Vol 93, No 6 (2017)

The stages of the formation of a model for the organization of dermatovenereological care to the population of the Russian Federation during the period from 1917 to 2017 were analyzed.

The paper presents the analysis of the incidence and prevalence of skin disorders in general and of some skin diseases in Russian Federation in 2003–2016. Age-specific and federal district-specific profile of prevalence and incidence rates is also present.

The review of literature presents analysis of the current state of molecular biological methods for research of Mycobacterium leprae. The characteristics and feasibility of application of the methods in use for diagnostics and epidemiological monitoring of the leprosy pathogen are discussed, as well as identification of possible genetic determinants of antibiotic resistance. The present knowledge is provided of genetic characteristics of mycobacteria of the above type, which enable to lay the foundations for development of methods for leprosy diagnostics, as well as also for their significant improvement.

Objective: to reveal ultrasonic features of of epithelial, dermal and vascular benign skin formations. Materials and methods. An ultrasonic study of 50 acantholytic nevuses, 50 acrochordons and 30 hemangiomas, which have an unambiguous clinical and dermatoscopic pattern and do not require differential diagnosis, was carried out. For the comparative evaluation of ultrasonic thickness and density of skin the ratio of scan indices in the lesion area relative to the indices in the adjacent healthy area of the skin was introduced. Results. On the scans of acantholytic nevus the formations that rose above the skin surface, with a nonuniform thickened, hyperechoic epidermis were visualized, in which hypoechoic round-shaped patches occur. A hypoechoic acoustic shadow was determined under the epidermis. On the scans of acrochordons the formations on a narrow base, which were located above the skin surface were visualized. In the region of formations, a discontinuous contour of epidermis with predominantly hyperechogenic areas was determined. Within the formations, the structure of the dermis is heterogeneous with the alternation of normoechoic and hypoechoic areas. Beneath the formation an epidermis structurally similar to the healthy skin epidermis is determined on the level of skin surface under which hypoechoic zone is visualized, which is an acoustic shadow. On the scans of hemangiomas the formations were visualized that rose above the skin surface, with a distinct lateral delimitation from the surrounding tissues. In the area of formations, the epidermis is non-uniformly thickened than healthy skin, hyperechoic round-shaped areas are visualized. Non-uniformly hypoechoic irregulary-shaped regions were determined in the dermis. Conclusion. All examined formations differ from healthy skin by increasing the thickness of the epidermis and dermis, as well as strengthening the overall acoustic solidity of the epidermis and decreasing the acoustic solidity of the dermis. The introduction of the ratio into practice makes it possible to quantify these changes. Moreover, each formation has a peculiar ultrasonic characteristic, allowing the use of pattern analysis for differential diagnosis between epithelial, dermal and vascular forms of benign skin formations.

Objective: biometric analysis of melanoma cells derived from different types of primary or secondary tumors could be necessary for better understanding tumor heterogeneity as that phenomenon would affect significantly the anti-cancer therapy efficacy. Materials and Methods. A comparative analysis of melanoma cells that reflect different stages of tumor progression was accomplished with following parameters tested: intensity of apoptosis, proliferation/metabolic activity, the ratio of the cell cycle phases distribution, chromosomal constitution analysis, invasion, and migration capacity. Results. It was found that melanoma cells derived from visceral metastases characterized by a high proliferative/metabolic potential, migratory ability, and mitotic potential. Melanoma cells which represent earlier stages of carcinogenesis have higher invasive activity and percentage of polyploidy cells, indicating high mutational potential. Both cell lines have no differences in the expression of apoptosis. Conclusion. Melanoma cells derived from metastasis demonstrate various abilities for growth, migration, and invasion depending on metastasis origin. In that context, isolation of pathological cells and tissues, both native and fixed, followed by their individual testing for each patient will have a high demand for both fundamental and clinical medicine for more adequate therapy choice.

A case of belatedly diagnosed late cardiovascular syphilis that had continued progressing despite two courses of ceftriaxone therapy is described. The patient had a combination of all possible complications of syphilitic mesaortitis including aortic regurgitation, coronary insufficiency, as well as fusiform aneurysm of the ascending aorta and the proximal aortic arch. Current issues of diagnosis and therapy of late cardiovascular syphilis are discussed.

A case of tungiasis is presented — infestation with Tunga penetrans of a man who was on vacation in Peru, with eruptions localized on toes I and V of the both feet. For treatment of the patient, the parasites were surgically removed out of the lesions, whereupon the lesions were treated with antiseptics.

Objective: demonstration of the case of the leprosy late diagnosis at the female patient previously watched with the diagnosis «skin tuberculosis». Materials and Methods. A 69 years old female patient watched from 2011 to 2016 with the diagnosis «skin tuberculosis» and was cured with weak effect; in 2016 the diagnosis «skin tuberculosis» was not confirmed. She undergone assessment at the State Research Centre for Dermatovenereology and Cosmetology of the Ministry of Health of the Russian Federation. The assessment included bacterioscopy of skin scrapings, pathomorphological studies of biopsy samples, molecular genetic testing. Results. On the grounds of complaints, medical history, data of surveying and physical examination, results of the clinical-laboratory studies the following diagnosis was stated: «dimorphous leprosy, leprosy BB (multibacillary leprosy, border line leprosy, active stage). Conclusion. The present observation indicates that the variety of leprosy clinical presentations and lack of suspicions on account of this ultra-rare disease lead to late diagnosis.

The authors present an overview of the present day knowledge of methods of biological therapy used for treatment of severe psoriasis at an early age. Data is presented on efficiency, safety, required monitoring of clinical and laboratory performance, specifics of vaccination during the treatment of children with genetically engineered biological drugs. Data is presented on the authors’ own clinical observations of 10 adolescents who were administered the preparation of ustekinumab. The objective of the observational study was assessment of efficiency and safety of application of ustekinumab for treatment of severe psoriasis with children over 12 years of age. Materials and Methods. The observation covered 10 children, their average age being 15±2.8 years old, the PASI index 39.3±9.5, who were administered ustekinumab at a dose of 45 mg under a standard administration regimen. Results. The therapeutic effect was assessed based on the PASI index, which was found to decrease by 75% with 6 adolescents, and by 90% with 4 adolescents as soon as by week 14 of the therapy. As is shown by the follow-up observation, the skin pathological process was completely resolved with 80% of adolescents after 3 injections of ustekinumab, and with 100% after 4 injections. Conclusion. The preparation of ustekinumab is efficient and safe for treatment of psoriasis at an early age. As based on the PASI index as the main criterion of assessment of treatment efficiency, ustekinumab (Stelara) is the medicine of choice for treatment of severe forms of the disease from the age of 12 years old.