Том 26, № 8 (2019)

Hyperaosinophilic syndrome (HES) most often affects people aged 20 to 50 years and is characterized by peripheral blood eosinophilia with involvement or organ dysfunction directly caused by eosinophilia in the absence of parasitic, allergic or other causes of eosinophilia. HES is defined as peripheral blood eosinophilia >1500/ц1, lasting >6 months. The clinical picture of HES is manifested by nonspecific symptoms (malaise, anorexia, weight loss, periodic abdominal pain, night sweats, cough, myalgia, fever). Skin lesions in HES are observed in more than 50% of patients. The “standard set" of skin manifestations of HES (itchy papules and nodules, blisters, angioede-ma) is not specific, and does not promote to the early diagnosis of this disease. And only eosinophilic cellulitis (EC), associated with the debut of the HES, has its own “clinical face". EC can be the starting point of the pathogenetic process leading to a full-scale clinical and morphological picture of multisystem eosinophil-associated states - Schulman syndrome, Churg-Strauss syndrome and HES. In the treatment of EC, glucocorticosteroids, sulfones (dapsone), cyclosporine, griseofulvin, azathioprine, and Hi antihistamines are used.

Background. Impaired skin and epithelial barrier function from the first days of life in children with epidermolysis bullosa can cause sensitization, including food sensitization. Objective. Evaluation of the features of the IgE response to cow’s milk proteins and the clinical manifestations of cow’s milk protein allergy (CMPA) in children with epidermolysis bullosa. Methods. 82 children with epidermolysis bullosa (60 children with dystrophic form and 22 with a simple form of the disease) were examined. Diagnosis of CMPA was based on a generally accepted set of clinical and laboratory methods (medical history, nature of clinical manifestations, diagnostic milk-free diet, open provocative test). The level of cow’s milk specific IgE and its fractions (casein, в-lactoglobulin, bovine serum albumin) was determined using the indirect immunofluorescence (ImmunoCAP250). Results. Sensitization to cow’s milk proteins, casein, and bovine serum albumin was detected statistically significantly more often in children with dystrophic form of epidermolysis bullosa compared to simple form (p<0.05). In the group of children with dystrophic form of epidermolysis bullosa, CMPA was diagnosed in 11 cases, which amounted to 17.7%, and clinically significant CMPA was diagnosed in 25% of cases. Among children with a simple form of epidermolysis bullosa, clinical reactions to food were detected in 2 (9.1%) patients. Conclusion Children with a dystrophic form of epidermolysis bullosa are characterized by a higher frequency of sensitization to milk proteins and clinically significant CMPA.

Background. The prevalence of scleroatrophic lichen and the lack of unified approaches to the diagnosis and treatment of this disease require the development of new approaches to both diagnosis and improvement of treatment methods for this nosology. Objective. Offering the methods for an objective assessment of the effectiveness of the treatment of vulvar lichen sclerosus (VLS) and evaluation of the stage-by-stage treatment of disease using these methods. The LS-S index was proposed for assessing the area of skin lesion, and LS-A index - for evaluating the activity of the skin process in VLS. The LS-S index was based on the assessment of the lesion area by subdivision of the vulva into zones, while the LS-A index includes the main clinical manifestations of VLS and their severity. The practical application of the indices against the background of a three-stage treatment of VLS was evaluated. Methods. The observation group consisted of 41 patients with vulvar lichen sclerosus aged 19 to 59 years. Using the LS-S index, the patients were classified as follows: 27 women had a lesion estimated at 9 points (there were no perianal lesions in this group); 11 patients had a lesion area of 5 points, and 3 patients - 7points An assessment was performed using the developed indices of vulvar lichen sclerosus, allowing to evaluate the activity of the skin process and its area. Evaluation was carried out before treatment, on the 14th, 30th, 90th and 120th days. The stages of treatment consisted in the sequential use of topical glucocorticosteroids, injections of autologous plasma, and fractional CO2 laser. Results. The use of indices for assessing the area and activity of the skin process after the stage-by-stage treatment showed the convenience and simplicity of their use and made it possible to objectify the data obtained as a result of treatment: after the three-stage treatment, 27 women had a lesion estimated at 5 points (there were no perianal lesions in this group); 11 patients had a lesion area of 2 points, and 3 patients had a lesion area of 4 points, which corresponded to a distinct positive dynamics, having a numerical expression. Administred therapy was not accompanied by significant adverse events. Conclusion. The use of the index of activity of the skin process and the index for assessing the area of skin lesion of the vulva region in VLS is a convenient and practical tool for an objective assessment of the dynamics of skin changes during therapy, which includes a three-stage approach with sequential use of topical corticosteroids, injections of autologous plasma, and fractional CO2 laser.

Background. Of particular interest is the eye lift. For this purpose, various instrumental and surgical methods are used. For many years laser therapy methods remain the “gold" standard for the correction of age-related changes. Many questions of combined methods, however, are still open, therefore, the search and development of the most effective protocols for their use are considered an urgent task of modern medicine. Objective. Based on the evaluation of the results of clinical efficacy, development of a combined method for the correction of involutive skin changes in the periorbital region in young and middle-aged patients using fractional Nd:YAG and CO2 laser in combination with transconjunctival lower blepharoplasty. Methods. The study involved 108 patients with involutive changes in the skin of the lower eyelid. Depending on the method of treatment, patients were divided into groups. The study used a clinical diagnostic complex using special clinical methods: a photoaging scale for eyelid skin, an aesthetic global rating scale (GRS), and an adapted rating scale for satisfaction with treatment results (FACE-Q Eye Module). Results. According to the GRS scale, the “loss of elasticity" indicator in the 3rd group decreased by 78.9% (compared with 69.2 and 52.3% for the 1st and 2nd groups), the “tuberosity" indicator - by 54.8% (47.6 and 36.8% for the 1st and 2nd groups), the «dehydration» indicator - by 79.02% (67.2 and 40.5% for the 1st and 2nd group), which contributed to the reduction of wrinkles by 90.1/93.4% vs 57.4/63.8% and 89.3/91.6 in the 1st and 2nd groups, respectively. The patient satisfaction index analyzed using the adapted FACE-Q Eye Module scale increased by 63.1%, while in the comparison groups it increased by 41.7and 53.5%, respectively, which indicates the high clinical efficacy of the developed combination treatment method. Conclusion. Based on the study, it can be concluded that the developed combined treatment method is highly effective.

Background. Prevention and treatment of post-acne scars is still an urgent task. The “gold" standard in scar correction is the ablative method using a CO2 laser. Dermabrasion with an erbium laser is less traumatic ablative method due to its high affinity to water molecules. However, in order to achieve an effect comparable to a CO2 laser, several procedures are required. Objective. Comparison of the effectiveness of a CO2 laser and an erbium laser in the treatment of post-acne scars. Methods. The study involved 84 patients with atrophic and hypertrophic post-acne scars. Patients were divided into groups depending on the type of cicatricial deformities (atrophic/hypertrophic) and the correction method (CO2/ erbium laser). Results. Based on the analysis of the values of the Manchester Scar Scale, a significant improvement of most parameters was revealed when applying laser technologies for the correction of both atrophic and hypertrophic post-acne scars. However, a significantly more pronounced dynamics in such parameters as color, texture, relief, density was obtained when using an erbium laser. Changes in the tissue displacement parameter were not observed, because the initial values of this parameter were within the normal limits. Conclusion. Based on the results of the study, it can be concluded that the use of an erbium laser in the treatment of post-acne is more effective than a CO2 laser.

The article highlights the issues of efficiency and safety of superpotent topical glucocorticosteroid (GCS) - clobetasol propionate. In terms of strength and effectiveness in steroid-sensitive dermatoses, it is superior to the majority of topical corticosteroids. The drug has several dosage forms that are convenient for use in various localizations. It is a drug of choice in the treatment of moderate and severe psoriasis, and is effective in the treatment of a wide range of dermatoses that are difficult to treat with less active corticosteroids. Clobetasol propionate is safe with the rational use. The development of serious complications is possible with prolonged use at very high doses.

Background. Atopic dermatitis (AtD) is a multifactorial, most common inflammatory dermatosis. The structural features of the skin of children of the first year of life determine a number of clinical characteristics caused by dysfunction of the epidermal barrier with increased transepidermal water loss and pronounced hydrophobicity of the skin surface of children in this age period, which largely limits epidermal fluid absorption. Depending on the severity of the skin pathological process, a step-by-step algorithm for the topical therapy of AtD in children of the first year of life is proposed, including the differentiated use of topical glucocorticosteroids, wet wraps and topical calcineurin inhibitors - pimecrolimus in combination with emollients. Conclusion. According to modern recommendations for skin care for children of the first year of life, it is important to ensure regular hydration and skin cleansing. The most effective way to restore the protective function of the skin barrier is the use of agents aimed to restoring the stratum corneum and preventing excessive transepidermal water loss.