Vol 99, No 4 (2023)

The paper describes changes in resources and performance of medical organizations providing medical care in the field of dermatovenereology in 2016–2022. The dynamics of the main rates of the service was analyzed, and the rates achieved in 2022 were compared with those before the pandemic of a new coronavirus infection. The rates of the provision of the population of the Russian Federation with dermatovenereologists, 24-hour and daytime dermatovenereological beds are presented. The analysis of the volumes of dermatovenereologic medical care dynamics provided in outpatient, inpatient and day hospital conditions was carried out. The dynamics of incidence of sexually transmitted infections is described, contribution of syphilis cases among foreign citizens to syphilis rates is presented. The changes in prevalence and incidence rates of diseases of the skin and subcutaneous tissue, as well as atopic dermatitis, psoriasis, contact dermatitis, other dermatitis, localized scleroderma, and discoid lupus erythematosus are analyzed.

Dystrophic epidermolysis bullosa is caused by mutations in the COL7A1 gene. The disease characterized by clinical heterogeneity. To date, scientific findings allow to evaluate correlations between the severity of clinical manifestations and genetic defects underlying in the development of the disease. A systematic literature search was performed using PubMed and RSCI, and keywords including “dystrophic epidermolysis bullosa”, “collagen VII”, “COL7A1”. The review includes description of clinical findings of dystrophic epidermolysis bullosa. The types and localization of pathogenic mutations of the COL7A1 gene, their influence on the protein synthesis, structure and functioning are characterized. The correlation between severe course of dystrophic epidermolysis bullosa and mutations resulting in premature termination codons generation which associate with the absence of type VII collagen at the dermo-epidermal junction has been described. Nevertheless, genotype-phenotype correlations should be analyzed carefully due to mechanisms which enable to restore protein expression as well as the possibility of the formation of premature termination codons associated with a more severe course of the disease, when replacing nucleotides in case of their influence on splicing.

Background. Psoriatic arthritis risk prediction and early detection in patients with psoriasis may help prevent irreversible musculoskeletal changes and improve patients’ outcomes.

Aims. To develop and validate predictive model for psoriatic arthritis risk assessment and classification for patients with moderate-to-severe psoriasis based on demographic and clinical characteristics.

Materials and methods. Data of psoriasis patient registry of Russian Society of Dermatovenereologists and Cosmetologists was analyzed. Significant differences between independent variables of interest among patients with and without psoriatic arthritis were determined by means of χ2-test or Mann–Witney test. Predictive models were developed stepwise by means of logistic regression analysis. Independent variables of low significance were excluded from the model. Regression coefficients were considered significant if p < 0.05. The optimal cut-off value was derived from ROC-analysis. The model performance was evaluated by calculation of AUC, sensitivity and specificity on training and test datasets. Finally, adjusted regression coefficients, AUC, sensitivity and specificity were derived for pooled data.

Results. Training sample included 3245 patients with psoriasis, 920 of them had diagnosis of psoriatic arthritis. The final predictive model included five significant predictors: psoriasis duration, medical history of psoriatic erythroderma, family history of psoriatic arthritis, arterial hypertension, and fatty liver. All regression coefficients were highly significant (p < 0.001). The AUC of prediction model adjusted on pooled data was 0,7473, sensitivity 70%, specificity — 66% for cut-off value 0.212.

Conclusions. Developed predictive model for risk assessment of psoriatic arthritis may contribute to its earlier detection in patients with psoriasis taking into account the degree of influence of significant predictors. The proposed classification may be used to discriminate patients at higher risk of psoriatic arthritis.

Background. The use of phototherapy for the treatment of dermatoses and lymphoproliferative disease is determined by the Procedure for rendering assistance in the field of "dermatovenereology" and clinical guidelines approved by the Scientific and Practical Council of the Ministry of Health of Russia. Foreign-made medical equipment for phototherapy occupies a key position in Russia, the equipment of medical organizations with it is more than 75%. However, in the current reality, foreign companies not only raise prices for the export of medical equipment, but also stop its supply and service in Russia, which may adversely affect the quality of medical care.

Aims. To assess the current state of the technical support of medical organizations of the dermatovenereological profile with equipment for phototherapy of dermatoses.

Materials and methods. Information about the availability of equipment for phototherapy of dermatosis and/or the need to purchase it, the intensity of use of the available equipment for various nosologies, as well as problems related to its service, obtained from 64 medical organizations of the dermatovenerological profile in 62 constituent entities of the Russian Federation. The initial data collected as a result of the survey were structured, unified and brought to a general form using the functionality of the Microsoft Excel program. Further processing of information was carried out using descriptive statistics methods.

Results. 8 (12%) specialized medical organizations are currently not equipped with phototherapy equipment. In 56 medical organizations using phototherapy equipment, the share of foreign-made medical equipment is 84%. Of the 22 models of medical equipment, only 12 (54%) are included in the State Register of Medical Devices and have a valid registration certificate. 192 (75%) pieces of equipment of medical organizations are intended for local phototherapy in the medium-wave (UVB) or long-wave (UFA) ultraviolet radiation mode, and only 63 (25%) units are represented by ultraviolet cabins (57 UVA (PUVA) and UVB-311 cabins). and 6 UVA (PUVA) and UVB (SFT) booths). Out of 57 UV cabins, only 18 (32%) are simultaneously equipped with UVA and UVB-311 radiation sources. Half of the medical organizations of the dermatovenereological profile (50%) experience difficulties with servicing the installed devices, 43 (67%) medical organizations reported the need for equipment for phototherapy of dermatosis.

Conclusions. Due to the instability of logistics and sanctions for the supply of medical equipment to the country, the development and registration of a medical device for phototherapy of dermatosis and T-cell lymphomas of the skin, and its further production in Russia, is relevant.

Vulvovaginal candidiasis is a widespread infection caused by Candida. The disease affects 75–80% of women of reproductive age at least once during their lifetime, and 9–20% of them indicate the presence of three or more episodes of the disease during the year, which is classified as recurrent vulvovaginal candidiasis (RVVC). To date, the question of the causes of the formation of recurrent forms of the disease has not been definitively resolved, since RVVC is also observed in women who do not have known risk factors. Due to the fact that about 20–30% of patients with RVVC are healthy women without factors predisposing to its development, interindividual differences such as genetic predisposition and ethnicity, immune disorders, as well as the species diversity of Candida fungi and their antimycotic resistance may play a key role in the pathogenesis of idiopathic RVVC.

In the literature review, the main etiopathogenetic mechanisms of the disease development are presented, the role of immune and genetic factors of predisposition to the development of recurrent vulvovaginal candidiasis is evaluated, changes in the species structure of the pathogen in recent years are analyzed. Modern approaches to the treatment of the disease are described, taking into account the indicators of antimycotic resistance, and the analysis of RVVC therapy regimens according to domestic and foreign clinical recommendations is carried out. The possibilities of using sertaconazole in the treatment of the disease are considered, the results of studies of its efficacy and safety in patients with vulvovaginal candidiasis are presented.

Granuloma annulare (GA) is a chronic inflammatory necrobiotic granulomatous skin disease, which is based on a delayed hypersensitivity reaction caused by the production of interferon-γ (IFN-γ) by tissue macrophages and th1-limocytes, tumor necrosis factor-α (TNF-α) and matrix metalloproteinases (MMP), which leads to the degradation of connective tissue.

The most frequent form of GA if localized which is characterized clinically by grouped papules and plaques of red or pink color on the extremities. although disseminated variants of disease occur in 15% of all cases of ag. in contrast to the practically asymptomatic course of the localized form, typical signs of disseminated form are intensive sense of itching, the presence of at least ten foci of skin lesions, recurrent and resistance to treatment course.

A 53-year-old female patient with a long-term recurrent course of annular granuloma after a weak clinical response to therapy with pentoxifilin, methotrexate and azathioprine turned to the dermatology department of the university hospital. In light of the lack of satisfactory treatment options anti-cytokine therapy with adalimumab was recommended at a daily dosage of 80 mg, once a week, for 2 weeks, then 1 time every two weeks for 1.5 months. Already on the 5th day after receiving the first injection, the patient reported that the feeling of itching disappeared. By the end of the second week of the induction phase of biotherapy, it became obvious that new rashes did not appear, and the old elements of the skin rash had significantly flattened, turned pale and decreased in volume. After the second week of consolidated therapy, the dermatologist confirmed the convalescence.