Vol 29, No 14 (2022)

The article presents data on discoid lupus erythematosus (DLE), characterized by a staged development of erythematous rash, follicular hyperkeratosis and cicatricial atrophy. Disease manifestations are associated with significant discomfort due to frequent occurrence on the face, scalp, ears; appearance of scarring. Factors that increase the likelihood of developing DLE include skin phototype I, drug intolerance, prolonged sun exposure, exposure to cold and wind, a history of chronic infection, and female gender. Ultraviolet radiation, dysregulation of the function of cytotoxic T-lymphocytes, dendritic cells and natural killers are pathogenetic components of the disease. Currently, the treatment of patients is associated with certain difficulties and the likelihood of relapse after discontinuation of drugs or after repeated exposure to trigger factors, which significantly worsens their quality of life.

Rosacea is a non-communicable dermatological disease of middle age that requires long-term and often life-long treatment. The debut of the disease begins with minor clinical manifestations, such as centrofacial transient erythema or conjunctivitis, which is not considered by patients as a need to see a doctor. Early therapy prevents chronicity of the process and the development of severe forms, such as papulopustular rosacea, ophthalmic rosacea and phimosis. One of the methods of rosacea therapy is physiotherapy, including laser therapy, cryotherapy, darsonvalization, electrophoresis, electrocoagulation, pulse therapy, inductothermy, phototherapy of vascular pathology, etc. This review presents the main mechanisms of the action of laser light on human skin and systematizes data on its use in various forms of rosacea.

Background. Psoriasis is a chronic systemic immune-inflammatory disease that affects not only the skin, but also the musculoskeletal system. According to epidemiological and clinical studies, every fourth patient with psoriasis develops psoriatic arthritis. Early diagnosis and early initiation of therapy allows to prevent the development of severe forms and disability. Identification of early predictors of psoriatic arthritis and referral of such patients for rheumatological examination may help to solve this problem. Methods. The existing literature was searched in the PubMed (MEDLINE), EMBASE and Google Scholar databases for 10 years up to 02/20/2021. The search for current registered trials was carried out in the clinical trial registries of the United States (Clinicaltrials. gov), China (Chinese Clinical Trial Registry) and the WHO International clinical trial registry platform. Statistical analyzes were prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using Statistic SPSS 26.0 (US-manufactured). Meta-analysis was prepared using RevMan 5 software. Results. We identified 342 articles published up to February 20, 2021. After further analysis, irrelevant articles were excluded. A total of 35 articles were included in the review and analysis. psoriatic arthritis predictors include enthesitis, nail lesions, uveitis, and axial lesions. In addition, there are biomarkers for psoriatic arthritis. According to meta-analysis, a statistically significant increase in the risks of developing psoriatic arthritis by 1.52 times (95% C11.22-1.88) was noted in the presence of damage to the nail apparatus. In addition, not only the risks of developing psoriatic arthritis but also the chances of developing psoriatic arthritis increased with statistical significance by 2.76 times (95% CI: 1.94-3.92). Conclusion. Psoriasis and psoriatic arthritis are multifactorial diseases with sharply reduced quality of life of patients, the possible development of severe forms and disability. Therefore, early diagnosis of such conditions is very important. Nail damage can be considered as predictors of psoriatic arthritis, so it is very important for dermatologists to evaluate not only smooth skin. Further research is needed to better understand this issue.

Background. Modern clinical guidelines for the treatment of patients with atopic dermatitis (AD) include the mandatory use of specialized dermatocosmetics - emollients (recommendation grade A), regardless of the severity of the process and the period of the disease (exacerbation, remission). During an exacerbation of AD, emollients are prescribed as part of complex therapy; during an remission, they can be used as a monotherapy. Objective. Evaluation of the effectiveness of complex therapy in patients with atopic dermatitis using a topical glucocorticosteroid (activity class 2) and Atopi Control products. Methods. The study included 27 patients aged 10 to 48 years (mean age 16.2±4.3 years) with AD in the acute stage with severe symmetrical erythema and itching on the forearms (modified SCORing Atopic Dermatitis (SCORAD) index 10.0±2.0). In accordance with clinical recommendations, all patients were prescribed a topical glucocorticosteroid (GCS) of the activity class 2, Atopi Control1 lotion 2 times a day on the right forearm and basic emollient2 2 times a day on the left forearm. After the exacerbation was removed (after 2 weeks), GCS was canceled, and patients continued to use emollients for 12 weeks. The number of relapses and the severity of symptoms at each exacerbation (local SCORAD) on the right and left hands were recorded, taking into account the presence of erythema, exudation, rash, excoriation, lichenification, and dry skin. The intensity of itching in the study area was assessed by patients using a visual analog scale (VAS) from 0 (no itching) to 10 (severe itching). Results. As a result of therapy, after 2 weeks the local SCORAD index decreased by 68%. In the control area (basic emollient application), the reduction in local SCORAD after 2 weeks was 45%. The number of relapses (persistent erythema for 3 or more days) in the Atopi Control group was 64% lower than in the basic emollient group (8 versus 22 reported exacerbations in 12 weeks), the severity of itching during exacerbations was also significantly lower in the Atopi Control group. All patients noted the comfort of using Atopi Control products, their excellent organoleptic properties. Conclusion. The inclusion of Atopi Control in therapy provides control over the course of AD: it quickly reduce the symptoms of the disease during exacerbations, reduce the number of relapses and their severity.

Background. In patients of the older age group, physiological xerosis of the skin is caused by structural and qualitative changes in the epidermis and dermis, and “fragility" - by decrease in the activity of the immune system in the epidermis. Skin xerosis can cause itching, which negatively affects quality of life (QoL). Objective. Evaluation of the effectiveness of Neotanin Comfort Plus cream in elderly patients with skin xerosis and itching. Methods. An open non-comparative study with 2-week follow-up period was carried out. 40 patients aged 60 to 74 years with skin xerosis and itching were included in the study. For two weeks, all patients used Neotanin Comfort Plus cream as a skin care product 1-2 times a day, and also during the day as needed. Results. As a result of the use of Neotanin Comfort Plus cream, the corneometry indicator increased by 16,6% (localization on the back) and by 12.3% (shin area), the indicator of transepidermal water loss decreased by 13.8% and 10.1%, respectively. The MAS indicator (itching) decreased by 85.1%, the total QoL index improved by 77.6%. All patients noted excellent or good organoleptic properties of the cream and the comfort of its use. Thus, 97.5% of patients rated the comfort/convenience during application as excellent or good, 95% of patients noted an excellent/good feeling after applying the cream, 95% - excellent absorption of the cream. Conclusion. Neotanin Comfort Plus cream can be recommended for patients with skin itching against the background of xerosis.

Objective. Evaluation of the features of the blood cytokine status, oxidative processes and the state of the antioxidant system in patients with true eczema in the acute stage. Methods. The study included 131 patients (mean age 58.7±3.6 years). Serum levels of pro-inflammatory cytokines - interleukins (IL) IL-10, -2, -6, IFN-y, TNF-а and anti-inflammatory cytokine IL-10, as well as indicators characterizing the state of oxidative stress and antioxidant protection were determined by enzyme immunoassay. Results. It has been established that during exacerbation of true eczema in patients, increased production of a complex of pro-inflammatory ILs, as well as IFN-y and TNF-а, was detected, accompanied by a decrease in the anti-inflammatory IL-10 level. Along with this, activation of the processes of lipid peroxidation (LPO) and insufficient production of the components of the antioxidant system were noted. Conclusion. Direct correlation between the activity of the system of pro-inflammatory cytokines and the severity of LPO processes was established; it must be taken into account when planning a complex of therapeutic measures.

Background. According to the incidence rate in pediatric practice, patients with allergic dermatosis complicated by a secondary infection rank first and account for 30-40% of the total number of visits. The most common manifestations are atopic dermatitis with symptoms of secondary infection, microbial eczema, advanced scabies complicated by pyoderma, seborrheic dermatitis (eczema), paratraumatic eczema, contact-allergic dermatitis complicated by secondary infection. Objective. Evaluation of the therapeutic effects and safety of using Levomekol medicinal ointment in the routine pediatric clinical practice in children with secondarily infected dermatoses. Methods. Non-interventional prospective study of the use of Levomekol® ointment in routine clinical practice in children with dermatoses complicated by secondary infectionwas conducted on the basis of the Children’s City Clinical Hospital n.a. Z.A. Bashlyaeva. 35 patients who received combined therapy with Levomekol® ointment and topical glucocorticosteroids - GCS (methylprednisolone aceponate, betamethasone dipropionate, hydrocortisone acetate, fluocinolone acetonide) were followed-up. The primary endpoint of efficacy was the relief of wound infection clinically characterized as the absence of edema, hyperemia, and purulent discharge at the sites of infection. Secondary efficacy criteria: reduction in the area of the site of infection by visual assessment using the results of photofixation; clinical improvement according to the CGI-I scale and efficiency index according to the CGI-E scale (in points); CGI-S score (disease severity); reduction of pain in the area of the site of infection (wound) by VAS by 2 or more points or by 50% of the initial value in points. Results. Achievement of the primary end point when using the drug Levomekol® (no edema, hyperemia and purulent discharge in the area of the site of infection) in patients with secondarily infected dermatoses was registered earlier than the 14th day. Additional administration of systemic drugs during treatment was not required. When evaluating secondary efficacy criteria, it was noted that Levomekol® demonstrated 90-100% efficacy according to all studied criteria in the treatment of secondarily infected dermatoses by the 3-7th day of therapy, as well as absolute safety and good tolerability by patients. Conclusion. The studied drug Levomekol® demonstrated a pronounced anti-inflammatory effect, high efficiency in the relief of wound infection, a high safety profile and good tolerance by patients. The method of combined use of Levomekol ointment and topical corticosteroids in the treatment of allergic dermatosis complicated by a secondary infection has many advantages: the possibility of selective selection of the «molecule» of corticosteroids, regulation of «priorities» antibiotic or corticosteroids; the presence of methyluracil in the composition of Levomekol® ointment enhances regeneration in case of cracks and excoriations.

Amelatonic melanoma is a rare and aggressive form of melanoma. This is a difficult oncological diagnosis that requires increased doctor’s alertness, and the need for adequate diagnosis and treatment. The prevalence of amelatonic melanoma among other malignant neoplasms of the skin is about 2-8%. Such differences in the epidemiological data are attributable, on the one hand, to the difficulties in diagnosing this tumor, and on the other hand, to the incorrect use of the term “amelatonic melanoma" by patients with hypopigmented melanoma. Despite the absence of specific markers, the use of modern diagnostic methods makes it possible to detect cases of amelatonic melanoma and start antitumor treatment in a timely manner. In establishing an accurate diagnosis, an important role is played by the clinical experience of an oncologist or dermatovenereologist conducting the initial examination, his proficiency in dermatoscopy, which is one of the main methods for the primary diagnosis of malignant skin tumors. Also, the professionalism and readiness of the pathomorphological laboratory, its equipment with reagents that allow for appropriate immunohistochemical studies, in particular for Melan A, S-100, HMB-45, tyrosinase, are of great importance. Currently, there is a small number of scientific studies aimed at studying rare skin malignancies.

Background. There are a lot of non-certified products on the cosmetology market, and there is no tendency to reduce the share of such low-quality drugs at the moment. It is important to be able to correctly diagnose and treat patients with complications after injectable lipolytic therapy with non-certified drugs. The article discusses the terminology, experience of injectable lipolysis, classification of lipolytics, the mechanism of action of phosphatidylcholine and deoxycholic acid, indications and contraindications for their use, topography of the method of injectable lipolysis, an overview of the most widely used lipolytics, their side reactions and complications. Description of the clinical case. A description of a clinical case of the development of an inflammatory reaction after injectable lipolytic therapy (non-certified in the Russian Federation) with an analysis of the tactics of correction the complication is given. This clinical case demonstrates the importance of using certified products. The objective reasons for the development of complications, in addition to the poor quality of the injected drug, may be inadequate injection technique (too close location of individual injections and their insufficient depth), the introduction of a large volume of lipolytic mixture, as well as non-compliance with the asepic and antiseptic regulations.

Background. Being one of the most common childhood allergic dermatosis, atopic dermatitis (AD) is realized under the influence of environmental factors in children at risk. Environmental conditions determine both the initiation of the formation of the atopic phenotype and the course of the disease itself. Understanding the complex mechanisms of evolution of the atopic march opens up opportunities to control and manage it. Description of the clinical case. A case of the onset of AD in a child aged 8 weeks is presented, selective phage decontamination (SPD) as a monotherapy for 16 days made it possible to completely stop the skin syndrome. Conclusion. The use of phage therapy in the treatment of children with AD, even in the form of monotherapy, can significantly influence the course of the disease and exclude the possibility of recurrence.