Vol 26, No 4 (2023)

Uremic pruritus is a common symptom in chronic kidney disease and end-stage renal failure. In addition to physical discomfort uremic pruritus disrupts sleep, negatively affects the psycho-emotional state and quality of life. In this group of patients, the association of uremic pruritus with an increase in mortality due to any causes was demonstrated. At the same time, there are no standardized approaches to the treatment of uremic itching. There is also a special category of patients receiving antitumor therapy and developing dermatological adverse events, also potentially accompanied by itching.

This article presents a case of uremic pruritus in a patient with papulo-pustular cutaneous reaction (grade II on a Scale Common Terminology Criteria for Adverse Events, CTCAE v 5.0) to the epidermal growth factor (EGFR) inhibitor cetuximab in combination with leucovorin and 5-fluorouracil for rectal cancer. Treatment of uremic pruritus with small doses of gebapentin (300 mg/day) led to complete regression of pruritus. Papulo-pustular rashes completely regressed after recommended systemic and topical therapy according to the severity of rush (doxycycline 100 mg 2 times a day for 5 days, cream with neomycin, natamycin and hydrocortisone 3 times a day for 7 days). Pruritus was absent during the next 6 months of follow-up. Antitumor therapy was not interrupted due to acneiform rush, and following supportive topical therapy allowed to control severity of exacerbations which did not exceed I–II grade according to CTCAE v 5.0 and did not require the addition of systemic therapy.

Thus, therapy of uremic pruritus with gabapentin has shown was effective also in a patient with severe comorbid pathology. Supportive topical therapy consistent with the severity of papulo-pustular rash reduced the severity of exacerbations during following EGFR inhibitor therapy.

BACKGROUND: Vitiligo refers to acquired hypomelanosis, characterized by the appearance of depigmented spots on the skin. The search for new vitiligo treatment approaches, which would simultaneously have a pathogenetic focus on the therapy of this disease and at the same time have a safe spectrum of side effects, is relevant today.

AIM: to evaluate the clinical and laboratory efficacy of azathioprine in progressive non-segmental vitiligo compared with NB-UVB monotherapy.

MATERIALS AND METHODS: 60 patients with progressive non-segmental vitiligo were divided into 2 equal groups: group 1 received azathioprine in combination with NB-UVB, group 2 received NB-UVB monotherapy. The follow-up period was 6 months. The effectiveness of therapy was evaluated based on the dynamics of the Vitiligo Area Scoring Index (VASI), dermatological quality of life index (DLQI), as well as the titers of proinflammatory cytokines IL-1ß, IL-2, IL-6, IL-8, IFN-γ, TNF-α and S100 protein in serum blood.

RESULTS: In the azathioprine + NB-UVB group, compared with the control group, a statistically significant prevalence of VASI and DLQI indices reduction was observed. (Me -61.70%, Q1–Q3: -75.14…-47.08%, p <0.001; Me -55.83%, Q1–Q3: -67.80…-40.29%, p <0.001). The dependence of the quality of life of patients on the prevalence of the skin process was noted (p <0.001). There was a statistically significant relationship between the activity of the skin process and the S100 protein in the blood serum of patients with vitiligo. (p <0.05) In addition, the analysis of the dynamics of immunological parameters of the main group compared with the control group showed a more significant decrease in the level of cytokines, as well as S100 protein in blood serum (p <0.001).

CONCLUSION: The combination of azathioprine and NB-UVB is effective and safe, helps to stabilize the skin process and stimulate the repigmentation of foci, significantly improving the quality of life of patients, contributes to the normalization of immunological parameters, leading to an earlier stop of the progression of the skin process.

Rosacea is a multifactorial dermatological disease that is widespread throughout the world, initially manifested as a cosmetic defect, and in the absence of systemic and topical therapy leads to a change in the structure and functions of the facial skin.

Patients with rosacea often seek medical attention, as these aesthetic problems impair their quality of life and contribute to the development of social and psychological problems. Chronic stress is often the cause of the development of social maladaptation, which occurs because of a constant feeling of self-doubt, own inferiority, and anxiety. Anxiety and chronic depression can cause even minor manifestations of rosacea, as it is localized on the skin of the face. Dermatosis often manifests itself in women older than 30 years, under the influence of multiple trigger factors, has a chronic relapsing course.

Understanding the pathophysiology and the use of combined therapies can improve the effectiveness of therapy in patients with rosacea, achieve and prolong clinical remission, identify trigger factors and possible prevention. This explains the need to study rosacea not as an independent dermatosis, but as a sign of more significant disorders that can lead not only to social and aesthetic problems, but also affect the general health of the patient.

BACKGROUND: Treatment of vitiligo is one of the most difficult problems in dermatology. Despite the availability of various safe and effective methods of treatment, there are problems with combining and correctly applying techniques for the most effective result. Vitiligo has an impact on the psycho-social aspects of patients' daily life. This makes it necessary to use additional techniques, such as cosmetic camouflage to improve the quality of life of patients with vitiligo.

AIM: to assess the effectiveness of microneedling and cosmetic camouflage for the treatment of vitiligo.

MATERIALS AND METHODS: The study included 78 people with vitiligo aged 28–46 years. At the first stage of the study, 49 patients underwent microneedling in combination with ultraviolet B therapy and local tacrolimus. The subjects of the control group (n=29) were affected only by ultraviolet B therapy and tacrolimus. Phototherapy with ultraviolet B rays of 311 nm was carried out according to the method of 3-fold irradiation per week (Monday, Wednesday, Friday) with an initial dose of 0.05 J/cm². 0.1% tacrolimus ointment was applied twice a day during the course of therapy. The treatment lasted for 2–5 months; 2 courses of 2 months were carried out with a break of 3 months (in total 5 months). On average, for therapeutic effect (complete or partial repigmentation), patients received 60–64 sessions. Patients of the studied groups underwent a comparative analysis of repigmentation 2 and 5 months after treatment. At the second stage of the study, patients after microneedling were divided into the main group (n=33) and the comparison group (n=16). The subjects of the comparison group underwent cosmetic camouflage of vitiligo sites. Before and after treatment, the dermatological index of quality of life was determined for patients.

RESULTS: After 1 month from the start of treatment, 67.4% of patients after microneedling and 6.1% of patients in the control group showed moderate improvement (26–50% repigmentation). There was a good improvement with 51–75% repigmentation in 26.5% of patients after microneedling. After 5 months from the start of treatment, 67.4% of the subjects after microneedling showed an improvement in repigmentation of more than 51%. It was found that the average indicators of the dermatological quality of life index after treatment in patients of the main group (9.6±0.3 points) and the comparison group (7.0±0.3 points) corresponded to the values of "moderate effect of the disease on quality of life" and were significantly (p=0.018) lower than the baseline level (20.8±0.2 points and 19.9±1.1 points). This was not determined in the control group (18.2±0.4 points and 22.4±0.1 points). In the comparison group, this indicator was significantly (p=0.001) lower in comparison with the scores of other study groups.

CONCLUSION: The combination of microneedling, ultraviolet B therapy and tacrolimus is an effective method of treating patients with vitiligo. It increases repigmentation and quality of life. Additional cosmetic camouflage improves various aspects of the life of patients with vitiligo.

Necrobiosis lipoidica is a chronic granulomatous skin disease of a vascular-exchange nature from the group of localized skin lipoidosis, accompanied by the development of degenerative changes in the connective tissue.

The reason for the development of necrobiosis lipoidica is unknown, but the most common theory remains the theory of vascular disorders, including the deposition of immune complexes (IgM, complement component C3), microangiopathic changes (deposition of a glycoprotein in the walls of blood vessels), as well as other combinations of inflammatory and structural changes leading to collagen degeneration and decreased perfusion and oxygenation of the skin. Necrobiosis lipoidica occurs in association with systemic diseases (sarcoidosis, autoimmune thyroiditis, inflammatory bowel disease, such as ulcerative colitis, and rheumatoid arthritis) and can also occur in otherwise healthy individuals. Necrobiosis lipoidica is closely associated with diabetes mellitus.

The predominant localization of necrobiosis lipoidica is tibial surface of the legs. Atypical localization is: skin of the scalp and face.

Clinical polymorphism of necrobiosis lipoidica, possibility of transition from one form to another, its combination with other dermatoses can pose difficult diagnostic questions for the doctor.

The article describes our own clinical observation of a patient with complaints of rashes on the skin of the legs and scarring alopecia in the scalp. The focus on the scalp had a tendency to grow and signs of development of scarring alopecia. According to the results of a biopsy performed at the Rakhmanov Department of Skin and Veneral Diseases, I.M. Sechenov First Moscow State Medical University, was diagnosed with "Necrobiosis Lipoidica". The case was interesting due to the extreme rarity of rashes on the skin of the scalp and the absence of dermatoscopic features of lesions in this area. Due to ongoing therapy for a month, there was a positive effect in the form of a lack of growth of existing plaques and the appearance of new ones, a decrease in the brightness of the color of the rash, a partial regression with an outcome in residual hyperpigmentation.

Thus, despite the absence of a gold standard in the treatment of necrobiosis lipoidica, the most well-studied group of drugs for the treatment of the disease at the moment are glucocorticoids, which confirms our experience. Therapy of patients with necrobiosis lipoidica should be carried out by an interdisciplinary team (dermatovenereologist, endocrinologist, therapist).

On April 18, 2023, the 1152nd meeting of the Moscow Society of Dermatologists and Cosmetologists named after A.I. Pospelov took place. The meeting was held in a face-to-face format. There were 115 participants in total. Ac-cepted as a member of the MSDC 1 person.

Two reports are presented in the clinical part of the meeting: clinical variations of the course of skin sarcoidosis: the mini-lecture describes 8 clinical cases of cutaneous sarcoidosis; Kaposi's sarcoma in a 24-year-old patient with positive antibodies to cytomegaly and Epstein–Barr viruses.

Three reports were presented in the scientific part of the meeting: The possibilities of im-proving the effectiveness of onychomycosis therapy (speaker I.S. Maximov, Sechenov University); The use of botulinum toxin type A for the correction of erythematous-telangiectatic subtype of rosacea (speaker A.O. Yakovleva, State Scientific Center of Dermatovenerology and Cosmetology); A post-graduate student of the Department of Dermatovenereology of the Peoples' Friendship University of Russia Aun Rami Yusefovi made a report on targeted therapy of children with moderate and severe forms of atopic dermatitis (co-speakers ― Prof. E.A. Batkaev, Prof. V.Yu. Ujuhu).

Juvenile hemangiomas can occur from the first months of life, with the prevalence of superficial juvenile hemangiomas (76.1%), more often solitary (83.3%).

Female infants predominate among the patients, with a 2:1 ratio.

Localization on the skin of the face and scalp is determined in 30% of cases; the remaining juvenile hemangiomas are located on the skin of the trunk and extremities.

Hemangiomas are mostly peripheral and small in size (10–20 mm), superficially and up to 5 mm deep.

The most frequent complication of juvenile hemangiomas is ulceration, both as a consequence of exophytic growth and treatment methods.

The predominance of arterial intramedullary blood flow was found at ultrasound diagnosis, however, variants of 2-phase blood flow can also occur, which requires additional ultrasound examination of all cases of juvenile hemangiomas.

We offer the publication of a photo gallery on this problem.