Vol 28, No 2 (2025)

BACKGROUND: Melanoma is one of the most aggressive skin tumors, the incidence of which is increasing. Dermatoscopic diversity and imitation of other skin tumors lead to erroneous diagnoses and the choice of incorrect tactics.

AIM: To identify clinical and dermatoscopic features depending on the thickness of atypical invasive melanoma that mimics other benign and malignant skin neoplasms.

MATERIALS AND METHODS: The study was carried out at the Clinical and Diagnostic Department at the University Clinic of Privolzhsky Research Medical University for the period from January 2018 to December 2022. A total of 3957 medical records of patients who applied to the center with skin neoplasms were analyzed, among them 270 cases of skin melanoma were identified, 57 of which had a clinical and pathomorphological discrepancy between the preliminary and final diagnosis (atypical), were further divided into subgroups by Breslow thickness ― thin <0.8 mm (n=37) and thick ≥0.8 mm (n=20), for comparative analysis 70 melanomas were taken as a control group (typical).

RESULTS: Atypical thin melanomas were more common in young patients aged 40 versus 57 years (p=0.000) and were characterized by a smaller average diameter ― 8 mm versus 10 mm (p=0.000). Clinically, cases of atypical thin melanoma differed in the following features: asymmetry 83.7% versus 100% (p=0.011), polychromy 70.1% versus 89.2% (p=0.043), smooth borders 27.1% versus 8.1% (p=0.032), cases of atypical thick melanoma differed in: asymmetry 71% versus 97.1% (p=0.004) and smooth borders 60% versus 14.7 (p=0.001). Dermoscopically, cases of atypical thin melanoma were characterized by the following features: polychromy 81.1% vs. 100% (p=0.005), atypical pigment network 67.6% vs. 94.6% (p=0.003), white streaks 16.3% vs. 40.5% (p=0.020), structureless area gray/gray-blue color 54.1% vs. 78.4% (p=0.027), punctate vessels 27.1% vs. 5.4% (p=0.012), glomerular vessels 13.5% vs. 0 (p=0.021); atypical thick melanoma cases differed in: atypical pigment network 25% vs. 79.4% (p=0.000), dots/globules at the periphery 15% vs. 41.2% (p=0.045), structureless area black/dark brown/brown 75% vs. 97.1% (p=0.013), structureless area gray/gray-blue 55% vs. 94.2% (p=0.001), structureless area red/pink 65% vs. 88.2% (p=0.041).

CONCLUSION: Statistically significant clinical and dermatoscopic features that are not characteristic of typical melanoma characterize atypical melanomas.

BACKGROUND: Endothelial dysfunction, a key factor in atherosclerotic vascular damage, increases cardiovascular risk in patients with psoriasis. However, studies on clinically measurable indicators of endothelial dysfunction and their changes during systemic therapy in psoriasis are limited and inconsistent.

AIM: Сomparative assessment of the clinical effect of the IL-17 inhibitor Netakimab and Methotrexate on the values of laboratory markers of endothelial dysfunction in patients with psoriasis in comparison with the dynamics of clinical efficacy indicators over 6 months of therapy.

MATERIALS AND METHODS: The study observed 66 PsA patients initially prescribed Methotrexate (Group 1: 30 patients) or Netakimab (Group 2: 36 patients). Group 1 received Methotrexate 15 mg weekly with Folic acid, while Group 2 received Netakimab 120 mg subcutaneously at weeks 0, 1, 2, then every 4 weeks. Clinical data were analyzed before, 3 months, and 6 months after treatment. Plasma levels of VEGF, endothelin-1 (En-1), and nitric oxide (NO) were measured before treatment and after 3 months.

RESULTS: In psoriasis patients, plasma levels of endothelial dysfunction markers were higher than in the control group: VEGF (19.8 [4.5; 49.4] pg/ml vs. 5.2 [0.5; 9.8] pg/ml, p=0.004), En-1 (286.4 [154; 439] pg/ml vs. 96.5 [32; 188] pg/ml, p=0.002), and NO (4.3 [2.1; 12.5] pg/ml vs. 2.2 [0.2; 5.0] pg/ml, p=0.02). By the third month of therapy, VEGF, En-1, and NO levels decreased, with more significant reductions in Group 2: VEGF decreased by 10.2 [8.4; 13.7] vs. 7.0 [5.6; 11.7] (p=0.043) and En-1 by 184.6 [167; 202] vs. 112.7 [97; 136] (p=0.008) in Group 1. Group 2 also showed a more pronounced decrease in PASI and NAPSI scores at 3 and 6 months.

CONCLUSION: The work demonstrated the ability of the IL-17 inhibitor netakimab to reduce initially elevated values of laboratory markers of endothelial dysfunction.

Papulonecrotic tuberculosis of the skin is a rare form of tuberculosis infection caused by Mycobacterium tuberculosis or Mycobacterium bovis, which manifests as inflammatory nodules with necrosis in the centre. This form of tuberculosis occurs in two clinical variants: superficial and deep, characterised by varying degrees of severity of skin changes and a tendency to form atrophic 'stamped' scars after the rashes have cleared.

Diagnosis of papulonecrotic tuberculosis of the skin is a complex task. The superficial form of tuberculosis of the skin should be differentiated from secondary syphilis, the deep form - from tertiary syphilis. Papulonecrotic tuberculosis of the skin should also be differentiated from the papulonecrotic form of dermal vasculitis. Diagnostic methods include radiological examination, skin biopsy followed by histological and immunohistochemical analysis, and specific tuberculin tests (T-SPOT.TB, Diaskintest et al.).

The present article describes a clinical case of a patient with chronic inflammatory skin lesions of the lower extremities who was initially diagnosed with vasculitis. However, further comprehensive investigation, including histological studies and consultation with a dermatopathologist, led to the final diagnosis of papulo-necrotic tuberculosis of the skin.

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, characterized by pronounced clinical heterogeneity and the development of a specific inflammatory reaction in the organs and tissues of the human body. Tuberculosis of the skin can be acquired as a result of direct contact, as well as lymphohematogenous or hematogenous genesis from another focus. Among all localizations of extrapulmonary tuberculosis, skin lesions occupy the fifth place, behind to tuberculosis of bones and joints, lymph nodes, genitourinary and digestive systems.

The increasing growth of tuberculosis among the population of the Russian Federation determines the relevance of timely correct diagnosis. The difficulties in diagnosing this disease are predetermined by the fact that atypical manifestations often occur, as well as the fact that clear histological and morphological signs of tuberculosis of the skin are not always noted.

The article presents epidemiological data on the incidence of tuberculosis of the skin and the classification used in practical medicine. Modern methods of diagnosing the disease are described.

The relevance of the clinical case presented in this article is due to the difficulties of diagnosis and low awareness of specialists. Thus, being under the supervision of a dermatovenerologist with a false diagnosis for 7 years, the patient achieved clinical remission after 8 months of specific therapy thanks to the joint work of a dermatovenereologist and a phthisiatrician.

BACKGROUND: Pemphigus is a group of life-threatening, chronic, progressive skin disease. To implement timely and adequate therapy aimed at preserving life and improving its quality, it is necessary to provide a diagnostic test confirming the diagnosis.

AIM: This study aimed to compare the expression levels of miR-338-3p and miR-424-5p in patients with pemphigus during therapy and remission, as well as in control groups of patients with other bullous skin diseases and healthy controls, and to evaluate the diagnostic value of miR-338-3p and miR-424-5p expression.

MATERIALS AND METHODS: Prospective comparative study was conducted. The study included 20 patients with active pemphigus, 15 patients in remission, 15 healthy control group participants, and 6 patients with other bullous diseases in the active stage. The expression of miRNA-338-3p and miR-424-5p was evaluated by qRT-PCR, cDNA was obtained using StemLoop technology. MicroRNA relative expression levels were analyzed based on its comparison with the expression of U6 gene using 2-ΔΔСT method.

RESULTS: The expression levels of miR-338-3p and miR-424-5p were significantly higher in patients with pemphigus active stage compared to all other groups (p <0.001). There was a statistically significant relationship between miR-338-3p expression level and disease severity according to the PDAI index (p <0.001), for miR-424-5p there was also a positive correlation with severity, but with a weaker relationship. ROC analysis showed high diagnostic accuracy of miR-338-3p (AUC 0.94) and miR-424-5p (AUC 0.93) for differentiating between patients with active pemphigus and healthy controls, with sensitivity and specificity of 95.0% and 75.0%, 95.0% and 73.3%, respectively. At week 3 from the start of glucocorticosteroid therapy, miR-338-3p levels were significantly decreased in patients in the active pemphigus (p=0.035), whereas no statistically significant decrease in miR-424-5p was observed.

CONCLUSION: miR-338-3p and miR-424-5p are significant in pemphigus as potential biomarkers for diagnosis and severity grade, and the expression level of miR-338-3p can be used to determine the efficacy of pathogenetic therapy.

The article presents the anniversary and memorable dates of venereology and dermatology in 2026.

Lesions of the oral mucosa in people living with Human immunodeficiency virus (HIV) are characterized by a wide variety and high frequency of occurrence. According to some data, they are registered in half of HIV-positive individuals and in 80% of patients in the later stages of HIV infection. Publications on this topic report on more than twenty different types of diseases of the oral mucosa, most often diagnosed in HIV-infected individuals. Candidiasis is the earliest and most common secondary disease of HIV infection. While the spectrum of pathology has significant regional differences, candidiasis is the most common nosology on all continents. Diseases of the oral mucosa can be indicators of infection with the human immunodeficiency virus, early clinical symptoms of HIV infection, and also indicate its progression. The severity of lesions of the oral mucosa correlates with the level of immunosuppression: the lower the number of CD4⁺ T-lymphocytes, the more extensive the pathological process and the higher the relapse rate. Timely detection of diseases such as oral candidiases, hairy leukoplakia, Kaposi's sarcoma helps to establish the stage and phase of HIV infection in patients in accordance with the Russian clinical classification, and their regression or decrease in clinical manifestations indicates the effectiveness of antiretroviral therapy.

The photo gallery presents various diseases of the oral mucosa in HIV-positive patients, including lesions often associated with HIV infection (hairy leukoplakia, Kaposi's sarcoma, non-Hodgkin's lymphoma, case series of various clinical variants of candidiasis). From the archive of author's. The photographs are published for the first time.