Vol 19, No 1 (2016)

The dysplastic nevus is a special type of melanocytic nevi, which is a clinical and morphological marker of increased risk for the development of cutaneous melanoma. Therefore, correct diagnosis and preventive oncological screening of patients in selected risk groups are necessary. Epidemiology and current classification of dysplastic nevi, as well as the problem of clinical and morphological correlation of findings in the differential diagnosis of dysplastic nevi are discussed. Related personal research data are presented.

Along with mucous membranes the skin as the main barrier to the outside world creates a system of protection against any influences of the world. It is not only the place of realization of immunological processes, but it also actively participates in them due to the existence of its own elements of the immune system which are able to actively participate in the development of inflammatory reactions and neoplastic processes. Skin cells interact with cells of the immune system by setting a direct contact or by secreting a number of soluble factors, called cytokines, and other protein components such as proteins of the complement system. The general concept of skin-associated lymphoid tissue and skin’s immune system with immunocompetent cells in the epidermis and dermis, for cooperation of which in various stages of the immune response requires identity concerning anti-genes of HLA system, is presented in the review. Thus, specific immunological reaction with antibody formation promote the release of antigen from the body of both exogenous and endogenous origin. However, at violation of any element of immunological protection there is a delay of antigen elimination process, that results in own tissue structural damage. Interaction with foreign antigens (physical, chemical, infectious, etc.), denaturation of its own proteins or disclosure of tissue structures (antigens), that did not contact with immunocompetent cells, promote the formation of autoantigens and the production of autoantibodies against them. Thus, skin is a highly organized structure with a network of immunocompetent cells and soluble mediators. Introduction of molecular and biological methods as a knowledge tool is continually expanding the information about the skin as an organ of the immune system. The gained knowledge will definitely promote the development of new therapeutic approaches to skin diseases.

A clinical case of Graham-Little-Piccardi-Lassueur syndrome characterized by combination of follicular keratotic rash (lichen ruberfollicularis) with a cicatricial alopecia on the scalp and non-cicatricial hair loss of the pubis and axillae is presented in the article. In spite of considerable prevalence of genetic and non genetic lichenoid dermatoses Graham-Little-Piccardi-Lassueur syndrome presents certain difficulties and requires careful attention of clinicians.

A clinical case of Sweet’s syndrome (dermatosis neutrophilica febrilis acuta) in a 59-year old man is presented. The data about etiology, pathogenesis and clinical picture are summarized. Difficulties in diagnosis of the disease are described. Sweet’s syndrome is characterized by skin lesions with marked neutrophilic infiltration. The syndrome manifests itself as a rash ofpainful red papules, plaxes, intradermal nodes on the head, neck and hands, multiple ostiofolliculitis. It is also characterized by fever, leukocytosis, arthralgias, episcleritis. Approximately 15% of cases are paraneoplastic. Patergiya can be seen in patients. It is a skin condition, characterized by lesions due to minor injuries. Diagnosis is based on a combination of clinical, physical, laboratory examinations and histological changes. The differential diagnosis should be made with exudative erythema multiforme, allergic vasculitis, erythema elevatum diutinum and erythema nodosum.

The study was carried out in 103 patients with psoriasis, who had the consultation of dermatologist and rheumatologist. Answers for 6 questions mPEST (Psoriasis Epydemiology Screening Tool) modified questionnaire were estimated, each positive answer corresponded to 1, PEST ≥ 3 was suggested the presence of psoriatic arthritis (PsA), PEST < 3 was considered the absence of PsA. All the patients were examined by rheumatologist, the gold standard was CASPAR (ClASsification criteria for Psoriatic Arthritis) criteria. If necessary the instrumental tests were performed: roentgenography, ultrasound examination, magnetic resonance imaging (MRI) and laboratory tests. At PEST ≥ 3 diagnosis of PsA was suspected in 60 (58.2%) of 103 patients. Diagnosis of PsA was confirmed by CASPAR criteria in 47 (45.6%) patients. mPEST less than 3 was in 43 (41.7%) of 103 patients. Diagnosis of PsA was absent by CASPAR criteria in 29 (67.4%) patients. Newly diagnosed PsA was in 32 (52.4%) of 61 patients. Any rheumatic disease, mainly PsA, can develop with psoriasis. mPEST questionnaire in most cases reveals PsA in early stage, however, its isolated use is insufficient to establish an accurate diagnosis, it requires a clear diagnostic algorithm of the disease, including consultation of rheumatologist, clinical and instrumental examination.

One of the most studied theories about pathogenesis of vitiligo, the theory of biochemical disorders, where oxidative stress plays an important role, is presented. Changes of intercellular antioxidative status in combination with epidermal cells indicate to part of the oxidative stress in pathogenesis of vitiligo and allow to effect on process offree radical oxidation. These positive effects of antioxidants in the treatment of vitiligo confirm the theory of oxidative stress. The biological properties of ozone, that has a direct effect on peroxidation and antioxidant defense system of vitiligo are described.

Expression ofprotease-activated receptors PAR-2 has been investigated on neutrophils isolated from atopic dermatitis patient peripheral blood and has been analyzed with index SCORAD. The simultaneous expression of both, PAR-2 receptors and heat shock protein 90 (HSP90) was measured on neutrophils at the first week of acute phase of atopic dermatitis. Methods. Peripheral blood neutrophils were isolated on the Percoll gradient. Cells were stained with antibodies to PAR-2 receptor and HSP90 followed by the flow cytometry. Results. The PAR-2 receptors have been shown to be expressed on the plasma membrane of neutrophils obtained from patients with atopic dermatitis. The percentage of PAR-2+ neutrophils was positive correlated with diseases severity. HSP90 was found to be elevated simultaneously with PAR-2 receptors on neutrophils at the acute phase of atopic relapse. Conclusions. Atopic dermatitis patients have the higher level of PAR-2 receptor expression compared with healthy donors. Percentage of PAR-2+ neutrophils is elevated with the increasing of disease severity. Simultaneous elevation of PAR-2 receptors and HSP90 was found at the first week of acute atopic dermatitis.

The results of the study of the nitrosoguanidine mutagen effect on phenotypic variability of Trichomonas vaginalis are presented. Formation of non flagellated protozoa is detected. The relationship between torpid and difficult to treat forms of urogenital trichomoniasis with the presence of amastigote (non flagellated) forms with simple changes in the genome that have a high potential for survival is described.