Vol 99, No 1 (2023)

Vitamin A and its synthetic analogues are used in the treatment of numerous skin diseases. The main genomic effects of the natural form of vitamin A (retinol palmitate) are associated with its active metabolite all-trans-retinoic acid and are compensated by several restrictive mechanisms. Numerous studies have proved that retinol stimulates the proliferation of keratinocytes of the basal layer of the epidermis and endothelial cells, and also activates dermal fibroblasts to synthesize proteins of the extracellular matrix of the dermis. As a result, the thickening the epidermis, increases the mechanical strength of the skin and the hydrating ability of the dermis, angiogenesis increase. The ability of retinol to enhance the adhesion of endothelial cells and leukocytes, regulate the processes of keratinization and sebum secretion was found. Vitamin A is also a powerful antioxidant. Retinol palmitate is used as the main or auxiliary drug for the treatment of a wide range of dermatoses. The principle of application is based on clinical studies and confirmed by existing experimental data. In the treatment, the following algorithm is followed. If retinol palmitate is necessary to improve epithelialization and strengthen the epidermal barrier, medium therapeutic doses should be used. For the treatment of disorders of keratinization processes, depending on the severity of the pathological condition, medium and high therapeutic doses of the drug are used. Violation of the processes of sebum secretion and severe hyperkeratosis respond better to treatment at high therapeutic doses. It should be noted that many skins clinical manifestations mostly regress under the action of vitamin A in doses that do not lead to the appearance of signs of toxicity of the drug.

Background. Methotrexate is a highly effective systemic treatment for moderate to severe psoriasis, but drug toxicity may limit its use. Recent evidence suggests that it is necessary to take into account the individual characteristics of methotrexate pharmacokinetics, which are determined by the presence of polymorphisms of genes encoding methotrexate carrier proteins, to predict the risk of methotrexate-induced toxicity.

Aims. The research aim is the assessment of associations of ABCB1 rs1045642 (3435C>T) polymorphism with methotrexate safety for the patients with moderate and severe forms of psoriasis.

Materials and methods. The study included 75 patients diagnosed with psoriasis treated with methotrexate during 21 day. Data on adverse drug reactions were collected using a clinically structured questionnaire, complete and biochemical blood tests, and urinalysis. The severity of adverse drug reactions was assessed using visual analog scales and the CTCAE toxicity scale. The severity of gastrointestinal ADR was assessed using the GSRS questionnaire. Genotyping was carried out by real-time PCR.

Results. The gastrointestinal toxicity was detected in 38 patients (50.67%). The mean GSRS score was 7.97 ± 9.18. Analysis of differences in the incidence of adverse drug reactions showed the presence of statistically significant differences in the frequency of adverse drug reactions in the gastrointestinal tract: the toxic effect of methotrexate was more often observed in carriers of the T allele of the ABCB1 rs1045642 polymorphism (3435C>T), (CC — 2 (14.3%), TC — 18 (52.9%), TT — 18 (66.7%), p = 0.006). Binomial regression demonstrated the presence of a statistically significant effect of the rs1045642 SNP polymorphism of the ABCB1 gene on the incidence of ADR from the gastrointestinal tract (OR = 8.64, p = 0.008).

Conclusions. An association of ABCB1 rs1045642 SNP with the safety of gastrointestinal methotrexate therapy in patients with moderate and severe forms of psoriasis was revealed. The data obtained can be used to personalize the prescription of methotrexate to patients with psoriasis.

Background. Evaluation of the severity of pathological angiogenesis in patients with psoriasis can be considered as a promising direction for monitoring the activity of the disease and the effectiveness of systemic therapy.

Aims. Evaluation of interconnections between indicators of angiogenesis in the skin and nail bed of psoriasis patients with clinical characteristics of disease course and therapeutic response to the use of methotrexate by a comprehensive study of the morphometric data dynamics of videodermatoscopy in vascular bed of the skin, the severity of blood flow in the dermis and nail bed during ultrasonic power dopplerography and plasma concentrations of vascular endothelial growth factor (VEGF) and endothelin-1 (En-1).

Materials and methods. Work is based on the data analysis from a survey of 82 patients with moderate to severe psoriasis vulgaris in the acute stage, who were first prescribed methotrexate in the form of subcutaneous injections at a dose of 10–15 mg per week in combination with folic acid 5 mg per week. Before treatment and three months after the start of methotrexate therapy, all patients underwent videodermatoscopy with dimension of the density and size of dilated skin capillaries, ultrasonography of psoriatic plaques and nail bed of affected nails and measurement of doppler blood flow parameters and concentration of VEGF and En-1 in blood plasma.

Results. A direct correlation was established between the average diameter of dilated skin capillaries (vascular glomeruli), the degree of increased blood flow in the doppler energy study of psoriatic plaques skin area and the plasma concentration of VEGF and En-1 and values of PASI, BSA, sPGA and DLQI indices, as well as the severity of doppler blood flow of the nail bed and NAPSI index (r = 0.21–0.73). Under the influence of methotrexate treatment, a decrease in diameter and density of vascular glomeruli (16.2 [12.9; 22.5] versus 25.2 [17.1; 33.7] µm before treatment (p = 0.002) and (44.6 [31.6; 53.3] versus 53.5 [34.6; 67.4] before treatment (p = 0.04), respectively), the degree of blood flow in area of psoriatic plaques and the concentration of VEGF and En-1 (12.5 [6.7; 26.8] pg/ml versus 19.5 [4.7; 48.1] pg/ml after treatment (p = 0.002) and En-1 (168.2 [97; 319] versus 274.5 [146; 439] pg/ml
(p = 0.003), respectively) was observed.

Conclusions. Studied indicators of angiogenesis can be used as additional criteria for assessing the degree of activity and achieving clinical improvement/remission during systemic therapy in patients with moderate and severe psoriasis.

Acne is a widespread inflammatory disease affecting the pilosebaceous follicles of the skin. It mostly affects teenagers and, in most cases, clinical healing occurs as patients grow up. However, 10–40% of adults may have acne tarda. Due to the fact that face is one of the favorite locations of rashes, acne significantly worsens the quality of life, as a result of which patients develop social phobia, anxiety disorders, depression and even suicidal ideas, which requires a personalized approach to prescribing highly effective treatment. According to world recommendations, regardless of the severity of acne, almost all patients are shown the use of local remedies. In our pharmaceutical market, the choice of this group of drugs is quite limited. However, in September 2022, a new drug appeared in the arsenal of Russian dermatologists, which is a combination of benzoyl peroxide and clindamycin. This review presents the accumulated experience of almost 20 years of foreign colleagues who have been successfully using a combination of benzoyl peroxide and clindamycin in the treatment of mild-to-moderate acne.

The article presents a description of a clinical case of necrobiosis lipoidica complicated by ulcera-tion in a 55-year-old woman and a brief review of the literature on the topic of modern ideas about necrobiosis lipoidica. The disease manifested itself in 2005 after traumatization of the upper third of both shins as a result of a fall. The patient did visit a dermatologist office for medical help, there was a slow progression of the disease. In 2017, as a result of visiting a dermatologist office at her place of residence, she was diagnosed with necrobiosis lipoidica. The ongoing therapy with vasodi-lators and topical steroids did not lead to significant improvement. In 2021, against the background of vaccination against COVID-19 (22.07.20201 and 12.08.2021 Gam-COVID-Vac — Sputnik V) the patient notes a sharp deterioration of the process after the injection of the second component of the vaccine there were an increased in the area of lesion, ulceration. No data for diabetes mellitus were obtained during the examination. There is a history of a multi-nodular non-toxic goiter, for which a complete resection of the left lobe of the thyroid gland was performed in 1995 and a partial resection of the right lobe of the thyroid gland in 2003. The patient has been receiving L-Thyroxine replacement therapy since 2003. A biopsy of the affected skin was per-formed. The final diagnosis: necrobiosis lipoidica erythematous-ulcerative variant was established according to the pathoanatom-ic examination of the biopsy and atypical clinical picture. As a result of the therapy, the patient was discharged from the clinic with improvement.