Vol 24, No 3 (2021)

Cholinergic urticaria (CholU) is a chronic inducible urticaria, characterised by itchy pinpoint wheals up to 3 mm in diameter, surrounded by a prominent flare, that occur following an exposure to characteristic triggers such as active or passive heating, physical exercise, emotions, hot or spicy foods.

Key pathophysiologic mechanisms include immediate hypersensitivity to autologous sweat antigens, functional sweating disorders, impaired acethylcholine metabolism, abnormal skin vascular permeability and disturbed skin innervation.

Clinical manifestations of CholU may vary from typical itchy pinpoint urticarial lesions, angioedema to anaphylaxis. Atypical CholU forms include cholinergic pruritus, cholinergic dermographism, cold cholinergic urticaria and persistent cholinergic erythema.

The diagnosis of cholinergic urticaria relies on patient’s history, clinical manifestations and challenge tests.

Treatment options include nonsedating H1 antihistamines in standard or increased doses. The evidence is accumulating for the use of biological treatment with omalizumab in cholinergic urticaria. The prospect of personalized treatment of cholinergic urticaria include autologous sweat desensitization.

The main research efforts in ColdU are directed at optimizing diagnostic approaches and developing innovative therapeutic options.

Lichen sclerosus is one of the clinical variants of limited scleroderma, a feature of which is the defeat of the anogenital zone. The issues of the etiology and pathogenesis of lichen sclerosus remain not fully understood, despite numerous studies in which the polygenic nature of inheritance and multifactoriality in the implementation of dermatosis are noted.

With the progression of the scleroatrophic process and the absence of timely pathogenetic therapy, there is a high probability of the development of comorbid pathology with a whole range of symptoms, such as urinary (dysuria, recurrent urinary tract infections - cystitis, urethritis, cystourethritis), gastrointestinal (pain during defecation, chronic constipation), vaginal severe dryness and increased sensitivity of the vaginal mucosa, burning, itching).

Treatment of patients with lichen sclerosus with lesions of the anogenital zone causes great difficulties. In cases of isolated localization of scleroatrophic lesions of anogenital localization, difficulties may arise in the differential diagnosis with diseases of similar localization, such as vitiligo, atrophic lichen planus, basal cell carcinoma, contact dermatitis, nonspecific balanoposthitis, Keir's erythroplasia. Treatment of limited scleroderma, the clinical variant of which is lichen sclerosus, should be multi-course and complex, with the obligatory use of penicillin antibiotics, hyaluronidase-based drugs, drugs that improve microcirculation, vitamins, immunoregulators and physiotherapeutic methods.

Thus, early diagnosis and timely pathogenetic therapy contribute to the prevention of the risks of developing genitourinary syndrome, progression of tissue sclerosis, and psychoemotional disorders.

This article presents a clinical case of diagnosis and treatment of a patient with lichen sclerosus.

BACKGROUND: Because of the low specificity morphea clinical manifestations in early stages, the differential diagnosis is difficult.

AIMS: The purpose of the research is to propose a new diagnostic method for early stages of localized scleroderma.

MATERIALS AND METHODS: During 2011–2020, 77 patients with clinical manifestations of morphea and 127 controls were examined and included in the study at the LenOblCenter. All participants were conducted a transcutaneous oximetry with the “TCM-400” Radiometer apparatus. The tissue oxygen perfusion (tcpO₂) level from 40 to 50 mm Hg was considered as a reversible decrease, from 30 to 40 mm hg was a borderline decline and the value below 30 mm hg was critical. The following diagnostic skin biopsy was conducted in all 77 patients

RESULTS: Skin biopsy allowed to form 4 research groups: 40 patients with morphea, 12 patients with granuloma annulare, 15 patients with small plaque parapsoriasis and 10 individuals with large plaque parapsoriasis. 7 (17.5%) patients with morphea had normal tcpO₂ values, 9 (22.5%) patients had significant decrease of tcpO₂, 24 patients (60%) showed a reversible decrease of tcpO₂. 3/12 (25%) patients with granuloma annulare and 1 patient (10%) with large plaque parapsoriasis had minor oxygen level decrease. Measurement on the healthy skin showed tcpO₂ decrease in patients with comorbidities ― 3/77 (3.9%) in research group and 28/127 (22%) in controls.

CONCLUSIONS: Transcutaneous oximetry is a new perspective direction in the diagnostic algorithm of the morphea based on the pathogenesis and morphological features of the disease.

BACKGROUND: Acne vulgaris (acne vulgaris) is an urgent interdisciplinary problem. Analyzing modern scientific data on the development of acne vulgaris, it is necessary to focus on the role of inflammation that accompanies dermatosis at all its stages of development, sometimes preceding the formation of clinical symptoms. Prolonged chronic recurrent course, difficulties in choosing the correct therapy tactics, sometimes unreasonable medical interventions, exacerbation, improper skin care lead to the formation of a number of complications.

AIMS: To optimize and improve the effectiveness of therapy in patients with moderate and severe degrees acne using isotretinoin and the combined innovative gel Contractubex Anti-Red.

MATERIALS AND METHODS: The study included 60 patients aged 18 to 45 years with moderate to severe acne. Isotretinoin was prescribed in standard dosages. To study the effect of Contraktubex Anti-Red on the dynamics of post-acne, patients with atrophic post-acne scars were divided into 3 subgroups, depending on the regimen of drug use.

RESULTS: Almost complete relief of the inflammatory process, regression of elements was noted 12 months after the use of complex therapy, the value of the dermanologic index of acne (DIA) index was more than 70% noted in 62% of patients, significant improvement in 38%. The severity of post-acne scars on the SCAR-S scale changed significantly during treatment and in 53.3% this indicator was 1. The Cadi index decreased by 70% compared to the baseline.

CONCLUSION: Good cosmetic effect, safety, absence of side effects, comfort and ease of use make it possible to recommend Contractubex Anti-Red together with basic acne therapy.

BACKGROUND: In the literature, there are no scientifically based studies on the use of combination therapy using radio wave lifting and autologous platelet-rich plasma for the correction of involutional changes in the skin of the lower third of the face.

AIMS: To determine the effect of complex therapy of involutional changes in the skin of the lower third of the face with minimally invasive radio wave lifting using a cannula electrode and platelet-rich autoplasma using non-invasive diagnostic methods.

MATERIALS AND METHODS: Examination and treatment of 55 healthy women of Slavic appearance with involutional changes in the skin of the lower third of the face were carried out. Group № 1 patients received radio wave lifting therapy (n=28) and group № 2 patients received combined therapy with radio wave lifting and autologous platelet-rich plasma (n=27). The study was conducted from January 2020 to December 2020. To assess the condition of the skin, laser Doppler flowmetry, ultrasound sonography, and elastometry were used before and after the study. Clinical manifestations were assessed by an anthropometric method.

RESULTS: The most pronounced changes were observed in the group where the combined method of radio wave lifting therapy with autologous platelet-rich plasma was used. The change in microcirculation was of a multidirectional nature, however, the average values were in the range of 8.866–8.89 pf units, which is the normalization of trophic processes in tissues (p >0.05). When analyzing the conduct of ultrasound sonography, statistically significant thickening of the epidermis and dermis was noted, however, in patients of the second group, the thickening was more pronounced (p <0.0005). The change in the echogenicity of the dermis was of a multidirectional nature; by the end of treatment, the mean values were in the range of 10.5–11.3 units, which, apparently, indicates a more homogeneous structure of the dermis (p <0.05). Anthropometric indices (measurement of ptosis of the lower cheeks) decreased in both groups, which is related to skin lifting as a result of treatment (p <0.0005). The amplitude of tissue upward mobility decreased in both groups (p <0.0005). The amplitude of downward movement of tissues after therapy was of a multidirectional nature in both groups, which is possibly associated with the density of the dermis and indicates the normalization of collagen and elastin fibers (p >0.05). Elastometry indices (F0, R4, R6, R8) decreased, R2 increased in both groups, however, the dynamics was more pronounced in the second group (p <0.0005).

CONCLUSIONS: Minimally invasive radio wave lifting in combination using a channel electrode with autologous platelet-rich plasma is an effective and safe method of treating age-related changes in the skin of the lower third of the face.

On May 14, 2021, the regular, 1143st meeting of the Moscow Dermatovenereology and Cosmetology Society named after A.I. Pospelova. The agenda included the following issues: analysis of 1 clinical case, hearing of scientific reports. Admission to membership in the MDCS not provided.

Sarcoidosis (synonym: Benier–Beck–Schaumann disease, benign granulomatosis, chronic epithelioid cell reticuldoendotheliosis) ― is a multisystem disease from the group of granulomatosis, of unknown etiology, the morphological feature of which is the development of epithelioid cell granulomas without caseous necrosis fibrosis in the tissues of various organs. Taking into account the variety of clinical lesions, there are three main forms: extrathoracic, intrathoracic, mixed (generalized).

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