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Vol 24, No 3 (2021)

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Cholinergic urticaria: novel aspects of pathogenesis, diagnosis and management

Borzova E.Y., Popova C.Y., Kurowski M., Rukhadze M.T., Darlenski R., Zaborova V.A., Kurshev V.V.


Cholinergic urticaria (CholU) is a chronic inducible urticaria, characterised by itchy pinpoint wheals up to 3 mm in diameter, surrounded by a prominent flare, that occur following an exposure to characteristic triggers such as active or passive heating, physical exercise, emotions, hot or spicy foods.

Key pathophysiologic mechanisms include immediate hypersensitivity to autologous sweat antigens, functional sweating disorders, impaired acethylcholine metabolism, abnormal skin vascular permeability and disturbed skin innervation.

Clinical manifestations of CholU may vary from typical itchy pinpoint urticarial lesions, angioedema to anaphylaxis. Atypical CholU forms include cholinergic pruritus, cholinergic dermographism, cold cholinergic urticaria and persistent cholinergic erythema.

The diagnosis of cholinergic urticaria relies on patient’s history, clinical manifestations and challenge tests.

Treatment options include nonsedating H1 antihistamines in standard or increased doses. The evidence is accumulating for the use of biological treatment with omalizumab in cholinergic urticaria. The prospect of personalized treatment of cholinergic urticaria include autologous sweat desensitization.

The main research efforts in ColdU are directed at optimizing diagnostic approaches and developing innovative therapeutic options.

Russian Journal of Skin and Venereal Diseases. 2021;24(3):211-226
pages 211-226 views

Pathogenetic justification of the use of simvastatin in the complex therapy of vitiligo

Davletshina A.Y., Lomonosov K.M.


BACKGROUND: Vitiligo is a chronic acquired disease with a genetic predisposition to pigmentation disorder caused by the destruction of skin melanocytes, leading to hypopigmentation. The effectiveness of currently available methods of treatment of vitiligo, on average, is about 40%. Therefore, it is necessary to search for new effective and safe methods of vitiligo therapy, characterized by minimal risk of side effects, and financial costs of the patient. Simvastatin inhibits cholesterol biosynthesis by inhibiting HMC-CoA reductase. In addition to lowering cholesterol, statins have pleiotropic effects, namely, they inhibit various inflammatory mediators and cytokines, activate the antioxidant system, and reduce the level of active forms of oxygen in melanocytes.

AIMS: To develop a pathogenetic therapeutic complex using simvastatin for patients with vitiligo.

MATERIALS AND METODS: To participate in the study, 81 patients with vitiligo were examined. Each patient was determined by the form and stage of the disease. The effectiveness of therapy in the groups was evaluated by assessing the area of repigmentation. The first group received treatment ― simvastatin in combination with UVB therapy 311 nm, the second group-UVB therapy 311 nm. Studies of cytokines were carried out using enzyme immunoassay. Study of the oxidative status using high-performance liquid chromatography-mass spectrometry. Statistical processing of the research materials was carried out using the SPSS Statistics software package.

RESAULTS: The combined method of therapy with the inclusion of simvastatin showed the following clinical results: 6 (12%) had a pronounced positive effect; improvement ― in 34 (69%) patients. Dynamics of the immune profile: decrease in IL-6 from 10±1 to 8.1±0.6; TNF-α from 18.8±2.1 to 12.9±1.1; increase in IL-10 from 3.2±0.4 to 7.3±0.3. Dynamics of the oxidative profile: malondialdehyde 1.7±0.12 to 1.48±0.11, 8-oxo-DG 0.30±0.03 to 0.23±0.02, SOD 170±3 to 207±7, glutathione 697±36 to 942±32.

CONCLUSION: The combined method of vitiligo therapy with the inclusion of simvastatin is effective and safe, leading to stabilization of the process, clinical improvement and a pronounced effect of therapy in 82% of patients. It also has an immune-correcting effect and normalizes the indicators of the oxidative profile.

Russian Journal of Skin and Venereal Diseases. 2021;24(3):227-242
pages 227-242 views

Lichen sclerosus as a variant of limited scleroderma with damage to the anogenital region

Bagramova G.E., Snarskaya E.S., Shnakhova L.M., Semenchak Y.A.


Lichen sclerosus is one of the clinical variants of limited scleroderma, a feature of which is the defeat of the anogenital zone. The issues of the etiology and pathogenesis of lichen sclerosus remain not fully understood, despite numerous studies in which the polygenic nature of inheritance and multifactoriality in the implementation of dermatosis are noted.

With the progression of the scleroatrophic process and the absence of timely pathogenetic therapy, there is a high probability of the development of comorbid pathology with a whole range of symptoms, such as urinary (dysuria, recurrent urinary tract infections - cystitis, urethritis, cystourethritis), gastrointestinal (pain during defecation, chronic constipation), vaginal severe dryness and increased sensitivity of the vaginal mucosa, burning, itching).

Treatment of patients with lichen sclerosus with lesions of the anogenital zone causes great difficulties. In cases of isolated localization of scleroatrophic lesions of anogenital localization, difficulties may arise in the differential diagnosis with diseases of similar localization, such as vitiligo, atrophic lichen planus, basal cell carcinoma, contact dermatitis, nonspecific balanoposthitis, Keir's erythroplasia. Treatment of limited scleroderma, the clinical variant of which is lichen sclerosus, should be multi-course and complex, with the obligatory use of penicillin antibiotics, hyaluronidase-based drugs, drugs that improve microcirculation, vitamins, immunoregulators and physiotherapeutic methods.

Thus, early diagnosis and timely pathogenetic therapy contribute to the prevention of the risks of developing genitourinary syndrome, progression of tissue sclerosis, and psychoemotional disorders.

This article presents a clinical case of diagnosis and treatment of a patient with lichen sclerosus.

Russian Journal of Skin and Venereal Diseases. 2021;24(3):243-250
pages 243-250 views

Psychosomatic aspects of psoriasis (review)

Dorozhenok I.Y., Ilina E.V.


The review reflects the increased scientific interest in the psychosomatic aspects of psoriasis in the world literature in recent years. The studied material of the articles is structured according to the principles of the modern clinical psychosomatic approach. The introduction substantiates the relevance of studying this topic. The article considers the stress manifestations/examinations of psoriasis under the influence of psychosocial acute and chronic stress, including under the action of the COVID-19 pandemic; the quality of life and stigmatization of patients with psoriasis. The driving factors leading to the formation of nosogenic psychosomatic disorders are identified: common disfiguring rashes, itching, recurrent course, the threat of disability, social restrictions, constitutional premorbid features of patients. The description of comorbid mental disorders of the anxiety and affective range with a discussion of suicidal risk is presented. A separate section of the review is devoted to itching, as one of the most discussed aspects of psoriasis in the modern literature. Different points of view on the psycho-biological structure of itching in psoriasis are presented. Various factors related to the intensity, objective and subjective perception of itching are considered. Among them are the clinical form and severity of psoriasis, the localization and prevalence of rashes, gender, age, level of education, marital status of patients, concomitant somatic and mental diseases.

Russian Journal of Skin and Venereal Diseases. 2021;24(3):251-262
pages 251-262 views

A new principle for the diagnosis morphea in the onset of the disease

Zaslavsky D.V., Sidikov A.A., Garyutkina L.V., Pyagai G.B., Alaeva M.D., Ibragimova N.S., Malikova N.N., Kozlova D.V.


BACKGROUND: Because of the low specificity morphea clinical manifestations in early stages, the differential diagnosis is difficult.

AIMS: The purpose of the research is to propose a new diagnostic method for early stages of localized scleroderma.

MATERIALS AND METHODS: During 2011–2020, 77 patients with clinical manifestations of morphea and 127 controls were examined and included in the study at the LenOblCenter. All participants were conducted a transcutaneous oximetry with the “TCM-400” Radiometer apparatus. The tissue oxygen perfusion (tcpO2) level from 40 to 50 mm Hg was considered as a reversible decrease, from 30 to 40 mm hg was a borderline decline and the value below 30 mm hg was critical. The following diagnostic skin biopsy was conducted in all 77 patients

RESULTS: Skin biopsy allowed to form 4 research groups: 40 patients with morphea, 12 patients with granuloma annulare, 15 patients with small plaque parapsoriasis and 10 individuals with large plaque parapsoriasis. 7 (17.5%) patients with morphea had normal tcpO2 values, 9 (22.5%) patients had significant decrease of tcpO2, 24 patients (60%) showed a reversible decrease of tcpO2. 3/12 (25%) patients with granuloma annulare and 1 patient (10%) with large plaque parapsoriasis had minor oxygen level decrease. Measurement on the healthy skin showed tcpO2 decrease in patients with comorbidities ― 3/77 (3.9%) in research group and 28/127 (22%) in controls.

CONCLUSIONS: Transcutaneous oximetry is a new perspective direction in the diagnostic algorithm of the morphea based on the pathogenesis and morphological features of the disease.

Russian Journal of Skin and Venereal Diseases. 2021;24(3):263-274
pages 263-274 views

Combined treatment regimen for severe acne vulgaris

Kruglova L.S., Gryazeva N.V., Tamrazova A.V.


BACKGROUND: Treatment of acne vulgaris remains an actual task of practical medicine. Despite the fact that the participation of severe acne in the structure of the morbidity of acne vulgaris is relatively small, precisely they most often leave behind scars, are accompanied by a pronounced cosmetic defect and significantly reduce the patient’s quality of life. Systemic treatment with isotretinoin is the gold standard of management of such patients, but this type of treatment is often accompanied by an exacerbation reaction, which negatively affects the general condition of the patient and reduces the compliance of treatment.

AIM: To determine the effectiveness of the combined use of isotretinoin and a systemic corticosteroid in the treatment of severe forms of acne.

MATERIALS AND METHODS: We observed 27 patients (16 men and 11 women) with severe or very severe grade on the IGA scale. All patients received combination therapy with isotretinoin (Sotret) at a dose of 0.5 mg/kg/day (cumulative dose from 120 to 150 mg/kg) for 8 months and prednisolone 30 mg/day 7 days, followed by dose reduction within a month. The assessment of treatment efficacy was based on the IGA scale, indicators DIA, DLQI and counting the number of inflammatory and non-inflammatory elements.

RESULTS: During the 8 months of the study, 81.4% of patients achieved a 2-point reduction in the degree on the IGA scale (“clear” or “almost clear skin”). The DLQI index showed 74.9% improvement compared to the start of treatment. The average DIA values decreased by 72%. The reduction in the number of inflammatory and non-inflammatory elements showed a marked clinical improvement (91.4% for nodules and 98.3% for pustules). Exacerbations of acne were recorded in 18.5% of patients.

CONCLUSIONS: Combined systemic treatment with isotretinoin and prednisolone for severe acne decreases the number of exacerbations and reduces the duration of treatment.

Russian Journal of Skin and Venereal Diseases. 2021;24(3):275-284
pages 275-284 views

Combination of isotretinoin and Contractubex Anti-Red in acne therapy

Katkhanova O.A., Grigoryants S.A., Glazko I.I.


BACKGROUND: Acne vulgaris (acne vulgaris) is an urgent interdisciplinary problem. Analyzing modern scientific data on the development of acne vulgaris, it is necessary to focus on the role of inflammation that accompanies dermatosis at all its stages of development, sometimes preceding the formation of clinical symptoms. Prolonged chronic recurrent course, difficulties in choosing the correct therapy tactics, sometimes unreasonable medical interventions, exacerbation, improper skin care lead to the formation of a number of complications.

AIMS: To optimize and improve the effectiveness of therapy in patients with moderate and severe degrees acne using isotretinoin and the combined innovative gel Contractubex Anti-Red.

MATERIALS AND METHODS: The study included 60 patients aged 18 to 45 years with moderate to severe acne. Isotretinoin was prescribed in standard dosages. To study the effect of Contraktubex Anti-Red on the dynamics of post-acne, patients with atrophic post-acne scars were divided into 3 subgroups, depending on the regimen of drug use.

RESULTS: Almost complete relief of the inflammatory process, regression of elements was noted 12 months after the use of complex therapy, the value of the dermanologic index of acne (DIA) index was more than 70% noted in 62% of patients, significant improvement in 38%. The severity of post-acne scars on the SCAR-S scale changed significantly during treatment and in 53.3% this indicator was 1. The Cadi index decreased by 70% compared to the baseline.

CONCLUSION: Good cosmetic effect, safety, absence of side effects, comfort and ease of use make it possible to recommend Contractubex Anti-Red together with basic acne therapy.

Russian Journal of Skin and Venereal Diseases. 2021;24(3):285-296
pages 285-296 views


Correction of age-related skin changes on face by the method of exposure to high-frequency currents of the radio wave range and autologous platelet-rich plasma: randomized study

Teplyuk N.P., Lebedeva S.V.


BACKGROUND: In the literature, there are no scientifically based studies on the use of combination therapy using radio wave lifting and autologous platelet-rich plasma for the correction of involutional changes in the skin of the lower third of the face.

AIMS: To determine the effect of complex therapy of involutional changes in the skin of the lower third of the face with minimally invasive radio wave lifting using a cannula electrode and platelet-rich autoplasma using non-invasive diagnostic methods.

MATERIALS AND METHODS: Examination and treatment of 55 healthy women of Slavic appearance with involutional changes in the skin of the lower third of the face were carried out. Group № 1 patients received radio wave lifting therapy (n=28) and group № 2 patients received combined therapy with radio wave lifting and autologous platelet-rich plasma (n=27). The study was conducted from January 2020 to December 2020. To assess the condition of the skin, laser Doppler flowmetry, ultrasound sonography, and elastometry were used before and after the study. Clinical manifestations were assessed by an anthropometric method.

RESULTS: The most pronounced changes were observed in the group where the combined method of radio wave lifting therapy with autologous platelet-rich plasma was used. The change in microcirculation was of a multidirectional nature, however, the average values were in the range of 8.866–8.89 pf units, which is the normalization of trophic processes in tissues (p >0.05). When analyzing the conduct of ultrasound sonography, statistically significant thickening of the epidermis and dermis was noted, however, in patients of the second group, the thickening was more pronounced (p <0.0005). The change in the echogenicity of the dermis was of a multidirectional nature; by the end of treatment, the mean values were in the range of 10.5–11.3 units, which, apparently, indicates a more homogeneous structure of the dermis (p <0.05). Anthropometric indices (measurement of ptosis of the lower cheeks) decreased in both groups, which is related to skin lifting as a result of treatment (p <0.0005). The amplitude of tissue upward mobility decreased in both groups (p <0.0005). The amplitude of downward movement of tissues after therapy was of a multidirectional nature in both groups, which is possibly associated with the density of the dermis and indicates the normalization of collagen and elastin fibers (p >0.05). Elastometry indices (F0, R4, R6, R8) decreased, R2 increased in both groups, however, the dynamics was more pronounced in the second group (p <0.0005).

CONCLUSIONS: Minimally invasive radio wave lifting in combination using a channel electrode with autologous platelet-rich plasma is an effective and safe method of treating age-related changes in the skin of the lower third of the face.

Russian Journal of Skin and Venereal Diseases. 2021;24(3):297-306
pages 297-306 views

Socio-hygienic research and assessment of the quality of life of cosmetology patients

Olisova O.Y., Krasilnikova O.N.


Health is largely determined by environmental factors. A number of skin diseases, as well as its age-related changes, are a poorly studied medical and social problem. The procedures provided in cosmetology clinics can be considered a relative indicator of an improvement in the quality of life, directly related to the restoration and maintenance of balance and harmony of individual and public health of a person with the natural and social environment.

The analysis of the quality of life of patients with cosmetology profile was carried out. It is noted that despite the rapid development of cosmetology, information proving the impact of surgical and non-surgical cosmetic procedures on the patient’s quality of life is limited; there are no effective, reliable rating scales for the patient’s self-assessment of the results of cosmetic therapy. Sociocultural and quality of life factors that force patients to undergo these procedures are not well understood.

The results of a sociological survey of patients with a cosmetology profile allow cosmetologists to plan a complex of interventions for the prevention and correction of age-related changes in appearance, emphasize the professional image of a specialist. The development of rating scales and methods for assessing the quality of botulinum therapy and the patient’s self-assessment of the results of medical care provided on the principles of evidence-based medicine is an urgent issue.

Russian Journal of Skin and Venereal Diseases. 2021;24(3):307-314
pages 307-314 views


Chronicles of A.I. Pospelov Moscow Dermatovenerology and Cosmetology Society (MDCS was founded on October 4, 1891). Bulletin of the MDCS meeting N 1143

Yakovlev A.B.


On May 14, 2021, the regular, 1143st meeting of the Moscow Dermatovenereology and Cosmetology Society named after A.I. Pospelova. The agenda included the following issues: analysis of 1 clinical case, hearing of scientific reports. Admission to membership in the MDCS not provided.

Russian Journal of Skin and Venereal Diseases. 2021;24(3):315-318
pages 315-318 views


Photogallery. Sarcoidosis (part 2)

Snarskaya E.S., Teplyuk N.P.


Sarcoidosis (synonym: Benier–Beck–Schaumann disease, benign granulomatosis, chronic epithelioid cell reticuldoendotheliosis) ― is a multisystem disease from the group of granulomatosis, of unknown etiology, the morphological feature of which is the development of epithelioid cell granulomas without caseous necrosis fibrosis in the tissues of various organs. Taking into account the variety of clinical lesions, there are three main forms: extrathoracic, intrathoracic, mixed (generalized).

We are publishing the second part of our photo gallery.

Russian Journal of Skin and Venereal Diseases. 2021;24(3):319-324
pages 319-324 views

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