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Vol 21, No 2 (2018)

Articles
FEATURES OF EXPRESSION OF KI-67 AND NFE2L2 IN TARGET ORGANS OF MELANOMA METASTASIS IN PREMETASTATIC PHASE
Sergeeva O.N., Palkina N.V., Aksenenko M.B., Komina A.V., Sergeeva E.Y., Ruksha T.G.
Abstract
Tumor microenvironment is known to be an active participant of tumor development. Tumor microenvironment is functional cell community interacting with cancer cells and promoting proliferation, invasion and metastasis of tumor cells. In the article features of Ki-67 and NFE2L2 expression levels in target organs of melanoma metastasis in premetastatic phase are investigated. Increased Ki-67expression levels in lung tissue, liver and kidneys and decreased NFE2L2 levels in liverandkidneys can be the markers of structural and functional reorganization of melanoma metastasis target organs in premetastatic phase of melanoma development.
Russian Journal of Skin and Venereal Diseases. 2018;21(2):68-71
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CLINICAL ASPECTS AND ALGORITHMS DIAGNOSTICS OF DIFFERENT TYPES OF ERYTHRODERMA
Olisova O.Y., Zaslavsky D.V., Sidikov A.A., Chuprov I.N., Wenzel J., Grekova E.V.
Abstract
Erythroderma - the term used for the description intensive and usually widespread reddening of the skin which has arisen owing to activation of the previous inflammatory dermatosis. The aim is to study and compare clinical manifestations of various forms of an erythroderma and also to develop an algorithm of their diagnostics and therapy. We observed 133 patients with an erythroderma undergoing investigation and treatment on bases of dermatologic depatments: V.A. Rakhmanov Clinic of skin and veneral diseases I.M. Sechenov First Moscow State Medical University, Leningrad Regional centre of specialized types of a medical care, Skin-Venerologic Clinic of St. Petersburg and university clinic Bonn the period from 2001 to 2018. A prospective study was conducted at 51 patients, is retrospective - at 82 patients. From them were men - 83 persons and women - 50 people, whose average age was 49 years (in the range 26-85 years). The collecting of the anamnesis is carried out; clinical data are studied and for verification of the diagnosis are compared with results of a histological research. Clinical manifestations of all surveyed groups were similar. The most frequent symptoms were generalized reddening and a peeling of the skin, an itch of skin, different degree of expressiveness and a form of changes of nail plates, changes of palms and soles. Diagnosis on the basis of only clinical examination gave the chance to make the correct diagnosis in 77(58%), in comparison with the final diagnosis 112(84,1%) from 133 made on the basis of set of clinical, histological data and reaction to therapy. In particular, the diagnosis of a psoriatic erythroderma was made in 26(34,58%) from 133, an atopic eythroderma - 20(26,6%), the eythroderma caused by reception of drugs - 24(31,92%), an erythrodermic form of mycosis fungoides/Cezary syndrome - 7(9,31%) from 133 patients. The clinical diagnosis didn’t correspond to the final diagnosis in other 56(42%) from 133 patients. Thus, at diagnosis and definition of forms of an erythroderma important aspect is clinical examination and clinicopathologic correlation.
Russian Journal of Skin and Venereal Diseases. 2018;21(2):72-80
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CLINICAL AND EPIDEMIOLOGICAL FEATURES OF HERPES ZOSTER IN TAJIK REPUBLIC
Isaeva M.S., Mirzoeva M.T., Olisova O.Y., Kochergin N.G.
Abstract
Herpes zoster (HZ) is one of the common viral skin disease with typical clinical picture and well known etiology and pathogenesis. Epidemiological and clinical peculiarities and differences of herpes zoster in different ethnic groups and geographical regions still present a field of special interest. The aim of this work was to investigate clinically HZ in Tajikistan republic. The male predominance (57.8% and 42.2%) was found as well as the higher level of the disease in urban aeries comparing to rural ones (66.7% and 33.3%). The most frequent clinical forms of HZ in Tajik population were erythematose and vesicular (63.3%), hemorrhagic (21.1%) and bullouse form (15.6%). Conclusion: the high level of severe hemorrhagic and bullouse forms of HZ and the disease predominance among urban population are characteristic for patients in Tajik Republic.
Russian Journal of Skin and Venereal Diseases. 2018;21(2):81-84
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INCIDENCE OF PSORIASIS DEPENDING ON THE REGION OF THE RUSSIAN FEDERATION
Gudinova Z.V., Okhlopkov V.A., Poleshchuk E.I., Zhernakova G.N.
Abstract
The article presents the results of a study on assessment the differences of psoriasis incidence in adults in regions of the Russian Federation. The indicators of general and primary incidence of psoriasis were used as the material for a study according to the data from Central Research Institute of Health Organization and Informatics of the Ministry of Public Health of the Russian Federation for the period 2009-2013. The comparative results of psoriasis prevalence among adults population in various regions in Russia were presented. Higher incidence rate was detected in the northern and northeastern regions of the North-Western, Volga, Ural, and Far Eastern regions. The results of classification for the regions of the Russian Federation according to the data of primary and general morbidity were presented. In order to establish the peculiarities of pathology formation and assess the quality of information in the regions of the Russian Federation, a multidimensional classification of the incidence of psoriasis was carried out using the cluster analysis method, using the comparison of prevalence (general morbidity) with primary incidence data for the period 2009-2011. As a result of the cluster analysis, four classes of the country regions are distinguished, the differences between which are statistically significant for all classification characteristics. The average indices of both primary incidence and prevalence of psoriasis are registered in regions of Class 1 (27 subjects of the Russian Federation). The minimum indices of primary and general incidence of psoriasis were noted in class 2 (24 subjects of the Russian Federation), which comprised regions predominantly of the Central, Southern, Siberian FD. The highest rates of primary incidence and prevalence of psoriasis were found in the group of regions that made up Class 4 (14 subjects of the Russian Federation), in a third of the regions of this class - Orel and Sverdlovsk regions, Udmurt Republic, Komi Republic and Sakha (Yakutia), data, unsatisfactory dispensary observation of patients with psoriasis. A certain decrease in the availability of specialized dermatological care can be expected in Class 3 regions, where the primary incidence is low, and the prevalence is above the average (18 subjects of the Russian Federation).
Russian Journal of Skin and Venereal Diseases. 2018;21(2):85-89
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PATHOGENIC ROLE OF CYTOKINES IN PSORIASIS
Karapetyan S.V., Khachikyan K.M.
Abstract
Aim. The aim of this study is determination of the role of certain pro-inflammatory and anti-inflammatory cytokines in the pathogenesis of psoriasis. Material and methods. The 110 patients with plaque form of psoriasis of moderate severity were examined, who were divided into 2 groups. Group 1 includes 65 patients (43 men and 22 women) from 18 to 64 years old with a duration of disease from 1 year to 39 years. The traditional treatment (detoxification, antioxidant, antihistamine, multivitamin, membrane stabilizing, local anti-inflammatory) was prescribed to the patients of group 1. Group 2 includes 45 patients from 18 to 65 years old (31 men and 14 women) with a duration of disease from 6 months to 32 years. The alternative treatment (with traditional therapy, the hepatoprotectors was also used) was prescribed to the patients of group 2. The control group makes 18 practically healthy periodic donors (9 men and 9 women) from 19 to 57 years old. The level of IFNγ, TNFα, IL-1α, IL-2, IL-10 and TGFβ was investigated in the serum of psoriatic patients by ELISA (commercial kits of Demeditec Diagnostics GmbH were used). Results. Before the treatment, the significant increase of level of circulating pro-inflammatory cytokines and significant decrease of level of anti-inflammatory cytokines were seen in both groups of patients with psoriasis compared with the control group. After the treatment, the level of proinflammatory cytokines is significantly reduced and the level of anti-inflammatory cytokines is significantly increased in group 1, approaching to the normal values. In group 2, the level of proinflammatory cytokines decreases more than in group 1 after the treatment. The level of anti-inflammatory cytokines also increases more than in group 1 (high treatment efficiency). The intensity of the rate of decrease of PASI after treatment in patients of group 2 is at least 1.2 times higher than in I group, of DLQI after treatment in patients of group 2 is at least 1.44 times higher than in group 1. Conclusions. The registered changes in the serum of patients with moderate severity of papular-plaque form of psoriasis indicate their essential role in the pathogenesis of psoriasis.
Russian Journal of Skin and Venereal Diseases. 2018;21(2):90-93
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OVEREXPRESSION OF STAT4 - A POSSIBLE DIAGNOSTIC MARKER OF EARLY STAGES OF MYCOSIS FUNGOIDES
Olisova O.Y., Grekova E.V., Gorenkova L.G., Alekseeva E.A., Zaletayev D.V.
Abstract
Background. Mycosis fungoides (MF) is the most common disease among the cutaneous T-cell lymphomas (85-90%). The accuracy of the diagnosis of MF, which is confirmed only by clinical, histological and immunohistochemical signs, is 50-75%. The aim of the study was to investigate genetic markers (FOXP3, STAT4, IL-12B) for early diagnosis of mycosis fungoides. Material and methods. A study involving 42 patients with MF and plaque parapsoriasis (PP) treated at the Dermatology Department of I.M. Sechenov First Moscow State Medical University and National Medical Hematology Research Сenter, was performed. The analysis of gene expression FOXP3, STAT4, IL-12B was carried out by TaqMan Real time-PCR. The objects of the study were lesional skin samples of patients. A group with MF consisted of 29 patients, a group with PP consisted of 13 patients, a control group included 10 healthy volunteers. Results. The study revealed that the level of STAT4 gene expression showed a significant (9 times) increase in the mRNA expression of STAT4 transcripts in patients with MF (166) compared with patients with PP (17.9; p < 0.05) and 553 times - with healthy volunteers (0.3; p < 0.05). There was also a statistically significant predominance of the level of mRNA expression of STAT4 transcripts in patients with spotted and plaque stages of MF (180; 318) compared with patients with PP (17.9; p < 0.05) and healthy volunteers (0.3; p < 0.05), as well as a sharp decrease in patients with erythrodermic form of MF (7.19). For early diagnosis of MF the level of expression of mRNA transcripts STAT4 is of great importance. Inclusion of STAT4 in the list of diagnostic features increases the accuracy of differential diagnosis of MF and PP from 59.1 to 81.8%.
Russian Journal of Skin and Venereal Diseases. 2018;21(2):94-100
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GENERALIZED ARGINIA
Krivosheev A.B., Khvan L.A., Bobokhidze D.N., Krivosheeva I.A., Morozov D.V., Artyushin V.A.
Abstract
A brief review of literature on the problem of argyria is presented. Hyperpigmentation of the skin in 10-20% of cases has an iatrogenic cause. Hyperpigmentation of the skin can form on the background of taking non-steroidal anti-inflammatory drugs, amiodarone, cytostatics, antimalarials, etc. Systemic deposition of silver in various organs and tissues is known as generalized argyria. The disease is caused by the prolonged use of compounds containing silver (lapis pencil, silver nitrate, etc.). Clinically, generalized arginia is characterized by the gradual appearance of ashy-bluish coloration of the skin of open areas of the body (face, neck) and nail plates of the phalanges of the hands. The period from the moment of the beginning of reception of preparations of silver and before occurrence of the first dermatological changes varies on the average from 1 year to 5 years. Generalized argiria is a rare disease. This is due to the limited use of silver drugs in clinical practice, as well as the improvement of technological processes in pharmacological production. The patient’s own observation with generalized arginia formed against the background of the long-term administration of the drug Argovit-S, whose silver content is 0.75-0.85 mg/ml, is analyzed. The patient took the drug alone as a food supplement for 25 years. The diagnosis of generalized arginia is verified clinically, but is confirmed necessarily in the course of histological examination. It is shown that argyria is not only the iatrogenic cause of skin hyperpigmentation, but a serious risk factor for the manifestation and progression of liver cirrhosis. Patients with generalized arginia should undergo a comprehensive examination in order to verify the serious pathology of internal organs.
Russian Journal of Skin and Venereal Diseases. 2018;21(2):101-105
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MORPHOLOGICAL CHARACTERISTICS OF EPIDERMIS AND DERMIS IN PATIENTS WITH DIFFUSE ALOPECIA, ANDROGENETIC ALOPECIA AND ALOPECIA AREATA
Kashutin S.L., Tedder E.I., Shagrov L.L., Shutskiy N.A., Nekludova V.S., Korolev K.K., Aristov D.E.
Abstract
Despite the emergence of non-invasive and very informative techniques, such as trichoscopy and confocal microscopy, it is still necessary to use a skin biopsy of the scalp. Currently, there is a lot of information about hystopathology of the scalp in patients with diffuse alopecia, androgenetic alopecia and alopecia areata [1]. Researches mostly aim to study the follicular unit, whereas data on pathological changes in the epidermis, papillary and reticular dermis in the above-mentioned alopecia are rare and scattered. In this connection, the aim of the research was to study morphological characteristics of epidermis and dermis in patients with diffuse alopecia, androgenetic alopecia and alopecia areata. Material and methods. We examined 25 patients (12 women and 13 men) aged 17 to 60 years with not cicatricial alopecia: androgenetic alopecia was observed in 10 patients, alopecia areata - in 9 patients, diffuse alopecia - in 6 patients. The age of the disease ranged from 1 month to 5 years. The control group consisted of 9 people. The review microscopy and morphometry of samples, taken for investigation, were performed using the eyepiece micrometer MOB-1-15xУ4.2. The following indicators in the dermis were evaluated: the presence of lymphohistiocytic infiltrates in the papillary and reticular dermis, mucoid swelling of sclerosis of the papillary dermis, and signs of destruction of hair follicles. Results. The tendency to increase thickness of the epidermis in patients with diffuse alopecia is associated with thickening of the stratum granulosum and especially the stratum corneum. In case of androgenetic alopecia and alopecia areata the tendency to decrease the thickness of the epidermis is associated with a tendency to reduce the thickness of the stratum lucidum. Regardless of the type of alopecia, the thickness of the stratum basale is statistically higher than in the control group. Regardless of the type of alopecia, changes in the dermis are manifested by the destruction of hair follicles followed by the presence of lymphohistiocytic infiltrates in the papillary and reticular dermis, as well as sclerosis of the papillary dermis. Discussion. It can be anticipated that the presence of lymphohistiocytic infiltrates in the papillary and reticular dermis may indicate the inflammatory process, which is accompanied by abnormal microcirculation and the destruction of the hair follicle which in turn insufficiently stimulates angiogenesis.
Russian Journal of Skin and Venereal Diseases. 2018;21(2):106-109
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ACROKERATOELASTOIDOSIS COSTA: REVIEW OF LITERATURE AND DESCRIPTION OF THE CLINICAL CASE
Ufimtseva M.A., Bochkarev Y.M., Nikolaeva K.I., Akulova S.A.
Abstract
The review of literature and clinical case of an acrokeratoelastoidosis Costa as rare form of a focal keratodermiya is presented in article. This dermatosis is characterized by symmetric hyperkeratical papular eruptions, settling down mainly on the lateral surfaces of palms and soles. Acrokeratoelastoidosis it is necessary to differentiate both with hereditary limited keratodermiya, and with a widespread infectious skin disease - viral warts that is important at inspection on medical examinations of persons the decreed groups. The patient sent from preliminary medical examination at employment to preschool institution at whom originally rashes have been taken for display of multiple palmar and plantar viral warts is described.
Russian Journal of Skin and Venereal Diseases. 2018;21(2):110-112
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INVASIVE METHODS OF TREATMENT OF VITILIGO
Melnikova Y.G., Lomonosov K.M., Gereykhanova L.G.
Abstract
The review of the literature is devoted to the use of various invasive treatments for a disease such as vitiligo. The article deals with the majority of methods of treating dermatosis with damage to the integrity of the skin from intraocular administration of corticosteroid preparations, immunomodulators to various methods of “surgical” intervention. Also, examples of techniques of micronidling and nidling with tacrolimus in combination with UVB are given. In addition, some data from one of the potentially effective methods in the treatment of this pathology-the use of platelet-enriched plasma are presented.
Russian Journal of Skin and Venereal Diseases. 2018;21(2):113-119
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DOUBLE PORPHYRIA: LITERATURE REVIEW AND ANALYSIS OF CLINICAL OBSERVATION
Krivosheev A.B., Kupriyanova L.Y., Kondratova M.A.
Abstract
A brief review of the literature on the problem of double porphyria and analysis of its own observation is presented. For more than 10 years patient B was observed for more than 10 years with a verified diagnosis of acute intermittent porphyria, which manifested with acute pain abdominal syndrome, neurological disorders in the form of peripheral polyneuropathy and hemiparesis of lower extremities, and hypertension syndrome was also noted. The observed clinical symptoms corresponded to an acute porphyrin crisis in the manifestation and / or relapse of acute intermittent porphyria. The diagnosis was confirmed by a quantitative determination of the excretory profile of porphyrin precursors (δ-aminocaproic acid, porphobilinogen) and porphyrin fractions (uroporphyrin, coproporphyrin). Their concentrations are significantly (especially porphyrin precursors) exceeding the control values, which is the cardinal diagnostic criterion of acute intermittent porphyria. Against the backdrop of persistent clinical and biochemical remission of acute intermittent porphyria, symptoms of photosensitization of the skin (blisters, erosion, pigment spots) on the dorsal surface of the hands began to appear in 4 years. Later, hypertrichosis was formed in the temporo-periorbital region. The constellation type of the excretory profile of porphyrins began to change. Against the backdrop of persistent increased excretion of porphyrin precursors (δ-aminolevulinic acid and porphobilinogen), a progressive increase in the excretion of the fraction of uroporphyrin was observed, which became dominant (up to 58% of the total content of porphyrins). Such a prolonged observation in the dynamics allowed us to state the appearance of a new variant of the porphyrin exchange disturbance, which, taking into account clinical symptoms, corresponded to another form of hepatic porphyria, namely, late cutaneous porphyria. The clinical and biochemical changes in the excretory profile of the parameters of porphyrin metabolism registered in the dynamics of observation may indicate the occurrence of a combined enzymatic defect characteristic of double porphyria. In our case, a manifestation of late cutaneous porphyria was noted against a background of compensated acute intermittent porphyria.
Russian Journal of Skin and Venereal Diseases. 2018;21(2):120-124
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VARIATIONS OF MICROBIOCENOSIS AND ACID-BASE BALANCE OF THE SKIN WITH ACNE VULGARIS AND THE POSSIBILITY OF THEIR CORRECTION WITH EUBIOTIC COMPLEX
Snarskaya E.S., Shnahova L.M., Shperling D.A.
Abstract
Presents a modern concept of the pathogenesis of acne vulgaris, data on the role of microbial factors and dysbiotic disorders in the development of endogenous intoxication. Endogenous intoxication syndrome (EIS) has a damaging effect on tissues, forming a complex of metabolic disorders that lead not only to suppression of the immune system organs functions, but also to interaction impairments of its individual effector links, causing the tendency of the macroorganism to nonspecific types of inflammation. The use of eubiotic complex “Eubikor” in the complex therapy of acne vulgaris leads to the normalization of the microbiocenosis of skin and parameters of the acid-base balance. The paper also provides its own successful clinical experience of using eubiotic complex “Eubikor” in the treatment of patients with acne vulgaris.
Russian Journal of Skin and Venereal Diseases. 2018;21(2):125-129
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PATHOGNOMIC MANIFESTATIONS OF SECONDARY SYPHILIS ON ORAL MUCOSA AND LIPS: CLINICAL CASES
Zavadsky V.N.
Abstract
Secondary syphilids on oral mucosa and lips are acute contagious; in addition, they are quite often the only clinical manifestation of the syphilis. Therefore the recognition of oral mucosal syphilids is an important, high-priority task. Purpose. To consider the peculiarities and clinical variants of oral mucosal syphilids, what may occur by usual examinations of patients. Material and methods. We observed 36 patients with secondary syphilis, who have syphilids on the oral mucosa or lips. It is presented 12 characteristic cases. The complex serodiagnostic tests for syphilis and HIV and clinical examination of all patients were maked. Results. The oral mucosal syphilids in hall cases (39-71%; p = 0.05), especially by recidive syphilis, were presented the MILIARY “point-papules” or “streak-papules” which grouped in the form of a “seed-pearls strings and rings”. The photographing is handy for their detection. Mucosal PLAQUES and lenticular papules are “delicate” (non-hard), opaline. They are marked but they accounted for little more of half of mucosal eruptions (50-81%; p = 0.05). Besides they were in ⅓ cases with miliary papules combined. Mucosal plaques are focal arranged or else they closely grouped (phenomenon “pseudo confluence”). Imaginary confluenсe of plaques, which are similar in size but various macerated, is particular specific (“mosaic lesion”). ERYTHEMA is out-lined, deep-red, in the form of “stamped” rounded sports (on the hard palate) or else as erythematous angina (on the molle palate) observed. Erythema were occurred in 13-41% of cases, often with papules were combined. PATHOGNOMIC indications of secondary syphilids are geometry regular form and grouping, rounded and out-lined contours, similarity in size. These peculiarities are attributable to the fact that eruptions are developed in places, where the circulating immune complexes (CIC) were fixated. CIC have bioelectric charge. Therefore, CIC arranged and fixed to a force isolines of natural electrostatic field in the tissue. These isolines have geometry regular form of arc or circle. The mechanism of CIC-fixation can be to describe by biophysical theory DLFO (Deryagin-Landau-Forway-Overbeck). The local conditions for CIC-fixation and for formation of infiltrate (papules) are created by lesions of small arterioles and local blood-stream disorders. Conclusion. Secondary syphilids on the oral mucosa are multiform. The use of photographing is handy for detection of miliary papules, which are often, but barely visible.
Russian Journal of Skin and Venereal Diseases. 2018;21(2):130-138
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MORPHOLOGICAL REACTION OF SKIN TO SUBDERMALNY INTRODUCTION OF MONOFILAMENTNY THREADS FROM A POLIDIOKSANON
Shtyrkova E.V., Poletaeva S.V., Medvedeva A.V., Palatova T.V., Morrison A.V., Maslyakov V.V., Supilnikov A.A.
Abstract
Purpose. To study morphological reaction of skin to subdermalny introduction of monofilamentny threads from a polidioksanon (PDO). Material and methods. The research is conducted on 14 white rats females of 3-months age. To the area of a back, to the right of a spine column, is 2 cm higher than a tail, about 4 threads from a PDO, in parallel each other, at distance of 1-1.5 mm are implanted. Wool in the field of implantation is shaved, rules of an asepsis and antiseptics are observed. 21 days of a rat later are humanely hammered, fragments of skin of 1.5 × 1.5 cm in size are withdrawn for a histologic research. As control intact samples of skin from the opposite side from a spine column are taken. Results. The received results of a morphological research show that use of threads/sutural material from a PDO has well expressed stimulating effect on collagenogenesis and angiogenesis. For 21 days after introduction of PDO of threads increase in the regenerator activity of cages of a fibroblastichesky row with increase in synthesis of a fibrous component of an intercellular matriks and also lack of ekssudativny inflammation which is poorly expressed by inflammatory infiltration by cages only lympho-plasmacytic a row, lack of allergic reaction, formation of granulomas and the expressed fibrosis is noted. It demonstrates to good regenerator activity of fabrics in reply introduction of threads from a PDO in 21 days.
Russian Journal of Skin and Venereal Diseases. 2018;21(2):139-144
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