Vol 94, No 5 (2018)

This article analyses the epidemiological situation concerned with sexually transmitted infections and dermatoses, as well as the dynamics of syphilis incidence, incidence of syphilis among migrants, incidence of dermatoses in the Russian Federation during the 2013-2017 period.

This review paper discusses the systemic character of psoriasis. For medical specialists, it is of crucial importance to understand that psoriasis is not exclusively a skin disease; rather, it is pathogenetically connected with the development of a number of comorbid conditions. This fact has a practical significance in terms of choosing therapeutic strategies for managing patients with medium and severe dermatoses characterized by relapses and comorbid conditions. The long-term use of systemic medications in such cases, including genetically engineered biological ones, seems to be theoretically reasonable, since it facilitates control over the main clinical manifestations of the disease.

This paper presents information on the innovative Russian drug — BCD-085-inhibitor IL17 — and its effects on the key stages of psoriasis immunopathogenesis. The efficacy and safety of this drug for patients with moderate and severe psoriasis are discussed.

BCD-085 is found to exhibit a fast and high therapeutic response in terms of the PASI75, PASI90, PASI100 and sPGA indexes during the first 12 weeks of therapy. According to the available data, BCD-085 is characterized by a favourable safety profile and the absence of immunogenicity from the clinical standpoint.

Multiple seborrheic keratosis (SK), especially when there is overexpression of the epidermal growth factor receptor (EGFR), is considered paraneoplastic dermatosis, but it is almost always associated with multiple fibroepithelial polyps (PF) and pseudoacanthosis, skin diseases in which the leading role is played by insulin resistance and type 2 diabetes mellitus. The study examines the possibility of the effect of disorders of carbohydrate metabolism on the clinical picture of multiple SK and the expression of EGFR.

Aims. To study the clinical features of multiple SC and the expression of EGFR in patients, depending on the presence of concomitant type 2 diabetes mellitus.

Materials and methods. There were 65 patients with multiple SK at the age from 55 to 77 years, including women (44) and men (21). All the patients were examined skin, consultation of the endocrinologist. For a histological and immunohis-tochemical study (IHC), a single SK was surgically excised in each patient. IHC-reactions were carried out with monoclonal antibodies to EGFR. The result was assessed by the number of stained cytoplasmic membranes of tumor cells.

Results. In 81.5 % of cases, multiple SK was associated in patients with type 2 diabetes mellitus. The location of the SK was also characteristic mainly in large folds of the skin, in contrast to patients without disorders of carbohydrate metabolism, in which the SK were located mainly on the lateral surfaces of the trunk and abdomen, without affecting the large folds of the skin. Multiple PF were also characteristic of individuals with type 2 diabetes mellitus. In IHC studies EGFR expression was detected in 100 % of cases in individuals with multiple SC and type 2 diabetes mellitus in over 30 % of tumor cells, and only in 16.7 % of cases in individuals with multiple SK without violations of carbohydrate metabolism.

Conclusions. The presence of multiple SK in patients, in combination with multiple PFs with characteristic tumor localization in large folds of the skin, serves as a diagnostic marker of carbohydrate metabolism disorders or predispositions to the development of type 2 diabetes. Increased expression of EGFR plays a leading role in the pathogenesis of multiple SK, stimulating the proliferation and growth of SK, in turn, as a consequence of impairment of insulin signaling pathways and insulin resistance.

An extremely rare case of sinus histiocytosis of the non-Langerhans cell histiocytoses type is described in 55-year-old patient with isolated localization of cutanious lesion on the right cheek without involvement of nodular structures. Main skin lesion was an erythematous-cyanotic node with multiple milia-like lesions on the top of it. Histologically revealed feature was a large number of plasma cells, besides phenomenon of emperipolesis was described, which was first falsely perceived by pathologists as phagocytosis. In immu-nohistochemistry assay the changes were characterized by proliferation of large polygonal histiocytes with accumulation of pentalamellar markers in its cytoplasm (protein S-100, CD68).

Background. Rhinophyma is considered to be the most severe stage of rosacea, associated with the proliferation of the nose skin epithelium, hyperproduction of the sebaceous glands and telangiectasia.

The treatment of rhinophyma remains a difficult task. One of the problems associated with rhinophyma is thickened and lumpy skin, penetrated with telangiectasias. The use of laser radiation in the treatment of rhinophyma seems to be promising, since this method allows blood vessels to be selectively heated.

For the first time, we describe the treatment of rhinophyma using a copper vapour laser (CVL) equipped with a computerized scanner.

Patient description. A 63-year-old male with Fitzpatrick skin type II was treated using an CVL (‘Yakhroma-med' model, RaS P. N. Lebedev Physical Institute). The clinical manifestations of the disease were typical of the phymatous or hypertrophic rhinophyma type, including significant thickening of the tissues and an uneven roughness of the skin surface. The treatment was carried out using a radiation wavelength of 578 nm, exposure duration of 0.2 s and energy exposure (fluence) of 15-30 J/cm². Operational parameters used for the CVL in the scanner mode were the average power of 0.6-1.2 W and the focusing size of the light spot on the skin of 0.6 mm. The hexagonal mode of the scanning head was used with a maximum size of 12 mm and 1 mm distance between the centres of the laser spots. The treatment resulted in the restoration of the natural nose shape without redness. No side effects were noted.

Conclusion: CVL radiation provided a selective photodisruption of the vessels with increased diameter.

Due to the remodelling of the vasculature, the described method showed excellent results in the treatment of rhinophyma without side effects.

Psoriasis is a chronic immune-mediated inflammatory skin disease with possible damage to the musculoskeletal system, affecting 2-3 % of the adult population of the planet. To date, special attention in the treatment of psoriasis is paid to the comorbid background, since it is known that it can aggravate the course of psoriasis and affect the effectiveness of therapy. The purpose of psoriasis therapy is to achieve clean or almost clean skin, sustainable improvement of psoriatic arthritis, improving the quality of life, all this became possible with the advent of genetically engineered biological drugs. However, in the treatment of genetically engineered biological drugs there are “pain points”: primary inefficiency, “the effect of slipping”, the scheme of transition from one drug to another, the safety of the combined use of GIBP and system-based drugs, interruption of therapy.

Objective. To study the therapeutic efficacy of ustekinumab in psoriasis patients with forced interruption of treatment, taking into account metabolic disorders.

Materials and methods. 52 patients with a diagnosis of plaque psoriasis receiving ustekinumab for 3 years were under observation, which were divided into 2 groups, depending on body weight and metabolic disorders.

Results. More than 80 % of patients taking the drug at a dosage of 45 mg, and at a dosage of 90 mg, to week 12 therapy reached PASI 75. By week 24, the proportion of patients in group I who reached PASI 75 was 96.3 %, in group II — 88.0 %.

By week 48 PASI 75 reached 90.4 % patients: in group I — 100 % patients, in group II — 80.0 % patients.

At 76 weeks, patients were interrupted ustekinumab treatment in connection with the purchase of the drug. The duration of treatment interruption ranged 36 weeks. By week 112, 86.5 % patients in both groups had a relapse of psoriasis, which was assessed by the loss of the therapeutic response of PASI 75.

By week 124 (12 weeks after the resumption of therapy) 82.7 % patients reached PASI 75: in group I — 92.6 % patients, in group II — 72.0 % patients.

After 16 weeks (week 128), all patients 100 % achieved PASI 75 IN group I. In group II to week 128 PASI 75 was observed in 80 % patients.

Conclusion. With the resumption of treatment of patients with psoriasis with ustekinumab after a long interruption, there is a rapid and complete restoration of therapeutic effectiveness, however, in patients with psoriasis with metabolic disorders, there is a decrease in efficiency after the resumption of therapy in comparison with patients without abdominal obesity, which can determine the further strategy and tactics of management of such patients.