Vol 15, No 5 (2012)

Precise standardized measurements are essentialfor the diagnosis and treatment of Sezary ’s syndrome (mycosis fungoides). The T-cellular skin lymphoma (T-CSL) severity index (SI) has been suggested in 2005. Evaluation of this index is a simple to use quantitative indicator of the disease activity in cases with involvement of many organs and systems (skin, lymph nodes, circulatory system, viscera) and a prognostically significant characteristic in multifactorial analysis. The index, quantitatively reflecting the disease activity in all involved organs and systems, effectively supplements the TNM classification in clinical practice and research.

The problems of UV radiation and molecular mechanisms of its effects on the skin, determining the development of skin tumors, are discussed. Topical means for photoprotection of the skin are essential for primary prevention. Bariesun, a new series of solar protective means, is presented. Due to synergically working three ingredients, it protects the cellular DNA even in patients with weak atopic skin.

Lort-Jacob's verrucous nodular keratoderma in a patient aged 70 years with prostatic cancer and Bazex ’ psoriasiform acrokeratosis in a patient aged 59 years in the presence of atypical pulmonary carcinoid with metastases in the liver are described. The diagnostic search included collection of anamnesis and clinical methods.

Toxic epidermal necrolysis in a female patient aged 68 years was caused by therapy with SH group containing drugs. The patient was treated by metiprede in the maximum daily dose of 48 mg, which was gradually reduced as a significant improvement was attained.

True pemphigus belongs to the group of autoimmune bullous dermatoses of the skin and mucosa, in which the key role is played by circulating autoantibodies (IgG) to the epidermal desmosomal system antigens. The disease is diagnosed by cytological and histological methods, but one of the main diagnostic methods is direct immunofluorescent study of the skin. Autoimmune pemphigus can be a separate disease or be associated with other skin diseases, such as psoriasis vulgaris, psoriasis guttata, lupus erythematosus, Layell ’s syndrome, dermatomyositis, pyogenic granuloma, vitiligo, folliculitis suffodiens. A case with pemphigus vulgaris combination with giant acantholytic seborrheic keratosis, involving the skin of the hairy part of the head, is described. Published data on atypical location ofvegetating pemphigus foci and detection of acantholysis in foci on the skin of the hairy part of the head necessitated differential diagnosis between vegetating pemphigus and pemphigus vulgaris combined with giant seborrheic keratosis. This case demonstrated the necessity of thorough collection of anamnesis and of all studies needed for correct diagnosis.

Severe refractory psoriasis is often a difficult therapeutic problem. Classical total systems antipsoriatic therapeutic protocols are now supplemented by modern high-technological highly effective biological preparations. Basic data on anticytokine drugs are presented. The results of the first use of adalimumab (the first Russian drug) have demonstrated its high clinical efficiency: dynamic reduction of the psoriasis activity and dissemination index (PASI) and of dermatological quality of life index, good compliancy and convenient use in an outpatient setting.

The role of immunometabolic disorders in the development of drug-induced toxicoderma was studied. A total of 59 patients with clinical variants of toxicoderma were observed. Immunological studies detected disorders in the immune homeostasis, characterized by disproportion of the cytokine profile, adhesion molecules, and Toll-like receptors, as well as in natural resistance of patients with toxicoderma.

Some problems in the etiology and pathogenesis of chronic dermatoses (acne, seborrheic dermatitis, psoriasis) are discussed. Modern data on the treatment and therapeutic and cosmetological care are discussed with consideration for skin type and pathological process location and variant. Isida, a new line for therapeutic and cosmetic care, is presented. It has been created for fat and mixed type skin with manifestations of acne, psoriasis of the hairy part of the head, seborrheic dermatitis variants. Therapeutic care is recommended during and after treatment of the underlying dermatosis and is aimed at rapid resolution of the inflammatory process and prevention of subsequent exacerbations.