Vol 27, No 5 (2024)

BACKGROUND: Melanocytic nevi can affect the complex anatomical localization of the face and the ear area, a very important part of the face from an aesthetic point of view. Treatment methods should provide not only a good cosmetic result but also not disrupt the function of the eye and vision. Surgical excision and non-selective technologies, including radiofrequency exposure, peels, and ablative lasers, can lead to scarring, eyelash loss, and severe functional complications of the organ of vision due to insufficient skin thickness.

AIM: To evaluate the effectiveness of treatment of melanocytic nevi of complex anatomical localization with copper vapor laser radiation.

MATERIALS AND METHODS: Treatment of melanocytic nevi in the periorbital region was carried out in 35 patients (28 women and 7 men), aged 14–65 years. The procedures were performed at an average output power of a copper vapor laser of 0.6–0.8 W, at 511 nm and 578 nm wavelengths, an exposure time of 0.2 s, and a light spot diameter on the skin of 1 mm. The laser treatment was performed without anesthesia. A total of up to four treatments were administered at monthly intervals. The criterion for choosing the energy of laser pulses (selective photohermal laser destruction) was chosen to change the color of the entire surface of the neoplasm to a dark gray color. The duration of skin healing after the procedure was two weeks.

RESULTS: The dual-wavelength copper vapor laser treatment of melanocytic nevi with complex anatomical localization completely removes skin neoplasms in all patients without scarring or recurrences within two years after treatment. According to the results of a computer simulation of selective heating of the pigmented layer, the copper vapor laser is an optimal treatment choice for melanocytic nevi.

CONCLUSION: Clinical data and computer simulation results demonstrate that the treatment of melanocytic nevi of complex anatomical localization using copper vapor laser radiation provides good results and is safer than near-infrared lasers. It makes it possible to use this method in the clinical practice of dermatologists and cosmetologists.

BACKGROUND: Atopic dermatitis is a chronic recurrent immunoinflammatory skin disease that develops against the background of a genotypic defect in the skin barrier function and innate and adaptive autoimmunity. Currently, there is no specific therapy for atopic dermatitis, so there remains a need to constantly search for effective pathogenetic approaches to its treatment. Today, the Janus kinase type 1 inhibitor abrocitinib is recommended for the treatment of moderate to severe atopic dermatitis.

AIM: To conduct a comparative assessment of the effectiveness of the combination of UVB 311 nm with abrocitinib and UVB 311 nm phototherapy against the background of standard therapy according to indications in the treatment of patients with moderate and severe atopic dermatitis.

MATERIALS AND METHODS: During the period from 2023 to 2024, the dermatological status and quality of life were assessed in 40 patients with moderate to severe atopic dermatitis who were prone to frequent relapses. The patients were treated at the clinic for skin and venereal diseases. Depending on the therapy, all patients were divided into two groups. The first group consisted of 20 patients receiving systemic, topical therapy in combination with UVB 311 nm phototherapy and additionally abrocitinib, at an induction dose of 200 mg followed by a dose of 100 mg. The second group included 20 patients who received systemic, local therapy in combination with UVB 311 nm phototherapy. Upon admission to the hospital and after two months of therapy, a comparative assessment of the DLQI index and an assessment of the prevalence and intensity of skin lesions in accordance with the SCORAD and IGA index were performed, an assessment of the level of IgE in the blood were performed

RESULTS: After the course of therapy, the SCORAD index in patients of the first and second groups decreased statistically significantly (p=0.001) by 2.4 times and 1.6 times, respectively. The DLQI index in patients of the first and second groups after the course of therapy significantly (p=0.001) decreased by 3.2 times, 2.1 times, respectively.

CONCLUSION: Our study revealed a more significant effectiveness of therapy with abrocitinib in combination with UVB 311 nm compared with UVB 311 nm monotherapy in patients with moderate and severe atopic dermatitis.

Psoriasis is an immune-mediated autoimmune inflammatory skin disease with a prevalence of 2 to 3% worldwide. In the psoriasis development and pathogenesis an important role is played by disorders in the immune system. Disruption of the innate and adaptive immune response mechanisms with the involvement of keratinocytes leads to the initiation and maintenance of inflammation.

Immune reactions are activated in the skin, in which various cells participate (macrophages, dendritic cells, mast cells, innate immune lymphoid cells, melanocytes, keratinocytes, Langerhans cells and γδT cells; T and B cells; epithelial endothelial and stromal cells of the skin), each of which expresses pattern recognition receptors that respond to pathogens and cell damage itself. Many of these receptors, in particular toll-like receptors and NOD-like receptors play an important role in the pathogenesis of psoriasis. The associated innate receptors signaling cascades that activate in the skin cells may become potential targets for the treatment of this disease.

To date, there are several approved drugs for biological therapy of psoriasis.

The study of the role of the innate immune cells receptors in inflammatory skin pathologies requires further exploration and new developments.

BACKGROUND: Most often, the natural form of vitamin A (retinol palmitate) is used to prevent skin aging. There are two topical preparations in the form of ointment on the Russian market that contain a high concentration of retinol palmitate, including in combination with cholecalciferol and tocopherol acetate. The specific effects of these drugs on the structure of aging skin have not yet been fully studied.

AIM: Comparative histological assessment of the effect of topical preparations in the form of ointment containing retinol palmitate on the epidermis and dermis of women aged 40–55 years.

MATERIALS AND METHODS: The clinical study included 18 women aged 40 to 55 years old. Group 1 included 6 women who used retinol palmitate ointment 2 times a day on the skin of the face. Group 2 consisted of 6 women who used the dermatoprotective agent 2 times a day on the skin of the face which, in addition to retinol palmitate, includes cholecalciferol and α-tocopherol acetate. Group 3 consisted of 6 women and was an intact comparison group. The observation period is 90 days. Patients underwent a punch biopsy with histological examination of the skin before and after the observation period.

RESULTS: According to the results of the study, it was revealed that ointments with a high concentration of retinol palmitate have a stimulating effect on the proliferation of keratinocytes of the epidermis, which manifested itself in an in increasing the number of rows of cells of the prickly layer. In addition, under the action of these drugs, the synthetic activity of keratinocytes of the granular layer increases, which contributes to the proper formation of the stratum corneum of the epidermis. The use of ointments leads to a significant increase in the thickness of both the granular and prickly layers of the epidermis and the dermis.

CONCLUSION: Ointments with a high concentration of retinol palmitate improve the structure of aging skin.

Vitiligo is an idiopathic disease of skin hypopigmentation that affects between 0.2% and 8% of the world's population. In half of the cases, this hypomelanosis manifests in young adolescence and childhood and can lead to profound psychological trauma and deterioration of the quality of life of both the child and his/her parents. Patients with vitiligo experience shame, anxiety and even depression, leading to low self-esteem and social isolation. Negative experience can affect not only childhood development, but also the further adult life of the patient, in this regard, the actual problem is the selection of effective and safe therapy in this cohort of patients. In the arsenal of doctors there are many therapeutic and surgical methods used in the treatment of this disease. However, not all therapies can be used in paediatric patients, which creates a challenge for paediatric dermatologists.

This review presents current, effective, and safe treatments for vitiligo in paediatric patients. Thus, external calcineurin inhibitors are first-line therapy, especially in children with stable vitiligo and limited lesions on the face, neck and body folds with thin skin. External glucocorticoid agents are recommended for moderate activity. Topical Janus kinase inhibitors provide the best results in the facial area. Demonstrated their effectiveness in achieving repigmentation in children with widespread and progressive vitiligo UVB-311 nm therapy, therapy with ultraviolet excimer light, PUVA-therapy (psoralen together with long-wave ultraviolet skin irradiation). Therapy with systemic corticosteroids can stop the progression of the disease and stimulate the repigmentation process. Surgical treatment (transplantation of melanocytes from healthy skin foci to depigmented foci) is rarely used in children. Cosmetic agents (camouflage) are used as symptomatic treatment, and psychological support is used as cognitive therapy.

Childhood vitiligo should be detected early to improve treatment outcomes and prognosis. Early detection of new exacerbations will allow rapid therapeutic intervention to prevent widespread spread of the disease.

The active interest of research in the topic of vitiligo is due to the increased possibility of treating this dermatosis of unknown etiology and its high psycho-emotional significance, concerning not only a certain individual, but also affecting society as a whole. The review examines the role of vitamins and micronutrients in the pathogenesis of vitiligo and possible comprehensive approaches to treatment taking into account these elements.

Aim: to evaluate the effect of vitamins and micronutrients on the course and development of vitiligo, and also to consider the advisability of their use in the treatment of patients with vitiligo.

A literary review of the PubMed, Cochrane Library, CyberLeninka, Clinicaltrial.gov and the Internet databases was conducted to study the role of specific microelements and vitamins involved in metabolic processes in the development of vitiligo disease.

Based on literature data, we can conclude that vitiligo by etiopathogenesis refers to multifactorial skin diseases, the final consequences of which is the cessation melanogenesis in certain areas of the skin. In all situations, one of the main factors is a metabolic disorder associated with the endoecology of the body. Vitamins and micronutrients play an important role in the pathogenetic chain of vitiligo. Thus, the introduction of individual micronutrients and vitamins into complex therapy of vitiligo seems extremely relevant and promising.

The article is dedicated to the 100th anniversary of the creation of the Novosibirsk Regional Clinical Dermatovenerologic Dispensary, a leading medical and preventive institution of the city, region and all of Siberia.

The article describes the history of the creation of the Novosibirsk veterinary dispensary, created on November 15, 1923, and reflects the main periods of its formation and development, some of the management difficulties encountered and their difficult solutions, and the article also gives an account of the fundamental contribution of each executive step by step in different periods of the history of the dispensary, how the modernization and optimization of treatment in dermatology was carried out, which allowed to solve many medical issues of that period. The modern structure and achievements of the dispensary are also presented, which helps to implement new approaches and technologies in dermatology and creates a strong bond with the scientific community, which is undoubtedly the engine of progress.

Despite all the changes the dispensary went through throughout the years, one thing remains unchanged ― the dispensary provides highly qualified specialized care to the population in the treatment of skin diseases and sexually transmitted diseases.

Against the background of any immunodeficiency, including that caused by HIV infection, the risk of developing superficial and invasive fungal diseases increases. Among people living with HIV, the most common fungal skin lesions are candidiasis, rubromycosis, and pityriasis versicolor. As immunosuppression worsens in HIV-positive patients not on antiretroviral therapy, the frequency and severity of mycoses increases. Thus, rubromycosis can spread beyond the feet, covering large areas of skin; sometimes the smooth skin of the hands, large folds, and areas of long hair growth are affected. In this case, the peripheral inflammatory ridge along the edge of the lesions, characteristic of rubromycosis, is sometimes absent.

According to some reports, over half of patients in the secondary disease stage of HIV infection suffer from onychomycosis. The progression of the disease often occurs in a short time. In addition to the nail plates of the feet, the nails on the hands are often affected. In patients with HIV infection who do not receive antiretroviral therapy, difficult-to-treat onychomycosis occurs.

Cryptococcosis is an opportunistic mycosis caused by yeast-like fungi Cryptococcus spp. It usually develops in HIV-positive individuals with a CD4+ T-lymphocyte level of less than 100 cells/μl. Skin lesions are usually secondary and indicate cryptococcal dissemination. Dermatological manifestations of cryptococcosis are varied. These may include papules and nodules surrounded by erythema and prone to ulceration, vesicular, pustular, herpetiform, acne-like rashes, ulcerative-necrotic lesions.

We present to your attention a photogallery of cases of fungal skin lesions that developed against the background of HIV-associated immunosuppression.