Russian Journal of Skin and Venereal Diseases

Currently, there is an increase and an increase in the incidence of primary skin lymphomas worldwide. B-cell cutaneous lymphomas account for 25–30% of primary skin lymphomas. Among all skin lymphomas, primary cutaneous lymphoma from follicular center cells occurs in 10–11% of cases and is characterized by great diagnostic difficulties due to the great similarity of clinical manifestations with other dermatoses, such as benign lymphoplasia, Beck's sarcoidosis, Jessner–Kanof lymphocytic infiltration, skin metastases.

This paper presents a clinical case of B-cell lymphoma in a 29-year-old woman with a lesion of the facial skin in the form of a node, initially incorrectly interpreted as benign lymphoplasia. For five years, the patient received therapy with topical glucocorticosteroids with no effect from. Subsequently, histological examination and immunohistochemistry were performed for the purpose of differential diagnosis of sarcoidosis with B-cell lymphoma. Histologically, there is nodular proliferation of atypical lymphoid cells in the dermis, most of which have cytological characteristics of a centrocyte with an admixture of a small number of central blasts. Nodular proliferates contain an admixture of compactly arranged small lymphocytes. There are no signs of epidermotropism. During immunohistochemical examination, cells forming nodular proliferates express CD20, bc16 with an index of proliferative activity for the expression of nuclear protein K167 ― 20–30%, a dissociated network of follicular dentritic cells expressing CD21 is determined at the base of nodular proliferates. They are not expressed by bc12, CD3, CD2, CD5 proliferate cells. CD117 is expressed by an admixture of discretely distributed mast cells. The morphological picture corresponds to primary cutaneous centrofollicular lymphoma. The node was excised. Radiation therapy was not prescribed due to the patient's pregnancy.

This clinical observation highlights the importance of considering the diagnosis of lymphoma in the differential diagnosis of treatment-resistant dermatological diseases.

BACKGROUND: Bullous pemphigoid is known to be an autoimmune, life-threatening blistering skin disorder characterized by subepidermal blister formation. In bullous pemphigoid activation of B-cell immunity depends on the interaction between T-cell receptors and classic HLA II molecules. Similar interrelation has been revealed in a vast variety of studies on severe allergic reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis. It was also suggested that Stevens-Johnson syndrome and toxic epidermal necrolysis might be associated both with HLA I and II classes.

AIM: To assess the prevalence of HLA-DRB1 and DQB1 alleles at a low and high-resolution levels in patients with bullous pemphigoid and Stevens-Johnson syndrome / toxic epidermal necrolysis.

MATERIALS AND METHODS: 29 Bullous pemphigoid, 14 Stevens-Johnson syndrome / toxic epidermal necrolysis patients and 92 health volunteers were included in the study. HLA-DRB1 and DQB1 alleles were assessed by polymerase chain reaction using specific primers.

RESULTS: At a low-resolution level, HLA-DRB1*4 (p <0.02) and DRB1*14 (p <0.0015) alleles were statistically significantly revealed in bullous pemphigoid patients compared to health controls. Additionally, at the high-resolution level the predisposing to bullous pemphigoid HLA-DRB1*04:02 allele was also identified (p <0.01). At the low-resolution level of HLA-DQB1 typing we displayed protective and predisposing to bullous pemphigoid alleles HLA-DQB1*1 (p <0.01) and HLA-DQB1*2 (p <0.039) respectively. At the low-resolution level of HLA-DQB1 typing, the chances to obtain DQB1*03:02 allele were 3.71 times higher compared to healthy volunteers (p <0.01). In patients with Stevens-Johnson syndrome / toxic epidermal necrolysis, HLA-DRB1*4 allele was shown to be predisposing (p <0.03). For all other types of HLA alleles (DRB1 and DQB1) at the high-resolution level no any statistically significant results have been observed in these patients.

CONCLUSION: We identified HLA-DRB1*4, DRB1*14, DRB1*04:02 alleles predisposing to the development of bullous pemphigoid, with the HLA-DQB1*1 allele being protective for the development of bullous pemphigoid and HLA-DRB1*4 allele predisposing to the development of severe drug reactions of Stevens-Johnson syndrome / toxic epidermal necrolysis. No any protective alleles in Stevens-Johnson syndrome / toxic epidermal necrolysis patients were detected.

BACKGROUND: The composition and changes of microbiota have a significant impact on overall health and the development of various diseases. Of particular relevance is the problem of changes in the oral microbiota in patients with lichen planus of the oral mucosa. Studying the relationship between the composition of the oral microbiota and the pathogenesis of oral lichen planus will improve the understanding of the mechanisms of this disease. Thus, this topic is of considerable interest to a wide range of specialists in the field of medicine and biology.

AIM: Detailed analysis of oral cavity microbiota and establishment of potential pathogenetic microbial associations with oral lichen planus.

MATERIALS AND METHODS: The study included samples from patients diagnosed with various forms of oral red squamous lichen planus (lichen planus erosive-ulcerative) and a control group. The investigation was based on analyzing microbial diversity metrics (alpha and beta diversity), relative abundance of bacterial taxa, and identification of unique bacterial taxa in the oral red squamous lichen planus patients. This analysis utilized the 16S rRNA sequencing method.

RESULTS: The analysis revealed a rich bacterial composition in patients with oral lichen planus, which was significantly different from that in the control group. Differences were also observed between the subgroups, especially between the typical and erosive-ulcerative forms of the disease. Notably, beta diversity did not show significant differences between the groups, indicating a similar overall microbiota composition despite fluctuations in the relative abundance of species. Nevertheless, the typical clinical form of the disease demonstrated more significant differences in the microbiota structure compared to the hyperkeratotic and erosive-ulcerative forms. Furthermore, analysis of the study groups revealed the presence of 50% shared microbial species, while the other half was represented by unique species associated with oral lichen planus. Regarding the subgroups, it was found that unique microorganisms correlated with the typical and erosive-ulcerative forms, respectively, providing a deeper understanding of the specific microbiological profile in the context of this disease.

CONCLUSION: The study confirmed the hypothesis of an association between the microbiota composition and oral lichen planus, which may be of importance for the development of novel therapeutic approaches.

BACKGROUND: The role of Cutibacterium acnes in the pathogenesis of acne vulgaris and its adverse effect on follicular hyperkeratosis, inflammation and the skin microbiome have now been established. Their excessive colonization contributes to the loss of microbial diversity of the skin, activates the innate immune system, leads to the appearance of skin rash elements and chronic inflammation. Bacteriophages are considered as a new promising direction in the treatment of patients with acne, as they have an antimicrobial effect against C. acnes; contribute to the preservation of the skin microbiome; have an indirect effect on the innate and adaptive immune response.

AIM: To evaluate the effectiveness and safety of topical therapy with cosmetic gel with bacteriophages Fagoderm in the complex treatment of patients with moderate to severe acne.

MATERIALS AND METHODS: In the design of a simple open prospective study in parallel groups, the effect of cosmetic gel with bacteriophages on the number of comedones, pupules and pustules was assessed in 35 adult patients with moderate acne. During therapy, possible adverse events were simultaneously recorded.

RESULTS: During therapy, similar dynamics were noted in the form of a decrease in non-inflammatory elements of acne both in the group of people receiving a combination of adapalene and phagoderm, and in the comparison group, where monotherapy with adapalene was carried out. The number of inflammatory elements of acne decreased in both groups, but in the main group this happened at an earlier time. Compared to the initial data, already in the 2nd week the number of inflammatory elements decreased by 50% (in comparison ― by 32%); by the end of the 4th ― by 95% (respectively in the comparison group ― by 74%).

CONCLUSION: Cosmetic gel with bacteriophages with bacteriophages helps reduce the inflammatory manifestations of moderate acne.

BACKGROUND: The extreme prevalence of acne, long-term course and multifactorial pathogenesis necessitate the development of new drugs and treatment methods aimed at increasing efficiency and achieving clinical effects in the shortest possible time. This article presents data from two international clinical studies to determine the effectiveness and safety of trifarotene 50 µg/g (0.005%) cream in the treatment of patients with moderate acne on the face and trunk.

AIM: To evaluate the safety and effectiveness of trifarotene cream, 0.005%, a new topical retinoid, for moderate acne of the face and trunk.

MATERIALS AND METHODS: Two international, double-blind, randomized, placebo (vehicle) controlled, 12-week phase III studies screened 2817 and randomized 2420 patients 9 years of age and over. The effectiveness of the drug was assessed based on the registration of the number of patients who achieved the effect of "clear" or "almost clear" skin condition and an improvement of ≥2 points in terms of IGA on the facial skin and PGA on the truncal skin during 12 weeks of treatment, as well as by calculating the change in absolute number of inflammatory and non-inflammatory acne elements relatively to the initial level. The safety of therapy was assessed based on the registration of adverse events, local tolerability (the formation and severity of retinoic dermatitis), abnormalities in vital signs and the results of standard laboratory tests.

RESULTS: The onset of effect of trifarotene versus that of its vehicle was rapid, with significant reductions in both inflammatory and noninflammatory lesion counts seen as early as 1 week after treatment on the face and as early as 2 weeks after treatment on the trunk. In both studies, at week 12 the facial success rates according to IGA and PGA and change in inflammatory and noninflammatory lesion counts (both absolute and percentage) were all highly significant (p <0.001) in favor of trifarotene when compared with the vehicle and the formation of the “almost clear” and “clean” effect was registered in the vast majority of patients, who used cream with 0.005% trifarotene.

CONCLUSION: The results of the study demonstrated the pronounced clinical effectiveness of trifarotene cream 0.005% in the treatment of patients with moderate acne on the skin of the face and trunk.

Psoriasis is one of the most important problems in the clinical practice of a dermatovenereologist. In addition to damage of the skin and joints, the nail involvement is often seen in psoriatic patients. Despite its wide prevalence and significant impact on the quality of life, psoriatic onychopathy is discussed relatively rare. A change in the nails may indicate early alterations in the small joints of the palms, еthat foster to suspect psoriatic arthritis at an earlier time. Besides, the severity of nails lesions determined on the base of the NAPSI index correlates directly with the severity of pain in enthesitis.

Nails damage in psoriasis does not entail persistent functional disorders, but significantly affects the patient’s quality of life due to a visible cosmetic defect. In addition, psoriatic onychopathy is difficult to treat. The use of topical agents is impractical, and systemic therapy gives a weak clinical response over a longer period. Even in the absence of a pathological process on the skin, nail psoriasis may persist much longer, which causes significant discomfort to patients.

The study of pathomorphological aspects and mechanisms of nail psoriasis development will allow to disover a new methods for the effective treatment of psoriatic onychopathy.

On February 20^th we held our last meeting of A.I. Pospelov Moscow Society of Dermatologists and Cosmetologists in person.

There were 115 participants and 3 applicants.

Our agenda included four reports. The first speaker reported a clinical case of cytostatic therapy ineffectiveness in a patient with pustular psoriasis (State Scientific Center of Dermatovenereology and Cosmetology); the second case was about the adverse dermatological reactions in patients receiving pembrolizumab and nivolumab for hepatocellular cancer (Sechenov University).

Two reports were presented in the scientific part of the meeting: the first report was about the clinical features of perianal dermatoses (Russian Medical Academy of Continuous Professional Education), the second one was based on the diagnosis of erythroderma (Sechenov University).

The human papillomavirus is ubiquitous. It is estimated that over a third of people with apparently healthy skin are carriers of human papillomavirus. HIV-associated immunodeficiency contributes to the manifestation of clinical symptoms of human papillomavirus infection. Against the background of severe (the number of CD4⁺ T-lymphocytes below 200 cells/μl) and pronounced (CD4⁺ T-lymphocytes from 200 to 349 cells/μl) immunodeficiency caused by HIV infection (human immunodeficiency virus), the period of persistence of human papillomavirus is longer, and the clinical picture and course of human papillomavirus infection can significantly differ compared to HIV-positive individuals with intact immunity and people without HIV. At the same time, formations on the skin and mucous membranes are often multiple and can be characterized by rapid growth, large size, location outside the typical localization, resistance to treatment, recurrent course, and lack of tendency to spontaneous regression. Taking antiretroviral drugs for the treatment of HIV infection has a generally beneficial effect on the clinical course and prognosis of viral warts; With regard to anogenital warts, the researchers’ conclusions are not so clear. A number of experts believe that viral-immunological control of HIV infection may not be sufficient to successfully combat venereal warts.

The photogallery presents various clinical types of viral and anogenital (venereal) warts in people living with HIV. Each of them is assigned one of the variants of the stage of secondary diseases of HIV infection (4A, 4B or 4V according to its Russian clinical classification) depending on the severity of concomitant opportunistic diseases. In all clinical cases, with the exception of the last one, patients experienced severe or pronounced immunodeficiency and progression of HIV infection in the absence of antiretroviral therapy. In the last observation, giant Buschke–Levenstein condyloma developed with a slight immunodeficiency against the background of effective antiretroviral therapy.