Vol 24, No 5 (2021)

BACKGROUND: Cutaneous lymphoid hyperplasia is a reactive dermatosis characterized by the development of lymphocytic infiltration due to prolonged exposure to provoking factors with a tendency to spontaneous regression after elimination of antigenic stimulation without the development of systemic manifestations, sometimes having a difficult-to-distinguish similarity with B-cell lymphoma of the skin. Currently available diagnostic methods do not always allow to obtain an accurate result, and the arsenal of therapeutic agents does not sufficiently meet the criteria of effectiveness and safety.

AIMS: Diagnosis and therapy of benign lymphoplasia of the skin.

MATERIALS AND METHODS: The study included 57 patients who were observed at the V.A. Rakhmanov Clinic of Skin and Venereal Diseases of Sechenov University for skin lesions clinically similar to cutaneous lymphoid hyperplasia. Based on the results of histological, immunohistochemical and molecular genetic studies, the main study group was formed, which included patients with cutaneous lymphoid hyperplasia (n=35). After verification of the diagnosis, the expression of IgG4 in the lesions was studied, and the efficacy and safety of photodynamic therapy was evaluated both in the form of monotherapy by the method red light irradiation with a wavelength of 660±2 nm using the photosensitizer chlorin E6 once a week, and in combination with intraocular (0.5 ml/cm²) or intramuscular (2 ml each) injections of betamethasone suspension (Diprospan), carried out 1 time a week until complete cleansing of the skin.

RESULTS: Among 35 patients with cutaneous lymphoid hyperplasia, there were 14 men and 21 women aged 18 to 78 years (the average age was 42.7±2.8 years). IgG4+ was detected in 5 (17%) of 30 patients with cutaneous lymphoid hyperplasia (tattoo n=3, idiopathic n=2), as well as in 7 (78%) of 9 patients with confirmed B-lymphoma of the skin. Photodynamic therapy monotherapy (n=20) made it possible to achieve clinical remission in an average of 3–6 irradiation sessions, the combination of photodynamic therapy and betamethasone suspension in 15 patients with widespread and resistant to photodynamic therapy monotherapy rashes led to the clinical remission in 100% of patients after 7 photodynamic therapy sessions and 4 diprospan injections. Minor side effects did not require discontinuation of treatment.

CONCLUSIONS: Thus, the diagnosis of cutaneous lymphoid hyperplasia is made only on the basis of a comprehensive examination (clinical and anamnestic assessment, histological, immunohistochemical, molecular genetic studies), however, there remains a certain percentage of patients in whom the verification of cutaneous lymphoid hyperplasia is difficult and requires improved diagnostics. IgG4 can be regarded as an additional diagnostic marker in the differentiation of cutaneous lymphoid hyperplasia and B-cell lymphoma of the skin: the tendency to increase the level of IgG4 may indirectly indicate the malignancy of the lymphoproliferative process. photodynamic therapy has demonstrated high efficacy and safety in patients with cutaneous lymphoid hyperplasia, allowing to achieve completely clean skin both with monotherapy and in combination with diprospan for resistant and/or widespread rashes.

Atopic dermatitis is a common chronic inflammatory skin disease that may be accompanied by food allergy, allergic rhinitis or asthma. The pathogenesis of atopic dermatitis is complex and based on interaction between an impaired epidermal barrier, immune dysregulation of both innate and adaptive immunity and the skin microbiome.

The skin microbiome plays an essential role in the development and, consequently, normal functioning of the skin immune system. The term “microbiome” is used to describe the collection of microorganisms and its genomic elements in a particular ecological niche. These microbial communities comprise a variety of microorganisms, including eukaryotes, archaea, bacteria, viruses and skin mites. The bacterial community of the skin is conditionally divided into two groups. Resident bacteria belong to a group of microorganisms that live relatively permanently on the surface of the skin. They are often referred to as commensal bacteria, which are necessary for the normal development and maintenance of the body’s immune defenses. In turn, transient microorganisms that temporarily inhabit the surface of the skin enter it from the environment and persist from several hours to several days. Under normal conditions, with proper hygiene and normal integrity of the skin barrier, resident and transient microbes are not pathogenic. Thus, cutaneous dysbiosis can lead to immune system overactivity as well as inflammatory skin conditions. It has been shown that the relationships between microbes within the skin surface play an important role in the development of atopic dermatitis.

Moreover, exacerbations of the atopic dermatitis are associated not only with the loss of microbial diversity but also with the predominance of Staphylococcus aureus.

Further skin microbiome studies and thus understanding of its role in atopic dermatitis could provide an effective therapeutic approach to restore well-balanced skin microbiome.

This clinical case is of interest due to the rare occurrence of Melkersson–Rosenthal syndrome in the population, as well as the difficulty in diagnosing and achieving remission of this disease.

Melkersson–Rosenthal syndrome is a rare chronic relapsing dermatosis in the population, in typical cases characterized by a triad of symptoms: macrocheilitis, neuropathy of the facial nerve and folding of the tongue. However, much more often the disease manifests monosymptomically. The etiology of the syndrome has not been definitively studied: the infectious and allergic component, inflammatory processes of the facial nerve, genetic predisposition, as well as contact with metals (cobalt and gold) are considered as the determining causes. The diagnosis is based on clinical data and the results of a pathomorphological study. With a monosymptomatic (only the presence of macroheilitis) course of Melkersson–Rosenthal syndrome, a differential diagnosis is carried out with angioedema Quincke, lymphangioma, hemangioma, lip abscess and other cheilitis.

The clinical picture of dermatosis is localized on the face and is a significant problem, significantly affecting the social status of patients and is highly threatened in relation to the development of dysmorphophobia.

The presented clinical case is rare in the practice of a dermatologist, patients with a similar pathology turn to dentists, allergists, where the clinical picture is regarded as Quincke’s edema. Given the rare occurrence of Melkersson–Rosenthal syndrome in the population and the difficulty of diagnosing the disease, the presented clinical case is indicative, since in our case the patient has only 2 main symptoms (folded tongue, macrocheilitis) and there is no clinical picture of facial neuritis.

Timely diagnosis and a thorough examination of patients with Melkersson–Rosenthal syndrome contribute to the greatest effectiveness of therapy and the achievement of a stable remission of the disease.

Information about the epidemiology, clinical features, prevention and treatment of a new coronavirus infection caused by the SARS-CoV-2 virus is continuously updated and updated. The most common clinical manifestations of COVID-19 are hyperthermia, symptoms of intoxication, cough, shortness of breath, decreased sense of smell and taste, less often abdominal pain, vomiting, diarrhea and other extrapulmonary manifestations. The main target of SARS-CoV-2 is type II alveolar cells, which defines lung damage as the main clinical manifestation of COVID-19. Damage to the neurons of the brain and glia leads to neurological symptoms (fever with headaches, loss of sense of smell, taste, ataxia and seizures). Immunological complications leading to cytokine storm syndrome and acute respiratory distress syndrome play a special role in the pathogenesis of COVID-19 coronavirus infection.

Recently, clinical observations have been increasingly appearing describing dermatological skin lesions as a variant of the manifestation of COVID-19 coronavirus infection, including at the onset of the disease, i.e. before the appearance of any signs of the disease. The specificity of skin symptoms in COVID-19 has not yet been proven, and some authors use the term “unexplained skin manifestations of COVID-19”.

The article presents a description of clinical cases of acute idiopathic urticaria at the onset of COVID-19, that does not respond to treatment with antihistamines. On the skin of the chest, abdomen, back, buttocks, arms and legs of patients, multiple, edematous, merging, bright pink, various sizes of urticaria were observed, appearing simultaneously with weakness, partial loss of taste, smell, muscle pain, temperature rise to 38–39ºС. Taking a single dose of the glucocorticoid combined drug betamethasone improved the patient’s condition within a day; in a man on the 7th day and in a woman on the 3rd day of antiviral therapy with favipiravir, all rashes disappeared. In the general blood test after 2 weeks of treatment, a slight negative dynamics was noted: in a man ― absolute leukopenia (3.6×10⁹/l), relative lymphocytosis (51%), an increase in ESR up to 28 mm/h, in a woman ― absolute leukopenia (3.4×10⁹/l), relative lymphocytosis (57%). The patients were discharged after a month of treatment with antiviral drugs in satisfactory condition with two negative PCR results for COVID-19.

The data obtained suggest that acute urticaria that cannot be treated with antihistamines in COVID-19 can be considered one of the variants of the course of a new coronavirus infection (SARS-CoV-2), and require further in-depth study.

Nest alopecia (circular baldness) ― acquired non-pubescent alopecia, which begins, as a rule, with rounded foci on the scalp. During nest alopecia, there are three stages ― active (progressive, or progressive), stationary and regressive. The study of the causes and mechanisms of the pathogenesis of nest alopecia indicates a pronounced role of neurotrophic disorders, autoimmune and genetic factors, endocrine diseases and injuries.

The course of alopecia areata is often chronic, recurrent (more than one episode was found in 85% of patients), however, spontaneous remission without treatment is possible in 50% of patients. In cases where the manifestations of alopecia areata start before puberty, the risk of developing a total form of the disease is high (up to 50%). The probability of a complete cure in severe forms of alopecia is less than 10% of cases.

The development of alopecia areata is often accompanied by damage to the nail plates, however, the incidence of onychodystrophies varies significantly (6–77%). More than ten types of changes in the nail plates have been described. According to our observations, onychodystrophies were seen in all 6 patients with alopecia areata, with thimble-type deformities in children and longitudinal lines in adults. The lack of evidence in the literature on the frequency and specificity of damage to the nail plates requires additional research.

Comorbid conditions in patients (systemic lupus erythematosus, psoriasis, vitiligo, atopic dermatitis, etc.) can be trigger factors in the development of nest alopecia and complicate the diagnosis and treatment of the underlying disease and concomitant dermatoses. This determines the need for a clear distinction between therapeutic and diagnostic approaches, based on their reliable significance, which will eliminate outdated or unreasonable therapeutic procedures.

The article presents two clinical observations: a combination of alopecia areata with anemia, chronic gastrointestinal diseases and celiac disease in a one-year-old child and with anemia, thyroiditis, and gastrointestinal diseases in an adult patient with post-COVID syndrome.

BACKGROUND: Scars of various sizes and localization are formed in more than 100 million patients annually. Atrophic scarring defects of the skin are verified in more than 80% of patients with acne and in 30% of patients with other injuries. Different skin remodeling technologies have different effectiveness, which actualizes the search for optimal methods of scar correction. The most promising of them are combinations of high-intensity laser radiation.

AIMS: Determination of therapeutic effects of high-intensity laser therapy in patients with atrophic skin scars.

MATERIALS AND METHODS: A prospective interventional cohort comparative study of the therapeutic effects of high-intensity laser therapy in patients with atrophic skin scars was conducted. In patients with emerging scars, a combination of homogeneous photothermolysis by long-pulse Nd:YAG laser radiation (l=1.064 microns) followed by fractional ablative photothermolysis of CO₂ laser (l=10.6 microns) was used, and in patients with mature scars, a combination of homogeneous photothermolysis of long-pulse Nd:YAG laser (l=1.064 microns) and planar laser photodestruction of CO₂ laser (l=10.6 microns).

115 patients with the diagnosis of "atrophic scars" (ICD-X, Class XII "Diseases of the skin and subcutaneous tissue", L90.5) were examined, among which groups with emerging (49 patients) and mature (66 patients) scars were identified. Empirical research methods ― clinical, instrumental, and medico-sociological ― have been applied. The analysis of the obtained data was carried out using the methods of descriptive, parametric and multifactorial statistics with the determination of the specific weight of the studied features.

RESULTS: The improvement of the clinical status, pronounced remodeling of the skin in the area of atrophic scars, under the influence of various combinations of high-intensity laser therapy was revealed. An increase in the quality of life indicators according to the Skindex-29 and Dermatology Life Quality Index (DLQI) scales was determined, more pronounced in the groups of patients with atrophic scars in comparison with the group of patients with mature scar deformities. Combinations of high-intensity laser therapy have a favorable safety profile, are characterized by a high degree of compliance and satisfaction with the results of treatment. The effectiveness of variant high-intensity laser therapy in patients with atrophic scars is 86–90%.

CONCLUSIONS: Combinations of high-intensity laser therapy in patients with developing atrophic scars cause dermoplastic and fibromodeling therapeutic effects, in patients with mature ones ― reepithelizing, fibrocorrecting therapeutic effects.

On March 16, 2021, the 1142nd meeting of the Moscow Society of Dermatovenereologists and Cosmetologists named after A.I. Pospelov took place.

Two people have been accepted as members of the MODV: the list of new members was approved unanimously.

The agenda includes a discussion of two clinical cases. The interest in the first demonstration ― mushroom mycosis lies in the relative rarity of T-cell lymphomas in the skin clinic, as well as the effectiveness of PUVA therapy in the plaque stage of the disease. Another observation is a case of acquired epidermolysis bullosa, a rare sporadic autoimmune disease with increased skin injury, the formation of subepidermal blisters, the presence of antibodies against type 7 collagen, the prognosis for which is usually favorable and even with a possible spontaneous recovery.

A number of scientific reports were made at the meeting. The first of them is on the problems of vulgar acne. The patient-oriented approach for vulgar acne implies individual, personalized treatment of the patient. Among the strategic directions in the development of therapeutic approaches to patients with vulgar acne, special attention, in addition to external remedies, systemic therapy, physiotherapy and cosmetic care, should be paid to the adherence of patients to treatment. Among the various technologies for determining the severity of vulgar acne, an interactive electronic DIA calculator developed at the Department of Skin Diseases of Sechenov University, combined with medicinal recommendations in accordance with a certain severity of the disease of a particular patient, deserves attention.

The report on modern and classical methods of diagnosis of human and animal mycoses represents the most pressing issues of medical mycology in general and dermatomycology in particular due to their extreme prevalence. To date, all laboratory methods for the diagnosis of mycoses can be divided into classical and modern high-tech, while in most laboratories on the ground, almost only confocal microscopy has been introduced.

The last report was devoted to dermatoses that developed at the site of tattoos and tattooing. Since the composition of the coloring pigment includes iron oxide, titanium dioxide, isopropyl alcohol, natural organic and inorganic pigments, dermatoses such as benign lymphoplasia (lymphocytoma), sarcoidosis, psoriasis, discoid lupus, vitiligo, vasculitis, lichen planus, annular granuloma, lipoid necrobiosis, melanoma may develop in places of skin damage, basal cell carcinoma, gangrenous pyoderma, mycosis, syphilis, tuberculosis. It is noted that the treatment of lymphocytoma and sarcoidosis is a difficult task.

Superficial fungal infections of the skin are common on all continents. Errors in the diagnosis and treatment of these patients are often observed. The lack of symmetry of the process, erythematous-squamous foci with a raised roller and more pronounced peeling along the periphery, polycyclic and annular outlines, as well as the presence of papules and pustules in the lesion can give a hint in making a correct diagnosis. Laboratory tests (microscopy and seeding) are mandatory for accurate diagnosis.

This article presents photos with anamnesis of the disease and treatment options for common superficial fungal infections of the skin.