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Vol 23, No 6 (2020)

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Atypical keratoacanthoma: a case report

Snarskaya E.S., Shnakhova L.M., Gomich D.A., Vasileva K.D.


In this article we summarized etiopathogenesis and clinical data, presented classification and described diagnosis challenges. One of the most common epithelial tumors, keratoacanthoma (KA) is characterized by rapid growth, histopathological features of squamous cell skin cancer and spontaneous regression tendency. Differential diagnosis of typical and atypical KA can be challenging since an early stage atypical KA may present similar to typical KA. Immunomorphological and immunohistochemical methods are particularly relevant for detecting atypical KA, making it possible to reliably differentiate it from squamous cell skin cancer. Years of experience in the management of KA patients, as well as foreign researchers’ data, suggest that the treatment approach should be based on the differentiation of clinical features of a typical KA from an atypical one.
This report describes a clinical case of a giant keratoacanthoma.

Russian Journal of Skin and Venereal Diseases. 2020;23(6):364-372
pages 364-372 views


Methotrexate in psoriasis treatment: a single-center retrospective study (2018–2020)

Olisova O.Y., Anpilogova E.M.


BACKGROUND: Despite the wide range of therapeutic options for moderate-to-severe psoriasis, dermatologists still experience some difficulties in its treatment. To date, methotrexate (MTX) is the most commonly prescribed systemic drug for the treatment of psoriasis worldwide. Given its low cost and good effectiveness, this drug has been continuously used along with recently developed highly effective biological drugs. According to international guidelines, MTX is a drug of choice for the treatment of moderate-to-severe psoriasis.

AIM: To evaluate the efficacy and safety of MTX in the treatment of moderate-to-severe psoriasis.

MATERIALS AND METHODS: We conducted a retrospective study on patients with psoriasis who had been admitted to the Dermatology Department of Sechenov University in 2018–2020. Based on electronic medical documents of the patients, we analyzed the demographic characteristics, disease duration, comorbidities, psoriasis severity before and after treatment with MTX, and its side effects.

RESULTS: The study included 655 patients with moderate (373; 57%) and severe (282; 43%) psoriasis. Of these patients, 279 (42.6%) were women aged 18–79 years, and 376 (57.4%) were men aged 18–86 years (median age: 44.9 and 41.6 years, respectively). The duration of stay in the hospital varied from 17 days to 21 days. In all cases, topical therapy was performed in addition to systemic drugs administration or phototherapy. The most commonly prescribed medication was MTX 326 (49.7%) in a dose of 25 mg/week. A total of 29 patients received MTX as monotherapy. However, the drug was most often prescribed in combination with phototherapy: MTX + PUVA (n = 140) and MTX + UVB-311 nm (n = 157). At the time of discharge from the hospital, 53% of patients in the MTX group had improved, 47% had a significant improvement. in the MTX group + PUVA – in 10.3; 75.7; 14% of patients, respectively; in the MTX + UVB-311 nm group – in 17.4; 71.2; 11.4% of patients, respectively. The side effects were mild and did not lead to treatment discontinuation.

CONCLUSION: MTX is a highly effective therapeutic option with a good safety profile and is a confirmed drug of choice for the treatment of moderate-to-severe psoriasis.

Russian Journal of Skin and Venereal Diseases. 2020;23(6):373-380
pages 373-380 views

Dermatoscopic patterns in vitiligo

Davletshina A.Y., Lomonosov K.M.


BACKGROUND: Vitiligo is a chronic disease characterized by the appearance of depigmented spots on various parts of the body. Bright white spots on the skin cause the psychosocial maladjustment of individuals with this condition. To date, modern medicine lacks effective methods for the objective and accessible diagnosis of this disease. However, research methods, such as dermatoscopy, can be useful in diagnosing vitiligo and determining its stage.

AIM: This study aimed to identify the main dermatoscopic patterns of vitiligo in association with the activity of the process.

MATERIALS AND METHODS: To participate in the study, 63 patients with diagnosed vitiligo were examined. Patients participating in the study were divided into three groups: 34 patients with progressive course, 11 with stable condition, and 18 at the stage of repigmentation. A dermatoscopic examination was performed using a Delta 20T dermatoscope. Statistical processing of research materials was carried out using the SPSS statistics software package.

RESULTS: The most significant changes were found in the perifollicular area. Progressive vitiligo was characterized by perifollicular pigmentation (91.2%), an altered pigment network (97.1%), blurred spot border (94.1%), and specific structures, such as star-like formations and a “comet tail.” The stable vitiligo was characterized by perifollicular depigmentation (81.8%) and a sharp border of the spots (72.7%). For the stage of repigmentation, marginal hyperpigmentation (100%), perifollicular depigmentation (72.2%), blurred spot border (77.8%), and “islets of pigmentation” (77.8%) were observed.

CONCLUSION: The diagnostic dermatoscopic patterns of vitiligo have been developed for the first time, and their value has been proven. Dermatoscopy is a promising non-invasive auxiliary method used to diagnose vitiligo and determine the stage of the disease.

Russian Journal of Skin and Venereal Diseases. 2020;23(6):381-387
pages 381-387 views

Microbiome and acne vulgaris

Ma Z., Kochergin N.G.


Acne vulgaris is a highly prevalent inflammatory skin disease involving sebaceous follicle. Although the pathogensis of acne remains uncertain, skin microbes are considered to plays an essential role in acne vulgaris. Cutibacterium acnes is the most important microbe in acne pathogenesis and its several processes: colonization, over-proliferation and inflammation have long been thought to contribute to the disease. Moreover, Staphylococcus epidermidis and Malassezia also synergistically collaborate with Cutibacterium acnes. Besides, given the growing number of patients who are treatment resistant, assessments are needed on phenotypic changes in the skin microbiome with retinoids and antibacterial therapy. Further research on the role of microbes in the pathogenesis of acne and the relationship between pathogenic microbes is expected to provide a new theoretical basis for clinical treatment of acne.

Russian Journal of Skin and Venereal Diseases. 2020;23(6):388-394
pages 388-394 views

Evolution of biological therapy for psoriasis: realities and prospects

Fayzullina E.V., Marsina A.R., Khismatulina I., Zinatulina G.M.


INTRODUCTION: Psoriasis is a common multifactorial chronic dermatosis. Despite numerous studies, its pathogenesis is still not fully understood. Currently, great importance is given to disorders in the regulation of the immune system. Knowledge of the key links of pathogenesis, the main cytokines allow us to purposefully act on them, leading to a stop in the cascade of immune-mediated inflammation reactions. It is for the treatment of psoriasis in dermatology that biological drugs were first used.

AIM: is to assess the development of theoretical and practical approaches to the use of biological drugs for the treatment of psoriasis. The analysis of literature data is carried out. We studied the sources of Russian and foreign literature on the biological therapy of psoriasis, published from 2004 to 2019.

RESULTS: Based on a systematic assessment of the experience of clinical use of biological therapy of psoriasis, the historical aspects of improving the points of application of drugs are studied. The first drugs were targeted by T cells, which were assigned a leading role in the development of psoriasis, then by pro-inflammatory cytokines: TNFa, later -- IL-12 and IL-23. However, uncontrolled inhibition of the basic components of the immune defense could lead to side effects in the form of reactivation of infectious processes in the body, a decrease in antitumor activity. Modern drugs have become highly selective, their point of application is inhibition of the A-17 receptor. An assessment of the evolution of medicines registered in the Russian Federation and in the United States was carried out.

CONCLUSION: A comparative assessment of the therapeutic response to biological therapy according to the PASI index showed that the netakimab as well as secucinumab and icsecizumab demonstrates low immunogenicity and high therapeutic effect in patients with severe forms of psoriasis.

Russian Journal of Skin and Venereal Diseases. 2020;23(6):395-401
pages 395-401 views

Reasons of the high rate of the population incidence of micosis of feet: role of doctor and patient

Sokolova T.V., Malyarchuk A.P., Gladko V.V., Montes Rosel K.V.


BACKGROUND: Mycoses of the feet is a significant interdisciplinary health problem.

AIM: To analyze and systematize the causes contributing to the high incidence of foot mycoses in Russia.

MATERIALS AND METHODS: With the use of an anonymous questionnaire survey, the attitude of patients toward their health and the opinions of dermatologists and related specialists about the causes contributing to the high incidence of foot mycoses in the Russian population were analyzed.

RESULTS: The reasons contributing to the high incidence of foot mycoses in Russia are ranked into four groups: (1) depend on the activities of the dermatological service; (2) are related to the level of professional training of doctors of related specialties; (3) objective organizational reasons for doctors of related specialties; (4) depend on the patient’s attitude to their health.

CONCLUSION: The data obtained can be used to develop a complex of therapeutic and prophylactic measures to improve medical care for this contingent of patients.

Russian Journal of Skin and Venereal Diseases. 2020;23(6):402-407
pages 402-407 views

Experience on the use of photodynamic therapy in vulvovaginal lichen plane

Surkichin S.I., Holupova L.S.


BACKGROUND: Lichen plane (LP) occurs in 0.5%–1% of the population. The exact epidemiology of genital LP is unknown. According to various data, LP occurs in 4–9% of all cases of vulvar lesions. The LP of the oral cavity and the vulva occurs in 19–57% of cases. The clinical forms of LP that occur in the anogenital region in women include the erosive, papulosquamous, and less often hypertrophic forms. No distinct guidelines are available for the treatment of vulvar LP. Except for the use of photodynamic therapy (PDT), no randomized controlled trials have been conducted for the treatment of erosive vulvar LP. The research results have shown that PDT can be effective in lichen plane of the oral cavity.

AIM: To evaluate the effectiveness of PDT in women with genital LP compared to topical glucocorticosteroids.

MATERIALS AND METODS: The study group included 15 patients with a diagnosis of vulvar LP. The patients were divided into two groups depending on the treatment method. Group 1 patients were treated with PDT. Group 2 patients – with topical 0.05% betamethasone cream once daily for 1.5 months.

RESULTS: Six months after the last procedure, the regression on the genital LP rating scale was 32% in group 1 patients and 25% in group 2 patients. The severity of pain, according to the visual analog scale, was 29% in group 1 and 22% in group 2. As for adverse events, in group 1, four patients experienced a burning sensation and dryness for 2–3 days after the procedure, and one patient, after two procedures, had blood discharge, which ceased after 1 day. In group 2, five patients complained of burning and dryness during treatment, two patients had acute candidiasis during treatment, and one patient had bacterial vaginosis.

CONCLUSION: The use of PDT can reduce the frequency of use of corticosteroid drugs in the genital area and accordingly reduce the frequency of steroid adverse events, such as atrophy and secondary infection.

Russian Journal of Skin and Venereal Diseases. 2020;23(6):408-413
pages 408-413 views

Comorbidity in patients with alopecia areata

Baltabaev A.M., Baltabaev M.K.


BACKGROUND: Alopecia areata (AA) is a non-scarring hair loss characterized by the immune intolerance of hair follicles, leading to the development of T-cell-mediated inflammation and subsequent hair loss. Different ages of onset, repeated relapses, and changes in the appearance of patients lead to psychoemotional distress and contribute to AA and socially significant skin diseases. Scientific data based on the effect of comorbid disorders in the course of alopecia (atopy, autoimmune diseases, and endocrinopathies) should be considered by dermatologists. This publication contains data of own research.

AIM: The study aimed to determine the concomitant pathology and its effect on the course of AA, especially on the content of vitamin D, to optimize further treatment.

MATERIALS AND METHODS: The research was based on the clinical materials of 132 patients with different severities of AA and concomitant nosologies. Several allergic (atopic dermatitis) and other autoimmune diseases (vitiligo and autoimmune thyroiditis) present similar pathogenetic mechanisms of development to AA. An ultrasound investigation was carried out, and a number of autoimmune and allergic nosologies accompanying the course of AA and the level of vitamin D in blood serum depending on the disease severity were revealed.

RESULTS: The analysis of results of ultrasound investigation of the inner organs was presented and revealed comorbid autoimmune and allergic nosologies affecting the course or associating with AA. The moderate (32.67 ± 0.91 nmol/l; р > 0.5) and severe clinical forms (32.9 ± 0.84 nmol/l) of AA vitamin D significantly decreased compared with the mild course of the disease (56.75 ± 0.62 nmol/l). Two clinical cases of patients with AA and concomitant diseases were presented.

CONCLUSION: The results revealed that the concomitant pathology of AA correlates with the literature source data and suggest their correction by doctors of narrow specialties. Vitamin D in the blood serum of patients was examined as a possible comorbid factor and predictor of disease activity. The role of trichoscopy as an investigation tool for the visualization and verification of the diagnosis and determination of the activity of AA was outlined.

Russian Journal of Skin and Venereal Diseases. 2020;23(6):414-421
pages 414-421 views

Bacterial vaginosis: evaluation of the effectiveness of simultaneous treatment of sexual partners

Okhlopkov V.A., Barinov S.V., Tirskaya Y.I., Babaeva T.S., Sinelnikova L.B., Terletskaya T.V.


BACKGROUND: Bacterial vaginosis (BV) is one of the most common diseases affecting women of reproductive age. The main problem of BV is the low efficiency of traditional methods of treatment with a frequent recurrence of up to 50%.

MATERIALS AND METHODS: A total of 59 patients were examined and treated with the diagnosis of BV, which was confirmed in accordance with the Amsel criteria. The main group included women with BV and their male partners, whereas the compared group included only women with BV. All women were treated with systemic metronidazole and topical clindamycin, and suppositories with lactic acid were prescribed at the second stage. The men partners were treated systemically with metronidazole and topically with clindamycin.

RESULTS: Gardnerella vaginalis, Atopobium vaginae, and Prevotella were the most commonly identified bacteria in the vaginal discharge. In men, BV-associated bacteria were found in the foreskin of the glans penis and distal urethra. The similarity of the microflora of the genital organs of women and their male partners was determined. In women with sexual partners who were treated 6 months after the therapy, the number of BV-associated bacteria was detected two or more times less frequently than in patients in the comparison group. For the men, the number of complaints and clinical symptoms significantly decreased after the treatment. Significant decreases in Gardnerella vaginalis, Atopobium vaginae, Prevotella spp., Leptotrichia amnionii, and Mobiluncus were achieved in the foreskin and Gardnerella in the urethra. In the main group of women, the frequency of BV recurrences recorded was 2.3 times less than that in the comparison group.

CONCLUSION: The treatment of partners of women with BV effectively reduces the growth of BV-associated bacteria and significantly decreases the frequency of recurrences.

Russian Journal of Skin and Venereal Diseases. 2020;23(6):422-431
pages 422-431 views


A comparative study of the effectiveness and safety of injectable combination therapy of keloid and hypertrophic scars with 5-fluorouracil and betamethasone

Ikonnikova E.V., Kruglova L.S., Manturova N.E., Petrii M.A.


therapy for their reliable removal. Standard methods of treatment often give unpredictable results, are accompanied by various complications, and require the use of expensive equipment.

AIM: To investigate the efficacy and safety of intralesional injection of a combination of 5-fluorouracil (5-FU) and betamethasone for the treatment of keloids and hypertrophic scars.

MATERIALS AND METHODS: The study involved 26 patients who were divided into two equal groups. Patients in group A received intralesional injections of betamethasone, and those in group B received 5-FU and betamethasone. Three injections were performed with an interval of 3 weeks. The scars were assessed at the beginning of the treatment, on the 3rd and 6th week during the treatment, and 4 and 16 weeks after the end of the treatment. The dynamics of scar condition was evaluated by the average decrease in the scar height and density, changes in subjective sensations, and the presence or absence of complications.

RESULTS: At 4 weeks after the end of the therapy, the total effectiveness of reducing the initial scar height was significantly higher in group B (10 patients; 76.9%) than in group A (6; 46.1%). In the comparison of long-term results at 16 weeks after treatment, 92.3% of the patients from group B and 53.8% of the patients from group A showed cessation of scar growth, flattening and softening, diminished itching and pain, smoothing of the scar contour, and a decrease in the color of the border between the scar and surrounding tissues.

CONCLUSIONS: The combination of betamethasone with 5-FU is safer and more effective than monotherapy with betamethasone or 5-FU in the treatment of keloid and hypertrophic scars, with a faster and more pronounced decrease in the height and density of the scar, erythema, and subjective sensations. This mode of therapy is characterized by a low relapse rate with prolonged follow-up. The article is of interest to practicing cosmetologists, dermatologists, and plastic surgeons.

Russian Journal of Skin and Venereal Diseases. 2020;23(6):432-442
pages 432-442 views


Photogallery of clinical cases presented at the international contest of Professor Marc Larregue 2020 (organized by Uriage Laboratory France)

Olisova O.Y.


In November 2020, an international contest for the best Professor Marc Larregue clinical photographs for dermatologists was organized by Uriage Laboratory France ( Dozens of doctors participated in this contest, and the jury consisted of leading experts. New clinical images submitted to the Professor Marc Larregue’s 2021 competition will be revealed soon. The detailed information and further instructions can be found on the official website We will publish the winners’ photographs and the most interesting clinical cases with the permission of the contest’s organizers.

Russian Journal of Skin and Venereal Diseases. 2020;23(6):443-454
pages 443-454 views

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