Vol 96, No 3 (2020)

Psoriasis is one of the most frequent chronic inflammatory skin diseases and it has been of interest to many scientists for ages. The review presents data on all systemic treatment options, that are to date officially registered in Russian Federation for moderate-to-severe psoriasis. Aspects of the mechanism of action, efficacy and tolerability of both basic drugs (methotrexate, cyclosporine, acitretin) and biologics (infliximab, adalimumab, etanercept, certolizumab pegol, ustekinumab, guselkumab, secukinumab, ixekizumab, netakimab) and small molecules (tofacitinib, apremilast) are considered in detail. Special emphasis is placed on the important nuances of biological therapy: immunogenicity, drugs' survival and switch due to lack of efficacy. Invention of biologics signified a new era of moderate-to-severe psoriasis treatment. It became possible to achieve complete clinical remission more safely, which significantly improved the quality of life of patients. However, due to the unknown etiology of psoriasis, there is still no universal remedy that would allow to cure every patient, this fact makes scientists from all over the world keep conducting numerous clinical trials to find even more effective and safe therapeutic options.

Purpose. Development and validation of the severity index of lichen planus (LP).

Materials and methods. At the first stage, by means of theoretical substantiation, the main parameters and signs were identified that affect the severity of the disease and the quality of life of patients, which culminated in the derivation of the final index formula, which was called the lichen area and severity index (LPASI). At the second stage, LPASI was validated during the examination of 45 LP patients who were treated in the clinic of skin and venereal diseases of the Military Medical Academy in 2018—2019. Determination of LPASI was carried out by five dermatovenerologists independently of each other twice with an interval of one week.

The analysis of the results was carried out using STATISTICA 10.0 programs and SPSS Statistics 17.0. The Spearman — Brown and Pearson correlation coefficients were used to evaluate the intra-expert and inter-expert reliability of the index, and the Cronbach's alpha coefficient was calculated to assess the internal consistency of the scale.

Results. The final formula for calculating LPASI is as follows: 0.2 × A + 2 × B + 5 × С + D, where A is the area of skin lesions in percentage, B is the severity of clinical manifestations on the skin, C is the severity of clinical manifestations on the oral mucosa and D is the severity of subjective sensations. The index can range from 0 to 82.

The LPASI values for the whole group (n = 45) were characterized by a normal distribution of the trait (p > 0.05), the minimum and maximum values varied from 7.2 to 42 points, the median was 22 points, the interquartile span from 14 to 27 points. The values of the Spearman — Brown and Pearson coefficients were equal to 0.91 (95% CI — 0.89—0.99) and 0,87 (95% CI — 0.86—0.93), which indicates the reproducibility of the results and the reliability of the index. In this case, a high consistency between the selected features within the scale (Cronbach's alpha criterion — 0.93) was established.

Conclusion. Objectification of the severity of the disease using LPASI should become an integral part of the clinical examination of patients. The use of LPASI will allow to control the effectiveness of prescribed therapy, as well as to compare the results of scientific research.

Introduction. Congenital melanocytic nevus (CMN) is detected at birth or shortly after birth in 1% of infants. The localization of CMN in aesthetically significant areas causes a decline in child self-esteem and causes concern for his parents. Surgical excision of skin areas with CMN is associated with an increased risk of cosmetic side effects and is often followed by long-term stress conditions after the invasive intervention.

Aim of the study. To evaluate the efficacy of the CMN removal in infants, children and adolescents with the dual-wavelengths copper vapor laser (CVL) radiation.

Patients and Methods. Medium-sized (up to 9 cm) single CMN was treated in nine fair-skinned patients: seven girls and two boys, aged from 2 months to 16 years. The procedures were carried out at an average CVL power of 0.6—1.0 W, with a power ratio of 3:2 at 511 nm and 578 nm wavelengths, and an exposure time of 0.2—0.3 s. Light spot diameter — 1 mm. The treatment was carried out during 2—10 sessions with an interval of 1—2 months between sessions.

Results. In children and adolescents, the treatment of CMN with CVL dual-wavelengths radiation made it possible to achieve significant clarification of the involved area without hypertrophic scars. The duration of the healing of the irradiated area lasted 2—3 weeks. Side effects were manifested with subtle skin atrophy.

Conclusion. The high efficacy of CVL removal of medium-sized CMN in infants and children using the dual-wavelengths CVL radiation without pronounced side effects allows introducing such an approach in the clinical practice of pediatric dermatologists and cosmetologists.

The article is of an overview nature, it outlines the current understanding of the pathophysiology of acne, provides data on the role of retinoids in the treatment of dermatosis, discusses the advantages of combination therapy and new technologies in the treatment of acne.

Purpose. To present a clinical case of Bloch — Sulzberger syndrome.

Material and methods. The examinations were performed to diagnose the disease: а visual examination of the skin, cytological analysis of the gallbladder fluid, general and biochemical blood tests, genetic research.

Results. During a visual examination of the skin, a differential diagnosis was made with infectious dermatitis, toxic-allergic dermatitis, epidermolysis bullosa and linear IgA-dependent dermatosis in children. Crucial in the diagnosis belonged to a genetic study, after which a deletion of exons 4—10 of the IKBKG gene was detected, which confirmed Bloch — Sulzberger syndrome.

Conclusion. Newborns with vesicle-bullous rashes entering the neonatal pathology department and observed by neonatologists require a thorough examination, a mandatory consultation of a dermatologist in order to determine further management tactics.