Vol 97, No 2 (2021)

Revisiting the question of pemphigus classification
Samtsov A.V., Sokolovskiy E.V., Teplyuk N.P., Belousova I.E., Kokhan M.M., Matushevskaya E.V.

Analysis of various classifications of pemphigus shows that there are no fundamental differences between them. The main distinctions consist in use of diverse terms in naming of some forms of pemphigus and in inclusion or exclusion of certain subtypes from the classifications. Authors propose to use the following classification in the dermatological clinical practice, for educational and scientific purposes and for clinical guidelines: 1) pemphigus vulgaris (1.1. Pemphigu s vegetans); 2) pemphigus foliaceus (2.1. Pemphigus endemic (Fogo selvagem), 2.2. Pemphigus erythematosus (Senear — Usher)); 3) herpetiform pemphigus; 4) paraneoplastic pemphigus; 5) IgA pemphigus (5.1. Subcorneal pustular dermatosis, 5.2. Intraepidermal neutrophilic dermatosis).

Vestnik dermatologii i venerologii. 2021;97(2):9-15
The role of endothelial damage and dyslipidemia in the development of cardiovascular pathology in psoriatic arthritis
Khismatullina Z.R., Koreshkova K.M.

An increased risk of cardiovascular events has now been identified in patients with psoriatic arthritis. The chronic immune-mediated inflammation underlying psoriatic arthritis (PA) leads to the development of dyslipidemia, atherosclerosis and its complications, in particular, a high risk of cardiovascular complications. For PA, dyslipidemias are most characteristic, manifested by an increased level of low and very low density lipoproteins, triglycerides and total cholesterol, which correlates with the activity of the disease. The literature review studied the pathogenesis of dyslipidemias and vascular wall lesions in psoriatic arthritis, analyzed the literature on cardiovascular complications and mortality among patients with PA, studied the issues of total cardiovascular risk, presented the results of numerous clinical studies that allow PA to be considered a disease associated with increased the risk of cardiovascular complications. Considering the role of proinflammatory cytokines in the pathogenesis of psoriatic arthritis, early detection of endothelial lesions represents the most promising direction in the prevention of cardiovascular diseases, which are the main cause of mortality in this group of patients.

Vestnik dermatologii i venerologii. 2021;97(2):16-22
Ceftriaxone treatment of syphilis
Katunin G.L., Plakhova X.I., Abuduev N.K., Vasiliev M.M.

The article presents literature data on the use of antibacterial drugs for the treatment of patients with syphilis, where the main focus is on ceftriaxone. Based on the materials of national and foreign studies, data on the effectiveness of ceftriaxone in the treatment of patients with various forms of syphilis have been analyzed, and information characterizing the pharmacological and pharmacokinetic features of ceftriaxone has been presented. Based on the scientific and clinical experience accumulated over previous years, both in Russia and abroad, some results of the use of ceftriaxone in the treatment of syphilis have been summed up. To search for the necessary literature, the PubMed, MedLine, Web of Science and RSCI databases were used.

Vestnik dermatologii i venerologii. 2021;97(2):23-31
DERMATOLOGY: Original Studies
Features of the cytokine profile and the effectiveness of radical treatment of focal infection in patients with psoriasis
Patrushev A.V., Samtsov A.V., Soukharev A.V.

Background. Focal infection (FI) are important trigger factors for the development of psoriasis, which means they can aggravate the course of dermatosis, including due to an increase in certain pro-inflammatory cytokines in the blood.

Aim. To study the cytokine profile of patients with psoriasis in the progressive period of the disease, as well as to assess the effect radical treatment of focal infection on the course of dermatosis.

Material and methods. Prospective comparative non-randomized study included 52 patients with psoriasis vulgaris, aged 18 to 65 years, who signed a informed consent. The first group consisted of patients who underwent radical treatment FI (16 people), the second — those who did not treat FI (16 people), and the third group consisted of patients in whom FI was not detected (20 people).

Cytokine concentrations were measured in the progressive stage of the disease in 52 patients with psoriasis and 20 individuals in the control group (healthy individuals).The spectrum of detected cytokines included: IL-1â, IL-2, IL-4, IL-6, IL-8, IL-10, IL-17A, as well as INF-á and INF-ã. For the detection of all cytokines, except for IL-17A, reagents from Vector-Best, Russia were used. The Human ELISA MAX ™ Deluxe Set (BioLegend, USA) was used to determine the concentration of IL-17A.

During the main course of treatment (0, 2 and 4 weeks), as well as the follow-up of patients (12, 24 and 52 weeks), the severity of psoriasis was assessed with the calculation of the PASI index. At the end of the study (week 52), the number of relapses and the total duration of remission were recorded.

Results. The level of IL-8 was increased in 90,6% of psoriasis patients with FI. In this case, significant differences were obtained in comparison with the group of patients with psoriasis without diagnosed FI and with the control group, in which an increase in the concentration of IL-8 was noted, respectively, in 65% and 30% of cases. A moderate positive correlation was found between the IL-8 level and the PASI index (rs = 0,48; p = 3,6 × 10–4). The levels of INF-á and IL-6 in psoriasis patients with FI were increased, respectively, in 15,6% and 21,9% of cases and significantly differed from the group of practically healthy individuals (p < 0,05), differences from the group of patients with psoriasis without FI was not identified. The concentration of TNF-á did not differ in all three groups. The level of IL-17A was significantly increased in comparison with practically healthy individuals both in the group of psoriasis patients with FI and in the group of patients without FI (Me = 3,3 and 4,3 pg/ml versus 0,2 pg/ml). The concentrations of five interleukin cytokines, namely IL-1â, IL-2, IL-4, IL-10 and INF-ã, did not exceed the upper limit of the reference range in all patients of the experimental (patients with psoriasis) and control groups.

Evaluation of the PASI index during the observation of patients in the first and second groups showed significantly lower values of this indicator for weeks 24 and 52 in the first group (0,2 vs. 7,0; p = 0,02 and 0,1 vs. 7,2; p = 0,002). The relative risk of disease recurrence in the absence of radical treatment for FI was 2,6 (CI 1,1 to 5,2).

Conclusion. Data were obtained showing the role of IL-8 and focal infection, with the presence of which its increased production is associated, in the worsening of the course of psoriasis with the frequent development of relapses. Important preventive measures leading to a decrease in the number of relapses of psoriasis are timely diagnosis and radical treatment of focal infection.

Vestnik dermatologii i venerologii. 2021;97(2):32-40
Treatment of pyogenic granuloma with copper vapor laser radiation
Ponomarev I.V., Shakina L.D., Topchiy S.B., Klyuchareva S.V., Pushkareva A.E.

Background. Pyogenic granuloma (PG) or lobular capillary hemangioma, ICD10 code: L98.0. appears as a single bright red or violet papule up to 20 mm in size, on the face, fingers, skull surface, arms, and intergluteal fold, as well as on the oral mucous membranes. Surgical removal of facial PG is not always possible due to insufficient thickness of the dermis. Treatment of PG with a pulsed dye laser (PDL) or neodymium laser (Nd:YAG) can achieve a noticeable elimination of the lesion but is reported to be accompanied by such side effects as purpura or scarring. It determines the feasibility of introducing into clinical practice the methods of laser treatment of PG using the radiation of a copper vapor laser (CVL) with a wavelength of 578 nm, which effectively absorbed by the blood.

Aim. The assessment of the clinical efficacy and safety of the CVL treating PG.

Methods. 26 adult patients with PG in various parts of the face, including the lips, limbs, and trunk, were included in this study. PG treatment was carried out in one session with CVL (Yakhroma-Med, FIAN) at an average power of 0.7–1.0 W, at a wavelength of 578 nm, exposure time — 0.2–0.3 s. The diameter of the light spot is 1 mm.

Results. Immediately after the single laser treatment, the PG involved area became grey. In 7–10 days, the irradiated area was utterly similar to the adjacent intact skin. No postoperative bleeding or infection was noted. Side effects included mild skin atrophy. During the follow-up observation for five years, no side effects were found.

Conclusion. The high efficiency of PG elimination using CVL in the absence of pronounced side effects allows suggesting this method for introducing into dermatologists and cosmetologists' clinical practice as a highly effective and inexpensive method of treatment.

Vestnik dermatologii i venerologii. 2021;97(2):41-49
Clinical evidence of therapy for genital psoriasis by biologic agents
Sokolovskiy E.V., Kokhan M.M.

Data in the scientific literature on the use of biologic therapy in localized forms of psoriasis elucidate mostly the problems of treatment of palmoplantar, scalp psoriasis and nail psoriasis. At the same time, the number of scientific data on the effect of biological therapy on genital psoriasis is extremely limited. Important that the quality of life on patients with genital psoriasis has very low level, which indicates a significant influence on the psychological and social well-being. At the same time, the limited number of therapeutic approaches makes this problem even more urgent. Unfortunately, special clinical trials for such patients are rather an exception. Ixekizumab has been reported an effectiveness for patients with anogenital psoriasis. New data on the comparative efficacy of ixekizumab and secukinumab give hope us for new opportunity for the treatment of genital psoriasis.

Vestnik dermatologii i venerologii. 2021;97(2):50-55
Case report on tuberous sclerosis
Krasnova N.V., Gimalieva G.G., Sinitsyna L.G.

Patient M., 23 years old, consulted a dermatologist with complaints of rashes on the face, which had bothered since childhood. On objective examination, skin lesions were widespread. A visual examination revealed spots of hypopigmentation, angiofibromas of the face, “shagreen” fate of the skin, periungual fibromas. She was diagnosed with tuberous sclerosis. Further examination revealed a neoplasm in the brain and right kidney, damage to the lungs, tubular bones, lymphadenopathy. The patient continues to be monitored by a neurologist and therapist. Based on the results of CT scan of the chest organs, an oncologist's consultation was scheduled to conduct an oncology search. Thus, with skin manifestations characteristic of this disease, it is necessary to conduct a comprehensive examination to identify concomitant pathology and early diagnosis of complications.

Vestnik dermatologii i venerologii. 2021;97(2):56-60
Perspective trends of topical therapy of patients with psoriasis
Zhukov A.S., Khairutdinov V.R., Samtsov A.V.

Topical medications are used to treat not only limited, but also common forms of the disease. Currently prescribed external anti-inflammatory drugs have a low selectivity of action, which does not allow achieving a long-term and pronounced clinical effect without the development of undesirable phenomena.

This review presents new options for the use of methotrexate in modern topical forms (AuNPs-3MPS), which make it possible to reduce the incidence of adverse events with a high efficiency of therapy. Shown is an innovative drug that blocks resident memory cells (PAP-1), which will influence the course and relapses of the disease, and possibly even lead to the cure of the patient from psoriasis. A new direction has been described — inhibition of serine proteases (ER143, AAN-16) and thus inhibition of IL-36-mediated inflammation, which will allow controlling the inflammatory process in psoriasis in the early stages of its development. In addition, a number of drugs are shown whose action is based on blocking intracellular signaling pathways, which leads to inhibition of the development of the inflammatory response and resolution of psoriatic eruptions: inhibitors of Janus kinases (tofacitinib), transcription factor Stat3 (rS3-PA), secondary messenger of signals (SIS3), phosphodiesterase 7 (ASB16165) and 4 (AN-2728/crisaborol), ROR transcription factor (PF-06763809), phospholipase A2 (AVX001), hydrolases (DZ2002).

The results of preclinical and initial stages of clinical trials with an assessment of the safety and tolerability of the studied substances are presented. Based on the review, the advantages and disadvantages of the proposed drugs are characterized. Topical therapy with a selective effect on the key links in the development of psoriasis will increase the effectiveness of treatment and reduce the frequency of unwanted effects.

Vestnik dermatologii i venerologii. 2021;97(2):61-68

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