Vol 23, No 6 (2020)

In this article we summarized etiopathogenesis and clinical data, presented classification and described diagnosis challenges. One of the most common epithelial tumors, keratoacanthoma (KA) is characterized by rapid growth, histopathological features of squamous cell skin cancer and spontaneous regression tendency. Differential diagnosis of typical and atypical KA can be challenging since an early stage atypical KA may present similar to typical KA. Immunomorphological and immunohistochemical methods are particularly relevant for detecting atypical KA, making it possible to reliably differentiate it from squamous cell skin cancer. Years of experience in the management of KA patients, as well as foreign researchers’ data, suggest that the treatment approach should be based on the differentiation of clinical features of a typical KA from an atypical one.
This report describes a clinical case of a giant keratoacanthoma.

BACKGROUND: Despite the wide range of therapeutic options for moderate-to-severe psoriasis, dermatologists still experience some difficulties in its treatment. To date, methotrexate (MTX) is the most commonly prescribed systemic drug for the treatment of psoriasis worldwide. Given its low cost and good effectiveness, this drug has been continuously used along with recently developed highly effective biological drugs. According to international guidelines, MTX is a drug of choice for the treatment of moderate-to-severe psoriasis.

AIM: To evaluate the efficacy and safety of MTX in the treatment of moderate-to-severe psoriasis.

MATERIALS AND METHODS: We conducted a retrospective study on patients with psoriasis who had been admitted to the Dermatology Department of Sechenov University in 2018–2020. Based on electronic medical documents of the patients, we analyzed the demographic characteristics, disease duration, comorbidities, psoriasis severity before and after treatment with MTX, and its side effects.

RESULTS: The study included 655 patients with moderate (373; 57%) and severe (282; 43%) psoriasis. Of these patients, 279 (42.6%) were women aged 18–79 years, and 376 (57.4%) were men aged 18–86 years (median age: 44.9 and 41.6 years, respectively). The duration of stay in the hospital varied from 17 days to 21 days. In all cases, topical therapy was performed in addition to systemic drugs administration or phototherapy. The most commonly prescribed medication was MTX 326 (49.7%) in a dose of 25 mg/week. A total of 29 patients received MTX as monotherapy. However, the drug was most often prescribed in combination with phototherapy: MTX + PUVA (n = 140) and MTX + UVB-311 nm (n = 157). At the time of discharge from the hospital, 53% of patients in the MTX group had improved, 47% had a significant improvement. in the MTX group + PUVA – in 10.3; 75.7; 14% of patients, respectively; in the MTX + UVB-311 nm group – in 17.4; 71.2; 11.4% of patients, respectively. The side effects were mild and did not lead to treatment discontinuation.

CONCLUSION: MTX is a highly effective therapeutic option with a good safety profile and is a confirmed drug of choice for the treatment of moderate-to-severe psoriasis.

Acne vulgaris is a highly prevalent inflammatory skin disease involving sebaceous follicle. Although the pathogensis of acne remains uncertain, skin microbes are considered to plays an essential role in acne vulgaris. Cutibacterium acnes is the most important microbe in acne pathogenesis and its several processes: colonization, over-proliferation and inflammation have long been thought to contribute to the disease. Moreover, Staphylococcus epidermidis and Malassezia also synergistically collaborate with Cutibacterium acnes. Besides, given the growing number of patients who are treatment resistant, assessments are needed on phenotypic changes in the skin microbiome with retinoids and antibacterial therapy. Further research on the role of microbes in the pathogenesis of acne and the relationship between pathogenic microbes is expected to provide a new theoretical basis for clinical treatment of acne.

BACKGROUND: Mycoses of the feet is a significant interdisciplinary health problem.

AIM: To analyze and systematize the causes contributing to the high incidence of foot mycoses in Russia.

MATERIALS AND METHODS: With the use of an anonymous questionnaire survey, the attitude of patients toward their health and the opinions of dermatologists and related specialists about the causes contributing to the high incidence of foot mycoses in the Russian population were analyzed.

RESULTS: The reasons contributing to the high incidence of foot mycoses in Russia are ranked into four groups: (1) depend on the activities of the dermatological service; (2) are related to the level of professional training of doctors of related specialties; (3) objective organizational reasons for doctors of related specialties; (4) depend on the patient’s attitude to their health.

CONCLUSION: The data obtained can be used to develop a complex of therapeutic and prophylactic measures to improve medical care for this contingent of patients.

BACKGROUND: Alopecia areata (AA) is a non-scarring hair loss characterized by the immune intolerance of hair follicles, leading to the development of T-cell-mediated inflammation and subsequent hair loss. Different ages of onset, repeated relapses, and changes in the appearance of patients lead to psychoemotional distress and contribute to AA and socially significant skin diseases. Scientific data based on the effect of comorbid disorders in the course of alopecia (atopy, autoimmune diseases, and endocrinopathies) should be considered by dermatologists. This publication contains data of own research.

AIM: The study aimed to determine the concomitant pathology and its effect on the course of AA, especially on the content of vitamin D, to optimize further treatment.

MATERIALS AND METHODS: The research was based on the clinical materials of 132 patients with different severities of AA and concomitant nosologies. Several allergic (atopic dermatitis) and other autoimmune diseases (vitiligo and autoimmune thyroiditis) present similar pathogenetic mechanisms of development to AA. An ultrasound investigation was carried out, and a number of autoimmune and allergic nosologies accompanying the course of AA and the level of vitamin D in blood serum depending on the disease severity were revealed.

RESULTS: The analysis of results of ultrasound investigation of the inner organs was presented and revealed comorbid autoimmune and allergic nosologies affecting the course or associating with AA. The moderate (32.67 ± 0.91 nmol/l; р > 0.5) and severe clinical forms (32.9 ± 0.84 nmol/l) of AA vitamin D significantly decreased compared with the mild course of the disease (56.75 ± 0.62 nmol/l). Two clinical cases of patients with AA and concomitant diseases were presented.

CONCLUSION: The results revealed that the concomitant pathology of AA correlates with the literature source data and suggest their correction by doctors of narrow specialties. Vitamin D in the blood serum of patients was examined as a possible comorbid factor and predictor of disease activity. The role of trichoscopy as an investigation tool for the visualization and verification of the diagnosis and determination of the activity of AA was outlined.

therapy for their reliable removal. Standard methods of treatment often give unpredictable results, are accompanied by various complications, and require the use of expensive equipment.

AIM: To investigate the efficacy and safety of intralesional injection of a combination of 5-fluorouracil (5-FU) and betamethasone for the treatment of keloids and hypertrophic scars.

MATERIALS AND METHODS: The study involved 26 patients who were divided into two equal groups. Patients in group A received intralesional injections of betamethasone, and those in group B received 5-FU and betamethasone. Three injections were performed with an interval of 3 weeks. The scars were assessed at the beginning of the treatment, on the 3rd and 6th week during the treatment, and 4 and 16 weeks after the end of the treatment. The dynamics of scar condition was evaluated by the average decrease in the scar height and density, changes in subjective sensations, and the presence or absence of complications.

RESULTS: At 4 weeks after the end of the therapy, the total effectiveness of reducing the initial scar height was significantly higher in group B (10 patients; 76.9%) than in group A (6; 46.1%). In the comparison of long-term results at 16 weeks after treatment, 92.3% of the patients from group B and 53.8% of the patients from group A showed cessation of scar growth, flattening and softening, diminished itching and pain, smoothing of the scar contour, and a decrease in the color of the border between the scar and surrounding tissues.

CONCLUSIONS: The combination of betamethasone with 5-FU is safer and more effective than monotherapy with betamethasone or 5-FU in the treatment of keloid and hypertrophic scars, with a faster and more pronounced decrease in the height and density of the scar, erythema, and subjective sensations. This mode of therapy is characterized by a low relapse rate with prolonged follow-up. The article is of interest to practicing cosmetologists, dermatologists, and plastic surgeons.

In November 2020, an international contest for the best Professor Marc Larregue clinical photographs for dermatologists was organized by Uriage Laboratory France (https://collectionmarclarregue.fr). Dozens of doctors participated in this contest, and the jury consisted of leading experts. New clinical images submitted to the Professor Marc Larregue’s 2021 competition will be revealed soon. The detailed information and further instructions can be found on the official website https://collectionmarclarregue.fr. We will publish the winners’ photographs and the most interesting clinical cases with the permission of the contest’s organizers.