Vol 25, No 1 (2022)

BACKGROUND: In recent years, thanks to the development of methods of molecular genetic analysis, microRNA has become one of the promising markers for the diagnosis of many human diseases.

AIMS: to study microRNA as a new method for the diagnosis of fungal mycosis.

MATERIALS AND METHODS: The study included 30 patients with histologically confirmed diagnosis of T-cell lymphomas of the skin, 25 were diagnosed with fungal mycosis, 5 ― Cesari syndrome. The control group consisted of 10 patients with benign lymphoproliferative dermatoses. The patients underwent the determination of microRNA 223, 16, 326, 663, 423, 711 in blood plasma. MicroRNA was also detected in plasma in patients with T-cell lymphomas of the skin at early and late stages.

RESULTS: Statistically significant difference of 223, 16, 326, 711 microRNAs in blood plasma was revealed in patients with fungal mycosis, compared with patients with benign lymphoproliferative dermatoses. Statistically significant difference of 663 microRNA in blood plasma was revealed in patients with T-cell lymphomas of the skin at early and late stages. A statistically significant difference of 223, 711 microRNAs in blood plasma was revealed in patients with fungal mycosis at an early stage compared with patients with benign lymphoproliferative dermatoses.

CONCLUSION: The determination of microRNA 223, 16, 326, 711 in blood plasma can be used for early diagnosis of T-cell lymphomas of the skin.

BACKGROUND: Vitiligo is an urgent problem both for patients and for the scientific community of dermatologists. There are many studies aimed at finding new methods of therapy for this disease, but there are no effective schemes for repigmentation of foci and stabilization of the process in modern dermatology. In this regard, the search for means that have a pathogenetic effect is relevant.

AIMS: Clinical and laboratory evaluation of the effectiveness of methotrexate in vitiligo.

MATERIALS AND METHODS: Preliminary results of a study of the effectiveness of methotrexate in the treatment of vitiligo are presented. Clinical effects were assessed using the VES index (Vitiligo extent score). The dynamics of immunological parameters and the influence of vitiligo on the quality of life were also determined.

The study included 77 patients suffering from non-segmental vitiligo. All the subjects were divided into 2 groups. Patients of group 1 (39 patients) received methotrexate in combination with phototherapy, patients of group 2 (38 patients) underwent a course of UVB-311nm. The area of depigmentation was determined, and after treatment – repigmentation, relative to the surface area of the body. The dynamics of the immune status against the background of therapy was analyzed. The correlation of the prevalence of the process with the quality of life was evaluated. The duration of the study was 4 months.

RESULTS: There were no statistically significant differences in clinical and laboratory parameters among the groups before treatment. Patients included in group 1 and receiving combination therapy with methotrexate and medium-wave narrow-band therapy with UVB-311nm demonstrated more active repigmentation of vitiligo foci than the studied 2 groups. Also, patients of this group demonstrated the most active positive dynamics of the dermatological quality of life index, correlating with the prevalence of the process. Analysis of the dynamics of immune status indicators allowed us to conclude that the best tendency to normalize cytokine levels among group 1 patients.

CONCLUSIONS: Our study demonstrated the clinical and pathogenetic efficacy of methotrexate. Small doses of the drug are well tolerated, which allows a long-term effect on pathogenetic mechanisms, stabilizing the skin process.

Lichen planus is a chronically occurring dermatosis of a multifactorial nature, which is characterized by the appearance of flat polygonal itchy papules on the skin and mucous membranes. Dermatosis is often associated with diabetes mellitus and diseases of the gastrointestinal tract, extremely rarely with oncological diseases. Antimalarial drugs with photoprotective, anti-inflammatory, weak immunosuppressive effect are recommended for treatment.

Actinic and hypertrophic forms of lichen planus are atypical forms of the disease. Actinic or tropical lichen planus is rare in the Russian Federation, mainly in the countries of the Middle and Near East, Central Asia, Africa. The actinic form of lichen planus is characterized by localization in open areas of the skin (face, neck). The hypertrophic form of lichen planus is characterized by large papules with a bumpy surface that do not look like a typical form. The rare occurrence of dermatosis and unusual localization leads to difficulty in making a diagnosis.

The article presents a clinical case of a combination of actinic, hypertrophic and typical forms of lichen planus in a patient born in the Caucasus, but having lived in Russia for a long time. The skin process in the patient was widespread, was localized throughout the skin, including the face, neck, mucous membranes of the oral cavity; only the skin of the palms and soles remained free from rashes. The rash was represented by flat polygonal papules, bluish-pink in color, the size of a lentil, and a whitish Wickham mesh on the surface.

Localization in open areas of the skin, combination with hypertrophic papules, outdoor work, severe itching with excoriations led to an incorrect diagnosis, and the ongoing therapy had no effect. To clarify the diagnosis, a histological examination was carried out, which revealed pronounced hyperkeratosis, uneven granulosis, massive papillomatosis, in the papillary and sub-papillary layers of the dermis (stripe-shaped moderate infiltrate of lymphoid elements, histiocytes, minor edema, vasodilation). Adequately selected drug therapy (dexamethasone intramuscularly; chloropyramine intramuscularly; antimalarial agent; nicotinic acid; external ointment dermatol), as well as acupuncture sessions with the second inhibitory method of therapy, led to an improvement in the patient’s condition.

Upon completion of treatment, the patient is recommended photoprotective external agents on exposed skin and a repeated course of acupuncture.

BACKGROUND: Pyoderma gangrenosum is a rare inflammatory skin disease that currently belongs to the group of neutrophilic dermatoses.

AIMS: Development of epidemiological, clinical, laboratory characteristics of patients with pyoderma gangrenosum, as well as the treatment of this disease.

MATERIALS AND METHODS: The study revealed 30 patients, 16 (53%) were women, the average age at the time of diagnosis was 59±16.3 years. The most common localization of rashes was the lower leg 20 patients (67%), lesions of the skin of the face, genitals, and breast rarely noted, in one case, respectively. In 14 patients (47%), two or more ulcers were detected at the same time (max. 9 ulcers). The pathergy phenomenon was positive in 23 patients (77%) of 30. Ulcerative pyoderma gangrenosum occurred in 25 (83%), and extracutaneous pyoderma gangrenosum with lung involvement was identified in one patient. The most common associated disease was rheumatoid arthritis in 6 patients (20%), there were also rare associated diseases, such as hepatitis C two cases, multiple endocrine neoplasia syndrome type 1, autoimmune hepatitis, non-Hodgkin’s lymphoma by one observation. Histological examination revealed neutrophilic infiltration of the dermis in 30 patients (100%), and the presence of leukocytoclastic vasculitis in 16 (53%). Complete scarring during the treatment was observed in 22 patients (73%). Relapses during the observation period were observed in 12 patients (40%), the number of deaths was two cases.

CONCLUSIONS: One of the largest case series of pyoderma gangrenosum to date is presented. During the examination of patients, it was found that neutrophilic infiltration of the dermis is a characteristic sign of the disease. Rare comorbidities (multiple endocrine neoplasia syndrome type 1, autoimmune hepatitis, hepatitis C, non-Hodgkin’s lymphoma) have been found. A sufficiently large percentage of relapses indicates the need for further research to develop an additional examination method for the purpose of modern diagnostics and justification for the timely prescription of targeted therapy.

On February 15, 2022, the 1146th meeting of the Moscow Society of Dermatovenereologists and Cosmetologists named after A.I. Pospelov took place.

The meeting was held in a “remote” format. There were 120 participants in total. Accepted as a member of MSDC 1 person.

Three clinical clinical observations are presented. The first of them is a case of giant-cell variant of annular granuloma with extensive skin lesions. Annular granuloma is a benign dermatosis of unclear etiology, prone to spontaneous resolution; it occurs as a reaction to ultraviolet radiation against the background of lymphoproliferative or autoimmune diseases, sarcoidosis, chronic lung diseases, prostate cancer. In the presented case, the clinical diagnosis was confirmed by histological examination.

The second presentation was devoted to livedoid vasculopathy with a tendency to thrombotic complications. This is a relatively rare disease that is excluded from the group of vasculitis due to one distinctive feature ― a pronounced tendency to thrombosis in the absence of indications of the primary nature of inflammation. In therapy, in addition to medications, the appointment of vitamins is mandatory.

The third observation concerned Merkel’s carcinoma, one of the relatively rare but extremely aggressive most malignant forms of skin cancer. With epithelial and neuroendocrine differentiation, which is superior to melanoma in terms of aggressiveness of the course and tendency to metastasis. Due to the rare occurrence of the tumor, diagnostic errors are frequent. Diagnosis requires histological and immunohistochemical examination. Any “inflamed atheroma” or synovial cyst that recurs after surgical treatment should be alarming.

Scientific reports were heard on the biological therapy of psoriasis, a chronic systemic immunoassociated disease of a multifactorial nature with a hereditary predisposition characterized by the formation of inflammatory papules and plaques, often with joint damage (arthropathy), accelerated proliferation of epidermocytes and a violation of their differentiation, an imbalance between pro-inflammatory and anti-inflammatory cytokines and chemokines. And the second scientific report contained information about modern approaches to the treatment of acantholytic pemphigus.

Anogenital warts are caused by the human papillomavirus (most commonly types 6 and 11, giant condylomas ― types 16 and 18) and are exophytic and endophytic growths on the skin and mucous membranes of the genital and perianal areas. There is no generally accepted classification, but based on clinical manifestations, there are: acute condylomas, papular, patchy, hyperkeratotic, and giant condyloma acuminatum (Buschke–Lowenstein tumor). Anogenital warts can be the result of infection through sexual contact, which is indicated by the synonym “venereal warts”. Anogenital warts is a separate nosology (International Classification of Diseases of the Tenth Revision: A63.0), but can also be part of the symptom complex of immunodeficiency conditions (in particular acquired immunodeficiency syndrome) and neoplasias (squamous cell carcinoma and erythroplasia of Queyrat).

We offer the publication of a photogallery on this problem.