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Vol 26, No 1 (2023)

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DERMATO-ONCOLOGY

Leser–Trelat sign in cosmetologist’s practice

Romashkina A.S., Snarskaya E.S., Shpak A.M.

Abstract

Leser–Trelat syndrome (eruptive seborrheic keratosis) is an unusial paraneoplastic dermatosis characterized by sudden appearance of seborrheic keratomas on the skin and a progressive increase of their number. This condition was first described in 1901 by the German surgeon E. Leser and the French surgeon U. Trelat. It occurs with the same frequency in both men and women aged 40+. The etiology and pathogenesis have not been studied in detail, however, there is evidence that the development of the syndrome may be associated with stimulation of the epidermal growth factor, which leads to stimulation of keratinocytes. The manifestation of the syndrome is usually start at the same time with cancer development, mostly it can be combained with adenocarcinoma of the gastrointestinal tract (47.7%), with intestinal carcinoma (32%), with lymphoproliferative diseases (21%), less often with malignant neoplasms of the lungs, breast, prostate.

The clinical picture of the Leser–Trelat sign is characterized by the sudden appearance оf seborrheic keratomas, which have typical clinical and histological signs. The most typical localization of seborrheic keratosis are back and chest (76%), limbs (18%), face (21%), abdomen (15%), neck (13%), armpits (6%), inguinal folds (3%). Keratosis can appear rapidly, over several months or even weeks. The rapid appearance of multiple seborheic keratomas may precede or develop with the oncological process in the internal organs.

Treatment is carried out at the same time with the establishment and treatment of the underlying disease and consists in removing the largest keratomas by destructive methods (surgical excision, radiowave method, cryodestruction, electrocoagulation).

The prognosis is favorable if paraneoplastic process was early detected.

The article describes clinical cases of multiple seborrheic keratosis and the tactics of examining this group of patients.

Russian Journal of Skin and Venereal Diseases. 2023;26(1):5-12
pages 5-12 views

DERMATOLOGY

Efficacy and safety of early treatment of patients with skin psoriasis and axial arthritis with IL-17 inhibitors

Pereverzina N.O., Kruglova L.S., Korotaeva T.V.

Abstract

BACKGROUND: On average, within 7 years from the debut of skin psoriasis, patients may develop psoriatic arthritis, characterized by a chronic, relapsing progressive course. Early manifestations of psoriatic arthritis may be axial lesions presenting with inflammatory back pain. Currently, many experts are raising the topic of early prescription of genetically engineered biological drugs for axial lesions in order to prevent disability. Members of the GRAPPA expert group (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) currently do not provide specific recommendations for the treatment of axial lesions in psoriatic arthritis. The most commonly used regimens are those for axial spondyloarthritis and ankylosing spondylitis. There are also no treatment regimens for early manifestations of axial lesions in patients with smooth skin psoriasis without an established diagnosis of psoriatic arthritis. All regimens consider axial lesions in patients who have already been diagnosed with psoriatic arthritis. Thus, it is necessary to form interdisciplinary standardized protocols for the management of such patients.

AIM: to investigate the efficacy and safety of IL-17 inhibitors in axial lesions in patients with skin psoriasis.

MATERIALS AND METHODS: A prospective non-interventional comparative multicenter study was conducted in parallel groups of patients with smooth skin psoriasis (n=87). To study the effectiveness of the developed method of therapy, the formation of comparison groups is provided. 3 variants of therapy were analyzed: IL-17A inhibitors (n=21; group 1, main); methotrexate (n=35; group 2, comparison); standard desensitizing therapy was used in group 3 (n=31; control). The distribution into groups was carried out taking into account the severity, prevalence of the skin process (according to PASI, BSA), the quality of life of the patient (according to DLQI), the patient's wishes and the patient's ability to purchase genetically engineered biological drugs.

RESULTS: According to our results, the use of IL-17A inhibitors shows high efficiency: by week 52, 100% of patients reached the level of PASI 75, 90.5% ― PASI 90 and 85.7% ― PASI 100, NAPSI 100 (Nail Psoriasis Severity Index) was observed in 71.4% patients. All patients reported a reduction of pain at 12, 24 and 52 weeks with a mean BASDAI of 5.9 (SD=2.3), 4.1 (SD=1.3), and 2.7 (SD=0.9), respectively. It was found that 90.5% of patients achieved ACR 20 by the end of the study at week 52. The majority of patients (85.7%) achieved remission or low DAPSA disease activity after 24 weeks of therapy. The mean ASDAS at 12, 24, 52 weeks was 3.07 (0.9), 2.2 (1.0), and 2.3 (0.9), respectively.

CONCLUSIONS: Thus, in patients with skin psoriasis and axial lesions, it is recommended to make the earlier prescription of biologic treatment from the group of IL-17 inhibitors in order to prevent the development of severe forms of psoriatic arthritis and human disability.

Russian Journal of Skin and Venereal Diseases. 2023;26(1):13-24
pages 13-24 views

Influence of the cream with filaggrin activity modulator for dry and sensitive skin in children with mild to moderate severity atopic dermatitis on objective indicators of skin barrier function and disease severity indices

Zaslavsky D.V., Barinova A.N., Plavinskij S.L., Zelyanina M.I., Zakharova I.N., Berezhnaya I.V., Shartanova N.V., Sidorovich O.I.

Abstract

BACKGROUND: Atopic dermatitis is a chronic, relapsing and severely itchy dermatitis that usually occurs in childhood and has a characteristic age-related distribution. Atopic dermatitis is relatively frequent, affecting 10–20% of children in developed countries. Atopic dermatitis in children associated with poor school performance, low self-esteem and family problems. Recent studies show importance in atopic dermatitis pathogenesis of protein filaggrin and modulation of its activity may be a promising direction in the pathogenic therapy of atopic dermatitis.

AIM: to study the effect of a cream for dry, sensitive and atopic skin with a modulator of filaggrin activity on the course of mild and moderate atopic dermatitis.

MATERIAL AND METHODS: An open, prospective, multicentre, non-comparative, single-group clinical trial was organized to test the effectiveness of a cream with a filaggrin activity modulator. The study was on outpatients in the participated centers and included 5 visits with a screening visit 1, and 5th visit ― therapy completion. Cream was used for 12 weeks. In total, the study involved 60 children aged 3 to 18 years with diagnoses of atopic dermatitis of mild and moderate severity. The severity of atopic dermatitis was measured with the SCORAD, EASI, IGA scales, also measured was skin pH and transepidermal water loss (TEWL), as well as the severity of xerosis according to visual analogue scale.

RESULTS: The severity of atopic dermatitis in children whose therapy regimens included Admera cream decreased by 19.6 points according to the SCORAD index, including in children who did not receive mometasone furoate in the therapy schemes, the SCORAD index decreased statistically significantly compared to the baseline data (p <0.001). The overall decline in the EASI index ― by 3.0 points, the IGA global assessment index ― by 2.0 points, the severity of xerosis decreased by 3 points (in all cases, p <0.001). Transepidermal water loss decreased (by 4.5 g/m2 per hour, p <0.001); Skin pH did not change (difference 0.02, p=0.34). The smell was rated as "excellent" by 86.7% (95% CI 75.4–94.1), the consistency ― by 83.3% (95% CI 71.5–91.7) of the respondents, and overall satisfaction was noted by ― 88.3% (95% CI 77.4–95.2) of the respondents.

CONCLUSION: Сream for dry and sensitive skin with a modulator of filaggrin activity during the study showed good efficacy and tolerability and can be used in atopic dermatitis treatment regimens as a basic care product, both during exacerbation and remission.

Russian Journal of Skin and Venereal Diseases. 2023;26(1):25-39
pages 25-39 views

Development of scalded skin syndrome in an adult patient with acquired epidermolysis bullosa after long-term treatment with methotrexate

Olisova O.Y., Teplyuk N.P., Ignatiev D.V., Dunaeva E.R.

Abstract

A clinical case of a patient with epidermolysis bullosa acquisita, which is a rare autoimmune disease ― 0.17–0.26 cases per 1 million population, with the development, most likely against the background of long-term cytostatic therapy with methotrexate, develops staphylococcal scalded skin syndrome is presented.

Staphylococcal scalded skin syndrome is a lesion that appears in 0.09–0.56 cases per 1 million and is predominantly observed in newborns and children under 5 years of age, and cases in adults are usually associated with immunosuppression, human immunodeficiency virus / acquired immunodeficiency syndrome, severe renal failure or malignant neoplasms.

The article presents literature data on the etiology and pathogenesis of the presented diseases, features of differential diagnosis, description of clinical and laboratory criteria, on the basis of which diagnoses are made.

This clinical case is of interest to dermatologists, as it describes the scalded skin syndrome, which is rare in everyday practice, in a patient with acquired epidermolysis bullosa, which, despite ongoing therapy, has a risk of death of up to 65%.

Russian Journal of Skin and Venereal Diseases. 2023;26(1):41-49
pages 41-49 views

Comparison of skin microbiome components analyzed by culture method in patients with autoimmune pemphigus

Teplyuk N.P., Kolesova Y.V., Vartanova N.O., Leonova A.Y.

Abstract

BACKGROUND: Autoimmune pemphigus is a group of severe, potentially fatal bullous dermatoses affecting both skin and mucous membranes. To date, the pathogenesis and therapeutic approaches to the disease have been well studied; despite this, secondary bacterial complications remain the leading cause of death in these patients. Study of qualitative and quantitative composition of skin microbiome in chronic dermatoses is an actual contemporary problem. These data allow one to investigate the influence of microorganisms on the disease severity, relapse rate and remission duration. Analysis of literature sources shows a high interest of scientific groups in the study of microbiome components of the skin and mucous membranes in patients with bullous dermatoses, however, similar works on autoimmune bullous vesicles are still limited.

AIM: to compare the composition of the skin microbiome in patients with autoimmune pemphigus and a healthy control group based on the results of the culture method performed.

MATERIALS AND METHODS: Experimental, prospective, comparative study. Seventeen patients with previously or first-time diagnosis of autoimmune vesicular disease, as well as a control group of 10 people were included in the study. Patients were enrolled between November 2021 and November 2022. Rakhmanov clinic. All study participants had their skin swabs taken (for patients with rash elements and with apparently unchanged skin in the back or chest area; for the control group, from healthy skin in the back area), after which the material was taken to the laboratory for culture study.

RESULTS: Data from 17 patients (5 men, 29.5%; and 12 women, 70.5%; average age 51±13.3 years) were analyzed. Also included were 10 individuals from the control group (7 women, 70%; and 3 men, 30%; mean age 40±14.7 years). Bacterial growth was detected in all samples submitted. No other microgranisms were identified. Eleven bacterial species were detected on the skin from the rash elements. The most frequent species encountered were: Staphylococcus aureus (in 70.59% of patients), Staphylococcus epidermidis (35.3%), Staphylococcus hominis (17.63%), Staphylococcus haemolyticus and Corynebacterium aurimucosum (11.8%). Twelve bacterial species were isolated on visibly unchanged skin. The most frequent were S. epidermidis (52.9%), S. aureus and S. hominis (35.3%), Staphylococcus capitis and Staphylococcus warneri (17.65%), Micrococcus luteus (11.76%). Fifteen bacterial species were identified in the control group. The following species were found most frequently: S. hominis (60%), S. capitis (50%), M. luteus (40%), S. epidermidis, S. haemolyticus and S. warneri (20%). The mean value of bacterial colony-forming units per 1 ml on rash elements was 5106.33±8752.46; on visibly unchanged skin 593.23±1223.06; in the control group 349.33±915.52.

CONCLUSIONS: We were able to obtain primary data on the composition of the skin microbiome in 17 patients with various types of autoimmune pemphigus and compare them with the control group. The data obtained demonstrate a great variety of microbial communities on the skin and a significant quantitative difference in the composition on the skin of patients and controls. A limitation of the study is the chosen cultural method, which cannot fully reflect all the diversity of microorganisms. To confirm the hypotheses put forward, we plan to conduct an additional study involving a larger number of patients and using genomic sequencing methods to identify microbial communities.

Russian Journal of Skin and Venereal Diseases. 2023;26(1):51-61
pages 51-61 views

Disease burden and physical activity in patients with chronic spontaneous urticaria

Popova C.Y., Zaborova V.A., Kurshev V.V., Kovalkova E.V., Serdoteckova S.A., Fomina D.S., Borzova E.Y.

Abstract

BACKGROUND: Сhronic spontaneous urticaria is a disease characterized by itchy wheals and/or angioedema on the skin over a period of 6 weeks or longer. Сhronic spontaneous urticaria is characterized by a significant disease burden for patients, their families, healthcare system and a society. Some aspects of сhronic spontaneous urticaria burden. Including the disease impact on physical activity and sport engagement, have not been well characterized.

AIM: to evaluate the сhronic spontaneous urticaria impact on patient’s quality of life and physical activity of patients, and to assess the correlation between the level of physical activity and a UCT control/severity.

MATERIALS AND METHODS: The study included 31 сhronic spontaneous urticaria patients, who underwent history taking and a survey using international questionnaires: UAS7 (Urticaria Activity Score for 7 days), UCT (Urticaria Control Test), DLQI (Dermatology Life Quality Index) и GPAQ (Global Physical Activity Questionnaire) developed by the World Health Organization (WHO).

RESULTS: According to the GPAQ results, the physical activity level below that recommended by WHO was noted in five (16.1%) patients (MET-minutes/week ≤600). The moderate level of physical activity was reported in 17 (54.8%) patients, and the high level ― 9 (29%). Median sedentary time in сhronic spontaneous urticaria patients was 420 [300–480] min/day, that exceeds the WHO recommendations. The DLQI assessment suggests that 16 (51.6%) сhronic spontaneous urticaria patients had difficulties in their sport activities. Four (12.9%) patients had very strong impact of сhronic spontaneous urticaria on their sport activities. Noteworthy, five patients had to stop their regular physical activity because of сhronic spontaneous urticaria severity. Based on the UCT data, uncontrolled сhronic spontaneous urticaria was reported in 23 of 31 (74.2%) patients, who also had a significantly lower quality of life compared to those with a well-controlled disease.

CONCLUSIONS: Сhronic spontaneous urticaria may negatively affect patient’s quality of life, including their physical activity. A sedentary lifestyle (below the WHO recommendations) was noted in 16.1% patients. In further studies, the optimized recommendations for physical activity in сhronic spontaneous urticaria patients should consider their disease control/severity, their fitness level and patient’s preferences.

Russian Journal of Skin and Venereal Diseases. 2023;26(1):63-71
pages 63-71 views

Application of noninvasive hardware technique of transcranial electrical stimulation (TES) in patients with atopic dermatitis

Kochergin N.G., Marchenko V.A.

Abstract

BACKGROUND: Transcranial electrostimulation (TES therapy) is a physiotherapeutic non-invasive technology that allows painlessly, selectively and strictly dosed activation of certain brain structures producing endogenous opioid peptides by modulating activity in these brain regions that are involved in the processing of pain and itching signals. Originally, this technique was used as an electronarcosis, then the scope of TES therapy in medicine expanded and began to be used in neurology, gynecology, urology, gastroenterology. The efficacy of its use in dermatology as an antipruritic action remain poorly understood.

AIM: the purpose of the pilot study was to evaluate the effectiveness and acceptability of the use of non-invasive TES therapy in patients with atopic dermatitis.

MATERIAL AND METHODS: According to the existing concept, itching is considered as a kind of pain sensation caused by an altered threshold level of nerve endings in the skin that perceive pain. Given this similarity of the mechanisms of pain and itching, noninvasive brain stimulation can simultaneously reduce itching, which opens up broad prospects for its further use in itchy dermatoses.

A pilot controlled study was conducted, the object of the study was patients with moderate atopic dermatitis (9 women and 6 men) aged 19 to 48 years. TES therapy was carried out by a pulsed bipolar electrical stimulator with acoustic effect "TRANSAIR-07" according to the standard method. All patients who received a course of TES monotherapy underwent 10 procedures, 1 time a day, lasting 30–40 minutes, with a current of 1–3 mA. To assess the dynamics of clinical manifestations of atopic dermatitis and the severity of the disease, the following scales were used: SCORAD, EASI, IGA, DLQI, HADS, BDI. The assessment was carried out twice: the first time on the day of diagnosis verification and again on the 10th day of treatment.

RESULTS: As a result of the treatment, there was a decrease in itching from 5 to 2 points, an improvement in mood from 5 to 1 point, an increase in performance from 4 to 1 point, a decrease in anxiety and depression from 4 to 2 points. With a general assessment of the dynamics of the indicators of the applied clinical scales (SCORAD, EASI, IGA, DLQI, HADS, BDI), the total average effectiveness in the form of parameter improvement amounted to 66.25% reduction by the end of the 10-day course.

CONCLUSION: The work presents the modern aspects of the application of non-invasive hardware transcranial electrical stimulation technique. The positive results of our own pilot study are presented and data confirming the clinical efficacy of transcranial electrical stimulation in patients with atopic dermatitis are presented, which determines the prospect of developing a combined application of TES therapy for this persistent disease.

Russian Journal of Skin and Venereal Diseases. 2023;26(1):73-78
pages 73-78 views

COSMETOLOGY

Comparison of a single treatment with a Q-switched ruby laser and a Q-switched Nd:YAG neodymium laser for blue and black tattoo removal

Pinson I.Y., Verchoglyad I.V., Kirilyuk T.I.

Abstract

BACKGROUND: Black and blue tattoo pigment are the most commonly used colors and can be injected at different depths. The effectiveness of tattoo removal is related to the selected wavelength, type of laser, energy parameters, number of procedures performed. Q-switched (QS) ruby and neodymium (Nd:YAG) lasers are most effective in removing blue and black tattoos due to their high peak power and ability to break the pigment into small particles that are absorbed by the macrophage system. In the literature available to us, it was not possible to find data on comparative efficacy and adverse events in their application.

AIM: comparison of single treatment of blue and black tattoos with QS ruby laser (wavelength 694 nm) and neodymium Nd:YAG laser (wavelength 1064 nm).

MATERIALS AND METHODS: 35 patients with blue and black tattoos were included in our study. The tattoos were divided into two parts or two adjacent tattoos were used on the same part of the body with the same density and color of the tattoo pigment; one side was treated with a ruby laser and the other with a neodymium laser. The comparison took into account the instantaneous reaction, the result of processing and side effects. Statistical significance was set at a power level <0.05.

RESULTS: Edema and erythema were more common immediately after ruby laser treatment (power <0.05). The neodymium QS laser lightened tattoos better than the ruby QS laser after a single treatment (<0.05 power). There was no difference in side effects between the two types of lasers.

CONCLUSIONS: Neodymium Nd:YAG QS laser shows more efficiency and fewer procedures when removing blue and black tattoos. The instantaneous reaction after treatment with this type of laser is less pronounced than after the ruby laser.

Russian Journal of Skin and Venereal Diseases. 2023;26(1):79-85
pages 79-85 views

CHRONICLES

Chronicles of A.I. Pospelov Moscow Society of Dermatovenerologists and Cosmetologists (MSDC was founded on October 4, 1891). Bulletin of the MSDC № 1150

Yakovlev A.B., Maximov I.S.

Abstract

On December 20, 2022, the 1150th meeting of the Moscow Society of Dermatovenerologists and Cosmetologists (MSDC) named after A.I. Pospelov took place.

The meeting was held in a face-to-face format. There were 110 participants in total. Accepted as a member of the MSDC 3 people.

Two clinical cases are presented in the clinical part of the meeting: widespread cutaneous leishmaniasis in an HIV-infected patient. The peculiarity of this clinical case was the extreme prevalence of rashes. No systemic pathology was detected; panniculitis in a patient after a COVID-19 infection. The process proceeded according to the type of non-stagnant Weber-Christian panniculitis: after surgical autopsy, a mucus-like substance was released.

Three reports were presented in the scientific part of the meeting. Corresponding member Prof. O.Y. Olisova (Sechenov University) made a report on the benefits of treating severe and moderate psoriasis with netakimab; researcher of State Scientific Center of Dermatovenereology and Cosmetology – Central Dermatology and Venereology Institute A.A. Vorontsova reported on the results of an original study of the generality of clinical and pathomorphological manifestations of psoriasis and T-cell lymphoma; with pathogenetic justification of the development of cutaneous toxicity as a result of targeted therapy of oncological diseases was performed by E.V. Orlova (Sechenov University): it is based on the suppression and dysfunction of EGFR-controlled processes in the skin.

Russian Journal of Skin and Venereal Diseases. 2023;26(1):87-93
pages 87-93 views

PHOTO GALLERY

Photogallery. Follicular occlusion syndrome

Teplyuk N.P., Pirogova A.S., Svistunova D.A.

Abstract

Hidradenitis suppurativa, dissecting cellulitis of the scalp, acne conglobata and pilonidal sinus ― are four diseases united by similar clinical findings and common mechanisms of pathogenesis. These conditions often coexist. The primer pathogenetic event is stratum corneum thickening and keratin plugging of the hair follicle ductal isthmus. The discovery of this mechanism led to association of all the diseases with the term "follicular occlusion syndrome". If three nosologies are detected follicular occlusion triad is diagnosed, if four are present ― follicular occlusion tetrad.

We present a photogallery on this problem.

Russian Journal of Skin and Venereal Diseases. 2023;26(1):95-100
pages 95-100 views


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