Vol 95, No 3 (2019)

Necrologue
Editorial a.

Abstract

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Vestnik dermatologii i venerologii. 2019;95(3):9
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On the peculiarities of seborrheic keratosis pigmentation
Alexandrova A.K., Smolyannikova V.A.

Abstract

Seborrheic keratosis (SK) is a common benign epithelial skin tumor that exists in a variety of clinical op - tions. The color of the tumor varies from yellow to dark brown, which leads to diagnostic errors. There is аlittle data about pigmentation of the SK in the literature. There is no consensus on the content of melanocytes in the SK.

Objective: to study the nature of the distribution of melanin in the SK and its relationship with the number of melanocytes.

Materials and methods. An analysis of 130 histological preparations with a verified diagnosis of SK and immunohistochemistry (IHC) test with monoclonal antibodies to Melan A (clone A103 ready-to-use) have been performed. Material sampling was performed in 130 patients with SK at the age of 46–77. In 48.5 % of the material was taken from places that are easily exposed to sunlight, 51.5 % — from places that are often closed, less prone to exposure to UV-radiation.

Results. As a result of histological examination, three types of pigmentation of the SK were identified, depending on the accumulation and location of pigment in the tumor. IHC test with monoclonal antibodies to Melan A in all cases of SK revealed a significant decrease in the content of melanocytes (0.7–5 %), compared with the unaffected epidermis (10.7–14.3 %) (р = 0.001). The greatest number of melanocytes (3–5 %) was recorded in SK, which were removed from places exposed to UV radiation.

Conclusions. A significant decrease in the content of melanocytes (less than 3 % of tumor cells) in the most pigmented SK (p = 0.0003), the lack of activation of melanogenesis in the tumor under the influence of UV radiation indicates the accumulation of pigment due to its slow utilization, due to aging and a de - crease in metabolismtumor cells.

Vestnik dermatologii i venerologii. 2019;95(3):10-15
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Influence of focal infection on the immune status of psoriasis patients
Patrushev A.V., Samtsov A.V., Nikitin V.Y., Sukharev A.V., Ivanov A.M., Gumilevskaya O.P., Sukhina I.A.

Abstract

Objective: to study the influence of focal infection on the immune status of patients with psoriasis.

Materials and methods. 30 patients with psoriasis aged 19 to 61 years (21 people — plaque psoriasis, 9 people — psoriasis guttata) were examined, which were divided into 2 groups. The first group — with the diagnosed of focal infection (18 people), the second group — without the presence of focal infection (12 people). The control group consisted of 15 healthy individuals admitted to the clinic for the removal of benign skin tumors. All patients underwent a comprehensive clinical, instrumental and laboratory examination, as well as an immunogram. Determination of lymphocyte subpopulations was carried out on a flow cytometer “Cytom - ics FC500” by Beckman Coulter using various combinations of direct monoclonal antibodies and isotopic controls. The groups were compared using nonparametric Mann — Whitney test, the differences were considered significant at p < 0.05.

Results. The absence of significant quantitative changes in the main and small subpopulations of T- and В-lymphocytes in both groups of patients with psoriasis was shown. At the same time, the group of patients with psoriasis and focal infection, was characterized by an increase in the relative number of T-lymphocytes (p = 0.034) and T-helpers (p = 0.012), the relative and absolute number of activated CD3+HLA-DR+cells (p = 0.028 and 0.036, respectively), as well as a decrease in regulatory T-helper (p = 0.031). Subpopulation of CLA+CD3+-lymphocytes tropic to the skin in comparison with control was increased both in the first (p = 0.016) and second (p = 0.044) groups. Also, patients with psoriasis differed from healthy individuals by increasing the number of memory T-cells (p = 0.049 for group 1, p = 0.003 for group 2).

Conclusion. Existing focal infection in psoriasis patients lead to an imbalance in the content of individual lymphocyte subpopulations: an increase in the relative number of CD3+CD4+ and CD3+HLA-DR+ cells, as well as a decrease in regulatory T-helper. These changes can lead to a long course of the disease and a reduction in remission periods.

Vestnik dermatologii i venerologii. 2019;95(3):16-24
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GUIDELINES FOR PRACTITIONERS
Treatment of seborrheic keratosis with a copper vapour laser
Klyuchareva S.V., Ponomarev I.V., Topchiy S.B., Pushkareva A.E., Andrusenko Y.N.

Abstract

Aim: to assess the efficacy and side-effect risk of the surgical treatment of seborrheic k eratosis (SK) using a copper vapour laser (CVL).

Patients and methods. 3980 patients (1214 men and 2766 women aged 20 to 78 years) suffering from SK were treated using a CVL (Yakhroma-Med model, Russian producer) equipped with a laser pen and a scanning nozzle. The laser treatment was performed without anaesthesia in one to four sessions. During the treatment procedure, the following radiation parameters were applied: wavelengths ranging from 511 to 578 nm (in the ratio of 3 to 2), an average power of 0.6–1.2 W and an exposure duration ranging from 0.2 to 0.4 s. The diameter of the light spot on the skin surface was 1 mm. The follow-up observation lasted 24 months.

Results. The computer simulation of tissue heating by CVL and other laser systems showed that CVL is an optimal treatment choice for seborrheic keratosis in terms of the energy deposition depth. According to our clinical data and the results of computer simulation, the CVL is established to be the safest and the most effective for seborrheic keratosis treatment.

Vestnik dermatologii i venerologii. 2019;95(3):25-33
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Differential diagnostics of syphilitic alopecia and alopecia areata: The clinical picture and trichoscopic signs
Mareeva A.N., Katunin G.L., Rubtsov A.B.

Abstract

This paper describes a clinical case of secondary syphilis, which was manifested exclusively by syphilitic alopecia.

We describe the details of the clinical picture, as well as a differential diagnosis of syphilitic alopecia and alopecia areata on the basis of trichoscopy data.

For a patient with scalp lesions typical of syphilis (focal form of alopecia), the trichoscopic picture was represented by hairs broken at different heights from 1 to 5 mm, “empty” follicles (“yellow” dots), anisotrichosis due to the loss of terminal hair. The eyebrow trichoscopy showed “yellow dots”, vellus hairs, hair thinning due to the loss of bristly hair. A comparison of the trichoscopic pictures for alopecia areata and syphilitic areata have revealed the absence in the latter of a number of signs typical of the former, such as pencil-point, ex clamation-point, zigzag, monilethrix and tulip hairs.

Patients with a clinical picture of focal, diffuse or mix ed alopecia should be tested for syphilis using serological methods.

Vestnik dermatologii i venerologii. 2019;95(3):34-39
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НАБЛЮДЕНИЕ ИЗ ПРАКТИКИ
Progressive symmetric eritrocarotodermia Gottron: A rare case
Tlish M.M., Sycheva N.L., Boyko N.A., Shavilova M.E., Psavok F.A.

Abstract

The article deals with ethiopathogenetic factors of origin of progredient symmetric erythrokeratodermia of Gottron which is mainly characterized by autosomal dominant mode of inheritance and is classified as a disorder of cornification with extra epidermal cellular proliferation.

Clinicopathologic criteria on the basis of which this pathology can be verified are described here, such as: onset of a disease at an early age, strictly divided polycyclic, fixed, hyperkeratotic plaques with a narrow erythematic crown and a clean-cut, sometimes hyper pigmented edge, which are symmetrically located on skin on head, buttocks, limbs and are not prone to quick peripheral growth; large frequency of palmoplantar keratoderma and also histological changes typical of erythrokeratodermia.

The article describes a rare clinical case of autosomal-recessive progredient symmetric erythrokeratodermia of Gottron which is distinguished by seasonal changes of skin pathological process — emergence of rash in winter and complete remissions in summer.

Vestnik dermatologii i venerologii. 2019;95(3):40-45
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Clinical case of Brock’s congenital ichthyosiform erythroderma
Novikov Y.A., Zykova E.A., Pravdina O.V.

Abstract

This article describes a sporadic case of Brock’s bullous congenital ichthyosiform erythroderma. This is a rare hereditary disease from the group of genodermatoses with an autosomal dominant type of inheri - tance. The questions of the prevalence of dermatosis, the variability of the clinical picture, the timeliness of the clinical diagnosis are considered. Particular attention is paid to skin manifestations and their differential diagnosis.

Vestnik dermatologii i venerologii. 2019;95(3):46-53
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Long-term efficacy and safety of netakimab in patients with moderate-to-severe psoriasis. Results of phase II open-label extension clinical study BCD-085-2-ext
Bakulev A.L., Samtsov A.V., Kubanov A.A., Khairutdinov V.R., Kokhan M.M., Artemyeva A.V., Derbin S.I., Chernyaeva E.V., Ivanov R.A.

Abstract

Netakimabis original monoclonal antibody against IL-17. This article outlines the key results of a phase II open-label extension trial of netakimab 80 mg and 120 mg in patients with moderate-to-severe psoriasis.

The main aim of the trial is to estimate efficacy, safety and immunogenicity of long-term treatment with netakimab 80 mg and 120 mg in patients with moderate-to-severe psoriasis.

Materials and methods. The BCD-085-2-ext study is a comparative, open-label phase 2 clinical study of the effi - cacy and safety of netakimab in patients with moderate-to-severe plaque psoriasis who had finished BCD-085-2 (NCT02762994) trial. Main efficacy endpoints includePASI75, PASI90, PASI100, sPGA = 0–1 on week 38 of the trial, long-term PASI75/90/100 retention, efficacy keeping after switch from once every 2 week regimen to once every 4 week regimen. Safety endpoints include adverse events, serious adverse events number and their profile.

Results. 103 patients were included. PASI75 at week 38 was reached by 98.06 %, PASI90 — by 92.23 %, PASI100 — by 59.22 % of patients. There were no cases of serious adverse event, early with drawal due to adverse events and cases of grade 4 toxicity according to CTCAE 4.03. There were no cases of binding antibodies to netakimab during the 38 weeks of the study.

Conclusion. The first Russian original IL-17 inhibitor netakimabis promising modern medicine for moderate-to-severe plaque psoriasis treatment. Netakimabshowed high efficacy, favorable safety profile and low immunogenicity during one year of the treatment.

Vestnik dermatologii i venerologii. 2019;95(3):54-64
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