Vol 97, No 6 (2021)


Topical treatment of inherited epidermolysis bullosa

Kubanov A.A., Chikin V.V., Karamova A.E., Monchakovskaya E.S.


Inherited epidermolysis bullosa is a group of genetic skin disorders characterized by skin erosions, ulceration, skin and mucosal blistering requiring topical treatment. This review demonstrates major clinical manifestations of epidermolysis bullosa and its mechanisms of development. According to these features the main principles of topical treatment and drug therapy were developed, including physical protection from trauma, moisturizing, improvement of wound healing, prevention and management of infection, itch and pain management. Drug therapy is outlined with dosage forms, drug routes of administration, age restrictions indicated in the instruction for medical use for the medications that could be used in epidermolysis bullosa patients. The authors provide indications for clinical use of antiseptics, disinfectants, antibiotics, antimicrobial agents, emollient cream and drugs reducing itch and pain.

Vestnik dermatologii i venerologii. 2021;97(6):6-19
pages 6-19 views

Non-surgical treatments for basal cell skin cancer

Kubanov A.A., Saytburkhanov R.R., Plakhova X.I., Kondrakhina I.N.


Basal cell carcinoma is the most common nonmelanoma skin cancer. It originates from undifferentiated cells in the basal cell layer of the epidermis or from the outer root sheath of the hair follicle. The most important factor in development of basalioma is ultraviolet radiation. Surgery is considered the gold standard of treatment for basal cell cancer. However, nonsurgical options are available for individuals who are unsuitable for surgery. The purpose of this review is to summarize the efficacy and indications of alternative, nonsurgical treatments that can be used in the management of basal cell cancer

Effective nonsurgical treatments include destructive methods (eg, curettage and electrodessication, cryosurgery, laser), photodynamic therapy, topical medications, hedgehog pathway inhibitors. Nonsurgical therapeutic alternatives are safe and effective for the treatment of BCC. Factors such as tumor location, size, and histopathological subtype should be taken into consideration when selecting optimal treatment, cosmetic results and patient preference should be considered too.

To search for the necessary literature, the PubMed, MedLine, Web of Science and RSCI databases were used.

Vestnik dermatologii i venerologii. 2021;97(6):20-32
pages 20-32 views

Disorders of the skin microbiome in atopic dermatitis and psoriasis

Nikolaeva M.Y., Monakhov K.N., Sokolovskiy E.V.


The notion of skin microbiome encompasses a heterogeneous group of microorganisms that belong to various taxonomic units, such as bacteria, archaea, viruses, and fungi. The impact of these microbial community constituents upon the epidermal barrier condition, and upon the immune system functioning, is being intensely scrutinized. There is a particular interest in studying the role that the microorganisms of genus Staphylococcus spp. play in the course of physiological and pathological processes occurring in the skin. This review examines in detail the interaction of the microorganisms of genus Staphylococcus spp. with the microbial community constituents, as well as with the skin immune system in normal condition and in the condition associated with inflammatory dermatoses. There are also the data given on S. aureus pathogenicity factors, the data on the impact of this microorganism upon the course of atopic dermatitis, and upon the course of psoriasis. The review examines the role that coagulase-negative staphylococci, S. epidermidis in particular, play in maintaining the microbiome homeostasis. The review as well examines the impact of the skin microbiome upon the development and activity of the skin immune system, and upon maintaining the integrity of the epidermal barrier.

Vestnik dermatologii i venerologii. 2021;97(6):33-43
pages 33-43 views

Narrow-band phototherapy in the treatment of atopic dermatitis: mechanisms of action, methodology of implementation

Zhilova M.B., Gorodnichev P.V.


Phototherapy is widely used to treat various chronic skin diseases. One of the most effective methods of treatment is narrow-band medium-wave ultraviolet radiation with a wavelength of 311 nm (UVB-311). UVB-311 is used for such immune-mediated diseases as atopic dermatitis, psoriasis, vitiligo, mycosis fungoides and others. Despite the fact that the method was developed more than 30 years ago, the exact mechanism of its therapeutic action remains insufficiently studied. To date, most of the effects of UVB-311 are explained by its effect on the immune cells of the skin. This review examines data on the effects on the main molecular targets, including T-lymphocytes, keratinocytes, Langerhans cells, cytokine profile, epidermal barrier proteins. Data on the features of the pathogenetic effect of UVB-311 on the immune mechanisms of pathogenesis in atopic dermatitis were obtained. The issues of dosing by determining the minimum erythemic dose (MED) or skin phototype, methodology of procedures are discussed. Prospects for further study of photobiological aspects of UVB-311 action are determined.

Vestnik dermatologii i venerologii. 2021;97(6):44-53
pages 44-53 views

The genetic determinants of Mycobacterium leprae resistance to antimicrobial drugs

Verbenko D.A., Solomka V.S., Kozlova I.V., Kubanov A.A.


The review is devoted to the appearance of resistance of a slowly developing disease — leprosy — to antimicrobial therapy (AMP), primarily recommended by the World Health Organization. The main danger of drug resistant leprosy is in the difficulty of identifying, since the causative agent of the disease is not cultivated on artificial media, and the methods for diagnosing drug resistance that are currently used take a long time. The drug resistance of the Mycobacterium leprae strain even to individual components of combination drug therapy result to the development of symptoms of the disease despite undergo anti-leprosy therapy, which in turn can cause the patient to become disabled. Currently, in the Russian Federation, there is no approved test for detecting Mycobacterium leprae DNA, and the determination of genetic determinants of resistance is carried out by sequencing genome regions determined by WHO recommendations: small gyrA, folP and rpoB genes loci. At the same time, modern studies in endemic regions reveal an increased level of Mycobacterium leprae strains resistant to individual components of combined drug therapy. The use of next generation sequencing (NGS) has made it possible to identify additional genetic determinants of leprosy resistance to the components of combination drug therapy. The current situation is relevant to antimicrobal drug resistance surveillance by using of quick identification systems for most frequent genetic resistance determinants of Mycobacterium leprae.

The literature search was carried out using keywords in the Scopus, PubMed and RSCI databases.

Vestnik dermatologii i venerologii. 2021;97(6):54-62
pages 54-62 views


The prevalence incidence of psoriatic onychodystrophy and the significance of its symptoms for the diagnosis of psoriatic arthritis

Platonova A.V., Zhukov A.S., Volkov K.Y., Svincickaya I.S., Khairutdinov V.R., Samtsov A.V., Kryukov E.V.


Background. There is a need to assess the diagnostic significance of the symptoms of nail damage, as well as available effective methods for diagnosing psoriatic arthritis in the early stages.

Aims. To study of the occurrence of symptoms of psoriatic onychodystrophy in patients with psoriatic arthritis and assessment of the diagnostic significance of the ultrasound method for diagnosing enthesitis as an early symptom of psoriatic arthritis among patients with onychodystrophy and without psoriatic arthritis in case history.

Methods. It was a prospective clinical study based on the Clinic of Skin and Venereal Diseases of the Military Medical Academy. We made the clinical assessment of symptoms of onychodystrophy among patients with and without psoriatic arthritis and the evaluation of the diagnostic significance of the ultrasound method for diagnosing psoriatic arthritis under the control of magnetic resonance imaging of the joints.

Results. 45 patients with psoriatic arthritis and 134 patients with psoriasis without arthritis were examined. Psoriatic onychodystrophy was significantly more common in the group of patients with psoriatic arthritis (p = 0.028). The most characteristic symptoms of onychodystrophy in patients with psoriatic arthritis are oil spots and symptom combinations: oil spots and subungual hyperkeratosis, onycholysis and subungual hyperkeratosis, pits and longitudinal ridges, oil spots and longitudinal ridges. The ultrasound method for the diagnosis of psoriatic arthritis has shown its high diagnostic significance (Se = 81.8%, Sp = 88.0%). The most characteristic symptoms of arthritis on ultrasound examination are hypoechoic structures of the Achilles tendons and the presence of fluid in the peri- and retro-Achilles bursa.

Conclusions. The symptom of oil spots and combinations of oil spots with subungual hyperkeratosis, onycholysis with subungual hyperkeratosis, pits with longitudinal ridges and oil spots with longitudinal ridges can be considered diagnostically significant in the examination of early psoriatic arthritis, and the ultrasound method is highly effective in diagnosing early manifestations of arthritis.

Vestnik dermatologii i venerologii. 2021;97(6):63-69
pages 63-69 views

Efficacy and tolerability of system isotretinoin and effect of this therapy on the quality of life of patients with severe and moderate acne

Khardikova S.A., Shirshkova V.I., Dmitruk V.S., Skrylova K.A., Kornetova E.G., Kornetov A.N., Urazova O.I., Kolobovnikova Y.V.


Background. The relationship between acne and depression is being actively studied by the medical community. Question is depression a restriction in prescribing or a side effect when using systemic isotretinoin remains controversial. Noteworthy is the presence in the scientific literature of data on the possible positive effect of adequately and timely prescribed acne therapy on the psychoemotional state of patients with this ailment.

Aims. The aim of our study was to evaluate the effectiveness of therapy with systemic isotretinoin in patients with moderate and severe acne, to assess the effect of the therapy on the quality of life of patients, as well as the persistence of remission after the end of the course of therapy with systemic retinoid.

Methods. We observed 32 patients with moderate and severe acne, the average age of patients was 24 years, the duration of the disease was on average 8 years. All patients underwent therapy with systemic isotretinoin (Sotret) at an average daily dose of 0.5–1.0 mg/kg until a cumulative dose of 120–150 mg/kg was reached. The effectiveness and tolerability of the therapy was assessed, as well as the quality of life of patients was assessed using the dermatological index of the quality of life (DQL), the dermatological akne index (DIA), the HADS scale (anxiety and depression scale). The indicators were assessed before the start of therapy, during therapy, at the end of the course of treatment with systemic isotretinoin, and also 12 months after the end of therapy.

Results. 100% of patients achieved clinical remission as a result of treatment with systemic isotretinoin.

Before starting therapy with systemic isotretinoin, the indices were as follows: DQL 18 (15–20), HADS 10 (7–16) and DIA 13 (6–15) scores. By the end of the therapy, the indices decreased to 1 (0–1), 2 (0–4) and 1 (0–1) points, respectively (p < 0.001).

12 months (year) after the end of therapy with systemic isotretinoin, the indices remained at zero or one level in all patients: DQL 1 (0–1), HADS 0 (0–1) and CIA 1 (0–1) points (p < 0.001).

Conclusion. A causal relationship between the intake of systemic isotretinoin and the development of depression has not been established. Systemic isotretinoin therapy was effective in all patients (100%), was well tolerated and had a positive effect on the psychoemotional status of patients with acne. 12 months after the end of therapy with the drug Erase, stable remission of the disease was noted in all patients

Vestnik dermatologii i venerologii. 2021;97(6):70-80
pages 70-80 views


Pagetoid reticulosis

Sergeeva E.Y., Khorzhevskii V.A., Ruksha T.G.


Pagetoid reticulosis (PR) is a rare type of mycosis fungoides. Clinical symptoms of PR can mimic other skin diseases of papulosquamous, neoplastic, and infectious origin that hampers PR diagnostics. The main histopathologic feature of PR is dense intraepidermal infiltration by medium to large-size lymphocytes through the epidermis leading to pagetoid plaque formation. There are three common immunophenotypes of PR: CD4-positive T-helper phenotype (CD3+, CD4+, CD8); T-cytotoxic/suppressor (CD3+, CD4, CD8+); and double negative phenotype (CD3+, CD4, CD8). The clinical case of PR with rare immunophenotype (CD2+, CD3+, CD8+ lymphoid infiltrate) is presented. The careful analysis of the symptoms, pathomorphological and immunohistochemical data is necessary for accurate PR diagnostics.

Vestnik dermatologii i venerologii. 2021;97(6):81-86
pages 81-86 views


Melanoma in patients with mycosis fungoides

Karamova A.E., Vorontsova A.A., Zhilova M.B., Znamenskaya L.F., Saytburkhanov R.R., Aulova K.M.


The development of both malignant neoplasms — mycosis fungoides and cutaneous malignant melanoma — is a rare condition; nevertheless, the literature describes both cases of the development of mycosis fungoides in patients with a primary diagnosis of melanoma and the detection of cutaneous malignant melanoma in patients with T-cell lymphomas of the skin. The question of the effect of previous therapy for mycosis fungoides on the risk of cutaneous malignant melanoma remains controversial. Currently, the world community is considering a possible pathogenetic relationship between these two oncopathologies. The clinical observations of the development of cutaneous malignant melanoma in 2 patients with mycosis fungoides presented in the article emphasize the importance of a thorough clinical and dermatoscopic examination of all pigmented formations for the timely detection of malignant melanocytic neoplasms, the presence of which radically affects the further choice of treatment tactics for patients.

Vestnik dermatologii i venerologii. 2021;97(6):87-95
pages 87-95 views

A clinical case of borderline leprosy

Semyonova V.G., Levicheva Y.Y., Shelepova T.N., Nabieva A.R., Nikonorov A.A., Smolyannikova V.A., Kubanov A.A.


Background. Described a rare case of leprosy, borderline form in the active stage.

Aim. To present a clinical case of the development of leprosy with atypical manifestations in a patient outside a region endemic for leprosy.

Case report. A 67-year-old patient from 2018 to 2020 received treatment for allergic dermatitis, pyoderma, no effect was observed; in 2020 he was examined for sarcoidosis, the diagnosis was not confirmed. In the Leprosy Research Institute, an examination was carried out, including a bacterioscopic examination of skin scarificates, a pathomorphological examination of skin biopsies, and molecular genetic methods.

Results. Based on complaints, anamnesis, examination data and physical examination, the results of clinical and laboratory examination, the diagnosis was made: leprosy, borderline form (ICD-10 A30.3), active stage.

Conclusion. The presented observation indicates that the variety of clinical manifestations of leprosy and the lack of alertness in relation to this disease, about the difficulty in establishing the correct clinical diagnosis in the patient, given the lack of history of data on contact with patients with leprosy.

Vestnik dermatologii i venerologii. 2021;97(6):96-103
pages 96-103 views

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