Vestnik dermatologii i venerologii

Therapy of patients with pemphigus vulgaris with systemic corticosteroids may not be effective enough or lead to the development of severe adverse events that make it necessary to reduce the dose of corticosteroid. In such cases, it is possible to use the immunosuppressants. The literature review analyzes case reports and the results of studies that evaluated the effectiveness and safety of drugs used for immunosuppressive therapy of patients with pemphigus vulgaris. The drugs doses, the studies design, and criteria for evaluating the effectiveness of therapy in patients with pemphigus are considered. As a result of the analysis, it was shown that case reports and non-compatarive studies demonstrate the effectiveness and steroid-sparing effect of azathioprine, dapsone, methotrexate, mycophenolate mofetil, cyclosporine and cyclophosphamide in the treatment of patients with pemphigus vulgaris. Nevertheless, comparative studies show an increase in the effectiveness of therapy in patients with pemphigus and a faster achievement of therapeutic effect when prescribing cyclophosphamide, but not azathioprine, dapsone, methotrexate, mycophenolate mofetil or cyclosporine. However, the toxicity of cyclophosphamide limits its use in pemphigus. Thus, adjuvant drugs can be used in the treatment of patients with pemphigus in situations where it is not possible to reduce the dose of a systemic corticosteroid, especially in cases of severe adverse events of corticosteroid therapy.

The literature review presents modern aspects of the etiology and pathogenesis of vulvovaginal candidiasis, highlights issues of immunological resistance and the significance of polymorphic and pathological gene loci, the functioning of which leads to insufficient activation of the immune system in the disease. The mechanisms of formation of biofilms by fungi of the genus Candida on mucous membranes and the role of lactobacillary microflora in preventing their spread, as well as ideas about the prerequisites for the development of vulvovaginal candidiasis are considered. The modern possibilities of drug therapy for vulvovaginal candidiasis, presented in domestic and foreign clinical recommendations, are discussed. The advantages of prescribing fenticonazole, which is active against various types of fungi of the genus Candida, as well as a wide range of anaerobes and microorganisms associated with bacterial vaginosis, are considered, and the results of studies on the effectiveness of the drug are analyzed.

Background. The use of the dermascopy for diagnosing skin diseases is determined by the clinical guidelines. Foreign made dermatoscopes make up 99% of the equipment of medical organizations in Russia. However, under the conditions of economic sanctions, the supply and maintenance of medical products by foreign companies in Russia has been significantly reduced or completely stopped, which may negatively affect the quality of medical care.

Aims. To assess the current state of technical support of medical organizations of the dermatovenereology profile with equipment for dermascopy.

Methods. Information on the availability of dermatoscopes was obtained from 72 medical organizations of the dermatovenereological profile. The data obtained were structured, standardized and brought to a general form. Further processing of the information was carried out using descriptive statistics methods.

Results. The surveyed medical organizations are equipped with 1,716 devices for dermascopy, of which 1,700 (99.1%) units are foreign-made, 16 (0.9%) units are Russian-made. Of the total number of dermatoscopes, 1,580 (92.1%) devices are portable models, 86 (5.0%) are digital devices with software and 50 (2.9%) are video dermatoscopes. Most of the foreign medical equipment — 1,546 units (90.1%) — is made in Germany. In 31 (48.4%) medical organizations, the number of dermatoscopes is less than the number of dermatovenereology offices. The equipment of 24-hour hospitals with dermatoscopes is 5.2%, day hospitals — 17.1%.

Conclusions. There is a need to equip medical organizations with high-quality dermatoscopes. In the context of economic sanctions, the development and registration of the national dermatoscope is an urgent task.

Background. Currently, the attention of dermatologists is often directed to the study of changes in bacterial colonization of the skin, as one of the important links in the pathogenesis of skin diseases, including psoriasis, atopic dermatitis, acne, and seborrheic dermatitis. In recent years, data have emerged indicating a direct link between changes in the composition of the skin microbiota and obesity, as well as related diseases, primarily type 2 diabetes mellitus.

The aims. To give a clinical and microbiological characteristic of seborrheic dermatitis of the face in persons with metabolic syndrome and type 2 diabetes mellitus and in persons without concomitant pathology.

Methods. The study included 90 patients with seborrheic dermatitis, divided into 3 groups (1 — patients with seborrheic dermatitis; 2 — patients with seborrheic dermatitis and metabolic syndrome; 3 — patients with seborrheic dermatitis, metabolic syndrome and diabetes mellitus). The severity of the disease was determined by SEDASI score (Seborrheic Dermatitis Area and Severity Index). Metabolic syndrome was diagnosed based on the criteria of NCEP ATP III. The diagnosis of diabetes mellitus was established according to the diagnostic criteria of diabetes mellitus and other glycemic disorders (World Health Organization, 1999–2013). Classical bacteriological methods and mass spectrometric method (MALDI-TOF MS) were used to study the skin microbiome.

Results. Our study revealed an association between the presence of certain microorganisms in the skin microbiome and seborrheic dermatitis, metabolic syndrome and type 2 diabetes mellitus. In patients with moderate to severe seborrheic dermatitis, an increase in bacterial species isolated from the skin surface and their number in the unit volume of the investigated material. It was found that the colonization of microorganisms on the facial skin was significantly higher in patients of groups 2 and 3 compared to group 1. Among the isolated representatives of the genus Staphylococcus, the most pathogenic species of S. aureus prevailed in patients of groups 2 and 3.

Conclusion. The severity of the course and widespread lesions on the facial skin in patients with seborrheic dermatitis, metabolic syndrome and with seborrheic dermatitis, metabolic syndrome and type 2 diabetes mellitus are interrelated with disorders of facial skin microbiota. The growth of microorganisms in patients with seborrheic dermatitis and carbohydrate metabolism disorder is associated with severe course of facial seborrheic dermatitis and plays a significant role in the pathogenesis of the disease.

Benign familial pemphigus (BFP) Gougereau–Haley–Haley is a rare autosomal dominant genodermatosis caused by mutations of the ATP2C1 gene responsible for the function of calcium-dependent ATPases regulating calcium sequestration in the Golgi apparatus. The article provides an overview of modern methods of treatment of various groups of drugs, including drugs for topical treatment (topical glucocorticosteroids, calcipotriol, combined drugs), systemic drugs (glucocorticosteroids, apremilast), injection techniques (intradermal administration of botulinum toxin) currently used.

Taking into account the lack of clinical recommendations for the treatment of patients with benign familial pemphigus, to evaluate the effectiveness of treatment methods described in modern publications.

The observational study included 4 patients with clinically and histologically verified benign familial pemphigus, and described the results of therapy using techniques using intradermal administration of botulinum toxin A (3 patients) and apremilast (1 patient). The results of observations of patients with BFP and photo documentation are presented.

BFP is a rare dermatosis, the description of treatment methods for which is scarce in various publications, large-scale randomized studies are needed to determine the comparative effectiveness and safety of various drugs and physiotherapy techniques for the treatment of this disease. The material presented in the article will help practitioners to offer patients possible methods of BFP therapy and take into account the experience of colleagues.

Isotretinoin is an effective drug for the treatment of patients with severe forms of acne, which has been proven in a large number of studies and is enshrined in the clinical recommendations of dermatological communities in various countries. Despite this, the multifactorial etiology and complex pathophysiological processes of acne development determine the risk of relapse of the disease. Determining prognostic factors for exacerbation of acne after isotretinoin therapy is a significant problem that has been actively discussed in scientific publications in recent years. The article focuses on the fact that the effectiveness of isotretinoin in patients with acne depends both on a competent treatment strategy and on the characteristics of the course of the disease (genetic burden, comorbid pathology), which are individual for each patient. An analysis of our own clinical observations of patients with acne, in whom relapses of the disease were the result of either an incorrect dosage regimen of the drug, or the lack of correction of concomitant pathology, or an early onset and initially severe course of dermatosis, is provided. It is noted that a personalized approach to the management of such patients and the prevention of factors that provoke relapse allow the doctor and patient to form realistic expectations from isotretinoin therapy, increase its effectiveness and reduce the likelihood of disease progression.