Vol 23, No 4 (2020)

INTRODUCTION: Nodular melanoma is a rapidly progressive skin tumour with a high risk of methastasis even on early stages. This fact leads to necessity of non-invasive procedures, which can verify this diagnosis before surgery. Nodular forms of amelanotic melanoma can be hardly diagnosed because of their unusual diagnostic and dermatoscopic features.

CASE REPORT: Pyogenic granuloma is the most difficult disease for differential diagnosis. It is a benign vascular formation, which mimics nodular amelanotic melanoma.

BACKGROUND: Psoriasis is a chronic immune-mediated inflammatory skin disease. The goal of psoriasis therapy is to achieve long-term stable remission and improve the patients quality of life. Continuity of therapy is the basis for successful disease control. To achieve this goal, the most effective genetic engineered biological drugs are currently used. However, in some patients the biologicals demonstrated insufficient effectiveness. The presence of comorbidities, in particular metabolic syndrome in such cases, is one of the reasons for low therapeutic response.

AIM: This study aimed to evaluate the therapeutic effectiveness of ustekinumab in psoriasis patients with metabolic syndrome after a long interruption and resumption of therapy.

MATERIALS AND METODS: We observed 68 patients diagnosed with advanced plaque psoriasis. They were divided into two groups according to their body mass index and metabolic disorders.

RESULTS: By week 24, 96.8% of the patients in group 1 and 91.6% in group 2 reached PASI 75. By week 48, 100% of the patients in group 1 and 86.1% in group 2 reached PASI 75. By week 76, PASI 75 was observed in 96.8% of patients receiving 45 mg of ustekinumab and in 83.3% of patients receiving 90 mg of ustekinumab. Treatment with ustekinumab was discontinued at week 76 due to economic factors. The therapy was discontinued for 36 weeks. By week 112, 86.7% of the patients in both groups had a relapse of psoriasis, which was assessed by the loss of therapeutic response. By week 124 (12 weeks after the resumption of therapy), PASI 75 was reached in 93.7% of the patients in group 1 and 77.7% in group 2. By week 136, all patients in group 1 had achieved PASI 75, and by week 128, 83.3% of patients in group 2 had PASI 75.

CONCLUSIONS: In patients with psoriasis on ustekinumab therapy, a long-term (36 weeks) interruption and resumption of therapy is possible. However, in patients with comorbid pathology, effectiveness is dimi-nished; thus, new methods of pathogenetic therapy to correct metabolic disorders are needed.

BACKGROUND: Recently there has been an increase in the number of patients with scleroderma.

AIM: This study aimed to investigate the pathogenesis and course and present the immunopathogenesis of localized scleroderma (LS) or morphea.

MATERIALS AND METHODS: From 2010 to 2019, a prospective study of 77 patients with LS was conducted on the basis of the Leningrad regional center for specialized types of medical care. Based on histological examination, LS diagnosis was verified in 40 of 77 patients. Patients with LS (n = 40) were included in the first research group and were then divided into two subgroups based on the limitation period for the first symptoms of the disease: in subgroup I (n = 20), the disease manifested no later than 1.7 months before clinic visit; in subgroup II (n = 20), the limitation period was 1.5 years.

RESULTS: Patients of both subgroups (n = 40) underwent immunohistochemical (IL-2, IL-4, CD4, CD8, vimentin, Toll-like receptor – TLR7) tissue analysis and immunological blood tests to determine autoantibodies. To improve the differential diagnosis of LS, a comparative assessment of clinical manifestations and histological signs was performed in patients with LS (n = 40) and patients with clinically similar dermatoses (n = 37): annular granuloma (n = 12, 7 women and 5 men, average age 44 ± 12 years), small plaque (n = 15, 6 women and 9 men, average age 42 ± 4 years), and large plaque (n = 10, 5 women and 5 men, average age 59 ± 8 years) parapsoriasis. According to the results of the histological examination, inflammatory changes are dominant in patients with LS manifestation period of 1.7 months from the onset of the disease, while fibrotic changes are apparent in patients with a manifestation period of 1.5 years. The expressions of CD4, CD8, IL-2, and TLR7 were more pronounced in subgroup 1, while those of IL-4, CD4, and vimentin were high in subgroup 2. No autoantibodies were detected in the blood of patients with LS. The results allow us to divide the pathogenesis of LS into two phases: inflammatory and fibrotic. Immune dysregulation and fibrosis occur simultaneously, but with phase dependant predominance.

CONCLUSIONS: In the future, a detailed understanding of the pathogenesis of LS will help improve diagnostic and therapeutic algorithms and reduce the frequency of relapse and complications.

Onychomycosis is widespread all over the world. The choice of treatment tactics continues to be a difficult task for dermatologists. The use of combination therapy showed high clinical and mycological results of treatment, and also reduced the risk of relapses after discontinuation of therapy. Evaluation of the effectiveness of this therapy is based on knowledge of the reverse development of clinical symptoms.

Androgenetic alopecia is a genetically determined disease characterized by gradual thinning of hair, which subsequently leads to hair loss, and thereby significantly affects a patient’s quality of life. The existing methods of disease management have a number of side effects and drawbacks. Thus, new treatment methods combining both high tolerance and efficacy are continuously determined. This current review presents an analysis of the effectiveness of single- and double-spin preparation methods of platelet-rich plasma for the management of patients with androgenetic alopecia.

September 15, 2020 on the basis of the Clinic for Skin and Venereal Diseases. V.A. Rakhmanov, the regular, 1139th, meeting of the Moscow Society of Dermatovenereologists and Cosmetologists named after I. A.I. Pospelova.

The clinical manifestations of various forms of vasculitis are presented with short comments to each photo.

The photo task in the form of multiple erythematous-squamous foci in open areas of the skin in a 60-year-old patient is described. The trigger factor for this disease was insolation. Diagnosis was verified histologically.