Vol 95, No 5 (2019)

Paraneoplastic pemphigus (PNP) is one of the least investigated and rare forms of bullous dermatoses, which comes from underlying neoplasm. The article presents a literature review of dermatologist`s longstanding international experience about etiology, pathogenesis, diagnostics and treatment of this disease. According to the research results of native and foreign authors systematization of modern diagnostic methods of PNP and detectable antigens was performed.

Conflict of interest: the authors state that there is no potential conflict of interest requiring disclosure in this article.

Psoriasis is a chronic immune-mediated inflammatory disease with predominant damage to the skin and joints. Despite fundamental studies of its pathogenesis, the cause of the development of the T-cell response has not been determined. More recently, a new concept has been proposed for the formation of psoriatic inflammation, where a significant role in the pathogenesis is assigned to melanocytes. Evaluation of the content of these cells and their relationship with other participants of inflammation will allow expanding the understanding of the pathogenesis of psoriasis and the targets of targeted therapy.

Aim: study of the quantity, distribution and proliferative activity of melanocytes.

Materials and methods. The study included 20 patients with plaque psoriasis: men — 18 (90 %), women — 2 (10 %). The severity of the disease was assessed by the index of the area and severity of PASI psoriatic lesions. In the histological specimens, the thickness of the epidermis, the length of the basement membrane in the visual field, and pathological changes in the epidermis and dermis were determined. For immunohistochemical detection of melanocytes, the MelanA marker was used, the cell proliferative activity was Ki67, and the cytotoxic T-lymphocytes, CD8. Used a dual visualization system. Differences were considered significant at p < 0.05.

Results. The number of MelanA⁺  cells in the affected skin of patients with psoriasis — 54 (44–64)/1.4 mm2 was 2.4 times higher than in unaffected skin — 24 (22–30)/1.4 mm² (p < 0.05), and 2 times higher than in the skin of healthy individuals — 27 (25–32)/1.4 mm² (p < 0.05). The content of MelanA⁺ cells per 1 mm of the basement membrane in patients with psoriasis in the affected skin is 11 [7–13] cells/mm, unaffected — 12 [11–14] cells/mm and in healthy individuals — 12 [9–13] cells/mm did not significantly differ (p > 0.05). In the affected skin of patients with psoriasis, multiple contacts of CD8⁺ and MelanA⁺ cells were detected — 10 [8–13]/1.4 mm².

Conclusions. In the affected skin of patients with psoriasis, the absolute number of melanocytes is significantly higher than in unaffected skin and the skin of healthy individuals, while the ratio of melanocytes to basal keratinocytes did not differ. In the skin of all the studied groups, no melanocytes in the proliferation stage were detected. Multiple contacts of MelanA⁺ and CD8⁺ cells are observed in the affected skin of patients with psoriasis.

Conflict of interest: the authors state that there is no potential conflict of interest requiring disclosure in this article.

Erythroderma is a condition damaging at least 80–90 % of the skin surface, characterized by erythema and peeling. This condition may be a manifestation of various diseases of the skin and internal organs, including malignant lymphoproliferative disorders. Sézary syndrome and the erythrodermic variant of mycosis fungoides are aggressive forms of cutaneous T-cell skin lymphoma, the diagnostics of which is challenging due to the similar clinical pictures of these diseases with benign dermatoses. This article presents two clinical cases of erythroderma in the setting of cutaneous T-cell lymphoma. An analysis of the anamnestic data, the clinical picture and the results of laboratory examinations in patients suffering from this condition allowed the diagnosis of Sézary syndrome to be confirmed. The presented cases reflect the importance of identifying the causes of erythroderma.

Conflict of interest: the authors state that there is no potential conflict of interest requiring disclosure in this article.

Tumor necrosis factor alpha (TNF-α) is one of the key inflammatory cytokines in the pathogenesis of psoriasis and psoriatic arthritis, and its inhibition with genetically engineered biological drugs ensures control of the main symptoms of these diseases. Certolizumab pegol is a PEGylated (linked to polyethylene glycol) Fab’ fragment of a monoclonal antibody that inhibits human TNF-α. It is approved for treatment of moderate to severe plaque psoriasis and psoriatic arthritis. This review summarizes the results of randomized clinical trials of efficacy and safety of certolizumab pegol in plaque psoriasis (CIMPASI 1, CIMPASI 2, and CIMPACT) and psoriatic arthritis (Rapid-PsA). The represented data demonstrate high efficacy of certolizumab pegol is bio-naïve patients and in patients previously exposed to other TNF inhibitors or IL17 inhibitors. The absence of the Fc-fragment in certolizumab pegol ensures minimal to no placental transfer of the drug and enables its usage during the entire pregnancy.

Conflict of interest: the authors state that there is no potential conflict of interest requiring disclosure in this article.

We describe three patients with a rare form rosacea-like chronic lupus erythematosus which at the beginning is diagnosed as rosacea due to similarity clinical picture. Literature data of clinical features, epidemiology, сlassification and treatment are presented.

Conflict of interest: the authors state that there is no potential conflict of interest requiring disclosure in this article.