Vol 30, No 8 (2023)

The article discusses modern aspects of the formation of resistance of mycotic infections to antifungal drugs, which is one of the reasons for the loss of the expected clinical efficacy of therapy. Factors such as the appointment of antimycotics without laboratory tests necessary to confirm or exclude the fungal nature of nail damage, misinterpretation of diagnostic test results, irrational treatment tactics, and self-treatment contribute to a decrease in the sensitivity of pathogens of superficial skin mycosis and onychomycosis. Changes in the nail apparatus are characteristic not only for fungal invasion, but also for onychodystrophies and a number of other nosologies. The similarity of clinical manifestations of onychopathy of various etiologies creates difficulties in differential diagnosis and can lead to therapeutic errors. The article presents the main clinical characteristics of nail pathology of various origins: onychomycosis (a chronic fungal infection of the nails that requires etiotropic therapy with antifungal agents), and onychodystrophy (different non-infectious changes in the nail plate, in which the use of antimycotics is not indicated). Modern methods of laboratory and instrumental diagnosis of onychomycosis are described, aspects of differential diagnosis of onychomycosis with all types of non-infectious dystrophies of the nail plates, including nail lesions in diseases such as psoriasis, lichen planus, eczema, are discussed.

The article presents data on rosacea, a chronic relapsing inflammatory skin disease with a high prevalence among fair-skinned adults of Northern European origin. It is known that various environmental factors, endogenous factors stimulate an enhanced innate immune response and neurovascular dysregulation, while the etiopathogenesis of rosacea requires further study. The article discusses trigger factors for rosacea, including endoplasmic reticulum stress and an extended protein response; ultraviolet radiation and thermal, mechanical, nutritional, psychological and other adverse risk factors. Information on the relationship of concomitant cardiovascular, neurological diseases in rosacea is also provided.

The article analyzes current information about pyogenic granuloma (PG), currently referred to as benign vascular tumors. The features of the clinical course of the disease are considered in detail, the factors that most often provoke the development of PG are described, a detailed description of the dermatoscopic picture is presented, with such signs as a reddish homogeneous area, white collar, white rail structures, ulceration and vascular structures. Special attention is paid to the differential diagnosis of PG with non-pigmented melanoma of the skin, Spitz nevus, lymphangiomas, angiokeratomas, bacillary angiomatosis, Kaposi’s sarcoma and basal cell skin cancer. The authors present their own clinical observations of PG in the nail bed, illustrating the possibility of self-regression, as well as the possibility of using a topical β-blocker for the treatment of PG in children.

The article presents data on alopecia areata (AA), a chronic inflammatory disease caused by hair loss with primarily genetic component. The frequency of occurrence of AA reaches 1–2% of the total population as a whole. AA can develop at any age. At the same time, in most patients, the first episode occurs before the age of 40 years, with a maximum onset between the second and fourth decades. In some patients, hair loss can develop into severe and chronic hair loss and cause severe psychosocial stress. Despite extensive research in the field of AA, the current understanding of pathogenesis is still incomplete. Genetic epidemiological studies are known to be effective in studying associations between gene variations with common diseases. The importance of genetic factors in AA is evident due to the high frequency of a positive family history. The article presents variants of genetic predisposition to AA, considers related and unrelated genes of the human leukocyte antigen in AA.

Background. Currently, there are many patients with acne who independently cancel the topical treatment prescribed by the doctor because of their own opinion about its inefficiency. In this regard, the study of the reasons for the failure of topical acne therapy, as well as ways to improve therapeutic efficacy, is of particular relevance.

Objective. Evaluation of the attitude of patients with acne to topical therapy (their satisfaction, reasons for self-cessation of topical therapy) and analysis of the possibility of increasing the effectiveness of topical treatment with a combination of drugs and a psychotherapy program developed taking into account the results of studying the personality of a patient with acne.

Methods. The study involved 100 patients with mild to moderate acne aged 14 to 18 years (mean age 16.2±1.6 years) who applied to a dermatologist because of dissatisfaction with previous topical therapy. All patients had previously received repeated courses of topical therapy and, for one reason or another, stopped treatment on their own. The study was conducted using a questionnaire.

Results. The use of topical monotherapy was considered ineffective by 81 (81%) patients. 84 (84%) patients independently canceled topical medicines prescribed by a doctor. The main reasons for withdrawal were the lack of information about the mechanism of action of the drug and the need for its use (67% patients), as well as the expectation of quick results (25% patients). On the example of a clinical case, the expediency of an integrated approach to improving the effectiveness of treatment through a combination of topical drug therapy and psychological correction has been demonstrated.

Conclusion. The use of a comprehensive therapeutic program, including topical acne therapy and psychological correction, allows to increase the effectiveness of treatment and improve the psychological status of the patient.

Background. It is well known that blood serum elevated uric acid (UA) level is the cause of a number of chronic diseases, such as gout, as well as osteoarthritis and uric acid nephritis. As a rule, prolonged hyperuricemia is accompanied by severe skin manifestations, such as pruritus, erythema, and hypersensitivity. However, the use of drugs to correct hyperuricemia, obviously, does not solve this problem. Moreover, as is known, a number of plant extracts effectively enhance the UA clearance, helping to reduce its blood serum and tissue concentration.

Objective. Evaluation of the the effectiveness of a composition based on the components of a dietary supplement based on plant components of meadowsweet (Filipéndula ulmária) and aspen (Pópulus trémula) – Hepalit* on the blood serum UA level in patients with initially elevated UA levels.

Methods. The study involved patients with elevated serum UA levels (more than 350 µmol/L in women and 415 µmol/L in men). A total of 107 patients aged 45–65 years were examined, including 47 men (Group 1) and 62 women (Group 2). During study follow-up period, patients keep a routine diet. The herbal composition of dietary supplement consisting of micronized meadowsweet leaves (Filipéndula ulmária) and aspen bark (Pópulus trémula) was used per os at a dose of 500 mg for 30 days.

Results. Taking this herbal composition for a month provided significant decrease in the UA level in both men and women. Characteristically, this effect persisted 1 month after the end of the use of composition. Simultaneously with the decrease in UA, there were positive significant changes in triglycerides and blood sugar levels in patients with initial hypertriglyceridemia and hyperglycemia. Almost 90% of patients indicated the disappearance of such manifestations as itching, erythema and hypersensitivity, 55% – a decrease in the size of tophi. The effect was observed regardless of the location and severity of skin changes.

Conclusion. The herbal composition presented in this dietary supplement is based on meadowsweet (Filipéndula ulmária) and aspen (Pópulus trémula), can be recommended for use in patients with elevated UA levels, metabolic syndrome and gout as a component of functional nutrition or an independent herbal preparation.

Background. The main component of the dermis is collagen, an organic compound of a group of fibrillar proteins. The papillary dermis is formed by smaller bundles of collagen fibers with predominance of fibroblasts, fibrocytes, mast cells, T-lymphocytes, while the reticular dermis is characterized by larger bundles that form a characteristic network providing strength to the skin, hence the name of the layer – reticular. In young skin, collagen type I (80%) and III (15%) fibers with ratio 6:1 predominate. With age, there is a decrease in the content of type I collagen, which leads to a thickening and disruption of the bonds between the fibers. Most cosmetic procedures are aimed at collagen stimulation; before stimulating collagen production, however, it is necessary to provide cells with essential amino acids for the synthesis of collagen types I and III and direct inflammation in a controlled way. Amino acid replacement therapy (AART) is a fundamental step in preparing patients for invasive procedures. In this article, for the first time, for the diagnosis of undifferentiated connective tissue dysplasia (UCTD) of patients, the «UCTD diagnostic genetic panel» developed by the authors and the questionnaire for UCTD screening in cosmetology practice were used.

Objective. Improvement of the effectiveness of skin correction protocols during collagen-stimulating procedures, development of screening questionnaire for the detection of UCTD in cosmetology practice, testing of a genetic panel to identify signs of UCTD during collagen stimulation, development of correction protocols based on the data obtained.

Methods. The study included three patients who received a complex correction protocol based on polylactic acid and AART.

Results. Due to the combined use of the UCTD screening questionnaire in cosmetology practice and genetic panels, the authors managed to achieve pronounced results when using collagen-stimulating methods in patients and prevent possible complications.

Conclusion. General approaches to the diagnosis of UCTD should be based on a comprehensive analysis of the results of clinical and laboratory tests. The capabilities of genetic panels in combination with a screening questionnaire make it possible to achieve pronounced results and avoid possible complications.

Objective. Evaluation of the prevalence of phakomatoses, features of clinical manifestations of diseases classified in the 10th revision of the International Statistical Classification of Diseases and Related Health Problems under the heading «Phakomatoses», not classified in other headings (Q85), in the population of the Novosibirsk region, including Novosibirsk.

Methods. Retrospective analysis of proband maps with an established clinical diagnosis, included in the group of phakomatoses: Q85.0 Neurofibromatosis (non-malignant), Recklinghausen’s disease, Q85.1 Tuberous sclerosis (Bourneville’s disease, Epiloia), Q85.8 other phakomatoses, not elsewhere classified (Syndromes: Peutz-Jeghers, Strudge-Weber, Hippel-Lindau) at the Clinical Department of the Medical Genetic Center (MGC) of Clinical Center for Family Health and Reproduction for 12 years (from 2010 to 2022) was performed. Diagnoses of specific phakomatosis, were made using diagnostic criteria recommended by the International Committee of Experts on Specific Nosology.

Results. Over the past 12 years, the following cases have been followed-up in the MGC: Q85.0 Neurofibromatosis (non-malignant), Recklinghausen’s disease – 118 probands, taking into account sick relatives (93 people) – a total of 211 patients; the prevalence in Novosibirsk and the region is 1: 13242; Q85.1 Tuberous sclerosis (Bourneville’s disease, Epiloia) – 44 probands, including sick relatives (15 people) – a total of 59 patients, prevalence in Novosibirsk and the region – 1:47,000 inhabitants; Q85.8 Other phakomatoses, not elsewhere classified: Peutz-Jeghers syndrome – 8 patients, all cases were sporadic, prevalence in Novosibirsk and the region – 1:349 283, Stradzh-Weber syndrome (more often called Sturge-Weber in the literature) – 15 patients, all cases were sporadic, the prevalence in Novosibirsk and the region was 1:186,284 residents, the Hippel–Lindau syndrome – 3 sporadic cases, the prevalence in Novosibirsk and the region was 1:9440.

Conclusion. Phakomatoses are polysystemic diseases that require a systematic approach to diagnosis and correction. The prevalence of type 1 neurofibromatosis in Novosibirsk and the region is 1:13 242, tuberous sclerosis – 1:47 000, Peitz-Jeghers – 1:349 283, Stradzh-Weber – 1:186 284, Hippel-Lindau – 1:931 422 The total prevalence of phakomatoses in Novosibirsk and the region is 1:9440.

Congenital ichthyoses are a heterogeneous group of hereditary cornification disorders of varying severity, characterized by generalized desquamation, hyperkeratosis, and often inflammation of the skin. Ichthyosis is caused by various mutations in more than 50 genes encoding structural proteins and enzymes of the epidermis involved in maintaining and regulating the skin barrier function. Violation of the structure of the epidermis leads to increased transepidermal water loss, increased xerosis and desquamation. Currently, there are no specific treatments that can completely cure a patient with ichthyosis. Various topical agents are used to reduce dryness, flaking, hyperkeratosis, and transepidermal water loss. In recent years, scientific advances have changed the understanding of the pathogenesis of ichthyosis and made it possible to take a different look at approaches to therapy using anti-inflammatory biologics, small molecules and gene replacement therapy. The review considers the mechanism of the pharmacological action of drugs used in the treatment of ichthyosis, as well as presents authors’ own data on the use of innovative methods for the treatment of severe forms of ichthyosis in children.

Antihistamines are the most commonly prescribed pharmacological therapy for allergic diseases, the prevalence of which reaches 30% of the population in the modern world, affecting people of all ages. The appointment of antihistamines for allergic rhinitis and urticaria is the first line of therapy, allowing in most cases to achieve control of symptoms. Existing antihistamines are usually divided into I and II generation antihistamines. Hifenadine, synthesized in the Acad. M.D. Mashkovsky laboratory in the 1970s, was historically assigned to the 1st generation antihistamines, however, according to its characteristics (low risk of sedation, absence of tachyphylaxis, antiserotonin effect, activation of diamine oxidase), it rather belongs to the 2nd generation antihistamines. This discrepancy raises questions and may confuse clinicians when prescribing the drug. In this regard, an Expert Council with the purpose to define the pharmacological properties of hifenadine, its clinical efficacy, tolerability and safety, which determine the place of the drug in the classification of antihistamines and the treatment of allergic diseases was held.

Background. Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases affecting both children and adults. Its effect on the patient largely correlates with the severity of the disease. Despite this, there is currently a high level of dissatisfaction with effective and safe systemic therapy. The immunological complexity of the pathogenesis of AD makes the suppression of Janus kinases a promising approach to treatment.

Description of the clinical case. This case report describes the successful use of upadacitinib, a selective oral Janus kinase 1 inhibitor, in a patient with severe AD. The drug demonstrated a rapid clinical response, good tolerance and ease of use. Our experience has confirmed that upadacitinib is an effective and safe treatment option for refractory forms of AD.

Syphilis (lues) is a major public health problem worldwide. Despite the preventive measures taken, syphilitic infection caused by Treponema pallidum remains the cause of serious health problems in patients up to persistent disability and death. In recent years, there has been a tendency to increase the number of latent and late forms, incl. cardiovascular syphilis and neurosyphilis in Russia. At the same time, the relevance of timely and adequate laboratory diagnosis of syphilitic infection remains. Despite the existing possibilities of using laboratory methods for diagnosing syphilis, establishing the correct diagnosis often presents a certain difficulty for doctors of clinical specialties related to dermatovenereology. The authors present an interesting clinical case of gummous brain lesions (cerebral syphilis), when clinicians were unable to timely establish the correct diagnosis for the patient during her lifetime. In this regard, it is necessary to regularly improve the skills of doctors of various specialties in matters of epidemiology, clinical manifestations and early laboratory diagnosis of syphilitic infection. The timely use of laboratory methods and the correct interpretation of the results obtained will reduce the number of incorrectly established diagnoses and choose the right therapeutic strategy.

Background. Orofacial granulomatosis (OFG) is a chronic inflammatory disease that currently includes two syndromes: Melkersson-Rosenthal syndrome and Miescher’s granulomatous cheilitis. The etiopathogenesis of the disease has not been studied enough, the metals used in the manufacture of dental implants, crowns and fillings are considered to be possible factors leading to its development.

Description of the clinical case. The article describes a case of OFG in the form of Misher’s macrocheilitis in a young female patient, which caused difficulties in diagnosis and treatment. The diagnosis was established 2.5 years after the onset of the disease; hydroxychloroquine therapy was ineffective. A good clinical effect was obtained during therapy with cyclosporine A at an initial dose of 350 mg/day (3.8 mg per kg). The patient continues the recommended treatment is under the supervision of a dermatologist of the Outpatient Department of the Clinic of Dermatovenereology of the Pavlov University.

Background. Contact dermatitis (CD) – irritant and allergic – is a group of skin diseases that are caused by skin contact with irritants or allergens, are characterized by a variety of morphological manifestations depending on the stage of the process and can mimic a wide range of dermatological nosologies. In the treatment of both variants of CD, the main factor is the elimination of the trigger agent/allergen, so it is important to differentiate CD from other skin diseases as early as possible, which will avoid prescribing unreasonable and often unsuccessful treatment.

Description of the clinical case. The article presents a clinical case of allergic contact dermatitis that developed against the background of a long course of scabies in a patient with limited scleroderma.

Conclusion. It is known that the clinical picture of scabies is determined both by the activity of the scabies mite and the allergic reaction of the body to the pathogen and its waste products, which in this case led to the development of complications in the form of allergic dermatitis. The rapid regression of rashes after the appointment of a scabicide convincingly shows how important the elimination of the irritant, in this case, the scabies mite, is for the relief of clinical symptoms of CD.