Vestnik dermatologii i venerologii

Tacrolimus ointment, which belongs to the class of topical calcineurin inhibitors, is one of the most studied topical preparations in the history of dermatology. It has a pronounced immunosuppressive and anti-inflammatory effect by suppressing the activation of the T-cell immune response. The high selectivity of its mechanism of action, the absence of an atrophogenic effect, and the possibility of use on delicate areas of the skin have ensured sustained interest in the drug among both researchers and clinicians. Although the approved indication is limited to atopic dermatitis, in actual practice, considerable experience has been gained in the off-label use of tacrolimus ointment for a wide range of chronic inflammatory and autoimmune dermatoses. The first part of the review, published earlier, presented information on the history of development and pharmacological characteristics of the drug, as well as summarized data on its efficacy in vitiligo and fibrotic connective tissue diseases. This publication continues to systematize the available evidence base and focuses on analyzing the clinical experience of using tacrolimus in other nosologies. This part of the review examines the results of using tacrolimus ointment for rosacea, perioral and seborrheic dermatitis, papulosquamous dermatoses (including psoriasis and lichen planus), as well as for skin manifestations of lupus erythematosus. In addition, data are presented on the use of tacrolimus in various forms of eczematous dermatoses not associated with atopy, as well as in alopecia and a number of other less common skin diseases. Analysis of published clinical trials and observational series indicates the promise of expanding the range of indications for the use of the drug. Systematization of the presented data may contribute to a more informed and rational use of tacrolimus ointment in dermatological practice and sets directions for future research.

Despite a large number of studies, the problem of impaired wound healing, in particular hypertrophic scars, remains relevant. Currently, there is no “gold” standard for the management of patients with hypertrophic scars. The purpose of this work was to analyze modern methods of prevention and treatment of hypertrophic scars, in terms of pathogenetic aspects, advantages and disadvantages. The review article includes systematic reviews, original research, and clinical cases describing the prevention and treatment of hypertrophic scars. The search was conducted for the key terms “hypertrophic scar”, “scar-free healing”, “therapeutic strategic”, and “wound healing” in the bibliographic databases PubMed, Scopus, and eLibrary. Articles with the highest citation index were selected from the data obtained. A total of 3,861 titles, 1,484 full articles were reviewed, and 139 articles are included in this review. An analysis of numerous scientific papers has provided a deep understanding of modern strategies for the prevention and treatment of hypertrophic scars. In this article, all the presented methods can be divided into 2 groups: methods that directly affect the blocking of extracellular matrix overproduction and methods that improve regeneration, including tissues around the wound. The latter, according to a few authors, are a promising area of wound healing, as they reduce the overall healing time, thereby contributing to a noticeable aesthetic improvement in the appearance of scars.

Background. The efficacy of antibiotic therapies used to treat syphilis in HIV-positive patients has not been sufficiently studied. In patients with coinfection, seronegativization of non-treponemal tests after syphilis therapy is often delayed, however, data on the reasons for the delayed serological response are limited and contradictory.

Aim. To assess the frequency of syphilis treatment failure in HIV-positive patients and to identify factors affecting the development of serological resistance (SR).

Methods. A post-hoc analysis of clinical, serological, liquorological and immunological data of 280 HIV-positive patients with syphilis who were under follow-up at St. Petersburg AIDS and Infectious Diseases Center has been conducted.

Results. Syphilis treatment failure was observed in 44.1% of patients with coinfection. The risk of SR was higher in women (p = 0.002), in elder patients (p = 0.006), in those with a more advanced HIV infection (p = 0.017) and depended on the duration of syphilis before the treatment initiation (p < 0.001). SR occurred more commonly after therapy for latent (p = 0.001), late syphilis (p < 0.001), neurosyphilis (p = 0.014), and reinfections (p = 0.027). The lack of positive dynamics in microprecipitation reaction (MPR) with serum was mainly observed when the recommended treatment methods were not adhered to and when the therapy prescribed was insufficient for the relevant stage and form of syphilis (р = 0,012). The CD4+ T-lymphocyte count < 350/μL increased the risk of SR 2.1-fold (p = 0.008). The occurrence of SR was not associated with ART, HIV RNA level (viral load), or pre-treatment MPR titer. Excessive doses of antibiotics during the initial treatment and additional therapy during the period of clinical and serological observation did not have a positive effect on the serological response.

Conclusion. Due to the high frequency of syphilis treatment failure, HIV-infected patients require a careful choice of the initial treatment regimen combined with regular and prolonged clinical and serological follow-up.

The article describes a case of skin vasculopathy due to systemic coagulopathy. In the setting of complete well-being, a 37-year-old female patient developed extensive areas of skin necrosis, predominantly in the lower extremities, over a period of 3 months. At the initial visit to the dermatovenerologic dispensary, papulonecrotic vasculitis was diagnosed, and systemic therapy with glucocorticosteroids was prescribed, which turned out to be ineffective. A repeated histological examination carried out at the Skin and Venereal Diseases Clinic of the Military Medical Academy allowed to make a final diagnosis — occlusive vasculopathy. When evaluating the coagulogram, the patient was found to have elevated prothrombin level (165 %) and a slight decrease in aPTT (22.3 s). Considering the normal platelet count, absence of concomitant visceral pathology, lack of history of warfarin use, and past infections, the patient’s condition was regarded as a manifestation of systemic coagulopathy. A search for possible causes of hypercoagulation revealed a significant mutation in the prothrombin gene F2(20210)GA. Anticoagulant therapy was initiated after consultation with a hematologist. Taking into account the large area of ulcerative skin defects, the patient was transferred to a surgical inpatient facility for further treatment. Thanks to the joint work of specialists in Dermatology, Hematology, and Surgery, it was possible to achieve healing of skin defects without plastic surgery, as well as to prevent repeated thrombotic events (no relapses during 6 months of follow-up).

The article considers a case of cutaneous amyloidosis that occurred in the setting of atopic dermatitis in a 32-year-old female patient. The patient has suffered from atopic dermatitis since the first months of her life, and homeopathic preparations have been used for treatment. Treatment with conventional medications and physiotherapy at the age of 20 years old resulted in a long-term remission, however, the patient noticed skin thickening in the areas of former rashes. Pathological examination of skin biopsy material and histochemical examination (hematoxylin and eosin, Van Gieson, toluidine blue, Congo red staining, PAS reaction) allowed to diagnose amyloid lichen. Amyloid lichen is a rare and severe complication of atopic dermatitis. Its incidence in patients with atopic dermatitis is approximately 0.8%. Contemporary methods of treating patients with atopic dermatitis accompanied by cutaneous amyloidosis are discussed. Topical products aimed at relieving inflammation and itching are used for initial treatment of amyloid lichen. Surgical treatments, as well as laser and phototherapy, may be used. Systemic medications (antihistamines, acitretin, cyclophosphamide and cyclosporine, upadacitinib, baricitinib) are an effective treatment option. Successful use of biological agents (dupilumab) has been reported.