Vol 28, No 14 (2021)

Acne (acne vulgaris) is a chronic inflammatory disease of the pilosebaceous follicle, the characteristic manifestations of which include open and closed comedones, as well as papules, pustules, nodes. Acne is diagnosed in 9.4% of the general population and belongs to multifactorial dermatoses, accompanied by excessive production of sebum, follicular hyperkeratosis of the excretory ducts of the sebaceous glands, followed by their occlusion, hypercolonization of Cutibacterium acnes and an inflammatory reaction. The study of the pathogenesis of the disease is relevant, because allows to expand the range of drugs for treatment and affect all links of pathogenesis thoroughly and comprehensively. The literature review presents the main pathogenetic aspects of the development of acne vulgaris.

Currently, studies on evaluation of the effectiveness of netakimab not only in psoriasis and psoriatic arthritis, but also in axial spondy-loarthritis are underway. Research results confirm the effectiveness of the drug in enthesitis, dactylitis, axial lesions. In this report, we present the clinical experience of using netakimab in the treatment of severe psoriasis vulgaris, inverse psoriasis and psoriatic onychodystrophy, as well as its effectiveness in the early manifestations of axial lesions of psoriatic arthritis.

The article discusses the possibility of timely diagnosis of malignant melanoma by assessing changes in the dermatoscopic picture of formations during follow-up. An analysis of 23 cases from authors’ own practice, identified mainly in patients at risk, is given. The age of the patients varied from 28 to 70 years, mean age 36.7±10.5 years. Follow-up of pigmented lesions before making a decision on excision was performed out for 3-24 months, on average - 10.5±5.4 months. Changes in the dermatoscopic picture were manifested by an asymmetric increase of the lesion and/or a change of its shape (43.5%), the appearance of a new color (69.6%), the formation of an atypical dermatoscopic structure (65.2%), a change in the pattern of the pigment network (56.5 %), modification of the dermatoscopic model of the structure (21.7%), partial regression of formation (4.3%). The mean diameter of the lesions during the follow-up period increased from 4.2±2.2 to 5.4±2.3 mm, the lesion value of the total dermoscopic score of the ABCD rule increased from 3.4±0.9 to 4.6±1.2 points (P<0.05). Histological examination diagnosed melanoma in situ in 52.2% of cases, in the rest - microinvasive melanoma (Clark level II) with Breslow thickness range from 0.2 to 0.5 mm.

Currently, there is a wide range of procedures, manipulations and substances designed to the prevention of age-related changes in the skin of patients in the arsenal of a dermatocosmetologist. Our article provides an overview of one of the most promising areas -thread lift.

Background. Menopause is a normal physiological event for middle-aged women. In about 50% of cases, the genitourinary syndrome of menopause (GSM) develops which significantly impairs the quality of life and definitely requires treatment. In recent years, photodynamic therapy (PDT) has been actively used to correct involutive skin changes, and the PRP-therapy method, the use of autologous platelet-rich blood plasma, is used as the advanced methods of rejuvenation. The effectiveness of PRP therapy looks promising, and the risks of this procedure with correct use are minimal. Objective. Evaluation of the efficacy and safety of PDT in combination with PRP in the treatment of GSM. Methods. This study included 15 patients diagnosed with genitourinary syndrome of menopause (involutive changes in the vulva). PDT procedures (photosensitizer chlorin E6 in the form of 1% gel was used) and plasmotherapy were performed only 10 times (each type of procedure 5 times) alternately once a week. The PDT AFS «Harmony» device (wavelength - 660 nm) was used as a radiation source. To assess the effectiveness of this therapy, the following scales were used: VHI (vaginal health index), VAS (visual analogue scale), and DLQI (Dermatology Life Quality Index). We also developed a scale for assessing VICV (visual involutive changes of the vulva) with assessment of 7 indicators: color/depigmentation, desquamation, skin texture to the touch, vascular pattern, hair-covering in the labia majora, flattening and wrinkling of the skin, cracks/erosion. Results. After alternating the course of PDT procedures with PRP-therapy, the patients noted a significant regression of itching, which completely disappeared in 11 patients; in the rest it significantly decreased. The symptoms of dryness completely disappeared in 6 patients, and decreased to insignificant value in the rest. After the completion of the course of procedures, a decrease in skin dryness on average up to 3 points was noted. Itching completely regressed in 6 out of 9 patients. Dyspareunia decreased significantly in 4 patients and disappeared completely in 6 patients. Significant changes were also observed when assessing the VHI in relation to the integrity of the epithelium (on average 4.93 points), indicators of moisture and transudate (4.73 each) and Ph-metry (4.4 points). The elasticity indicators did not change compared to the initial values. No serious side effects were detected during the entire period of treatment and after it. Conclusion. The use of PDT in combination with PRP-therapy in this study showed high efficacy in the form of a significant regression of the main complaints, such as itching and dryness, as well as an improvement in visual indicators of changes in the vulvar area. These procedures are safe in the treatment of GSM (no complications were observed during and after therapy). The new developed VICV scale will provide a more effective approach to the diagnosis of involutive changes in the vulva, as well as allow to prescribe the correct therapy depending on the severity of symptoms.

Background. Due to the active rhythm of life and the increase in life expectancy, the demand for non-injection methods for correcting age-related skin changes is growing. Photodynamic therapy (PDT) methods, in particular, with the use of chlorin E6 derivatives, are increasingly used in cosmetology clinics. Objective. Evaluation of the effect of PDT with the use of chlorin E6-based photosensitizers and light radiation with a wavelength of 410 and 630 nm on the thickness of the epidermis and dermis of the face immediately after treatment, as well as in the long-term period. Methods. The epidermal and dermal thickness in the facial area was determined in women aged 35 to 45 before therapeutic exposure (course of PDT procedures using chlorin E6 once a week No. 5) - immediately after, and after 3 and 6 months, compared with the control group aged 25 to 35. Results. The epidermal thickness at the end of the course of treatment increased by 12%, and the dermal thickness - by 9.2%, after 3 months - by 21.2 and 20.7%, respectively, and after 6 months - by 23 and 24.7%, respectively. As a result of PDT, the indicators in the 35-45-year-old group became comparable to those in the 25-35-year-old control group. Conclusion. The data obtained indicate an increase in the epidermis and dermal thickness as a result of PDT using chlorin E6 and make it possible to recommend this method for the correction and prevention of involutive skin changes.

Background. Not only risk factors such as androgenic stimulation, follicular hyperkeratosis, inflammation and activation of Cutibacterium acnes, but also the activation of innate and adaptive immunity are of great importance in the development of acne. An important role in the immunogenesis of acne belongs to interleukin-1 and a number of other cytokines; however, the literature sources indicate a number of conflicting data on the characteristics of the immune system during the development of various clinical forms of acne. Objective. Evaluation of the HBD-2 and TLR2 gene expression in the skin of patients with acne before treatment and assessment of the effect of the combined use of low doses of isotretinoin and phototherapy with broadband light with a wavelength of440-950 nm on the expression of these genes compared with therapy with standard doses of isotretinoin. Methods. 78 patients diagnosed with moderate papulopustular acne were followed-up in outpatient settings. By the method of simple randomization, 78 patients were divided into 2 groups depending on the method of therapy. These 2 groups were divided into 2 age subgroups: 12-24 years old (subgroups A1 and A2) and 25-45 years old (B1 and B2). The study evaluated the expression levels of the TLR2 and HBD-2 genes in the skin of acne patients before and after treatment and analyzed the results. Results. Decrease in the HBD-2 expression in the skin, an increase in the TLR2 level and the normalization of these parameters after treatment in patients with acne indicate their important role in the pathogenesis of this disease. Conclusion. Thus, the expression of defensin HBD-2 and TLR2 recognition receptor in the skin plays an important role in the pathogenesis of acne.

Background. Currently, the benefits of dynamic clinical and dermatoscopic follow-up of patients with multiple melanocytic nevi and high risk for melanoma development are widely discussed. Long-term follow-up for patients with a history of melanoma is recommended in a number of international and domestic clinical guidelines for the diagnosis and treatment of this malignant skin tumor. On the other hand, there are practically no data on the management tactics and frequency of observations for patients with single melanocytic nevi, which may have a potential risk of developing malignant melanoma. Objective. Comparison of the frequency of detection of clinical and dermatoscopic changes in single and multiple nevi in patients with a high risk of developing malignant melanoma. Methods. The dynamic follow-up program included 75 patients with one or more risk factors for the development of malignant melanoma, distributed in group I - 43 patients (50 or more melanocytic nevi) and in group II - 32 patients (<50 melanocytic nevi). The patients underwent a questionnaire survey, a clinical dermatological examination, and double photo-mapping with an observation interval of at least 2 months. If significant dermatoscopic changes were detected, an excisional diagnostic biopsy with histological examination was performed. When clinical or dermatoscopic signs suspicious of melanoma were detected, the diagnosis was verified in the settings of an oncological institution. Results. During the follow-up period, out of 9676 studied melanocytic neoplasms in group I, 473 (4.89%) had dynamic dermatoscopic changes, of which 60 (12.7%) were removed with subsequent pathomorphological examination. In group II, 122 (9.58%) of 1274 melanocytic neoplasms changed during dermatoscopic monitoring. Five (4.1%) lesions out of 122 with clinical and dermatoscopic changes were excised for pathomorphological verification of the diagnosis. The proportion of histologically verified melanomas among neoplasms with significant dermatoscopic changes in patients with single nevi was 40%, in patients with multiple nevi - 9.1%. Conclusion. It was found that in patients with single melanocytic nevi and risk factors for the development of melanoma, dynamic changes in dermatoscopic structures in melanocytic nevi were detected no less frequently than in patients with multiple melanocytic nevi (P=0.022). The necessity of including patients with single melanocytic nevi and risk factors in dynamic dermatoscopic follow-up was substantiated.

Diabetes mellitus (DM) is a common chronic age-associated disease, which is becoming a non-infectious epidemic worldwide, and affects many organs, including the skin. Diabetic patients can have completely different dermatological manifestations, which differ in severity, pathogenesis, and degree of manifestation. The article presents data on the most common dermatoses in elderly diabetic patients; identifies the main links of their pathogenesis and diagnostic methods. Considering the fact that skin lesions in elderly diabetic patients can cause certain difficulties in diagnosis and choice of therapeutic tactics, the features of treatment and the need to combine the efforts of doctors of various specialties (endocrinologist, dermatologist, surgeon, allergologist, gerontologist) to achieve the goal of treatment are discussed.

Background. Granulomatous cheilitis (GC) is a chronic granulomatous inflammation of the lips (usually the upper one), accompanied by non-pitting diffuse painless edema. This disease can occur in the form of a monosymptomatic form (Miescher’s syndrome) or be part of the Melkersson-Rosenthal syndrome triad (granulomatous cheilitis, facial paralysis, folded tongue). The disease is rare, and the etiology remains unknown. Description of the clinical case. This article presents a clinical case of GC in a 50-year-old female patient, who was followed up by a beautician for a long time with a presumptive diagnosis of delayed inflammatory edema of the upper lip after filler injection. Conclusion. This clinical case is of interest to doctors of various specialties due to the need for interdisciplinary interaction for the timely diagnosis, observation and treatment of such patients.