Том 29, № 8 (2022)

It has long been recognized that the rate of skin aging is determined by internal and external factors, but only recent advances in skin gerontology have helped to analyze the molecular and cellular processes that underlie skin aging. Some of the aging processes are triggered or enhanced by the presence of damaged molecules and organelles within cells, and their turnover is partly controlled by autophagy. In this article, we look at the contribution of autophagy to the control of premature skin aging. We propose the concept that aging is driven by changes in three categories of cells with different dependencies on autophagy. Modern protocols for the treatment of acne, rosacea and premature aging should be based on the latest scientific pathogenetic data and include injection and hardware methods. The experimental drug tested by us is definitely the procedure of choice in preparation for invasive techniques and as a tool for activating autophagy in cosmetic patients.

Unwanted hyperpigmentation is one of the most common complaints of patients seeking cosmetic help. Currently, the possibilities of cosmetic correction and prevention of skin dyschromia are very diverse. To correct hyperpigmentation, it is necessary to use drugs and/or hardware procedures that can affect the regulation of melanin synthesis at different stages and levels; the mechanism of action, effectiveness and safety of this drugs aree confirmed not only by clinical, but also by laboratory research. This article presents the experience of using Meso-Xanthin F199® and IPL therapy in patients with unwanted hyperpigmentation.

The article presents data on the rosacea, chronic inflammatory disease of the face. The incidence of rosacea is highest among fairskinned people, especially those of Celtic, Northern, and Eastern European ancestry. The onset of dermatosis usually occurs between the ages of 30 and 60, with women suffering more often than men. The formation of rosacea is facilitated by many trigger factors that activate the neuronal, vascular, nervous, immune systems, antioxidant defense mechanisms, leading to clinical manifestations of the disease in erythematous-telangiectatic, papulo-pustular, fibrous and ocular rosacea. Rosacea is most commonly associated with cardiovascular, gastrointestinal, and neurological disorders. Rosacea has a negative impact on the quality of life of patients, leading to loss of confidence, emotional distress, impaired social interaction.

Pemphigus unites a group of rare autoimmune bullous dermatoses affecting the skin and mucous membranes. The disease is characterized by a chronic severe course, leading to deterioration in the quality of life and often death. Autoantibodies that are directed against various desmosome proteins are produced, that leads histologically to intraepidermal cleavage and clinically to blistering and erosion of the mucosal and/or skin epithelium. The diagnosis of the pemphigus subtype is based on clinical signs, the level of histological segregation, and the identification of antigens recognized by circulating autoantibodies using immunoassays. The epidemiological features of pemphigus vary considerably in different regions of the world. The prognosis, mortality, and clinical outcomes of pemphigus have changed significantly over the years.

Psoriasis is one of the most widespread dermatoses in the world with incidence about 2%. There are various clinical forms of psoriasis. One of the clinical varieties is inverse psoriasis, which is characterized by lesions of intertriginous areas, in particular the perianal area. Psoriasis in perianal area does not always have the clinical characteristics of typical plaque psoriasis. The scientific evidence accumulated to date suggests that patients with inverse psoriasis report a lower quality of life compared to patients with other psoriasis localizations. Localization of psoriasis in an area prone to maceration makes it difficult to carry out a differential diagnosis, which can lead to errors in the diagnosis, irrational treatment and increase the patient’s anxiety. The objective of this review is to systematize the available information on the clinical diagnosis and treatment of psoriasis in perianal area. The authors discuss in detail the features of the clinical manifestations of psoriasis in perianal area and the issues of differential diagnosis. Dermoscopy can be helpful in the diagnosis of psoriasis, especially in cases of unusual anatomical locations and/or manifestations. Therapies widely used in the treatment of plaque psoriasis in other areas of the skin may not always be suitable for the treatment of lesions in the intertriginous area, where the skin is significantly thinner, has more glands and is constantly exposed to pollution and friction. The best strategy in the treatment of psoriasis in perianal area may be to alternate topical calcineurin inhibitors or vitamin D analogs with short courses of topical glucocorticosteroids.

Background. Atopic dermatitis (AD) is one of the most common dermatological diseases. Over the past decades, there has been a significant increase in the incidence and an increase in the proportion of severe dermatosis. AD worsens during pregnancy. There is a high risk of manifestations of AD in a child in the first year of life. Objective. Evaluation of the effectiveness of the use of the synbiotic by pregnant women as a prophylaxis of AD in their children. Methods. A comparative analysis of the anamnesis data and clinical manifestations in 60 women with AD at various gestational ages, as well as an analysis of the state of their children at the present time was carried out. In group I (25 patients), the synbiotic preparation was administered orally during meals, 1-2 sachets per day for 1-3 months. Group II (35 patients) was used as a control. Results. In group I, AD in children developed in 16% of cases; in group II - in 57.15%. Food intolerance as a predictor of the development of AD in children in group II was observed in 65.7% of cases, in group I - in 28%. Conclusion. The use of a synbiotic drug during pregnancy by patients with AD reduces the likelihood of developing this disease and the risk of developing food intolerance in their children.

Background. In HIV-infected patients, psoriasis is classified as a common skin pathology; it often occurs in severe forms in this category of patients. In this regard, the issues of psoriasis therapy, the use of modern methods of treatment remain relevant. Objective. Evaluation of the possibility of using the drug Netakimab in HIV-infected patients. Methods. Five HIV-infected patients with psoriasis vulgaris were followed-up; all patients received antiretroviral therapy (ART). There were 4 men (80%), 1 woman (20%). The mean age in the groups was 36.4 years (from 32 to 41 years). The mean duration of psoriasis was 7.6 years (from 0.5 to 17 years); in one patient, psoriasis developed against the background of HIV infection (3 months after the verification of the HIV diagnosis). PASI was 17.5 (from 14.8 to 35.4). 3 patients had psoriatic arthropathy. The mean duration of HIV infection was 4.5 years (range 0.5 to 9 years), duration of ART was on average 2.5 years (range 0.5 to 7.2 years). All patients underwent the necessary examination before using Netakimab. Results. after 14 weeks of therapy, there was a significant improvement in skin status, a decrease in the inflammatory process in the joints with a complete resolution of the pain syndrome in HIV-infected patients with psoriasis. There was no deterioration in the indicators of HIV infection (clinical course, a decrease in the number of CD4+ lymphocytes, an increase in the HIV viral load). Conclusion. Netakimab in HIV-infected patients can be used to treat severe forms of psoriasis.

Background. Every year there are more and more effective drugs, including those for the treatment of orphan diseases. One such disease is tuberous sclerosis (TS). However, doctors must be well aware of the clinical manifestations at the initial stages of the development of the disease in order to prescribe timely treatment for patients. All this together makes the evaluation of the prevalence and characteristics of the course of TS in the population of residents of the Novosibirsk Region an urgent problem. Objective. Evaluation of the prevalence of tuberous sclerosis, the features of clinical manifestations of the disease in patients from the Novosibirsk Region population, including the city of Novosibirsk. Methods. Retrospective analysis of proband medical records with an confirmed clinical diagnosis of TS at the Clinical Department of the Medical Genetic Division of the City Clinical Hospital № 1 for 11 years from 2011 to 2021 was performed. The diagnosis of TS was made using the diagnostic criteria recommended by the 2012 International Tuberous Sclerosis Consensus Conference. Results. Over the past 11 years, 41 patients with TS have been followed-up in the Medical Genetic Division. The prevalence of TS in the Novosibirsk Region was 1:67947 of the population. 12 patients had relatives with TS. The ratio of familial to sporadic cases was 1 to 2.4, which was in line with world data. Of the 41 patients, there were 18 children (43.9%) and 23 adult (56.1%) patients. By gender, there were 20 male (48.7%) and 21 female (51.3%) patients. Thirty-two patients (78%) had multisystem involvement. In TS, there was a significant variability in clinical manifestations, both in unrelated patients and within the same family. Conclusion. The prevalence of TS in the Novosibirsk Region was 1:67947 of the population. The most common skin symptoms in TS were hypopigmented macules and angiofibromas of the face. With TS, skin lesions are present at birth or develop in early childhood, the disease progresses during life and can lead to disability and reduced life expectancy of the patient; so, the awareness of dermatologists is critical to ensure early diagnosis and initiation of therapy.

Background. True acantholytic pemphigus belongs to the group of rare bullous dermatoses; it is characterized by a severe course and requires long-term, usually lifelong use of systemic glucocorticosteroids. Diagnosis of pemphigus remains one of the most difficult issues of modern dermatovenereology, so the availability of sensitive and specific laboratory techniques seems to be particularly relevant. Description of the clinical case. In a 70-year-old patient G., rapidly opening blisters with a thin cover were formed against the background of moderate itching of the skin within 3 months. Crusts appeared on the surface of erosions, under which spontaneous epithelialization with the formation of secondary hyperpigmentation occurred. A dual cytological examination did not reveal acantholytic cells; eosinophils 3-5 in the field of view and leukocytes 10-15 in the field of view were detected. A dual histological examination concluded that the pathomorphological picture corresponded to pyoderma gangrenosum or bacterial infection. An indirect immunofluorescent test revealed IgG autoantibodies to desmoglein 1, which made it possible to verify the diagnosis of seborrheic pemphigus. The prescribed systemic glucocorticosteroid therapy led to remission. Conclusion. The described clinical case demonstrates the difficulties of differential diagnosis of bullous dermatoses and proves that compared to routine cytological and histological methods, which are estimated subjectively, more modern and objective laboratory tests (direct and indirect immunofluorescence), which allow to identify circulating or fixed in the epidermis IgG autoantibodies to surface antigens of epidermocytes have greatest diagnostic value today.