Vol 95, No 4 (2019)

Dermatovenereologic health care delivery management in the Russian Federation. Results of 2018
Kubanov A.A., Bogdanova E.V.
Abstract
The paper presents the analysis of resources and the results of work of dermatovenereologic healthcare organizations in 2018. The dynamics of incidence of sexually transmitted infections, and the dynamics of prevalence of skin disorders in the Russian Federation is described.
Vestnik dermatologii i venerologii. 2019;95(4):8-23
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Management of patients with congenital epidermolysis bullosa
Karamova A.E., Albanova V.I., Monchakovskaya E.S.
Abstract
Congenital epidermolysis bullosa (EB) is a clinically and genetically heterogeneous group of hereditary skin diseases characterized by the formation of blisters and/or erosions in response to minimal trauma. Etiopathogenetic methods for treating the disease are undergoing various stages of clinical research; therefore, external therapy implying caring for affected and non-affected skin remains to be the main treatment method. Such a therapy aims to reduce the healing period of erosive and ulcerative skin defects, thus improving the overall quality of patients’ life. This review sets out to provide clinical recommendations for the management of EB patients developed by different groups of experts, which generalize methods for treating EB patients, main principles of external therapy and relieving subjective sensations, as well as to describe specific situations entailing this pathology.
Vestnik dermatologii i venerologii. 2019;95(4):24-30
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Studying of the interleukin-36γ expression level in the skin of patients with plaque psoriasis
Pashkin A.Y., Zhukov A.S., Khairutdinov V.R., Belousova I.E., Samtsov A.V., Garabagiou A.V.
Abstract

Currently, it has been established that the cytokines of the IL-36 family occupy a significant place in the initiation and regulation of the inflammatory process in psoriasis.

Objective: studying the expression level of IL-36γ cytokines in the skin of patients with plaque psoriasis.

Material and methods. Skin biopsy specimens of 31 patients with plaque psoriasis were studied. The comparison group consisted of 20 biopsy samples of the skin of patients with lichen simplex, discoid eczema, lichen planus, mycosis fungoides (plaque stage). As a control group studied the skin bioptates of 10 healthy people. An immunohistochemical study of the skin was carried out using anti-IL-36γ antibodies.

Results. An increase in the relative expression area of IL-36γ in the affected skin of patients with plaque psoriasis (7.4 %) was found, compared with the unaffected areas (0.10 %) and the control group (0 %). The expression of IL-36γ in the skin of patients with psoriasis in the progressive period (8.85 %) was 1.42 times higher than in the stationary period of the disease (6.2 %). A strong direct relationship was revealed (r = 0.71) between the level of IL-36γ expression in the affected skin and the value of the PASI index, a moderate direct relationship between the level of IL-36γ expression and epidermal thickness (r = 0.34). In the affected skin of psoriasis patients, expressed expression of IL-36γ was observed in the upper layers of the epidermis, patients of the comparison group (discoid eczema, lichen simplex, lichen planus, mycosis fungoides) were weak or moderate, in the unaffected areas of the skin of patients with psoriasis and healthy people — weak or absent.

Findings. It was found that the expression of IL-36γ in the skin of patients with plaque psoriasis is significantly higher than with other skin diseases. The data obtained allow us to consider this cytokine as a possible diagnostic marker and use it in the differential diagnosis. 

Vestnik dermatologii i venerologii. 2019;95(4):31-39
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The attitude of medical students towards HIV-infected people: fear or help?
Khryanin A.A., Reshetnikov O.V., Shpiks T.A., Bocharova V.K., Russkikh M.V., Marinkin I.O.
Abstract
The study was conducted during the 2017–2018 period using the method of anonymous questionnaire. In total, 838 4-year-students from medical, pediatric, dental and medical-prophylactic departments participated in the study. Two questionnaires were used for the survey: an adapted version of the standard UNAIDS questionnaire and that based on V. V. Boyko’s methodology of diagnosing communicative tolerance. It is found that medical students do not condemn HIV-infected people, nor believe that people with a positive HIV status necessarily behave immorally, thus deserving this disease. Medical students show a high level of professional communicative tolerance and readiness to help these patients, although being afraid of getting the infection during medical manipulations. At the same time, a low level of awareness concerning a number of legal issues regarding HIV-infected patients has been established.
Vestnik dermatologii i venerologii. 2019;95(4):40-47
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GUIDELINES FOR PRACTITIONERS
Dermatoscopy in the diagnosis of pigmented nevi
Bakulev A.L., Konopatskova O.M., Stanchina Y.V.
Abstract
The high incidence of melanoma and unsatisfactory results of its treatment in some cases make the issue of timely diagnostics of pre-melanoma skin pathology, in particular the identification of pre-melanoma pigmented nevi, of great importance and can be used for choice an adequate tactics of treatment. The purpose of the study was to evaluate the informativeness of dermatoscopy in cases of patients with pigmented nevi of skin as a part of melanoma prevention. 168 patients with pigmented nevi were screened. All nevi were photographed with a digital camera SONY Cyber-Shot DSC-H3, first in normal mode with the capture of the localization zone of the tumor and its surrounding tissues, and then in macro mode (“Zoom 10”). To confirm the clinical diagnosis, additional characteristics of the pigment formation on the skin, the manual immersion dermatoscopy, was used using the contact non-polarized HEINE mini 3000 LED dermatoscope. Evaluation of images was carried out using the diagnostic algorithm ABCD and ABCD-E. Our findings suggest that the clinical diagnostic algorithm used by us for detecting signs of the activation of a pigmented nevi is highly informative — the sensitivity is 97.6 %. Performing immersion dermatoscopy allows to increase the informativeness of the clinical and instrumental examination at the preoperative stage up to 98.2 %, which is comparable with the data obtained at the stage of urgent cytological examination: the method sensitivityis 98.2 %.
Vestnik dermatologii i venerologii. 2019;95(4):48-56
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CLINICAL CASE REPORTS
Langerhans cell histiocytosis in an adult patient
Karamova A.E., Chikin V.V., Znamenskaya L.F., Nefedova M.A., Mikhina V.A., Battalova N.S.
Abstract

Aim: to present a clinical case of a rare dermatosis — Langerhans cell histiocytosis (LCH) in an adult patient.

Materials and methods. A clinical and laboratory examination of a 64-year-old woman who had complained of rashes on the skin of the scalp, neck, trunk and lower extremities accompanied by itching was carried out. A histological study of skin biopsy samples from the lesion area, as well as an immunohistochemical study of Langerhans cell markers — langerin and S-100 protein — were performed.

Results. Clinical manifestations of the disease, the presence of histiocytic infiltrate in the epidermis and dermis during the histological study and immunohistochemical detection of langerin infiltrate cells and S-100 protein were all consistent with the diagnosis of LCH. The therapy with methotrexate subcutaneously significantly improved the patient’s condition.

Conclusion. Verification of the LCH diagnosis requires a histological study of skin biopsy samples and an immunohistochemical study of Langerhans cell markers. The efficacy of methotrexate in the treatment of this disease has been confirmed.

Vestnik dermatologii i venerologii. 2019;95(4):57-66
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A case of borderline tuberculoid leprosy with atypical and complicated manifestations
Semenova V.G., Karamova A.E., Nefyodova M.A., Chebotarev V.V., Zemtsov M.A., Odinets A.V., Shikhanova E.N., Chumakova E.S.
Abstract

This article presents a clinical case of a 52-year-old man suffering from oligobacillary border-tuberculoid leprosy in the acute phase associated with an established diagnosis of pulmonary tuberculosis and hepatitis C.

Aim: to present a clinical case of leprosy with atypical and complicated manifestations.

Materials and methods. A 52-year-old patient had been receiving treatment for allergic dermatitis for a long time.

Results. The patient was diagnosed with: A 30.2. Borderline tuberculoid leprosy (Paucibacillary Leprosy, Borderline tuberculoid form. Acute phase). The patient demonstrated atypical complications of the leprosy process in the form of ulcerative necrotic rashes.

Vestnik dermatologii i venerologii. 2019;95(4):67-78
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Fulminant acne. Modern solution of the problem
Drozhdina M.B.
Abstract
Modern ideas about the etiological factors underlying a rare, serious illness — fulminant acne, the influence of genetic and exposure factors on the formation of the disease, and the pathogenesis of this form of acne are described. The main pathogenetic factors affecting the debut and course of fulminant acne were identified: Cutibacterium and the microbiome of the skin as a whole; sebum overproduction of sebum with the direct participation of dihydrotestosterone, progesterone, insulin-like growth factor-1; features of innate immunity, follicular hyperkeratosis. The clinic, complications and optimal therapeutic tactics at the present stage are described. A clinical case with a successful therapeutic outcome is presented.
Vestnik dermatologii i venerologii. 2019;95(4):79-86
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Results of the long-term observational noninterventional prospective study BODYGUARD in psoriasis patients
Bakulev A.L., Petrunin D.D.
Abstract

Introduction. Currently there is insufficient data regarding routine use of various topical treatments for plaque psoriasis outside from randomized clinical trials, their efficacy, cost-effectiveness and perception by dermatologists and patients. The primary rationale for this study was local data generation for the long-term (up to 52 weeks) treatment of body psoriasis in Russian patients’ population with fixed-dose combination of calcipotriol and betamethasone dipropionate in the formulation of gel to evaluate patient’s adherence to the therapy and their satisfaction level.

Materials and methods. Primary study objectives were evaluation of the long-term (up to 52 weeks) treatment success of body psoriasis with fixed-dose combination of calcipotriol and betamethasone dipropionate gel by Physician (Physician Psoriasis Global Assessment (PsGA, 5-point scale)) and by patient (Patient’s Global Psoriasis Assessment (PaGA, 5-point scale) and overall patient’s satisfaction using 4-point scale), patient’s satisfaction with the treatment via Patient Preference Questionnaire (PPQ), patients’ adherence to the treatment using Questionnaire of Adherence, impact of treatment on patients’ quality of life using DLQI questionnaire, and patients’ readiness to buy topical therapy product out of pocket based on consumption of the study medication during follow up period. Patients received treatment with topical calcipotriol/betamethasone gel which was prescribed as a routine medication without connection to the study purposes for up to 8 weeks. After the treatment patients were followed up for up to 52 weeks; during this period they were allowed to continue treatment with either maintenance or intermittent schedule. 128 dermatologists participated in the study, 612 patients with body plaque psoriasis (mean age 42.0 ± 13.30 years) were included; from this sample 544 (88.7 %) patients underwent follow up.

Results. All 612 included patients received initial therapy with calcipotriol/betamethasone gel; during follow-up period 410 (76.1 %) patients received treatment by any schedule (out of 539 assessed). Overall treatment success based on average PsGA score: initially 3.0 ± 0.54, after appr.8 weeks — 1.3 ± 0.80 and after appr.52 week 1.1 ± 0.96; based on average PaGA score — initially 3.0 ± 0.54, after appr.8 weeks — 1.5 ± 0.88 and after appr.52 week 1.1 ± 0.99. The proportion of patients which described their overall satisfaction with the treatment as “satisfied” or “absolutely satisfied” equaled 92.3 % at visit at the end of active treatment and 93.1 % at visit up to 52 weeks afterwards. Also at visit at the end of active treatment 93.8 % of patients considered their current treatment as “more effective” than previous topical treatment they received. Patients’ adherence to the therapy was satisfactory — average application rate of calcipotriol/betamethasone (should be applied daily) gel at the last 7 days of treatment at visit at the end of active treatment comprised 5.6 ± 2.6 days, which means that 6 out of 7 days of the treatment were not missed. Initial DLQI score was 13.6 ± 5.95 and it reduced down to 3.89 ± 5.95 at visit at the end of active treatment (p < 0.001) reflecting positive impact of successful therapy on patients’ psychosocial wellbeing.

Discussion. Results of this study provides additional information regarding routine topical therapy in patients with plaque psoriasis. These findings demonstrate that the therapy of body plaque psoriasis with calcipotriol/betamethasone gel is effective both in short and long term according to the evaluation by dermatologists and by patients themselves. This therapy provides good rate of adherence and patients’ satisfaction as well as affects positively at patients’ psychosocial wellbeing assessed by DLQI score. 

Vestnik dermatologii i venerologii. 2019;95(4):87-93
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