Vol 28, No 3 (2025)

Atypical fibroxanthomas are rare cutaneous neoplasms classified among fibrohistiocytic tumors. They most commonly develop in elderly individuals with a history of chronic sun damage and are typically located on the head, shoulders, and upper back. Atypical fibroxanthoma is frequently associated with other skin tumors and is characterized by locally destructive growth with extremely rare metastases (1%–2% of cases). However, in immunosuppressed patients, the tumor may demonstrate more aggressive behavior. The clinical presentation of atypical fibroxanthoma is nonspecific. It appears as a pink or reddish-pink nodule or papule. Atypical fibroxanthoma lacks specific dermatoscopic features; common findings include polymorphous vessels (linear, dotted, glomerular, arborizing) and chrysalis structures, which are not sufficient to reliably differentiate it from clinically similar lesions. Its resemblance to aggressive neoplasms such as amelanotic melanoma and Merkel cell carcinoma presents a diagnostic challenge. A definitive diagnosis relies on characteristic histopathologic and immunohistochemical findings. The gold standard of treatment is wide local excision. Mohs micrographic surgery may be considered. Other treatment modalities are not recommended because of the high recurrence rate.

We report a case of atypical fibroxanthoma in a 72-year-old male with photodamaged skin and a history of other skin tumors (basal cell carcinomas self-treated with liquid nitrogen cryotherapy). Histopathologic examination revealed an ulcerated, polymorphic, poorly differentiated tumor with marked anaplasia and areas of epithelioid and spindle-cell morphology. The differential diagnosis included melanoma, fibrosarcoma, and atypical fibroxanthoma. The patient underwent wide excision of the tumor, with the specimen submitted for histologic and immunohistochemical analysis. The postoperative period was uneventful with scar formation, and no recurrence was observed during follow-up.

Androgenetic alopecia is a genetically determined, multifactorial disorder characterized by the miniaturization of terminal hair into pathologically thinned vellus hair, eventually leading to hair loss. Minoxidil and 5α-reductase inhibitors are considered first-line treatments for androgenetic alopecia; however, some patients experience adverse effects or show inadequate response to these therapies, necessitating the development of novel, effective, and safe treatment options.

Exosomes are small membrane-bound vesicles involved in intercellular communication. They can carry proteins, lipids, RNA, and growth factors that may promote prolongation of the anagen phase (growth phase), enhance microcirculation, and stimulate hair follicle regeneration.

This article presents two clinical cases of patients with mild to moderate androgenetic alopecia treated with a solution containing exosomes derived from salmon tissue. Phototrichogram data demonstrated a marked therapeutic benefit in both cases, including increased hair density (via higher anagen hair count) and reduced vellus hair proportion (from 21/12% to 10/8% and from 32/10% to 3/10% before and after treatment, respectively).

BACKGROUND: Hidradenitis suppurativa is a relatively rare chronic dermatosis with a severe and treatment-resistant course that significantly impairs patients’ quality of life and poses a serious medical and social issue.

AIM: To evaluate the clinical and immunological efficacy of secukinumab in patients with hidradenitis suppurativa.

METHODS: The study included 12 patients (7 men and 5 women) aged 12 to 52 years with hidradenitis suppurativa. A control group comprised 20 conditionally healthy volunteers. The severity and dynamics of clinical symptoms during treatment were assessed using the Hidradenitis Suppurativa Severity Index. T helper cells (Th) were analyzed using CD3 and CD4 antibodies. Th cell differentiation was assessed with CD45RA and CD62L markers. Serum interleukin levels were measured via enzyme immunoassay. All 12 patients with hidradenitis suppurativa received secukinumab for 16 weeks.

RESULTS: Positive changes in the clinical course of hidradenitis suppurativa were observed within one week of initiating secukinumab gene-engineered therapy, with continued regression of efflorescences leading to significant clinical improvement by the end of the 16-week treatment course. Treatment resulted in normalization of peripheral blood levels of Th17 and Treg cells, as well as Th17/Treg and IL-17A/IL-10 ratios.

CONCLUSION: A pronounced Th17/Treg imbalance may serve as a marker of disease severity in hidradenitis suppurativa and a rationale for initiating biologic therapy with secukinumab.

BACKGROUND: Standard systemic inflammation markers such as high-sensitivity C-reactive protein, erythrocyte sedimentation rate, and leukocyte count correlate only moderately with psoriasis severity. Therefore, novel in vivo measures of inflammation are essential to understand the extent of systemic inflammation in psoriasis. Currently, limited data are available on the role of emerging composite systemic inflammation indices such as SIRI, MLR, NLR, SII, PLR, and AISI in psoriasis monitoring.

AIM: To evaluate the role of novel hematologic biomarkers of systemic inflammation in patients with various forms of psoriasis.

METHODS: All patients with psoriasis and psoriatic arthritis included in the study had systemic inflammation indices calculated. The extent and severity of psoriatic skin involvement were assessed using the standardized PASI score.

RESULTS: The study group included 77 patients with psoriasis: 33 women (42.9%) and 44 men (57.1%), with a mean age of 41.3 ± 13.4 years. The median PASI score was 10.8 (3.2; 15.3). Of these, 58 patients (75.3%) had only cutaneous manifestations, and 19 (24.7%) had psoriatic arthritis. The diagnostic significance of SIRI, MLR, NLR, SII, PLR, and AISI varied among patients. Psoriatic nail dystrophy was associated with elevated SII (p = 0.005), NLR (p = 0.053), and PLR (p = 0.037) indices in the psoriasis subgroup. Scalp involvement was significantly associated with higher MLR values (p = 0.049). In patients with cutaneous psoriasis only, the mean SIRI was twice the reference value. The mean AISI was 1.5 times the reference value in patients with both psoriasis and psoriatic arthritis. Notably, AISI was significantly higher in patients with severe psoriatic arthritis (PASI 20–30) than in those with severe psoriasis.

CONCLUSION: Composite hematologic indices of systemic inflammation are sensitive tools for assessing and predicting psoriasis severity. Elevated SIRI and AISI are prognostically relevant for early detection of psoriatic arthritis. Increased SII, NLR, and PLR are significantly associated with the development of nail dystrophy, while elevated MLR is linked to scalp involvement.

BACKGROUND: Acne is one of the most common skin disorders, affecting up to 96% of the population. However, there is a lack of up-to-date data on the incidence and clinical characteristics of acne across different age groups, particularly in young adults.

AIM: To assess the prevalence, clinical and epidemiological features of acne, and the morphofunctional characteristics of the skin in patients aged 18–25 years.

METHODS: A total of 655 individuals aged 18–25 years were examined for clinical signs of acne. In patients with severe acne, skin morphofunctional properties were assessed using the Multiskin Test Center MC 1000 system (Courage + Khazaka electronic GmbH, Germany). The skin microbiome was studied by bacteriological analysis on enriched culture media with subsequent quantification of colony-forming units (log CFU/mL).

RESULTS: Acne was identified in 60.5% of participants. Among patients, 36.6% were men and 63.4% were women. Mild acne predominated (52.7%), followed by moderate (33.3%) and severe (7.8%) forms. Mild and moderate acne were more common in women, while severe cases were more frequent in men. Mild acne occurred most frequently in women and men aged 19 years (28.4% and 29.3%) and 21 years (30.6% and 28.0%, respectively); moderate acne in those aged 18 (21.7% and 20.0%), 19 (36.8% and 34.0%), and 21 years (22.6% and 24.0%, respectively); and severe acne in patients aged 19 (54.5% and 30.0%) and 21 years (27.3% and 20.0%, respectively). Acne was associated with disrupted skin morphofunction, including dehydration, sebaceous hyperactivity, reduced elasticity, increased pore size, and pigmentation. Changes in the skin microbiome were observed, with an increased concentration of pathogenic microorganisms (Staphylococcus aureus, Klebsiella, Enterobacter, Bacillus spp., hemolytic Candida) and a decrease in opportunistic flora, promoting inflammation.

CONCLUSION: This study fills a gap in the current understanding of acne prevalence, clinical and epidemiological features, and skin morphofunction in young Russian patients. The findings enhance knowledge of acne pathogenesis, supporting the development of more effective treatments and prevention of complications.

BACKGROUND: Atopic dermatitis is a multifactorial, genetically determined inflammatory skin disease. Mutations in the filaggrin (FLG) gene, which encodes a key protein of the epidermal barrier, represent the most significant genetic risk factor for the development of atopic dermatitis. Filaggrin deficiency impairs skin barrier function, increases transepidermal water loss, and facilitates allergen penetration. Contemporary research focuses on strategies to restore filaggrin levels. Emollient plus formulations represent a promising pathogenetic approach for restoring epidermal barrier integrity.

AIM: To evaluate the efficacy of a filaggrinol-containing emollient plus in increasing filaggrin levels and improving clinical outcomes in patients with atopic dermatitis.

METHODS: Sixty patients with atopic dermatitis were enrolled and divided into a study group (n = 45), who used a filaggrinol-containing emollient plus, and a control group (n = 15), who received standard moisturizing therapy. The study assessed changes in clinical indices (vIGA-AD, EASI, POEM, ELMAN, DLQI, and SKINDEX) and filaggrin expression in the skin before and after treatment.

RESULTS: The study group demonstrated a statistically significant increase in filaggrin levels (p = 0.024) along with significant improvements across all clinical and quality-of-life indices (p < 0.05). Although positive trends were observed in the control group, several scales did not show statistically significant improvement. The absolute intergroup differences in post-treatment filaggrin levels were not statistically significant, yet the intragroup dynamics in the study group support the pathogenetic efficacy of filaggrinol-containing emollient plus in restoring filaggrin.

CONCLUSION: Filaggrinol-containing emollient plus increases filaggrin levels and significantly improves clinical symptoms and quality of life in patients with atopic dermatitis. These findings support its use as a pathogenetically justified, effective, safe, and well-tolerated agent for baseline therapy of atopic dermatitis.

BACKGROUND: Sleep disturbances frequently accompany chronic dermatologic conditions and negatively impact patients' quality of life and emotional well-being, often exacerbating disease severity. Statistically, women are more frequently affected, with sleep quality disruptions linked to hormonal fluctuations across various life stages.

AIM: To evaluate the effect of oral melatonin intake on acne severity and quality of life in women.

METHODS: This prospective single-center study was conducted from 2023 to 2024 and included 130 women (mean age, 23.32 ± 2.75 years) diagnosed with mild to moderate acne. Acne severity was assessed using the Global Acne Grading System (GAGS); sleep disturbances were evaluated via the Pittsburgh Sleep Quality Index (PSQI); and the Dermatology Life Quality Index (DLQI) was used for psychosocial assessment. Laboratory monitoring included hormone profiling (luteinizing hormone, follicle-stimulating hormone, 17-hydroxyprogesterone, dehydroepiandrosterone sulfate, free testosterone) and metabolic parameters (insulin-like growth factor 1, insulin, and blood glucose) with HOMA-IR calculation.

RESULTS: Signs of dyssomnia were identified in 65.38% of patients (n = 85), with severity significantly correlating with acne grade (ρ = 0.565; p < 0.001). Patients with sleep disturbances experienced significantly lower quality of life (p < 0.001), elevated free testosterone levels (p < 0.001), and increased IGF-1 (p = 0.008). Combination therapy, including topical agents and oral melatonin administered 30 minutes before bedtime, resulted in faster regression of acne lesions, and improved psychosocial and sleep quality scores.

CONCLUSION: Sleep disturbances are highly prevalent among women with mild to moderate acne. Timely identification and correction of dyssomnia improves treatment outcomes and enhances quality of life.

On December 17 we held our last meeting of Moscow Society of Dermatologists and Cosmetologists named after A.I. Pospelov in person.

The meeting was held in the conference hall of the V.A. Rakhmanov Clinic of Skin and Venereal Diseases (Sechenov University) and took place in a face-to-face format. There were 110 participants and 2 memberships were approved.

Two reports were presented in the clinical part of the meeting. The report on ANCA vasculitis (antineutrophil cytoplasmic antibodies) highlighted not only the etiopathogenesis of the disease, but also diagnostic difficulties due to polymorphism of skin manifestations. Thus, in the presented clinical case 6 years passed from the debut of ANCA vasculitis to the final diagnosis, and 11 doctors of different specialities participated in the treatment of the patient.

Two theories of pathogenesis of mammary form of Paget's cancer were reported in another report of the clinical part of the session, which also presented a case of the disease that ended with surgery.

The first report of the scientific part of the meeting on antibacterial properties of low-temperature argon plasma, in addition to the historical excursion, interested the audience in the modern fields of application (purulent surgery, traumatology, military field surgery, plastic and maxillofacial surgery, dermatology and cosmetology, etc.), as well as the results of their own research on the effectiveness of argon plasma in the treatment of acne and gangrenous pyoderma.

The report on the prospects of anticytokine therapy for toxic epidermal necrolysis included clinical examples of successful treatment of the disease, while the report on dermatoses and skin tumours of the breast and nipple-areolar complex focused on pathological conditions that somehow lead to malignant neoplasms (hyperkeratosis of the nipple and areola, added nipple, scleroatrophic lichen, nipple eczema, etc.).

Lichen planus is a chronic inflammatory disorder affecting the skin and mucous membranes (less commonly the nails and hair), characterized by the presence of lichenified papules. When localized on the scalp, it manifests as a follicular variant known as lichen planopilaris, often resulting in scarring alopecia.

There are four recognized clinical variants of follicular lichen planus: classic lichen planopilaris; frontal fibrosing alopecia; Graham–Little–Piccardi–Lasseur syndrome; and fibrosing alopecia in a pattern distribution, which combines features of lichen planopilaris and androgenetic alopecia.

Despite their different presentations, all lichen planopilaris variants are characterized by one or more areas of scarring alopecia and scalp erythema. Pruritus is a common symptom and may vary in severity; trichodynia (scalp tenderness) is also frequently reported. Some patients may exhibit typical lesions of lichen planus on other skin areas or oral mucosa. In the active stage, dermoscopy of alopecic patches typically reveals perifollicular hyperkeratosis with tubular hair casts, diffuse or perifollicular erythema, and light pink-to-red fibrotic zones. The hair-pull test is positive in inflamed areas, yielding anagen hairs with intact inner root sheaths. During remission, alopecic scars may remain with a few preserved hairs and tufts (tufted hairs). Dermoscopy may show follicular ostia loss (“white dots”) and absence of inflammation.

Diagnosis is based on clinical examination and trichoscopic findings, supplemented by histopathology from an active lesion if needed. Histologically, perifollicular lymphocytic infiltrates with sebaceous gland destruction are typical. Recommended evaluations include routine laboratory tests and thyroid function screening; many authors also advocate testing for viral hepatitis.

Photographic documentation before and during treatment is advised to monitor clinical progression, alongside trichoscopy for assessment of inflammatory activity.

This photo gallery presents various clinical manifestations of follicular lichen planus of the scalp.