Vol 91, No 4 (2015)

The article provides the overview of incidence of sexually transmitted infections and skin disorders over time in Russian Federation in 2004-2014 with its main positive tendencies; results of reorganisation of bed capacity of dermatovenerologic medical organizations; dermatovenerologic bed rates.

The authors present current data from the literature relating to major characteristics and efficacy of methods of non-invasive diagnostics of rosacea (dermatoscopy, dopplerography, ultrasound scanning, confocal laser scanning microscopy) as well as aspects of a systemic external therapy, laser therapy and use of IPL systems in the treatment of patients suffering from rosacea.

This review reflects modern information about the possible mechanisms of skin lymphomas. Generalized the data of the possible etiologic factors of the disease. Described the basic pathogenesis and show practical importance identified molecular markers in the diagnosis and treatment of patients with lymphoproliferative diseases of the skin.

Goal of the study. To assess the efficacy and safety of using broadband pulse light emission with smooth pulse and photon recirculation technologies in the treatment of patients suffering from erythematous and papulous subtypes of rosacea. Materials and methods. Sixty rosacea patients (21 male and 39 female) at the age of 25-65 including 38 patients with erythematous and 22 patients with papulous subtypes of rosacea underwent treatment using broadband pulse light emission (5-8 treatment sessions). Results. After one month of treatment with broadband pulse light emission using smooth pulse and photon recirculation technologies: 68.4% of patients with the erythematous subtype had clinical recovery, and 31.6% - improvement; 27.2% of patients with the papulous subtype - clinical recovery, 54.5% - improvement, and 18.3% had no effect. After 5 months of treatment most of the patients still had a positive effect of the therapy, yet 21.1% of patients with the erythematous subtype and 11% of patients with the papulous subtype had single telangiectasias, increased erythema and single papules. After 10 months of treatment 44.7% of patients with the erythematous subtype of rosacea had an increase in the number of enlarged vessels, and 18.3% of patients with the papulous subtype had signs of a recurrence of the disease. Conclusion. The use of broadband pulse light emission with smooth pulse and photon recirculation technologies has a multiple, painless and significant effect on large lesions in the treatment of patients suffering from erythematous and papulous subtypes of rosacea.

It is now known that one of the main causes of pathology of pregnancy, childbirth and placenta, is infection. The purpose of the study. To reveal the peculiarities of pregnancy and delivery, as well as histological changes of placenta in syphilitic infection, depending on the time of detection of the disease. The materials and methods of research. Under the supervision of 114 women with confirmed syphilis infection. In accordance with the intended purpose of the study three groups of women with syphilitic infection. Group I included 42 women who are diagnosed with syphilis installed for the first time in this period of pregnancy or nursing home. II group consisted of 34 women who have had syphilis prior to the present pregnancy had been trained in specific therapies, but during this pregnancy had a positive DAC. In the third group consisted of 38 women who had syphilis and received a course of specific therapy prior to the present pregnancy, with a negative DAC during this pregnancy. The control group included 30 women without a history of syphilis. Results and discussion. We found a significant increase in the overall frequency of complications in childbirth in women with syphilitic infection, the most common manifestation of the pathology of childbirth should be considered the changing nature of amniotic fluid and the need for manual examination of the uterine cavity. Degenerative changes in the form of petrification was absent in the control group and identified in women I-III bands 21.4-28.9 percent. Inflammatory changes of the placenta was detected with significantly higher frequency in group I. We found a significant prevalence of pathological changes in the stroma of the villi in placentas in groups I-III compared with the control. Conclusion. Leading macro- and microscopic pathological disorders of the placenta, concomitant syphilitic infection and emerging at 16-18 weeks of gestation and may be involved in the development of complications of pregnancy and childbirth.

The authors present the results of a questionnaire survey conducted in serological laboratories in 60 dermatovenerology enterprises in the subjects of the Russian Federation on the use of up-to-date methods for the determination of Class M antibodies for the diagnostics of early syphilis. It was revealed that treponemal specific Class M antibodies were determined in 86.67% of laboratories: the EIAIgM method was used in 86.67% of laboratories, IBIgM - in 18.33%, and PHTIgM - in 6.67% of laboratories only. The total number of IgM tests did not exceed 1.3% of the entire volume of immunochemical reactions conducted for the diagnostics of syphilis in laboratories in 2012; as for IgM methods, the use of EIAIgM prevailed - 97.27% while the frequency of using PHTIgM and IBIgM was 2.0 and 0.73%, respectively. In the authors’ opinion, such ratios were stipulated by the absence of production of kits made in Russia during the study period (in 2012) and allowed for use for methods such as PHTIgM and IBIgM while there was a wide choice of kits required for EIAIgM and laboratories had a long-term experience of using this method.

The continued growth of HIV-infected patients is associated on the one hand, with increase of life expectancy because of antiretroviral therapy, and the other - with high incidence of new cases of HIV-infection. It is important to remember that almost every HIV-infected patient has concomitant disease. The presence of comorbidity increases days of hospitalization, disability, impedes rehabilitation and leads to polypharmacy. Moreover, polypharmacy, particularly in HIV-patients, contributes to a sharp increase of adverse local and systemic side effects of drugs. This article presents the clinical examples of skin diseases in patients with HIV-infection.

Goal. To assess the efficacy of the photodynamic therapy with the external use of methyl aminolevulinate as a photosensitizer with further irradiation with visible red light with the wavelength of 630 nm in the treatment of patients suffering from a surface form of basalioma and actinic keratosis. Materials and methods. The study involved 28 patients diagnosed with the surface form of basalioma and 34 patients diagnosed with actinic keratosis. They underwent treatment by the photodynamic therapy method using a LED lamp radiating visible red light with the wavelength of 630 nm, with the total dose of irradiation equal to 37 J/cm2. All patients also underwent a confocal in vivo laser scanning microscopy of lesions at the baseline and after 7, 30, 90 and 180 days of treatment. Results. Absolute regression of abnormal lesions was observed in 25 (91%) patients diagnosed with the surface form of basalioma and 30 (88.9%) patients diagnosed with actinic keratosis after 30 days of treatment. No signs of the diseases were revealed in these patients after examination by the method of confocal in vivo laser scanning microscopy. Conclusion. The photodynamic therapy with the local administration of methyl aminolevulinate with further irradiation with visible red light with the wavelength of 630 nm is an efficient method of treatment of the surface form of basalioma and actinic keratosis.

A growth in the incidence rate for atopic dermatitis (AD) in infants has been observed for this decade. Early formation of AD (at the age of 3-6 months) is observed in 45% of infants, and in 60% of infants - during the first year of life. As many as 65% of children (by the age of 7) and 74% of children (by the age of 16) suffering from AD have a spontaneous remission of the disease. As many as 20-43% of children suffering from AD further develop bronchial asthma, and the incidence rate of allergic rhinitis is twice as high. In spite of the fact that topical corticosteroids (TCS) are prescribed frequently enough, there is a need in the non-hormonal therapy due to poor compliance with the TCS treatment regimen in connection with side effects. Treatment of AD is often complicated by the colonization with Staphylococcus aureus and inefficacy of the external therapy with topical corticosteroids because many patients with AD have a high level of IgE against the superantigen of Staphylococcus. 1% pimecrolimus cream (PIM) and TCS were compared in a long-term large-scale study involving younger children suffering from mild to moderate AD. Materials and methods. The five-year open-label study involved 2,418 children, who were randomized into groups receiving PIM (n = 1205; in case of an aggravation - short-term administration of TCS) or TCS (n = 1213). The main goal of the study was to compare the safety of these two methods of treatment; an auxiliary goal was to confirm the long-term efficacy of PIM. Treatment was considered to be successful if the score based on the IGA scale was 0 (clean skin) or 1 (almost clean). Results. The effect in both groups of the drugs - PIM and TCS - was fast, and the success of treatment was recorded for >50% of patients by Week 3. In both groups, treatment was determined to be successful after 5 years in >85% of patients, and treatment of manifestations of AD on the face was efficient in 95% of all subjects. In the PIM group, the need in steroids was considerably lower than in the TCS group (7 days of administration vs. 178 days in the TCS group). In both groups, there were adverse events similar by their nature and frequency, and no disorders of humoral or cellular immunity were revealed. Conclusions. The long-term administration of PIM in case of mild to moderate AD in children was revealed to be safe and had no effect on the immune system. When PIM was used, the need in corticosteroids was considerably reduced (steroid-preserving effect). These data confirm that PIM is as efficient as TCS and can be used as the first-line therapy for mild to moderate AD in infants and younger children.

Lupus erythematosus tumidus is a rare skin form of lupus erythematosus. About 250 cases of lupus erythematosus tumidus have been described in the world by now. A specific clinical sign of this dermatosis is the appearance of annular or arcuate urticaria-like rash. As a rule, the appearance of the rash is preceded by ultraviolet irradiation. The administration of glucocorticosteroid drugs of local action belonging to classes of potent and very potent steroids is the first-line therapy for lupus erythematosus tumidus. The authors describe a case of the successful treatment of lupus erythematosus tumidus with methylprednisolone aceponate (Advantan ointment) in a female patient aged 56.