Vol 26, No 2 (2023)

Pseudolymphomas of the skin are a heterogeneous group of diseases manifested by benign lymphoid infiltrates that clinically and/or histologically mimic skin lymphoma.

The group of pseudolymphomas of the skin includes actinic reticuloid, benign lymphocytoma of the skin, true pesvdolymphoma, postscabious lymphoplasia, lymphocytic reactions to insect bites, etc. The diagnosis of pseudolymphoma is based on anamnesis data (the presence of a provoking factor, with the exception of idiopathic pseudolymphomas), clinical picture (a single papule, less often a plaque localized in open areas of the upper half of the body ― the face: cheeks, nose, earlobes; scalp, upper extremities, chest), results histological, immunophenotypic studies, and with persistent persistence of rashes ― on the results of molecular biological studies.

The similarity of clinical and pathomorphological signs of pseudolymph with malignant lymphoproliferative processes creates significant diagnostic difficulties and requires a thorough examination with the involvement of pathologists and oncologists. Diagnostic difficulties are often the cause of erroneous or late detection of skin lymphoma, which negatively affects the prognosis of the disease. Treatment tactics are determined by the morphological variant of lymphoid infiltration, as well as the presence and nature of the provoking factor. The majority of idiopathic psvdolymph is successfully treated with systemic glucocorticosteroids, however, in the case of resistance to systemic glucocorticoids, recommendations on treatment tactics have not yet been developed. Prolonged, often recurrent course, as well as the possibility of transformation of the process into malignant lymphoma of the skin, requires long-term clinical observation of patients.

The case presented in the article confirms that the crucial importance for the successful diagnosis of pseudolymphoma lies in the analysis of anamnesis data, clinical picture, histological and immunohistochemical studies.

BACKGROUND: Pathological angiogenesis is one of the important pathogenetic links of psoriasis. At the same time, the prognostic significance of instrumental methods for studying the severity of angiogenesis in psoriatic plaques remains poorly understood.

AIM: Clinical assessment of the correlation between the dynamics of angiogenesis parameters (morphometric parameters of vascular glomeruli and Doppler blood flow in the skin and nail bed) and indicators of the methotrexate clinical efficacy during 12 months of therapy.

MATERIALS AND METHODS: The work is based on the clinical data analysis of 82 patients with moderate and severe psoriasis vulgaris in the acute stage, who were prescribed methotrexate after initial examination. Patients underwent Doppler ultrasound examination of the skin in psoriatic plaques area and digital dermatoscopy to study the characteristics of vascular angiogenesis loci before treatment and at 1, 3 and 12 months of methotrexate therapy.

RESULTS: As a result of comparative correlation analysis of dermatoscopy and ultrasonographic Dopplerography indicators dynamics and psoriasis clinical index values during the treatment of patients with methotrexate, moderate and strong correlations were established between the values of the average diameter of the vascular glomerulus and the degree of increased blood flow in psoriatic plaque area after 1 month of methotrexate treatment and the values of PASI at 3, 6 and 12 months from the start of treatment (r=0.54–0.76, p=0.002–0.005), as well as between the mean vascular glomerulus diameter values and the degree of skin blood flow increase after 3 months and PASI and BSI indices after 6 and 12 months (r=0.36–0.74, p=0.001–0.036). Disappearance of Doppler signals in psoriatic plaques skin and decrease in vascular glomeruli average diameter after 1 month from the start of therapy in 1.76 [1.38; 2.30] and 1.30 [1.38; 2.30] times increase the probability of achieving clinical improvement after three months of methotrexate treatment. The correlation coefficient between the degree of NAPSI reduction after 6 and 12 months of treatment and the dynamics of Doppler blood flow in the nail bed and resistance index of arterial vessels in the nail bed after three months from the start of treatment varied from 0.53 to 0.73.

CONCLUSIONS: The dynamics of instrumental methods indicators for studying pathological angiogenesis correlates with the probability of achieving clinical improvement in psoriasis symptoms during systemic methotrexate therapy.

Hair shaft defects, which are the result of both congenital and acquired pathologies, are usually accompanied by a violation of their physical characteristics and a change in appearance. Hair becomes dull, dry, not elastic, poorly styled, broken. Determining the presence of hair fragility formed the basis for the classification of heterogeneous abnormalities of the hair shaft and their division into two groups.

The similarity of clinical symptoms and the impossibility of visual verification of the diagnosis dictate the need for additional research methods (dermatoscopy, microscopy, histology), the results of which will help to correctly diagnose. Knowledge of the nuances of the clinical picture, the main dermatoscopic and microscopic markers, the distinctive features of the course of various anomalies of the hair rods expands the capabilities of practicing trichologists, cosmetologists, dermatovenerologists and doctors of other specialties in the field of diagnosis, therapy and prevention of structural hair changes.

The literature review presents the main clinical, dermatoscopic, microscopic and histological signs of various disorders of hair shafts.

Unna-Toast's keratoderma is a disease belonging to the group of genodermatoses with an autosomal dominant type of inheritance and characterized by hyperkeratosis on the palms and soles. This nosology can manifest itself at any age as an independent process, but more often it debuts at 1–2 years of age, in some cases combined with various congenital malformations of ectodermal origin.

The prevalence of this disease ranks second among hereditary dyskeratoses, however, it is rare in the practice of a dermatologist and there are no static data on the disease.

The article presents a clinical observation of Unna-Toast's keratoderma that first appeared against the background of atopic dermatitis. The clinical picture is represented by smooth yellow horny layers located on the palms and soles, with a sharply defined border and an erythematous corolla along the periphery. Other areas of the skin are represented by lichenification foci with small-lamellar peeling, excoriations and serous-hemorrhagic crusts on the surface.

This clinical case confirms the possibility of manifestation of hereditary hyperkeratosis against the background of aggressive atopic dermatitis. Unna-Tost's keratoderma is of high interest in the practice of a dermatologist and requires a detailed description of the available clinical cases, due to the rare occurrence of this nosology in the population.

BACKGROUND: The incidence of syphilis is an indicator of social disadvantage in society as a whole and in particular regions, and is mostly determined by medical, social, biological and economic factors.

AIM: To study modern clinical and epidemiological aspects and assess epidemic trends of syphilis in the population of the Ural Federal District for the period from 2014 to 2022 in order to determine further preventive epidemic control measures.

MATERIALS AND METHODS: The object of the study are the data of statistical forms No. 9 and No. 34 on the number of registered cases of syphilis in the Ural Federal District for the period from 2014 to 2021, the data of statistical materials "Resources and activities of medical organizations of dermatovenerological profile. Incidence of sexually transmitted infections, contagious skin diseases and skin diseases" and operational data for 6 months of 2021 and 2022 years. Intensive and extensive morbidity rates are calculated and their analysis using descriptive statistics is presented.

RESULTS: The main patterns of the course of syphilitic infection in six subjects (which are parts of the Ural Federal District) of the Russian Federation have been studied. Modern clinical and epidemiological features and trends have been established: variability of morbidity indicators, its clinical structure and territorial dynamics; variability in the age-associated characteristics of patients, the emergence of high-risk groups have been noted. Target indicators characterizing the epidemiological situation of syphilis in the region have been determined. The necessity of interdisciplinary interaction of doctors of various specialties on early detection of patients with syphilis is indicated.

CONCLUSIONS: During the analyzed period from 2014 to 2022, in certain areas of the Ural Federal District, the current trends of syphilitic infection prevalence is characterized by multi-directional dynamics and levels of morbidity, an increase in early and late forms of syphilis in the structure of clinical forms of the disease; an increase in the registration of late latent forms of infection, cases of congenital syphilis, an increase in the incidence rate among adolescents, foreign citizens and pregnant women in the territory of the Ural Federal District.

On February 21, 2023, the 1151st meeting of the A.I. Pospelov Moscow Society of Dermatologists and Cosmetologists took place.

The meeting was held in a face-to-face format. There were 105 participants in total. 4 people have been accepted as MSDC members.

Two clinical cases are presented in the clinical part of the meeting: 1) fulminant rosacea, in clinical manifestations and course strongly resembling ulcerative vegetative pyoderma. No systemic pathology was detected in a 50-year-old patient; 2) tuberculous lupus in a 42-year-old patient in the absence of active tuberculosis of internal organs (petrifications in the lungs).

Three reports were presented in the scientific part of the meeting: 1) new methods of diagnosis of fungal mycosis (speaker ― D.R. Amshinskaya, co-speaker ― Chairman of the MSDC , corresponding member Russian Academy of Sciences, professor O.Y. Olisova); 2) R.R. Saitburkhanov, a researcher at the State Scientific Center of Dermatovenerology and Cosmetology – Central Institute of dermatology and venereology told about the treatment of basal cell skin cancer with the use of coherent laser radiation that causes cessation of blood flow in tumor vessels; 3) a report on traditions and innovations in the external therapy of itchy dermatoses, on the combination of anti-itchy and keratoplastic properties in one external cosmeceutical agent was made by Professor of the Department of Skin and Venereal Diseases of Sechenov University E.S. Snarskaya.

Orphan dermatoses are caused by both genetic causes and a number of autoimmune, inflammatory and infectious processes in the body. Congenital giant nevus is associated with serious complications: malignant melanoma, CNS lesions (neurocutaneous melanosis). Multiple epidermoid cysts are often a component of Gardner's syndrome. Angiolymphoid hyperplasia with eosinophilia, a vascular tumor formation with proliferation of histiocytoid endothelial cells, with severe lymphocytic and eosinophilic infiltration, recurs in 1/3 of cases. Morbigan's disease is persistent erythema and swelling of the middle third and upper part of the face. Skin mastocytosis in children is prone to spontaneous resolution during puberty. Squamous cell skin cancer accounts for 20% of all skin cancers and has a high risk of recurrence, metastasis, and death. Buschke's scleroderma is a scleroderma-like disease that causes progressive fibrous-mucinous thickening of the skin affecting the neck, shoulders, proximal upper extremities, and face. Fulminant (lightning) acne is a sharply exacerbated form of acne vulgaris, characterized by an acute onset and the appearance of confluent abscesses. Cases of acne fulminans have been observed during treatment with isotretinoin. Norwegian (crustose) scabies is associated with a compromised immune response, which allows the mites to multiply and can number in the millions. Pretibial myxedema (thyroid dermopathy) is a rare extrathyroid manifestation of Graves' disease along with thyrotoxicosis, thyroid hypertrophy, ophthalmopathy, and acropachy. Porokeratosis Mibelli predisposing factors of development are immunosuppressive conditions, malignancy is possible. Osteomas are formations from bone tissue in the dermis or subcutaneous fat as a result of metaplasia of fibroblasts into osteoblasts, or differentiation of primitive mesenchymal cells into osteoblasts and their migration to an ectopic site. Sarcoidosis of the skin is characterized by a variety of clinical forms, rarely observed before 40 years. Xanthomas with histiocytosis X ― a violation of lipid metabolism. The rural type of leishmaniasis (acute necrotizing) has a short incubation period, a significant spread of rashes and healing with the formation of scar tissue. The giant condyloma of Buschke–Levenshtein is characterized by progressive growth, large size and recurrent course, it can transform into squamous cell carcinoma. Degos disease ― malignant atrophic papulosis ― a rare disease caused by blockage of the arteries and veins.