Vol 92, No 5 (2016)

Goal of the study. evaluation of psycho-vegetative disorders in patients with atopic dermatitis, and the determination of their influence on the severity of the disease. Material and methods. The study involved 72 patients with atopic dermatitis aged 18 to 46 years (men - 41, women - 31). The control group, similar in age and sex characteristics, and 30 healthy volunteers. All patients underwent an individual computer study psychophysiological and emotional state of a human body with a digital telemetry hardware and software system - analyzer of biorhythms «Omega-M» Scientific-production company «Dynamics» (Saint-Petersburg). Evaluates the performance of the autonomic, neurohumoral and central regulation, as well as the integral indicators of the functional state of the organism. Quality of life assessed by questionnaire DLQI (dermatology life quality index), the severity of the disease was determined by the index SCORAD (scoring atopic dermatitis). Results. Autonomic disorders were diagnosed in 75.0% of patients (54/72), represented mainly sympathicotonia and centralization of heart rhythm. Neurodynamic methods and fractal analysis of cardiac rhythm disorders of neurohumoral regulation and psycho-emotional diagnosed respectively in 69.4% (50/72) and 76.6% (53/72) of patients with atopic dermatitis. A moderate correlation between the severity of the disease and some indicators (IV, IVE, VR, C1, D1) showing violations of the vegetative and central regulation (0,25 < Ir_sI < 0,75).

This article provides a clinical observation of paraneoplastic syndrome of a patient with basal cell carcinoma of skin. Authors present clinical features of the described for the first time, paraneoplastic retentional follicular hyperkeratosis of facial area.

The description of two clinical cases of basal cell skin cancer, which developed against the background of a nevus of sebaceous glands.The article reflects the clinical features and criteria for the differential diagnosis of pigmented form of basal cell skin cancer.

The review discusses the possibility of result-oriented treatment therapeutic strategy (Т2Т) for patients with psoriasis implementation, as well as analysis of the key factors to ensure stability of long-term therapy with the use of genetically engineered biological drugs. It contains data on targeted influence of inhibitor IL17A secukinumab on key factors in the immunopathogenesis of psoriasis, its efficiency and safety in treating patients with moderately-severe to severe psoriasis in the course of therapy lasting up to 3 years. It is shown that long-term usage of secukinumab with 300 mg dose once a month subcutaneously allows to reduce the severity index values and the prevalence of psoriasis PASI 90% to vast number of patients with this dermatosis, which fully corresponds to the T2T strategy. The review discusses the possibility of therapeutic response usage in the form of achieving PASI 90 as a new global goal for effective therapy for patients with psoriasis to be attained in clinical practice. We present data on immunogenicity profile of secukinumab and beneficial impact on efficiency, as well as on safety of treatment with the usage of this genetically engineered biological medication.

Psoriasis is recognized as system immune inflammatory disease at a certain genetic basis. It was found that psoriasis develops under the influence of chronic systemic inflammation low intensity (low grade inflammation) that induced insulin resistance, and is one of the clinical forms of the Immune Metabolic Disease (IMD), along with atherosclerosis, hypertension, type 2 diabetes, obesity and many other diseases, whose tight relationship with psoriasis are installed. Knowledge of the etiology, pathogenesis and molecular mechanisms of communication with other clinical forms of the IMD opens up new ways of prevention and treatment of psoriasis. Please note that other diseases associated with psoriasis, occurring hidden, often have greater predictive value for the life and health of the patient than mild or moderate forms of psoriasis, and be not limited to ascertaining the diagnosis and symptomatic treatment and actively participate in prevention. Debated question of the application of funds, suppressing systemic inflammation and insulin resistance in the treatment of psoriasis.

This article presents current data from publications on new direction in systematic treatment of patients with psoriasis with help of "small molecules" that act intracellularly, selectively inhibiting signaling pathways responsible for production of key pro- and anti-inflammatory mediators that play an important role in the pathophysiology of psoriasis. We discuss key issues that refer to immunopathogenesis of psoriasis, targeted influence of "small molecules" on key components of innate and adaptive immune system of patients psoriasis. This article presents results of the studies performed according to the evidence-based medicine approaches, on the efficiency and safety of apremilast - the first and only current selective inhibitor of intracellular phosphodiesterase 4 - for treating medium-severe and severe psoriasis, including patients with problematic localizations of dermatosis (psoriasis of scalp pilar part, palms, soles, nail plates), as well as in the long run. It is shown that continuous apremilast therapy for the term of 52-156 weeks was accompanied by a significant decrease in prevalence and severity of psoriasis. Adverse events were recorded rarely, they were mild, and frequency of serious adverse reactions was comparable to placebo.

The article presents 3 clinical observations of women of 51, 55 and 57 years old with severe rosacea, who reached the state of remission after a prolonged course of systemic therapy with low doses of isotretinoin. Cumulative dose of isotretinoin for persistent clinical remission was 46.4 mg/kg of weight, 17.6 mg/kg, 12.6 mg/kg respectively. Difficulties related to the subjective perception of patients of his condition has limited the possibility of increasing daily dose of isotretinoin, and the lack of result from the previous therapy with basic medications has made isotretinoin a drug of choice.

Successful treatment of onychomycosis associated with the necessity of microbiological research aimed at the selection of culture with proven etiological significance. Features of morphological and functional characteristics of the nail, poly etiology of onychomycosis, the availability of labor input in the use of topical antifungal drugs and irrational approaches to the treatment of various forms of the disease, as well as the duration and high cost of treatment create difficulties in the treatment of this contingent of patients . Goal. To study the etiology of onychomycosis in the Krasnodar region, and a comparative analysis of the efficacy and tolerability of antifungal drug regimens "Irunine". Materials and methods. A total of 64 patients (39 men and 25 women) with complaints about the change of nail plates in the hands and feet. The diagnosis of onychomycosis was established for 46 (71.88%) patients, of which 2 patients in the study group were not included. The rest were randomly selected and divided into 2 equivalent groups of 22 patients. Patients of the 1st group received "Irunine" by the method of pulse - therapy, and the patients in group 2 on continuous therapy scheme. Results. In the study of the samples from the nail plates, the major causative agent of onychomycosis was T. rubrum - 61,37%. Candida spp. was diagnosed in 11%. Equally often - at 9.09%, were the growth of T. mentagrophytes var. interdigitale and T. tonsurans. Furthermore, associations have been identified T. rubrum and Candida albicans - 6,82%, T. rubrum and Aspergillus versicolor - 2,27%. The result of our study showed a high clinical and mycological efficacy of the drug "Irunine" in the treatment of onychomycosis. Comparative analysis of this drug therapy results showed that the method of pulse therapy, compared with continuous therapy scheme is more efficient and economically advantageous, since it allows to reduce the amount of drugs, and therefore significantly reduce the risk of adverse reactions and improve its tolerability. Conclusion. The findings suggest that the leading position in patients with onychomycosis mycobiota hold dermatomitsetami genus Trichophyton. Pulse therapy with "Irunine" is a priority and can be recommended for use as a systemic drug for the treatment of onychomycosis, as a highly effective and safe drug.

Objective. To assess the efficiency and tolerability of the Mardil Zinc Max, solution for external application, in topical therapy of patients with anogenital warts. Materials and methods. The study involved 58 women and 12 men at the age of 18 to 57 years old, suffering from anogenital warts. the diagnosis was confirmed by identification of human papillomavirus by the polymerase chain reaction in real time. All the patients were treated by the chemical destruction of anogenital warts with the 1.5% solution of zinc chloropropionate in 50% 2-chloropropionic acid (Mardil Zinc Max) by a single application of the solution on the pathological eruptions. The results of treatment were assessed in 2 weeks, in 1, 3, 6 and 9 months after the destructive therapy. Results. In 2 weeks 62 (88.6%) patients showed a clinical cure with complete tissue regeneration in the lesions, in 8 (11,4%) cases in areas of the preparation erosions were visualized in the epithelialization phase, and they completely resolved within 1 week. recurrences of anogenital warts were detected in 1 (1,4%) patient in the observation period up to 3 months and in 2 (2,8%) patients during 9 months after carrying out the destruction. Adverse drug events have not been identified in the course of therapy and follow-up. Conclusions. As a result of the treatment of anogenital warts with the Mardil Zinc Max high rate of performance and security was set (100%), as well as the low percentage (4,2%) of development of relapses.

The paper presents the results of the comparative analysis of dermatovenerologists service density within West-Siberian railway and territorial entities of Siberian Federal District of Russian Federation. To give an overall characteristic of dermatovenerological service at WSR, a complex assessment of occupied positions, number of individual persons, manning level and the portion of certificated doctors is used.

September 2016 marks 95 years since the foundation of Dermatology and Venereology Department in Perm State Medical University. This article provides information on its organization, formation and development, the brightest and the most outstanding representatives of the department, main directions of scientific, educational and therapeutic activities.