Vol 17, No 5 (2014)

Published data on cyclosporine A mechanism of action, treatment protocols, side effects, and combinations with other drugs are reviewed. Clinical data on the efficiency of the immunosuppressant, used in modern practical dermatology for therapy ofpsoriasis, atopic dermatitis, pemphigus vulgaris, alopecia areata, etc., are presented. Published data indicate high efficiency of cyclosporine A in the treatment of these diseases. Positive effects of the drug on the involved skin and induction of clinical remission in response to treatment are described.

Blashko’s lines correspond to the mutant cell migration and proliferation routes during embryogenesis. Unilateral dermatoses (UD), congenital and acquired ones, are located along Blashko’s lines. The term UD is more often used in Russian publications. Segmented, linear, blashkoid, or Blashko line dermatoses are the terms used by foreign specialists. The skin mosaicism theory is now confirmed at the cell level for at least 15 dermatoses, including nevoid andX-linked dermatoses. However, the pathogenetic mechanism of unilateral location inacquired UD remains unclear. Monolateral involvement may be observed in type I segmented mosaicism in autosomal dominant diseases. On the other hand, some authors explain the unilateral location of these dermatoses by involvement of the central and peripheral nervous system.

Immunomodulating pulsed mesotherapy (IPMT) is described. Suspension of a long acting glucocorticoid (betamethsone, 7 mg/month, or triamcinolol, 40 mg/month) is diluted in saline and injected intracutaneously into the foci once a month. This treatment is effective in immunoassociated chronic dermatoses - atopic dermatitis, eczema, psoriasis, chronic urticaria in adults, adolescents, and children. This treatment is a convenient alternative to topical corticosteroids; in nonsevere dermatoses dermatoses it is a sufficient pathogenetic therapy. The advantages of IPMT are a convenient protocol - injections just once a month; the effect manifests from the very first days and is stable, relapses are becoming more and more rare and less severe; the total glucocorticoid dose in IPMT is even less than in topical corticosteroid therapy; the treatment is safe due to permissible fixed dose of the drug and its reliable natural reduction. The quality of life improves, the patient no longer depends on the use of ointments, the procedures are rare and easily tolerated; temporary disability is shorter, no hospitalization is needed.

Modern topical drug therapies in vitiligo are discussed, with due consideration for the size and location of depigmented foci, activity of the process, clinical variety, presence of concomitant diseases, and age. The most rational modern drugs are topical corticosteroids, topical immunomodulators, topical antioxidants, calcipotriol, liposomal preparation, and prostaglandin E, each of them focused on several pathologically modified components in vitiligo. Intralesional drug injections are maximally effective and promote the onset of a rapid lasting effect with lesser probability of systemic side effects.

Today the diagnosis of acne severity is not limited by evaluation of clinical manifestations only. Therefore, indications for isotretinoin therapy of the dermatosis have been extended. We evaluated the efficiency and safety of Sotret in therapy of 30 patients with severe acne and with acne resistant to other therapies. Of these, 19 patients (63.33%) presented with mild-severety and 11 (36.67%) with severe condition. The acne dermatological index (ADI) and CADI score were evaluated and biochemical and clinical blood analyses were carried out in all patients. Sotret monotherapy was carried out. The clinical remission was attained in 28 (93.33%), and slight amelioration in 2 (6.67%) patients. Sotret therapy proved to be highly effective and was well tolerated.

Sexually transmitted infections (STI) often become the cause of organic obstruction of the uterine tubes. Multicomponent mechanisms of sterility formation in young women under conditions of inflammatory diseases of the pelvic organs, detected in 60--65% women of reproductive age, are described. The spectrum of genital infections, detected by PCR analysis of discharge from the cervical canal and uterine cavity from women with chronic endometritis, includes chlamydiasis (in 14.9% patients), genital herpes (33.6%), ureaplasmosis (37.8%), mycoplasmosis (11.6%), and cytomegalovirus infection (18.9%). Today the clinical picture of many STD is blurred, and the main clinical sign of a chronic disease in young women is often disordered reproductive function, presented by sterility, including failure of repeated extracorporeal fertilization. Addition of longidase to combined therapy for sterility of different origin led to good results.