Vol 20, No 4 (2017)

Psychosomatic disorders, comorbid with true acantholytic pemphigus (pemphigus) and identified clinical manifestations, the relationship of pemphigus with psychogenic disorders are described. Some patients had mental disorder (adjustment disorder) provoked by pemphigus - nozogenic reactions. In some patients with aberrant hypochondria iatrogenic (drug) hypomania was discovered on the high doses of systemic glucocorticoids. The Dermatоlоgy Index оf Disease Severity (DIDS) and The Dermatology Life Quality Index (DLQI) was calculated for all patients. According to the results of the study dissociation between the severity and the subjective perception of the disease with the help of these indicators was determined.

Postacne is a frequent consequence of vulgar acne. In our research the possibility of using hyaluronidase-based medication with prolonged action was considered. Materials and methods. Type of study: randomized, double-blind, placebo-controlled, comparative in parallel groups. 78 patients aged 18 to 35 years with moderate and severe acne vulgaris and postacne scarring were observed, patients were divided into 2 groups of 39 each by randomization. The first group received Bovhyaluronidase + Azoximer (HA) 3000 ME, the second group received a placebo. In accordance with the method of administration within the groups, patients were divided into subgroups. The drug or placebo was administered by intramuscular injection into the gluteus muscle (N = 10, 1 per 3 days) or by ultraphoonophoresis (N = 15, daily). Evaluation of the skin was performed by confocal laser scanning microscopy (CLSM) in vivo (VivaScope 1500, “Lucid Inc.”, USA) and laser Doppler flowmetry (LDF) (LAKK-01 laser capillary blood flow analyzer, “LAZMA”, Russia). The effectiveness was evaluated by the Qualitative scaring grading system and Goodman’s quantitative global acne scarring system. Results. With the use of Bovhyaluronidase + Azoximer 3000 ME improvement was in 84.6%, 5.13% of patients had a significant improvement. In the placebo group the reduction of indices was insignificant. In the drug group a statistically significant change in the microcirculation index (flux) was established. In the placebo group the dynamics of flux was less pronounced. CLSM results showed a significant decrease in fibrosis and inflammatory infiltration in the scar area in the BGA group. In inflammatory areas was reduction of fibrosis and vasodilation. In the placebo group these changes were less pronounced.

A growing understanding of the cellular and molecular mechanisms of inflammation in psoriasis and psoriatic arthritis opens the way to the treatment these diseases with the help of new small molecules, associated with the blockade of intracellular signal transduction. Jaqinus®/Xeljanz® (tofacitinib, “Pfizer”) is the first oral inhibitor of Janus kinases for the treatment of chronic moderately severe and severe plaque psoriasiswhich was approved for usage in Russia. The authors also present own local data regarding usage of tofacitinib 10 and 20 mg/day by short course for the treatment group of 13 patients with severe forms of plaque psoriasis in a progressing stage with resistance to prior systemic conventional therapy who were treated at the TDVCD. The efficacy of therapeutic strategies with the use of tofacitinib for patients of the dermatological hospital with the aim of improving and stabilizing of acute process is shown. Further prospective and observational studies to refine the dosing and safety profile of this group of drugs are needed.

The case report of a rare form of combined autoimmune diseases in patient with psoriasis vulgaris (plaque form), non-segmental vitiligo and autoimmune thyroiditis was presented. This case may be of interest to dermatovenereologists, since it is an example of rare-associated dermatoses.

The results of combined phototherapy using UVB 311 nm and excimer laser 308 nm in 30 vitiligo patients over 18 years old (main group) are presented. As a comparison group, 30 patients with vitiligo (control group) received only narrow-band UVB therapy at 311 nm. The distribution of the clinical forms of vitiligo in both groups was uniform. Phototherapy with UVB rays was performed according to the procedure of 4-times irradiation per week, excimer laser - 2 times a week. As a result of the treatment in the main group, a clinical cure (repigmentation of more than 96%) was observed in 18 (60%) patients, a significant improvement (repigmentation 51-95%) in 8 (26.7%), improvement in 4 (13.3%). For this purpose it took from 16 to 48 (on average 32) the procedures of an excimer laser (the maximum single dose varied from 0.5 to 2.4 J/cm2 (mean 1.45 J/cm2), the course dose from 2.2 Up to 32 J/cm2 (14.7 J/cm2 on average) and from 24 to 82 procedures of UVB therapy at 311 nm (an average of 52), with a maximum radiation dose ranging from 1.3 to 3.7 J/cm2 ( the mean value of 2.45 J/cm2); the course dose was from the exchange rate of 26.8 to 80.2 J/cm2 (an average of 53.5 J/cm2). In the control group, as a result of 311 nm UVB therapy, clinical recovery was achieved in 7 (23.3%) patients, a significant improvement in 15 (50%), improvement in 8 patients (26.7%). In total patients received from 44 to 94 (an average of 69) procedures for treatment. The maximum radiation dose varied from 2.6 to 5.8 J/cm2 (mean 4.2 J/cm2); the course dose was from 44.4 to 98.7 J/cm2 (an average of 71.6 J/cm2). Portability of phototherapy with UVB rays of 311 nm in combination with an excimer laser of 308 nm and in the form of monotherapy was good in patients of both groups. Side effects from the action of UV rays were reduced to the manifestation of photodermatitis (without blisters) in 5 (8.3%) patients and dry skin in 7 (11.7%) patients. When comparing the obtained results, it was found that the efficiency of the phototherapy was significantly higher with a combination of narrow-band UVB therapy of 311 nm and an excimer laser of 308 nm (60% of patients with clinical cure) than with only one narrow-band phototherapy (clinical cure in 23.3% patients). Using the Cutometer 580 MPA CK electronic device (Germany) with a Mexameter MX 18nozzle before and after treatment melanin levels were determined in the vitiligo foci. After application of combined phototherapy with UVB rays of 311 nm and excimer laser of 308 nm, an increase in the melanin level by 2-2.5 times was revealed, which was clinically expressed in the repigmentation of lesions and was an objective evidence of the effectiveness of combined phototherapy.

A brief literature review of the main methods of treatment of hyperpigmentation on the basis of modern scientific publications is presented. The overview reflects the main trends in the use of external treatment, laser and light therapy, and the possibility of a combination of some methods of treatment.