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Vol 24, No 6 (2021)

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Merkel cell carcinoma: a case report

Vertieva E.Y., Tertychnyy A.S., Dubinich A.D., Konstantinova Z.E.


Merkel cell carcinoma is a rare and aggressive cutaneous neuroendocrine malignancy that presents as a persistent red-purplish, asymptomatic and rapidly growing nodule. It typically affects sun-exposed skin of white elderly individuals. In addition, risk factors for Merkel cell carcinoma include immunosuppression, as well as the presence of multiple myeloma or a history of chronic lymphocytic leukemia.

To diagnose Merkel cell carcinoma, five criteria of the AEIOU algorithm proposed in 2008 by a group of scientists at the University of Washington are used.

From the methods of laboratory diagnostics a detailed analysis of blood is used, also a histological and immunohistochemical study is carried out . Among the methods of instrumental diagnostics, ultrasound examination of the primary tumor and groups of lymph nodes of the appropriate localization, abdominal and pelvic organs; chest X-ray and skeletal bone scintigraphy; positron emission tomography combined with X-ray computed tomography are mandatory. A sentinel node biopsy followed by histological and immunohistochemical examination is recommended in the absence of metastatic lymph node lesions.

We herein contribute by reporting a case of Merkel cell carcinoma affecting the forearm of a 51-year-old female. This clinical case confirms the aggressiveness of this type of the skin cancer as well as high possibility of misdiagnosis due to the scarce occurrence of Merkel cell carcinoma and lack of professional knowledge.

Therefore, it is important for the practitioners involved in the care of skin lesions to be aware of this condition and the need for a multidisciplinary treatment approach.

Russian Journal of Skin and Venereal Diseases. 2021;24(6):529-535
pages 529-535 views


Vitiligo treatment: a look into the future (literature review)

Krotkova E.A.


Vitiligo is a disease that negatively influences patient’s quality of life, lowers their self-esteem, and causes significant psychological discomfort. According to numerous studies, patients with vitiligo are more likely to develop depressive and anxiety disorders, suicidal thoughts. Despite the prevalence and social significance of the disease, vitiligo therapy remains a topical issue today. So, at the moment in the world there are still no specially registered drugs and treatments for vitiligo. Therapy of the disease today is mainly represented by drugs from the group of corticosteroids and calcineurin inhibitors, both in the form of monotherapy and in the form of combination therapy with narrow band UVB phototherapy. However, the overall effectiveness of standard treatment regimens does not exceed 80%, and the relapse rate can be up to 75%, which does not meet the expectations of the patient and the dermatovenerologist.

This article is of a review character. The aim of the article was to study new promising methods of treatment of the disease in the practice of Russian and foreign specialists, their availability and principles of action.

A systematic literature review was performed using PubMed, Cochrane Library,, Cyberleninka, and Internet databases to identify new drugs/methods in development, in clinical trials, and soon to be on the biopharmaceutical market. Keywords such as “vitiligo,” “quality of life,” and “treatment” were used in the literature search of the above-mentioned databases. The results of various clinical trials are given. The review identified the main contenders for the role of long-term therapy for vitiligo, which in the future will optimize patient management tactics and adherence to treatment.

This review, addressed to practicing dermatovenerologists interested in vitiligo therapy, points to a process of active research and development of new therapies, in which more than 20 biopharmaceutical companies worldwide are currently involved. It should be expected that in the next few years the range of drugs used to treat the disease will completely change. Based on recent research on the pathogenesis of vitiligo, it can be concluded that from the entire list of promising drugs, local janus kinase inhibitors are probably the most promising new class of drugs for the treatment of this disease.

Russian Journal of Skin and Venereal Diseases. 2021;24(6):537-542
pages 537-542 views

Lichen planus and itch-related psychosomatic disorders

Dorozhenok I.Y., Snarskaya E.S., Mikhailova M.


BACKGROUND: The relevance of studying psychosomatic disorders associated with itching in patients with lichen planus (LP) is due to a wide range of transnosological comorbidity of nosogenic and depressive disorders with clinical phenotypes of LP.

AIMS: Clinical verification and typological differentiation of psychosomatic disorders associated with itching in accordance with the LP phenotypes we identified in patients of the studied sample.

MATERIALS AND METHODS: 120 patients (77 women and 43 men, average age 47.6±5.2 years) with various LP phenotypes and comorbid psychosomatic disorders associated with itching were examined. Dermatological, using the modern lichen planus area and severity index (LPASI); questionnaire of the severity of itching (behavioral rating scores, BRS), the dermatological quality of life index (DQLI) questionnaire; psychopathological, using the Hospital Anxiety and Depression Scale (HADS); clinical-psychological.

RESULTS: Psychosomatic disorders associated with itching were identified and typologically differentiated in patients with lichen planus: nosogenic reactions that develop in response to manifestations of a skin disease (depressive, sociophobic, beauty hypochondria), as well as recurrent depression. For each type of psychosomatic disorders, different ratios of dermatological and psychosomatic symptoms have been identified. Nosogenic reactions that develop within the considered ratios are comparable to nosogenies in severe somatic diseases and are clinically manifested by anxiety and depressive disorders. In other cases, the key trigger is not the severity of the dermatosis, as in nosogenic depression, but the cosmetically significant localization of the rash. These psychosomatic disorders are represented by sociophobic nosogenic reactions, as well as beauty hypochondria nosogenies, in the formation of which constitutionally determined somatoperceptual accentuations with deformation of the body image make a significant contribution.The role of constitutional factors and somatoperceptive accentuations is determined. The structure of amplified pruritus was analyzed, including the stressful impact of the SARS-CoV-2 pandemic. Methods of effective therapy based on an integrated interdisciplinary approach are presented.

CONCLUSION: Effective diagnosis and treatment of psychosomatic disorders associated with itching contribute to a significant optimization of the course of LP and improve the quality of life of patients.

Russian Journal of Skin and Venereal Diseases. 2021;24(6):543-551
pages 543-551 views

Nonspecific adaptive reactions in outpatients of dermatovenereological profile

Makhnvea N.V., Syuch N.I., Kuznetsova N.A.


BACKGROUND: Changes in the morphological composition of the blood are among the most important criteria for diagnosing and predicting the course of diseases, allowing to assess the physiological state of the body. Calculated indices that can catch minimal changes in the indicators of the leukocyte blood formula in the early stages of the development of the pathological process make it possible to judge complex changes, sometimes imperceptible during the clinical examination of the patient. A well-known method characterizing the state of homeostasis is a method for assessing the state of homeostasis by adaptation reactions, which has been successfully used in patients with various pathologies.

AIMS: Study of the state of homeostasis of outpatients of the dermatovenereological profile to assess the severity of the disease and determine the tactics of their management and further treatment.

MATERIALS AND METHODS: Peripheral blood of 58 patients of dermatovenereological profile was examined. As a control ― peripheral blood of 24 practically healthy individuals. A complete blood test was performed on the device “ABX Micros ES 60” (France) with kits of the same company. The state of homeostasis was assessed according to adaptation reactions determined on the basis of the leukocyte blood formula by the method of L.H. Harkavy and E.B. Kvakina (1998). To increase the diagnostic value of the method, calculated integral hematological indicators were simultaneously used, characterizing the severity of the inflammatory process, intoxication, allergic reactions, and the state of the immune system.

RESULTS: In most outpatients of the dermatovenereological profile, physiological adaptation reactions prevail (90%, Z58;0.05=6), represented mainly by reactions of high levels of adaptation ― reactions of increased and calm activation (77%, Z40;0.05=12), which indicates a high functional activity of protective and adaptive mechanisms and the preservation of the constancy of homeostasis. In patients who made an outpatient appointment for problems from the urogenital tract, physiological adaptation reactions were observed more often (95%). At the same time, the physiological adaptation reactions in the majority (57%) of patients showed signs of tension, which indicates a violation of the harmony and functioning of the body’s subsystems and a decrease in the level of reactivity that require attention from the attending physician when prescribing treatment, choosing the appropriate drug and individually selecting doses. Signs of tension were more common (67%) observed in patients with a dermatological profile. Pathological reactions were observed in 6 (10%) patients and were represented by reactions of reactivation (4 patients), as well as reactions of acute (1 patient) and chronic (1 patient) stress. Among patients with pathological adaptation reactions, persons with skin diseases prevailed.

CONCLUSIONS: A comprehensive assessment of the state of homeostasis by adaptation reactions and calculated leukocyte indices significantly expands the diagnostic capabilities of a clinical blood test and allows assessing the course, severity of the inflammatory process and endogenous intoxication, the level of immunoreactivity of the body in outpatients of a dermatovenereological profile.

Russian Journal of Skin and Venereal Diseases. 2021;24(6):553-563
pages 553-563 views

COVID-19-induced alopecia: a clinical case of diffuse focal alopecia in a patient with generalized pustular psoriasis after a new coronavirus infection

Petrova M.S., Kartashova M.G., Molochkova Y.V., Molochkov A.V., Varfolomeev A.D.


The clinical picture of dermatological diseases in synergy with the pandemic of coronavirus infection demonstrates various, additional, more striking features of the course of dermatoses. The proposed case of observation illustrates the development of diffuse alopecia in a patient with torpid generalized pustular psoriasis, metabolic syndrome, endocrinopathy against the background of a coronavirus infection complicated by polysegmental pneumonia.

In the presented clinical observation, the severity of the lesion of the skin and skin appendages correlated with the severity of the course of COVID-19, which was the trigger point of the general pathological process ― immune-mediated T-cell inflammation. In the manifestation of psoriasis and its exacerbation, a significant role was played by viral load and a pronounced comorbid background ― autoimmune thyroid disease and metabolic syndrome. Thus, the severe course of COVID-19 with involvement in the pathological process of the microcirculatory bed, coagulopathy, hypoxia of hair follicles as a result, as well as the reduced estrogenic background of the sixty-one-year-old patient contributed not only to the exacerbation of psoriasis, but also led to diffuse hair loss. The degree of hair loss according to SALT criteria was 82%, which corresponded to a severe degree of lesion. The use of prolonged-acting injectable corticosteroids in the complex treatment of various forms of alopecia was an effective method of therapy in this patient, which is associated with the immunosuppressive effect of corticosteroids in autoimmune damage to hair follicles, a decrease in inflammation of the microvascular bed in various infectious and inflammatory conditions. In the presented case, the high efficiency may also have been associated with the mechanisms of reducing the damaging effect of cytokine inflammatory factors, expressed both with the existing background disease psoriasis and with coronavirus complicated infection.

As numerous observations show, COVID-19 is a potential trigger for many dermatological conditions. Examination and treatment of patients with skin pathology infected with COVID-19 requires a systematic integrated approach.

Russian Journal of Skin and Venereal Diseases. 2021;24(6):565-572
pages 565-572 views

Polymorphic dermal vasculitis flare up after COVID-19: case report

Olisova O., Vovdenko K.A., Mak D.V., Mishin S.A.


Several types of antiviral vaccines have been developed to control the spread of the disease since COVID-19 pandemic onset. Currently, many countries are taking measures aimed at increasing vaccination rates for herd immunity formation. However, with increased number of vaccinated individuals, there are more reports of possible adverse events after vaccination, including chronic dermatoses aggravation.

The article describes a clinical case of polymorphic dermal vasculitis (hemorrhagic and urticaria types combination) flare up after COVID-19 vaccination in a 73-year-old woman, who was admitted to Department of Dermatology and Venereology (Sechenov University) with complaints of skin rashes in the trunk, upper and lower extremities and intense itching. The presence of comorbid diseases (ischemic heart disease; atrial fibrillation; chronic gastritis; diverticular colon disease; chronic kidney disease) and wide range of drugs intake on a regular basis made it difficult to diagnose. Due to appropriate therapy, clinical remission was achieved 2.5 months after treatment onset as a complete rashes regression on the trunk and upper extremities. The patient was given recommendations to maintain achieved therapeutic effect.

The “Discussion” section provides up to date statistical data on the frequency of skin reactions adverse events after various COVID-19 vaccines administration and discusses possible hypotheses for such side reactions manifestation. Recommendations are given to practicing dermatologist about possible chronic dermatoses exacerbation after vaccine administration. When deciding on vaccination, potential risks should be assessed individually and each patient should be informed accordingly. Despite developed management protocols for patients with a new coronavirus infection, treatment options are still limited. The clinical experience accumulated during the pandemic period shows that COVID-19 vaccination significantly reduces disease severity, minimizes lethal outcome and restrains pandemic outbreak. Therefore, there are no certain dermatological diseases as absolute contraindications to COVID-19 vaccination.

Russian Journal of Skin and Venereal Diseases. 2021;24(6):573-580
pages 573-580 views

Development of cutaneous sarcoidosis to permanent eyebrow makeup procedure

Snarskaya E.S., Tavitova A.R., Bratkovskaya A.V., Semko N.S.


The article summarizes the data on historical aspects, epidemiology, etiopathogenesis, clinical picture, diagnosis and treatment of skin sarcoidosis. Sarcoidosis is a chronic multisystem disease from the group of granulomatoses of unknown etiology, the morphological feature of which is the development of epithelioid cell granulomas without caseous necrosis with the processes of dystrophy, destruction and fibrosis in the tissues of various organs. Diagnosis and differential diagnosis of sarcoidosis are based on clinical examination, changes in laboratory data, X-ray methods and skin biopsy. The differential diagnosis includes many dermatoses, including tuberculoid type of leprosy, tuberculous lupus, lichen planus, annular granuloma, etc. In the treatment of sarcoidosis of the skin, corticosteroid drugs are used, including prolonged action. In case of resistance or contraindications, synthetic antimalarial and immunosuppressive agents are prescribed.

According to the literature, cases of granulomatous reactions after permanent makeup procedures have become more frequent. The tattoo procedure is widespread and considered to be safe, but adverse reactions, particularly sarcoidosis of the skin, may develop.

The etiology of sarcoidosis has been studied for more than 150 years and remains poorly understood until now. There are increasingly frequent reports in the literature about the development of immune granulomatous inflammation reactions after a numerous of cosmetic procedures, such as tattooing, botulinum toxin A injection, hyaluronic acid injections, permanent makeup, biorevitalization, facial modeling fillers, blepharoplasty. The increasing number of cases of skin sarcoidosis due to cosmetological manipulations is the subject of great scientific interest, and the growth of publications on this topic is an evidence of modern etiopathogenetic mechanisms of the disease development.

Here is our clinical observation of skin sarcoidosis without systemic manifestations in a 54-year-old patient after permanent eyebrows make-up procedure outside the medical organization, without prior examination and lack of follow-up (the skin process is subacute; polymorphism of the rash is noted; rashes on the skin in the eyebrow area are represented by merging papules, foci correspond to the area of pigment injection). According to the results of physical, laboratory and instrumental studies, many epithelioid cell granulomas without caseous necrosis were found. The patient received a course of intraocular pricking with a prolonged glucocorticoid drug (Betamethasone suspension, No. 5), which led to a complete regression of rashes. Recommendations for the removal of pigment are given.

In order to prevent infection and minimize the risks of complications, a high level of qualification of a dermatocosmetologist working in a specialized medical institution is a prerequisite for permanent makeup.

Russian Journal of Skin and Venereal Diseases. 2021;24(6):581-588
pages 581-588 views


Efficacy of cooling-vacuum assisted 1540 nm erbium-doped glass laser (Er:Glass) in mild-to-moderate acne

Pinson I.Y., Verchoglyad I.V., Anpilogova E.M.


BACKGROUND: Acne is a common skin disease that affects millions of people around the world. There are several options for acne treatment: the application of local anti-acne agents often has limited effectiveness, and systemic treatment carries the risk of significant side effects. Sources of visible, infrared and laser radiation have become common physical methods of treating acne.

AIMS: to evaluate the effectiveness and safety of an erbium laser on glass (1540 nm) with integrated cooling and vacuum amplification for the treatment of mild-to-moderate acne

MATERIALS AND METHODS: We observed twelve patients (seven men and five women) from 17 to 27 years old (average age 19±1.6) with Fitzpatrick skin type II to IV. Acne severity was assessed using the Investigator’s Assessment Scale (IGA). 5 patients had mild acne (IGA 2) and 7 had moderate acne (IGA 3). Patients were treated with an erbium laser on glass using the mid-infrared region of the spectrum, with a wavelength of 1540 nm (Harmony XL, Alma Lasers Ltd.), 4 to 6 procedures were performed every 2 weeks. The number of sessions was determined by clinical improvement.

RESULTS: All 12 patients completed treatment (from four to six procedures, mean value 4.6±0.4) and were observed 1 and 3 months after the last session. The improvement in the appearance of the skin occurred gradually. Clear (IGA 0) or almost clear (IGA 1) skin were achieved in all patients. The subjective assessment of patient satisfaction ranged from “satisfied” (four patients) to “very satisfied” (eight patients) during the last visit. Side effects were mild and included mild erythema and edema in all patients, their severity and the percentage of patients suffering from them decreased during treatment. No edema was observed during follow-up visits after 1 and 3 months.

CONCLUSIONS: The study proves the effectiveness and safety of the cooling-vacuum assisted 1540 nm erbium-doped glass laser (Er:Glass) in mild-to-moderate acne. Further studies with a larger number of participants and a longer follow-up period are needed to establish long-term efficacy.

Russian Journal of Skin and Venereal Diseases. 2021;24(6):589-595
pages 589-595 views

Effective laser correction of multiple teleangiectasia on the face

Sustretov V.A.


Telangiectasia is a persistent dilation of small-caliber skin vessels (arterioles, venules, capillaries) of a non-inflammatory nature, manifested by polymorphously convoluted and dilated vessels. Telangiectasias are classified according to the cause of occurrence, the form of changes in the vascular pattern, time and localization, and are also divided into 3 large groups ― essential (idiopathic); symptomatic in various diseases; congenital and hereditary syndromes and diseases accompanied by vascular anomalies. In addition, telangiectasias can be single and multiple, located locally or disseminated, differ in shape, location, color; sometimes they bleed. Differential diagnosis is carried out with flaming and telangiectatic nevus; multiple senile, glomerular, bundle angiomas; Fabry angiokeratoma, Sivatt’s poikiloderma. In addition, telangiectasia is a typical clinical symptom in the erythematous-telangiectatic form of rosacea, systemic scleroderma, discoid lupus erythematosus, nodular form of basal cell carcinoma, hyper- and atrophic scars, late radiation dermatitis.

The article describes a case from the clinical practice of effective treatment of telangiectasias on the skin of the face using a neodymium crystal laser, which is of interest, among other things, due to the complexity of diagnosis within the existing International Classification of Diseases 10 revision, therefore the diagnosis is made syndromally based on macro- and microscopic morphological features. In addition, there is no single approach to the treatment of the pathology in question. External therapy, as well as systemic drugs, are often ineffective, sclerotherapy and exposure to a high-power vascular laser have a more pronounced clinical effect (broadband light; neodymium laser; pulsed dye laser; alexandrite, diode, ruby laser). Based on the recommendations of the laser manufacturer on percutaneous vascular coagulation and modern theories about the pathogenesis of telangiectasias, an algorithm for treatment with a long-pulse laser with a wavelength of 1064 nm on a clinical example is proposed. By prescribing a course of treatment of vascular malformation by laser percutaneous coagulation, we expect to obtain the destruction of pathologically dilated vessels of the papillary and mesh layer of the dermis by gluing the walls of the vessels (preferably) or complete thrombosis of their lumen while maintaining the structures of the dermis and epidermis intact. Laser percutaneous vascular coagulation has demonstrated excellent treatment results in a short period of time, significantly reducing the number of pathologically altered vessels. The rehabilitation period after laser coagulation of blood vessels did not exceed 3 days and was manifested by moderate edema of soft tissues in the area of laser exposure, hyperemia and single petechial hemorrhages, which resolved themselves.

Laser coagulation of skin telangiectsies is a highly effective method with a long-term clinical effect.

Russian Journal of Skin and Venereal Diseases. 2021;24(6):597-604
pages 597-604 views


Chronicles of A.I. Pospelov Moscow Dermatovenerology and Cosmetology Society (MDCS was founded on October 4, 1891). Bulletin of the MSDC № 1145

Yakovlev A.B., Maximov I.S.


On December 21, 2021, the 1145th meeting of the Moscow Society of Dermatovenereologists and Cosmetologists named after A.I. Pospelov took place.

The meeting was held in a face-to-face format traditionally in the countries of the V.A. Rakhmanov Skin Clinic. There were 110 participants. Accepted as a member of the MSDV 4 people.

Clinical observations of linear IgA-dependent dermatosis, systemic lupus erythematosus, annular granuloma were presented. Two scientific reports were heard ― about foot mycetoma; about skin reactions to tattoos.

Linear IgA-dependent bullous dermatosis is a rare immune ― mediated vesicular skin disease characterized by the presence of homogeneous linear fixation of IgA along the basement membrane. Trigger factors: medications (vancomycin, cephalosporins, diclofenac, captopril, etc.); infectious diseases; vaccination against influenza; exposure to ultraviolet rays; paraneoplastic process (5% of cases) in lymphoproliferative diseases; inflammatory bowel diseases (ulcerative colitis and Crohn’s disease). The differential diagnosis in adults is During’s herpetiform dermatitis, Lever’s bullous pemphigoid, an atypical form of multiform exudative erythema; in children ― bullous impetigo, genetic epidermolysis bullosa.

Systemic lupus erythematosus is a multisystem connective tissue disease with lesions of the skin and mucous membranes, joints, kidneys, heart, lungs and central nervous system. Systemic glucocorticoids, hydroxychloroquine, azathioprine, cyclophosphamide, belimumab, rituximab are used in the treatment.

Annular granuloma is a benign inflammatory dermatosis of unknown etiology, which is characterized by the development of flesh colored or red papules on the skin, often arranged in the form of rings. Fractional laser action is used in the treatment.

Mycetoma is a one sided, slightly painful dense tumor-like infiltrate limited on the foot or hand, edema with the formation of granulomas, microabcesses, the formation of fistulas and the release of actinomycetes or fungal mycelium from them. Differential diagnosis: chronic arthritis, arthrosis, sprain and rupture of ligaments, synovitis, chronic and postoperative osteomyelitis, bacterial mycetoma, botryomycosis, tumors, “cold” abscess, phlegmon, post-injection infiltrate, etc.

Tattooing is a subspecies of avant ― garde art and a way of changing appearance, in which the integrity of the skin is violated with the help of various piercing tools and a persistent indelible pattern is applied by introducing a coloring agent. The pigments trapped in the tattoo partially exit through the lymph and are deposited in the regional lymph nodes. The nodes are imperceptibly colored along with the skin. A certain amount of pigment nanoparticles can enter the bloodstream and theoretically cause harm somewhere in the body.

Russian Journal of Skin and Venereal Diseases. 2021;24(6):605-611
pages 605-611 views


Photogallery of clinical cases from the international contest of professor Marc Larregue 2021 (organized by Uriage Laboratory, France)

Olisova O.Y., Lonescu M.


In summer 2021, an international contest of best clinical photos of professor Marc Larregue for dermatologists was organized by Uriage Laboratory France ( Dozens of doctors took part in this contest and the jury consisted of leading experts. New clinical photos submission to professor Marc Larregue’s contest 2022 will be opened soon. Detailed information and further instructions you can find on the official website http://collectionmarclarregue fr.

We publish winners’ clinical photos and the most interesting cases with the permission of contest’s organizers. Each photo entered in the competition was taken after obtaining informed consent from each patient.

Russian Journal of Skin and Venereal Diseases. 2021;24(6):613-618
pages 613-618 views

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