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Vol 25, No 3 (2022)

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Laser induced thermotherapy of multiple actinic keratosis

Sukhova T.E., Molochkova Y.V., Pronina A.I.


Actinic keratosis (AK) is one of the most common precancerous diseases of the skin, which is characterized by local intraepidermal atypia of keratinocytes that occurs under the influence of ultraviolet radiation, clinically manifested by typical foci of hyperkeratosis in exposed areas of the skin. This is an urgent medical and social problem due to the potential tendency of atypical keratinocytes to malignant transformation, proliferation of keratinocytes and their spread beyond the epidermis with the development of tumor progression [1]. Recently, a number of authors have established important features of the course of this precancerous tumor. First of all, we are talking about an increased risk of malignant transformation of AK into squamous cell carcinoma in the presence of a history of visceral malignancy, as well as the same changes in the lesion and the adjacent clinically unaffected skin in the form of accumulation of genetic and epigenetic mutations that form "cancerization fields" [ 33,34], indicating the need to treat AK, especially multiple foci, using the ablastic rule with the capture of 1-1.5 cm of apparently healthy skin [35,36]. For the treatment of multiple AK foci in a patient with an aggravated oncological history, for the first time, we used, in an independent version, a modern method of treatment - laser-induced thermotherapy (LITT). LITT is a non-invasive, antitumor, immunomodulatory method based on the selective death of atypical keratinocytes in the epidermis by local tissue heating to a temperature of 42.5-44℃ (hyperthermia) caused by infrared laser radiation with a wavelength of 800-1300 nm. The presented case of AK in a patient with breast cancer in history was characterized by a combination of keratotic and erythematous forms of the tumor. At the same time, LITT with an extended exposure zone by 1 cm from the visible boundaries of the lesions was not only clinically effective in terms of immediate and long-term results, but also gave an excellent cosmetic result with a completely satisfactory tolerability of the treatment procedure.

Russian Journal of Skin and Venereal Diseases. 2022;25(3):181-190
pages 181-190 views


Pathogenesis of psoriasis: past, present, future

Kandalova O.V., Klyuchnikova D.E., Ayvazova T.V.


Psoriasis is a common, chronic, systemic immune-mediated inflammatory disease that affects the skin, joints, and other organs and systems. Despite the fact that psoriasis is one of the most studied dermatoses, its pathogenesis has not yet been fully clarified. In recent years, the pathogenetic model leading to the formation of psoriatic papules and plaques has undergone significant changes.

This article presents a retrospective analysis of the study of the disease over the past 60 years from the generally accepted concept of epidermal dermatosis to understanding the complex interactions between keratinocytes, dendritic cells, T-lymphocytes, neutrophils and mast cells, with a significant role of interleukins (IL) 23, 17, 22,10, T-helper cells (Th) 17, 22, T-regulatory cells, transformative growth factor b1 (TGF-b1), in the pathogenesis of the disease. Targeted therapy using new biologics and small molecules, patient education, screening for comorbidities, and regular patient follow-up allow to apply a personalized approach to the patient and achieve impressive results.

Achievements in psoriasis research have led to the fact that today we are witnessing the so-called translational revolution in psoriasis therapy, consisting in the fastest possible transfer of fundamental discoveries of the field of theoretical research to the field of practical application.

Russian Journal of Skin and Venereal Diseases. 2022;25(3):191-200
pages 191-200 views

Metabolic screening as a tool for assessing the pathogenesis and course of psoriasis

Olisova O.Y., Kukes V.G., Kukes I.V., Ignatiev D.V., Rogacheva V.V.


Psoriasis is a chronic, autoinflammatory/autoimmune systemic skin disease. The etiology and pathogenesis of the disease are still unclear. However, Th17/IL-17 activation and abnormalities in the Th17/Treg balance axis are observed in psoriasis, but this pathomechanism does not fully explain the frequent occurrence of metabolic disorders. Therefore, it is necessary to search for better biomarkers in the diagnosis, prognosis and monitoring of comorbid disorders and therapeutic effects in psoriasis.

Metabolomics is a new technology that allows to identify a set of small molecular chemicals involved in metabolism. This method has traditionally been studied with the aim of identifying biomarkers in the diagnosis and prognosis of the disease. Metabolic screening is essential for clinical diagnosis, therapeutic monitoring, predicting the efficacy of psoriasis treatment, and further discovery of new metabolic-based therapeutic targets.

Pharmacometabolomics is aimed at predicting individual differences in response to treatment and in the development of side effects associated with specific drugs.

This review summarizes studies that show responses to drug treatment based on their metabolic profiles obtained before, during, or after therapeutic intervention.

Russian Journal of Skin and Venereal Diseases. 2022;25(3):201-209
pages 201-209 views

Efficacy and safety of PUVA and UVB-311 nm in psoriasis: single-center retrospective study

Yazkova O.S., Anpilogova E.M.


BACKGROUND: Psoriasis is a widespread, genetically determined immune–mediated dermatosis of a multifactorial nature, characterized by a recurrent course with frequent associative damage to other organs and systems, which significantly reduces the quality of patients’ lives. For many years, phototherapy (PUVA and UVB-311 nm) has had one of the leading places in the treatment of moderate and severe psoriasis according to the world dermatological communities. However, with the advent of genetically engineered biological drugs, the frequency of its administration has significantly decreased.

AIM: to evaluate the efficacy and safety of PUVA and UVB-311 nm in the treatment of moderate and severe psoriasis.

MATERIALS AND METHODS: A retrospective study was conducted on the basis of the Federal State Institution “Central polyclinic” with the participation of 920 patients with moderate and severe psoriasis who received phototherapy (PUVA and UVB-311 nm) in the period from 2005 to 2021. The initial radiation dose was 0.5–1 J/cm2 at PUVA and 0.1–0.2 J/cm2 at UVB-311 nm with a gradual increase in the dose every 1–2 sessions by 0.5 J/cm2 and 0.1 J/cm2, respectively. The treatment was carried out according to the method of four-time irradiation per week using the UV-7001K cabin (Waldmann, Germany).

RESULTS: Among 920 patients there were 478 (52%) men and 442 (48%) women (aged 21 to 68 years). The average age of psoriasis onset is 34±5.2 years. The duration of the disease averaged 10.5±8.2 years. Vulgar psoriasis was observed in 756 (82%) patients, teardrop-shaped ― in 36 (4%), exudative ― in 73 (8%), inverse ― in 55 (6%). 249 (27%) were diagnosed with psoriatic arthritis. On average, the first phototherapy sessions were prescribed 2.1±1.6 years after the onset of the disease. The choice of phototherapy method depended on the severity of the process. Thus, with moderate psoriasis, patients were prescribed UVB-311 nm (n=473). The course consisted of 25–35 sessions of radiation with a cumulative dose of 35.3±5.9 J/cm2. Clinical remission was observed in 93% of patients, significant improvement ― in 7%. The achieved clinical remission was maintained for 361±194 days. In total, during the studied period, 149 people received 27 courses of UVB-therapy, 132 ― 24 courses, 53 ― 19 courses, 69 ― 15 courses, 58 ― 11 courses, 12 ― 7 courses. Multiple infiltrated plaques and refractory course of severe psoriasis was an indication for PUVA therapy (n=447). The course consisted of 20–30 irradiation sessions with a cumulative dose of 81.5±14.3 J/cm2. Clinical remission was observed in 98% of patients, a significant improvement in 2%. 14 people received 23 courses, 21 ― 20 courses, 12 ― 19 courses, 227 ― 15 courses, 104 ― 13 courses, 33 ― 10 courses, 27 ― 4 courses, 9 ― 2 courses of PUVA. The achieved clinical remission was maintained for 420±275 days. 12 (1.3%) patients cancelled PUVA prematurely due to the inability to take a photosensitizer. In other cases, the observed side effects were minor and did not cause discontinuation of therapy.

CONCLUSION: PUVA and UVB-311 nm have demonstrated high efficacy and safety in the treatment of moderate and severe psoriasis. At the same time, it is necessary to conduct further research to improve the methods of phototherapy for faster achievement of long-lasting clinical remission, which will allow phototherapy to regain its leading position in the treatment of psoriasis, increasing the doctors’ trust and patients’ compliance.

Russian Journal of Skin and Venereal Diseases. 2022;25(3):211-218
pages 211-218 views

Problems of diagnostics of oral lichen planus

Grabovskaya O.V., Kayumova L.N., Nikulina A.S., Damdinova B., Shakhmanova S.


Lichen planus is a disease most commonly found in both dermatological and dental practice. The etiology of this dermatosis is not fully understood. As a rule, with lichen planus, the organs of the gastrointestinal tract, cardiovascular, nervous, endocrine and other systems are affected. The disease can develop against the background of strong psychoemotional stress. Differential diagnosis of lichen planus is performed with leukoplakia, autoimmune pemphigus, candidiasis and lupus erythematosus.

The authors present their own clinical observation of a patient with a lichen planus of the oral mucosa, in whom a diagnostic error led to the series of unsuccessful hospitalizations, examinations, surgical interventions against the background of a gradual aggravation of the mental state.

The interest of this clinical observation is that in the case of diagnosis of lichen planus of the oral mucosa, a complete examination of the skin and all mucous membranes is necessary in order to identify the elements characteristic of this disease. Of particular importance is a biopsy with histological and immunohistochemical examination before the start of therapy. With a prolonged course of the disease, the ineffectiveness of invasive therapies requires timely administration of systemic glucocorticoids to achieve remission. Prolonged and persistent course of lichen planus of the oral mucosa can lead not only to the transformation of the process, but also to the development of psychogenic reactions.

The article shows the importance of a tandem between a dermatovenerologist, a dentist and a psychiatrist for the effective care of patients with lesions of the oral mucosa with lichen planus.

Russian Journal of Skin and Venereal Diseases. 2022;25(3):229-238
pages 229-238 views

Comparative study of the effectiveness of anti-aging cream with hydroquinone and broadband pulsed light in melasma

Sidorenko O.A., Opruzhenkova E.P., Arkatova E.A.


BACKGROUND: Melasma is one of the most common types of hyperpigmentation that significantly impair the quality of life of patients. Despite the availability of effective means and methods of hyperpigmentation therapy, to date there are no clear protocols for the management of patients with melasma.

AIM: of the study was to evaluate the clinical efficacy of anti-aging cream (2% hydroquinone and 0.025% tretinoin) as part of the complex therapy of melasma in women.

MATERIALS AND METHODS: The article presents data on the comparative evaluation of the clinical efficacy of anti-aging cream (2% hydroquinone and 0.025% tretinoin) in the treatment of melasma in 30 women aged 35 to 46 years. The patients were divided into 3 groups: group 1 (n=10) received external therapy with anti-aging cream once a day at night for 3 months, group 2 (n=10) received phototherapy with Lumenis M22 Universal IPL Module 1 time a month for 3 months, group 3 (n=10) ― anti-aging cream + phototherapy with Lumenis M22 Universal IPL 1 time per month for 3 months.

Before the start of therapy, the severity of melasma was determined for all patients based on the calculation of the MASI index (Melasma Area and Severity Index) and the MSS index (Melasma Severity Scale), the level of melanin in the skin was also measured by the method of mexametry, the impact of melasma on the quality of life (QOL) was assessed based on the MELASQoL questionnaire. The effectiveness of therapy was evaluated based on the dynamics of changes in the MASI index and the parameters of the mex before treatment and after 29 days of therapy. Comparison of MELASQoL indicators was carried out before treatment, after 29 days of therapy and 3 months.

RESULTS: Studies have shown that the most pronounced clinical efficacy, namely, a decrease in the severity of melasma, a decrease in the amount of melanin in the skin and an improvement in QOL was observed in 3 group of patients who received combined therapy with anti-aging cream and phototherapy with Lumenis M22 Universal IPL 1 time per month for 3 months. Also, in group 1 patients who received only external therapy with anti-aging cream, there was a significant decrease in the level of melanin in the skin and an improvement in the quality of life after 29 days of therapy and after 3 months of treatment.

CONCLUSIONS: The combination of anti-aging cream with hydroquinone with broadband pulsed lights is an effective method of correcting melasma.

Russian Journal of Skin and Venereal Diseases. 2022;25(3):219-227
pages 219-227 views


Study of the influence of fractional photothermolysis and biorevitalization on skin rejuvenation in middle aged women

Kudrevich Y.V., Kuznetsova E.K., Ziganshin O.R., Zayatc T.A.


BACKGROUND: There is a fairly high demand of patients for procedures to improve the appearance and rejuvenation of the skin, while the methods used have a different, often aggressive principle of action, requiring a long period of rehabilitation.

AIM: The purpose of the work was to determine the safety and effectiveness of exposure to the skin in order to improve its quality and rejuvenate such methods as biorevitalization and fractional photothermolysis using an erbium laser, to determine changes in the structural components of the skin that affect its condition, before and after exposure to various types of procedures.

MATERIALS AND METHODS: 40 patients were examined, who were divided into two groups. Patients of the first group received the biorevitalization procedure, the second group of patients underwent fractional photothermolysis. A fragment of skin was taken from all patients before and after the procedures and the volumetric density of collagen types I and III, laminin, growth factors (VEGF, FGF, TGF, IGF) in the dermis and epidermis, interleukins (IL-4, IL-1α) in the dermis and epidermis was assessed. We assessed the level of changes in these indicators before and after procedures in different groups, correlation analysis.

RESULTS: An increase in the volumetric density of collagens, laminin, growth factors, interleukins was recorded, but the correlations in different groups were different. The structural parameters of the skin during biorevitalization positively correlated with growth factors, and with fractional photothermolysis with indicators of local immunity, such as interleukins, TGF.

CONCLUSION: It was concluded that both biorevitalization and laser exposure have a positive effect on the quality of the skin, but in the case of revitalization, these changes occur through the stimulating action of hyaluronic acid, the entrainment of growth factors in the skin, and in the case of fractional photothermolysis, the formation of new collagen, strengthening of the dermo-epidermal connections occur through the processes of inflammation and regeneration.

Russian Journal of Skin and Venereal Diseases. 2022;25(3):239-246
pages 239-246 views


Chronicles of A.I. Pospelov Moscow Dermatovenerology and Cosmetology Society (MDCS was founded on October 4, 1891) Bulletin of the MSDC № 1148

Yakovlev A.B., Maximov I.S.


The 1148th meeting was held in a “face-to-face” format. In total there were 135 participants. Six people were accepted as members of the MSDVC.

A number of clinical observations were presented at the meeting. The case of severe gangrenous pyoderma with mucosal lesions is of interest due to the complexity of differential diagnosis with Wegener’s granulomatosis, while the main method confirming the diagnosis of gangrenous pyoderma is histological examination of a biopsy. The agenda also discussed the validity of the allocation of the clinical concept of “red scrotum syndrome”. Patients with red scrotum syndrome, as a rule, seek advice from a dermatologist late, which leads to a decrease in their quality of life. In the presented observation, the patient was treated as with rosacea. The clinical experience of the use of IL-17 inhibitors in the treatment of generalized pustular psoriasis of Tsumbush is also analyzed.

The scientific part of the meeting was entirely devoted to the issues of psoriasis, a disease that is a significant psychosocial problem and has a great impact on the quality of life of patients. Not only the differences between psoriasis and seborrheic dermatitis were considered, but also the similarity of the clinical picture, including the pathophysiological features of the stratum corneum, namely the generality of keratinization processes, while the leading therapeutic approach for both diseases is the use of external agents with anti-keratinizing and anti-inflammatory effects. Liposomal cream with silymarin is used for external therapy of psoriasis. Dermatocosmetic products containing silybin demonstrate a positive effect in the treatment of psoriasis, which is confirmed by the results of the study. Nevertheless, the development of effective and safe local remedies for psoriasis therapy remains an urgent problem of modern dermatology.

Russian Journal of Skin and Venereal Diseases. 2022;25(3):247-253
pages 247-253 views


Photogallery. Pyoderma

Teplyuk N.P., Shakhova L.M., Kolesova I.V.


Pyoderma is an acute (less often chronic) purulent inflammation of the skin, its appendages, and subcutaneous adipose tissue. Pyodermas are the most common skin diseases, accounting for 30–40% of all skin diseases. According to the etiology, staphyloderma, streptoderma, streptostaphyloderma are distinguished.

Staphyloderma is more common in men aged 45 to 65 years, who are diagnosed with 60–70% of all cases of the disease; streptoderma ― more often in women and children with delicate skin and a thin stratum corneum.

Along the course, pyoderma is divided into acute and chronic; according to the mechanism of occurrence into primary or secondary; according to the depth of the lesion into superficial, deep.

Staphyloderma is usually associated with sebaceous hair follicles; pathogen ― more often Staphylococcus aureus (facultative anaerobe, lives in the mouths of follicles, sebaceous and sweat glands). Streptoderma is mainly caused by β-hemolytic streptococcus (an obligate aerobe, present mainly on smooth skin, near natural openings and folds).

Russian Journal of Skin and Venereal Diseases. 2022;25(3):255-259
pages 255-259 views

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