Vol 90, No 6 (2014)

State Research Center of Dermatovenereology and Cosmetology, Ministry of Healthcare of the Russian Federation Korolenko str., 3, bldg 6, Moscow, 107076, Russia Goal. To study potential molecular and genetic markers of an increased risk of development of malignant skin melanomas on the basis of the assessment of nucleotide replacements of genes in the excision system of DNA repair in psoriasis patients receiving a phototherapy. Materials and methods. Biological blood samples taken from 47 psoriasis patients, 24 patients with malignant skin melanomas and 20 healthy subjects. The following methods were used in the study: clinical, molecular and biological (DNA extraction, amplification, PcR, sequencing). Results. The study revealed molecular markers of an increased risk of development of malignant skin melanomas in psoriasis patients: CC genotype of the XPD gene at the 35931 locus (p = 0.00001); TC genotype of the XPF gene at the 27945 locus (p = 0.0067). It also revealed a molecular marker of an increased risk of development of malignant skin melanomas in healthy people: CC genotype of the XPD gene at the 35931 locus (p = 0.0042).

Goal. To assess the expression of neurotrophin, a nerve growth factor, amphiregulin, an epidermal growth factor, semaphorin 3A, a nerve repulsion factor, and PGP9.5 protein, a nerve fiber marker, in the skin of patients suffering from atopic dermatitis and psoriasis. Materials and methods. The study involved 30 patients suffering from atopic dermatitis and 30 patients suffering from psoriasis vulgaris. The disease severity was assessed by SCORAD and PASI. The extent of itching was assessed by the visual analogue scale. The expression of amphiregulin, semaphorin 3A (a nerve growth factor) and PGP9.5 protein (a nerve fiber marker) in the skin of patients was assessed by the indirect immunofluorescence method. Quantitative parameters of their expression were assessed by using the basic pack of the Olympus Fluoview software, Ver. 1.7b. Results. Increased epidermal innervation was revealed in the patients suffering from atopic dermatitis and psoriasis, which demonstrates an increased skin production of anti-inflammatory neuropeptides and reduced itching sensitivity threshold. A positive correlation between the itching extent and skin expression of neurotrophin (a nerve growth factor) was revealed in the patients with atopic dermatitis. In patients with severe psoriasis, an increased skin expression of amphiregulin, an epidermal growth factor, was discovered. Conclusion. These data demonstrate a pathogenic value of neurotrophin, a nerve growth factor, for the development of itching in patients with atopic dermatitis and amphiregulin in case of psoriasis vulgaris.

Goal of the study. To study the sensitivity of N. gonorrhoeae strains found in the territory of the Russian Federation in 2010- 2013 to antimicrobial drugs. Materials and methods. During the monitoring of antibiotic resistance of N. gonorrhoeae in 2010-2013, phenotypic properties of N. gonorrhoeae strains to antimicrobial drugs (penicillin, tetracycline, ciprofloxacin, spectinomycin, azithromycin and ceftriaxone) were examined by the agar serial dilution technique. As many as 1,305 viable N. gonorrhoeae strains from different regions of the russian Federation were examined. The results were evaluated according to the criteria such as CLSI (Clinical and Laboratory Standards Institution) and EUCAST (European Committee for Antimicrobial Susceptibility Testing). The results were processed by using the WHONET software, version 5.4. Results. According to the results of a study of N. gonorrhoeae antibiotic resistance, N. gonorrhoeae is highly resistant to penicillin (in 2010 - 72.4%, in 2011 - 50.6%, in 2012 - 51.2%, in 2013 - 49.3%), to tetracycline (in 2010 - 68.5%, in 2011 - 55%, in 2012 - 61.9%, in 2013 - 49.3%) and ciprofloxacin (in 2010 - 56.2%, in 2011 - 37.1%, in 2012 - 35%, in 2013 - 24.6%) for the entire observation period without any substantial trend towards its reduction. During studies of the resistance of the gonococcal infection pathogen to spectinomycin, the share of non-sensitive strains to the antibiotic reduced from 16.7% in 2010 to 0.7% in 2013. A slight reduction in the share of non-sensitive N. gonorrhoeae strains to azithromycin was also observed (in 2010 - 15.3%, in 2011 - 25.3%, in 2012 - 17.5%, in 2013 - 9.9%) yet these data substantially exceed the level recommended by the WHO for prescribing an antimicrobial therapy. A high level of N. gonorrhoeae sensitivity to ceftriaxone (100%) was revealed in 2010-2013. Conclusions. According to the analysis of resistance of N. gonorrhoeae strains to antimicrobial drugs found in the territory of the russian Federation in 2010-2013, there is a trend towards the reduction in the number of non-sensitive N. gonorrhoeae strains to penicillin, tetracycline, ciprofloxacin, spectinomycin and azithromycin, which can confirm the efficacy of the Neisseria gonorrhoeae antibiotic resistance monitoring measures taken by State research Center of Dermatovenereology and Cosmetology since 2002.

Goal of the study. To study genetic variability of M. hominis (based on the vaa gene) and M. genitalium (based on the mg192 gene) derived from biological material samples taken from women with different clinical manifestations of inflammatory diseases of the urogenital system and clinically healthy women (for M. hominis). Materials and methods. Genetic variability of twenty M. hominis samples taken from patients with inflammatory diseases of the urogenital system and twenty M. hominis samples taken from patients without clinical and laboratory signs of inflammatory processes of the urogenital system was studied by the sequence analysis method. Genetic variability of eight M. genitalium samples taken from patients with different clinical signs of inflammatory diseases of the urogenital system was also examined by the sequence analysis method. Results. Three genetic variants of M. hominis based on the vaa gene were found; variant I was revealed more often in patients with clinical manifestations of inflammatory diseases (65.0%), and variant II - in clinically healthy women (60.0%). Three phylogenetic M. gentium groups based on the mg192 gene were revealed; two samples were referred to Groups I and II, and four samples were referred to Group III. Samples from each phylogenetic groups were taken from patients with clinical and laboratory manifestations of cervicitis and urethritis. Conclusion. The study data demonstrate a potential effect of the VAA surface protein on the virulence of opportunistic M. hominis pathogens.

Lichen planus is a disease characterized by a large variety of clinical forms and morphological patterns. Localized rash on the palms and soles is considered rare and may create certain problems in diagnosis if it is present as an isolated finding in the absence of typical papular rash on the skin and mucous membranes, and such problems may be solved by histological examination. We report a case of a 41-year-old male with palmoplantar lichen planus. The disease was characterized by pruritic erythematous well-defined plaques dotted wit h multiple, punctate brown keratotic plugs on the palms and soles, which were difficult to separate when scraping. Histological examination revealed changes in the excretory ducts of eccrine sweat glands. We suggest that the presented case is a unique clinicopathologic variant of palmoplantar lichen planus that may be designated by the term “lichen planoporitis.”

Goal. To study clinical manifestations and frequency of skin photodamage symptoms in psoriasis patients receiving a longterm multi-course phototherapy. Materials and methods. The study involved 106 patients suffering from psoriasis vulgaris and receiving a multi-course treatment by methods of the PUVA therapy, broadband medium-wave UV therapy and narrowband phototherapy with the wavelength of 311 nm. The average number of courses was 7 while the average number of treatment sessions was 141. Depending on the number of treatment sessions, the patients were divided into three groups: Group 1 (n = 33) - patients that received 50-100 phototherapy sessions, Group 2 (n = 58) - patients that received 101-200 treatment sessions, and Group 3 (n = 15) - patients that received over 200 treatment sessions. The control group comprised 20 psoriasis patients that did not receive any phototherapy before. Major results. The comparative analysis of the entire group of patients receiving a phototherapy revealed a statistically significant incidence of lentigo/sunspots, diffuse skin hyperpigmentation and actinic elastosis vs. the control group. The frequency of clinical manifestations characteristic of the skin photodamage grew as the number of treatment sessions increased. All of the symptoms except for guttate hypomelanosis and venous lakes demonstrated statistically significant dynamics. Conclusion. There is a dose-dependant increase in the frequency of skin photodamage symptoms in patients suffering from psoriasis vulgaris and receiving a long-term multi-course phototherapy.

Goal. To evaluate the efficacy and safety of combined treatment with methotrexate and a broadband medium-wave phototherapy for psoriasis patients. Materials and methods. As many as 365 psoriasis patients underwent examination and treatment. The patients were divided into three groups by the treatment method. The first group of patients received a broadband medium-wave phototherapy, the second group received treatment with methotrexate, and the third group received combined treatment with methotrexate and a broadband medium-wave phototherapy. Results. Combined treatment with a broadband medium-wave phototherapy and methotrexate turned out to be more efficient than a monotherapy with methotrexate or a broadband medium-wave phototherapy. The administration of a combined therapy enhances the efficacy of treatment for psoriasis patients due to the reduction of cumulative doses of ultraviolet irradiation and methotrexate. In addition, it was revealed that a broadband medium-wave phototherapy does not enhance typical side effects observed during the treatment with methotrexate.

Topical photodynamic therapy has become an established therapy option for superficial non-melanoma skin cancers with a substantial evidence base. In this update the increased choice in photosensitizers and light sources are reviewed as well as novel protocols to move beyond lesional treatment and address field therapy. Daylight PDT is emerging as an alternative to conventional office/hospital-based PDT that offers the advantage of much reduced pain. Although most studies have assessed efficacy of PDT in immune-competent patients, there is accumulating evidence for topical PDT being considered an option to assist in reducing the skin cancer burden in organ transplant recipients. The fluorescence associated with photosensitizer application can help delineate lesions prior to full treatment illumination and offers a useful adjunct to treatment in patients where diagnostic uncertainty or poor lesion outline complicates clinical care. PDT may also offer significant benefit in delaying/preventing new cancer development and combined with its recognized photo-rejuvenating effects, is emerging as an effective therapy capable of clearing certain superficial skin cancers, potentially preventing new lesions as well as facilitating photo-rejuvenating effects in treated areas.

This literature review examines the role of neurotrophins and neuropeptides for the development of skin inflammatory reactions in case of chronic inflammatory dermatoses. The article describes inflammatory effects of neurotrophin, a nerve growth factor, neuropeptide substance P and calcitonin gene-related peptide. Factors affecting the condition of skin innervation and development of inflammation - neurotrophin, a nerve growth factor, amphiregulin, an epidermal growth factor, and semaphorin 3A, a nerve repulsion factor - were examined. Searching for and administering antagonists of proinflammatory effects of neuropeptides, neurotrophins and epidermal growth factor can become new approaches to the treatment of chronic inflammatory dermatoses.

The goal of the study. Evaluating of the effectiveness of treatment of men with a diagnosis «Seborrheic dermatitis of the scalp» by the system using of retinol palmitate. Material and methods. 36 patients every day for 2 months received overnight per os 200000 ME of retinol palmitate, and in the comparison group (39 people) antiseborrheic shampoos have been used. The dynamics of severity of skin oiliness, pruritis, erythema, peeling, infiltration, excoriations has been evaluated in points. Before and after the treatment a histological and morphometric study of biopsy material from the affected areas has been carried.The terms of relapses have been set. Results. Retinol palmitate treatment efficiency - 91.7%, antiseborrheic shampoos - 84.6%. Along with the regression of symptoms of the disease in both groups after retinol palmitate treatment significantly declined oiliness of skin; the sizes of sebaceous glands acini and the presence of differentiated sebocytes, the squares of lymphocytic-macrophage clusters in the dermis, the number of keratinocytes with vacuolated cytoplasm have been reduced. Relapses of the disease during a year occured more rare - in 21 patients out of 32 (in the comparison group- in 25 out of 31) and at a later date (in the first 3 months in 2 patients out of 32, in comparison group in 10 out of 31). Identified effects were due to the action of retinol palmitate on the morphogenesis of the sebaceous glands.

Goal. To assess the efficacy and safety of Azelic (15% gel of azelaic acid for topical administration) for the treatment of chloasma in pregnant women. Materials and methods. The study involved 28 pregnant women aged 18-36 (mean age: 24.7) with a normal course of pregnancy. The patients consulted a doctor in the spring, summer or fall complaining of focal skin hyperpigmentation on the face, chin and chest area. Ten patients (35.7%) developed hyperpigmentation prior to their pregnancy and 18 women (64.3%) - during the pregnancy. As of the consultation date, the pregnancy terms in all of the patients were 18-20 weeks. Chloasma was diagnosed by using dermatoscopy and skin examination with the Wood’s lamp. The patients were informed about the content and procedure of the study and gave their consent to take part in the study. Thin layers of Azelic (15% gel of azelaic acid for topical administration) were applied to the hyperpigmented skin of the patients and gently rubbed twice a day (in the morning and evening) as topical treatment for four months. The treatment results were assessed taking into consideration the patient’s subjective assessment, study group structure depending on the clinical efficacy, percentage of adverse events, and survey results based on the Dermatology Life Quality Index questionnaire. To reveal any potential general toxicological effects of the treatment, hepatic samples, total blood count and coagulogram results were analyzed as a part of obstetrical and gynecologic care for pregnant women. Key findings. Positive dynamics of the following characteristics was revealed: subjective assessment of treatment results by the patients, clinical efficacy of treatment and life quality index. Therapeutic results were observed as early as after one month but not later than three months after the treatment began. The therapeutic efficacy was recorded in 92.9-96.4% of all cases after four months of treatment: pigment spots disappeared or became paler, and their dimensions and their contrast as compared to the healthy skin reduced, the skin texture and life quality improved (the Dermatology Life Quality Index reduced from 15.5 ± 1.8 to 6.7 ± 0.5 points against the background of the treatment efficacy: from severe to moderate impact of the disease on the patient’s life, respectively). Five women (17.9%) developed erythema and burning sensations in the drug application site within the first two weeks immediately after the gel application (one of the patients had the same symptoms for six weeks of the treatment); the symptoms were weak and transient and did not require any additional treatment. Hepatic samples, total blood count and coagulogram results were within physiological standards during the treatment. Conclusion. Topical application of Azelic (15% gel of azelaic acid for topical administration) twice a day for four months is an efficient and safe method to treat chloasma in pregnant women.

The article presents a life story of a great French dermatologist and venereologist, one of the founders of the theory of syphilis Jean-Alfred Fournier (1832-1914). It provides data on the published works by Jean-Alfred Fournier, some of which earned him a doctoral degree. It also provides data on Fournier’s election as a member of the French Academy of Medicine in 1879 as well as on the founding of the French Society of Dermatology and Syphiligraphy by Fournier and other French dermatologists in 1889. The article defines the contribution made by Fournier to the development of venereology and practical medicine in the second half of the 19th century and early 20th century.