Vol 92, No 4 (2016)

The article presents a clinical case study of an efficient therapy with infliximab used for a 33-year-old patient with a severe course of psoriasis, psoriatic arthritis, psoriatic onychopathy; chronic hepatitis C with the minimum activity, replication phase; hyper- and normatrophic scars affecting 40% of the body surface; cicatricial contractures; complicated posterior polar cataract of both eyes; secondary amyloidosis of the kidneys with a nephrotic syndrome. It also demonstrates the significance of the anti-cytokine therapy as a method of choice in a complicated clinical situation.

The article presents the results of a survey held among orphaned children and children without parental care with regard to the prevention of sexually transmitted infections as well as results showing the efficacy of awareness-raising workshops regarding reproductive health.

The article presents current information about the immune mechanisms of psoriasis. Inflammation in the skin of psoriasis patients is considered as an autoimmune process, in which a key role is played by T-cells sensitized to keratinocytes. One of the most probable self-antigens that trigger an immune inflammation in psoriasis may be cytosolic DNA. We describe the functions of the subpopulations of immune cells and the effects of secreted cytokines in the pathogenesis of psoriasis: the dendritic cells - langerhans cells, plasmacytoid dendritic cells, CD11c+ dendritic cells ; T-cells - T helper type 1 and 17, cytotoxic t lymphocytes, T-regulatory lymphocytes. Important role in the development of relapses of psoriasis is plays a formation in the skin of patients with T-cell memory and intradermal proliferation of T-cells.

Rosacea is a polietiologic disease with a complex pathogenesis, resulting in the problem is the selection of therapeutic tactics, especially in severe disease. The result of the study revealed that the isotretinoin treatment for rosacea had a positive result, even in the absence of the effect of previous systemic antibiotic therapy. Aim of the study. To study the effect and tolerability of systemic isotretinoin treatment for severe rosacea that is resistant to antibiotic therapy. Materials and methods. Under the supervision and treatment were 16 patients with severe course of rosacea, 14 of them had pustules and papules and 2 - fimatodes subtype. The severity was estimated by the method a 4-point scale proposed by V.P. Adaskevich, and was in average 18.6 points. All patients had a duration of 3 ± 1.2 years for systemic antibacterial therapy (clarithromycin, Ornidazole) with insufficient effect in the past. All patients (n = 16) was conducted therapy with isotretinoin (using Aknekutan). Daily dose was calculated on body weight, the initial dose was 0.2-0.3 mg/ kg, with subsequent dose reduction. Topically patients received clindamycin phosphate gel 1% treatment (5-7 days), then metronidazole 1% cream (Rosamet) 1-2 times a day. The duration of therapy ranged from 3 to 5 months. Results. After the course of therapy using Aknekutan remission or significant improvement was achieved in 87.5% of cases. The severity of the disease fell to 6.5 points, i.e. 2.8 times. Conclusion. Aknekutan showed a high therapeutic effect in severe rosacea, so it can be recommended to patients with resistance to conventional therapy. As external therapy, and supportive treatment patients are recommended - cream metronidazole 1% (Rosamet) and adequate skin care, photoprotective creams.