Vol 30, No 13 (2023)

Melanin hyperpigmentation (HP) is a fairly common reason for visiting dermatologists and cosmetologists. In clinical practice, melasma and secondary post-inflammatory HPs are the most common. Tyrosinase is considered to be the key enzyme in the melonogenesis disorder. At the same time, inhibition of the tyrosinase enzyme activity is the safest and most effective way to reduce HP today. However, the clinical effectiveness of current tyrosinase inhibitors is limited due to the fact that they have generally been selected based on their ability to inhibit fungal tyrosinase. In recent studies, thiamidol has been characterized as a particularly potent inhibitor of human tyrosinase. In vitro, thiamidol was superior to commonly used HP inhibitors such as arbutin, kojic acid, and hydroquinone. This superiority of thiamidol compared to hydroquinone was confirmed in studies in vivo.

Up to 8% of dermatological patients visit doctors about hair loss. Among the causes of hair loss, cicatricial alopecia (CA) represents a challenging diagnostic and therapeutic challenge. CA includes a group of diseases in which the common end result is the destruction of the hair follicle, which is replaced by connective tissue. The irreversibility of hair loss and the associated adverse cosmetic consequences of CA require special attention to their timely diagnosis. There are primary and secondary CAs. Primary CA is characterized by a folli-culocentric inflammatory process, which leads to the destruction of the hair follicle; in secondary RA, the hair follicle is indirectly affected along with other skin structures. The proportion of primary RA, which represents the greatest difficulty in diagnostic and therapeutic terms, accounts for 3–7%. Diagnosis of the disease that caused primary CA is based on a careful collection of the patient’s medical history, clinical examination, dermoscopic (trichoscopic) data and the results of a biopsy of the scalp, which is a necessary condition for prescribing appropriate therapy. The article presents literature data on the classification, diagnosis and treatment of various types of CA.

Backrground. In psoriasis (PS), a complex immune cascade with the participation of both the innate and adaptive immune systems occurs, and is characterized by the development of multiple comorbid pathologies that complicate the course of the underlying disease.

Objective. Evaluation of the safety profile and effectiveness of genetically engineered biological drugs from the group of IL-17A inhibitors (netakimab) in patients with smooth skin PS and inflammatory back pain, taking into account comorbid pathologies.

Methods. 39 patients with PS were followed-up: 21 (53.8%) men and 18 (46.2%) women aged 18–48 years (mean age 35.3±2.1 years), who received the genetic therapy netakimab at a dosage of 120 mg subcutaneously at weeks 0, 1, 2 and then 120 mg every month for 52 weeks.

Results. The majority of patients taking netakimab noted significant positive changes in the skin and joints by the end of the 3rd week of therapy. By week 12, 36 (92.3%) patients achieved PASI 75, 33 (84.6%) – PASI 90 and 31 (79.5%) patients – PASI 100. By week 24, delta PASI 75 was noted in 38 (97.4%) patients, PASI 90 – in 37 (94.9%) patients, PASI 100 – in 35 (89.7%) patients. By week 52, 39 (100%) patients achieved PASI 75, 39 (100%) achieved PASI 90, and 38 (97.4%) patients achieved PASI 100.

Conclusion. IL17-A inhibitors (netakimab) have shown high efficacy and a favorable safety profile against the clinical symptoms of PS, inflammatory back pain (possibly as early signs of psoriatic arthritis) and multiple concomitant comorbid pathologies.

Background. Psoriasis (PS) is a chronic non-infectious disease of an autoimmune nature, which is characterized by predominantly skin lesions.

Objective. Determination of the clinical effectiveness of adalimumab and ixekizumab in the treatment of PS.

Methods. The study involved 140 patients, 87 (62.14%) men and 53 (37.86%) women aged 18–60 years (mean age 38.2±11.7 years). The effectiveness of therapy was assessed after 4, 8, 12, 52 weeks and 2 years. The severity of PS was assessed using the PASI, BSA, sPGA indices. The quality of life of the study participants was assessed using the Dermatological Quality of Life Index (DIQL) and the HADS Hospital Anxiety and Depression Scale.

Results. All 140 patients completed the study. At week 12 of therapy, complete clinical remission was achieved in 40% of patients receiving ixekizumab. In the group of patients receiving adalimumab, complete remission was achieved in 7%.

Conclusion. Ixekizumab showed higher efficacy rates in the treatment of vulgar PS than adalimumab, and therefore can be recommended for the treatment of vulgar PS.

Background. Treatment of severe acne is a difficult task in the daily practice of dermatovenerologists.

Objective. Determination of the effectiveness, tolerability and validity of prescribing systemic antibiotics in the early stages of treatment of patients with severe acne.

Methods. The present study scientifically validated the use of systemic antibiotics in the treatment of 52 patients with severe acne before prescribing isotretinoin.

Results. This method of patient management not only contributed to the high effectiveness of therapy, but also led to the formation of stable remission in the majority of subjects, a decrease in signs of systemic inflammatory reactions in the early stages of treatment, and most importantly, high assessment of treatment results by patients.

Conclusion. This observational study demonstrates the absolute validity of introducing systemic antibiotics into the treatment of patients with severe acne at the initial stages before prescribing systemic isotretinoin.

Background. Atopic dermatitis (AD) is a multifactorial, genetically determined, inflammatory skin disease characterized by itching, chronic relapsing course and age-related features of the localization and morphology of lesions. AD is an atopic disease with a dominant role of T helper cells type 2 (Th2), increased levels of interleukins (IL-4, -5, -13 and -31), which forms IgE-mediated sensitization and inflammation. Alopecia areata (AA) is an autoimmune disease characterized by CD8+ T cell-mediated hair loss. Although AA has historically been classified as a process driven primarily by T helper type 1 (Th1) cells, findings from genomic susceptibility loci and cytokine activation support the involvement of the Th2 pathway. Accordingly, dupilumab, an IL-4 receptor antagonist that suppresses the Th2 response, may represent an effective drug for the treatment of severe forms of AA.

Objective. Evaluation of the effectiveness of dupilumab in children with AA and AD.

Methods. A cross-sectional retrospective cohort study was conducted. The mean age of the patients was 11,3±2,8 years (range, 7 to 18 years). A total of 12 patients took part in the study, including 7 girls and 5 boys. Patients were administered dupilumab by subcutaneous injection at a dose of 600 mg, followed by 300 mg every 2 weeks. The median duration of treatment with dupilumab was 24 weeks (median 29.4, range 20–54). To assess the effectiveness of treatment for HA and AD, the SALT (Severity Alopecia Tool) scale and the Eczema Area and Severity Index (EASI) were used.

Results. After 24 weeks of dupilumab treatment, patients’ mean SALT score decreased from 71.9 to 25.2. All patients treated with dupilumab experienced significant regression of skin lesions and a significant reduction in EASI scores. The mean EASI score in patients before initiation of dupilumab was 52.3 and decreased to 8.15 after 24 weeks of treatment.

Conclusion. The results obtained indicate that dupilumab may be effective in the treatment of severe forms of AA in children with AD.

Background. According to the International Federation of Psoriasis Associations (IFPA), about 125 million people worldwide suffer from this disease. In Russia, at the end of 2022, based on the results of visits to medical organizations, more than 371.2 thousand patients with psoriasis were registered, and 94.2 thousand new cases of psoriasis were identified during this period. Features of the social characteristics of patients, including with psoriasis, not enough studied all over the world.

Objective. Evaluation of the influence of chronic skin disease (using the example of patients with psoriasis and arthropathic psoriasis) on the social activity of patients.

Methods. In order to study the influence of psoriasis and arthropathic psoriasis on the social activity of patients, an anonymous quantitative on-line survey of patients was conducted. The questionnaire included 36 questions. The object of the study was patients with a confirmed diagnosis of psoriasis and arthropathic psoriasis aged 18 to 75 years. Patients were included in the study regardless of the duration and severity of the disease. 512 respondents took part in the survey. After the “repair” the sample amounted to 486 people.

Results. It was revealed that the overwhelming majority of respondents do not have disabilities caused by psoriasis/arthropathic psoriasis (90.5%), did not receive therapy with genetically engineered biological drugs and did not encounter help (except for medical care) from government or public organizations (more than 90%). More than 85% of surveyed patients with psoriasis and arthropathic psoriasis do not receive medications for free. Moreover, almost half of the respondents spend up to 30% of their monthly income on medications necessary for treatment. In general, the presence of psoriasis/arthropathic psoriasis in patients does not interfere with their full work and study. At the same time, a significant portion of respondents had difficulties interacting with colleagues and friends due to the presence of these diseases, and 40% of respondents had to refuse job offers due to the presence of the disease. About half of the respondents experience various difficulties in their personal lives (the corresponding restrictions are manifested by both reluctance to enter into a long-term relationship and problems in intimate life, including among married respondents). Also, about half of the respondents experienced various difficulties in communication with their sexual partner, as well as in their sexual life. Moreover, more than 80% of patients with psoriasis/arthropathic psoriasis have the support of their family, which is an important factor in building self-confidence and reducing discomfort in creating new social connections.

Conclusion. The social characteristics of patients with psoriasis and arthropathic psoriasis, identified from the results of the study, can be used in preparing measures for the adaptation of patients, as well as programs for medical rehabilitation and prevention.

Androgenetic alopecia (AGA) is the most common hair loss condition affecting both men and women. The most common drug of choice in the treatment of AGA is minoxidil, which has vasodilating, anti-inflammatory and antiandrogenic properties; it is an inducer of the Wnt/β-catenin signaling pathway, and enhances the synthesis of growth factors. Minoxidil affects several pathogenesis of AGA at once, prolonging the anagen phase and reducing the telogen phase, enhancing DNA synthesis and stimulating proliferative processes. Currently, minoxidil is considered as a drug for both local and systemic therapy of AGA. Treatment methods with minoxidil in combination with finasteride, spironolactone, topical tretinoin, as well as platelet-rich plasma, low-intensity laser therapy and microneedling are of particular, which significantly expands the treatment options for patients with AGA.

Parasitic sycosis is a form of zooanthropophilic trichophytosis, and therefore is more common among the rural population, which has some difficulties with the availability of qualified medical care. Moreover, being a type of sycosis and having similar clinical manifestations, it often becomes the cause of diagnostic errors. Coverage of this problem, in our opinion, is relevant for dermatologists. A review of the literature on the problem of sycosis including classification, clinical manifestations, differential diagnosis and treatment tactics was carried out. Taking into account similar clinical manifestations and a specific diagnostic error, a description of a clinical case of parasitic sycosis is presented.