a woman’s body. However, in recent years, the development of numerous and serious complications has been proven, including increased risk of contracting sexually transmitted infections (STIs). Objective. Assessment of the incidence of STIs in women of reproductive age with asymptomatic BV undergoing preventive medical examination (low-risk group for STIs). Methods. Retrospective cross-sectional study assessed the relationship between asymptomatic BV and obligate pathogens of the urogenital tract. The study included 115 patients of reproductive age with clinically and laboratory confirmed asymptomatic BV., who came to preventive medical examination and had no complaints, the mean age was 28.7±6.1 years. Before inclusion in the study, all patients underwent microscopic examination of discharge from the vagina, cervical canal, urethra; examination of samples from the cervical canal for reproductively significant infections by the nucleic acid sequence-based amplification method; quantitative assessment of opportunistic microbiota by real-time PCR with the «Femoflor-16» diagnostic system. Results. Obligate pathogens in women with asymptomatic BV were found in 53 (46.1%) cases, including Human papilloma virus - in 25, Chlamydia trachomatis - in 20, Mycoplasma genitalium - in 18, Trichomonas vaginalis - in 5, Neisseria gonorrhoeae - in 2. Depending on the identified STIs, a comparison of vaginal microbiocenosis was performed. A significant decrease in the number of lactobacilli was found against the background of excessive growth of anaerobic microbiota in all groups. The coincidences of biotopes in groups of one or more microorganisms were revealed. Conclusion. The results of this study confirm that women of reproductive age with asymptomatic BV undergoing medical examination need additional screening for the presence of obligate pathogens. This will be an important strategy for improving STI control.

Background. Psoriasis is a common chronic multifactorial immune-mediated inflammatory skin disease characterized by an increased rate of keratinocyte division. Recent studies have shown that interleukin-36 (IL-36) plays a significant role in the initiation and regulation of the inflammatory process in psoriasis. IL-36 is inactive in the skin, and neutrophilic serine proteases are required for its activation. These data led to scientific interest in the study of a new direction in the topical therapy of patients with psoriasis based on local inhibition of serine proteases. To test this hypothesis, we have developed a drug in a topical formulation based on serine proteases inhibitor sivelestat. Objective. Evaluation of the therapeutic efficacy of various concentrations of a topical serine protease inhibitor (sivelestat cream) on a laboratory model of psoriasis. Methods. To compare the effectiveness of various concentrations of civelestat in suppressing the inflammatory reaction in the skin, a cream (lanolin+olive oil+water in equal proportions) containing sivelestat at concentrations of 0.5, 1 and 5% was used. The study was carried out on 40 inbred BALB/c mice, randomized into 4 groups of 10 animals each. For the experiment, an experimental model of psoriasis was preliminarily formed on laboratory animals. The therapeutic efficacy of various concentrations of sivelestat was determined based on the results of clinical and histological examination. Results. On the 10th day of the study clinical changes were pronounced in group 1 (control) and 2 (0.1% sivelestat), and there was a resolution of the elements of the skin rash in group 3 (1% sivelestat) and 4 (5% sivelestat), more pronounced in the last group. By the 10th day of the study, the prominent decrease in the mPASI index was observed in group 4 (sivelestat 5%) and 3 (sivelestat 1%), which significantly differed from the indicators in group 1 and 2 (p<0.05). When comparing indicators, the mPASI index in group 4 significantly differed from group 3 (p<0.05). It was found that the epidermal thickness in animals of group 4 (sivelestat 5%) was 1-2.7 times smaller than in other groups (1, 2, 3; p<0.05). There were no significant difference in the epidermal thickness between group 1 (control), 2 (sivelestat 0.1%) and 3 (sivelestat 1%). Conclusion. Topical application of 5% sivelestat cream once a day for 5 days in a laboratory model of imiquimod-induced psoriasis has high therapeutic efficacy compared to the control group and groups of 0.1- and 1% sivelestat cream. When using 5% sivelestat cream, the severity of clinical manifestations according to mPASI was lower by 70%, and histological ones according to the epidermal thickness - by 63% than in the control group.

The article provides information about annular granuloma (AG), a self-limiting granulomatous-inflammatory dermatosis, which is characterized by independent regression. AG is most commonly found on the skin of children, adolescents, or young adults. Women suffer more often than men in a 2:1 ratio. When planning the treatment of patients, the tendency of AG to spontaneous resolution should be taken into account. In about 75% of cases, AG foci spontaneously regress within 2 years.

Skin aging is a polyetiological, pathophysiological process caused by external and internal stimulating factors. Pharmaceutical companies conduct numerous studies and create new drugs aimed at restoring skin functions. Synthetic peptides based on natural analogs have become an alternative to hyaluronic acid-based drugs. The biorestructuring agent containing Wharton’s Jelly Peptide P199 has an enhanced therapeutic potential through exclusive synergistic ingredients. The drug is the first original peptide-containing biorestructuring agent that restores the cell pool in aging skin more effectively than classical biorevitalizants. The main result - skin rejuvenation and repair - is achieved after a course of medication and lasts for a long time.

Background. Sneddon-Wilkinson’s subcorneal pustulosis is a rare chronic relapsing disease; single descriptions of this pathology in pediatric practice make any such case an important source of information. Over the past 5 years we followed-up 4 patients who required differential diagnosis with this dermatosis. This article presents the most difficult case. Description of the clinical case. A 17-year-old girl with severe protein-caloric deficiency against the background of organic lesions of the central nervous system and lifelong antiepileptic therapy was admitted with progressive lesions of the skin; trigger for the occurrence of skin lesion was the Mycoplasma pneumoniae respiratory infection. Clinical signs and histopathological characteristics of skin lesions were consistent with those of Sneddon-Wilkinson subcorneal pustulosis, but the detection of IgA antibodies in the epidermis during immunohistochemical study favored IgA pemphigus, serological detection of which is not widely available. Also, the choice of management tactics was not easy, since systemic glucocorticosteroids are recommended for patients with pemphigus, but in the treatment of neutrophilic dermatoses, preference is given to the sulfone preparations. Conclusion. The presented case allows to discuss the difficulties of differential diagnosis and the need to revise the approaches to classification and therapy.

Background. Cutis verticis gyrata also known as paquidermia verticis gyrata, cutis verticis plicata and bulldog scalp syndrome, is a rare benign progressive dermatosis characterized by convoluted folds and deep furrows on the scalp resulting from hyperplasia of connective tissue of the derma and epidermis, developed against the background of lymphostasis and persistent expansion of the lymphatic vessels. The article discusses the etiology and pathogenesis of cutis verticis gyrata, describes its clinical manifestations, differential diagnosis and approaches to the treatment of the disease. Description of the clinical case. The article presents a clinical case of a patient with cutis verticis gyrata who first contacted a dermatologist 30 years after the onset of the disease. Conclusion. Cutis verticis gyrata is diagnosed on the basis of clinical data, confirmed in doubtful cases by histological examination of skin biopsy samples. An important point in the diagnosis is the determination of the primary or secondary nature of the disease. In the absence of consensus guide-lines for the management of patients with this pathology, in order to ensure high-quality and comprehensive medical care, special attention to the issues of differential diagnosis should be paid.