Vol 98, No 2 (2022)

ORGANIZATION OF HEALTH CARE AND EPIDEMIOLOGY

Structural transformations of the material and technical resources of the dermatovenereological service in the Russian Federation in the period 2010–2020 and their effect

Kubanov A.A., Melekhina L.E.

Abstract

Background. The quality and availability of medical care to the population directly depends on the organization of the treatment and diagnostic process, which is directly related to the material and technical resources of medical organizations.

Aims. Assess how the level of performance indicators of medical organizations of the dermatovenereological profile has changed after the restructuring of their material and technical resources for the period 2010–2020 in the Russian Federation as a whole.

Materials and methods. The study is based on a retrospective analysis of the main intensive and extensive indicators that evaluate the work of medical organizations of the dermatovenereological profile.

Results. Structural transformations of material and technical resources, which are under the jurisdiction of the dermatovenereological service, gave the following results in the whole of the Russian Federation. The activities of medical organizations intensified, which naturally led to a positive economic effect. The reduction of the excess number of resource-intensive beds in round-the-clock hospitals and the expansion of day hospitals due to the redistribution of part of the round-the-clock beds into beds and beds in day hospitals, increasing their capacity, did not negatively affect the volume of specialized dermatovenereological medical care for the population, they not only did not decrease, but even slightly increased.

Conclusion. Thus, the study showed that the restructuring of the material and technical resources of the dermatovenereological service in the Russian Federation as a whole led to a positive effect of the use of material and technical resources. However, it should be noted that their further reduction is inappropriate, as it can have the opposite effect. For example, a further reduction in the ATC may adversely affect the provision of the population with human resources, which will affect the availability and quality of medical specialized dermatovenereological care.

Vestnik dermatologii i venerologii. 2022;98(2):14-27
pages 14-27 views

REVIEWS

Post-acne symptom complex. Approaches to therapy

Drozhdina M.B., Bobro V.A., Sennikova Y.A., Kornilova E.I.

Abstract

Postacne-persistent skin changes that appear as a result of long-term acne, inadequate therapy and manipulations performed in the management of this group of patients. The post-acne symptom complex is stable skin changes that appear as a result of long-term acne inadequate therapy and manipulations performed during the management of this group of patients. The pathogenetic mechanisms underlying the launch of acne currently look as follows: androgens cause hyperseborrhea, sebum lipids activate innate immunity; pathological keratinization due to the production of IL-1 inflammatory mediator and androgen hyperproduction; Cutibacterium acnes activate innate immune responses through toll-like receptors and metalloproteinases, stimulate the production of antimicrobial peptides and sebum production. The subsequent rupture of the follicles activates the wound healing process. Depending on the genetically determined features of the course of the inflammatory process, various individual postacne changes of the skin will prevail in different patients. The article highlights the main factors influencing the formation of post-acne, pathogenetic mechanisms underlying the formation of these changes, systematizes modern data on the classification, morphological and pathohistological characteristics of scars. Quantitative and qualitative scales of assessment of post-acne scars for determining the severity of the pathological process are presented, differentiated approaches to modern methods of therapy are discussed in detail, including the advantages and disadvantages of the most common methods of treating patients based on the principles of evidence-based medicine using a number of personalized methods.

Vestnik dermatologii i venerologii. 2022;98(2):28-41
pages 28-41 views

ORIGINAL STUDIES

Efficacy and safety profile of 2-year netakimab treatment in patients with moderate-to-severe plaque psoriasis in terms of the randomized double-blind placebo-controlled BCD-085-7/PLANETA clinical trial

Bakulev A.I., Samtsov A.V., Sokolovskiy E.V., Kokhan M.M., Khobeish M.M., Khairutdinov V.R., Karamova A.E., Olisova O.U., Ignatiev D.V., Nikiforova A.N., Artemeva A.V., Zinkina-Orikhan A.V.

Abstract

Background. Netakimab, a recombinant humanized monoclonal antibody, specifically binding to IL-17 blocks its activity resulting in plaque psoriasis signs decrease. The results of the first year of BCD-085-7/PLANETA study showed high efficacy and a favorable safety profile in the treatment of patients with moderate-to-severe psoriasis.

Aims. Efficacy and safety assessments of netakimab through 2 years of treatment in patients with moderate-to-severe psoriasis.

Materials and methods. BCD-085-7/PLANETA study is ongoing Randomized, Double-blind, Placebo-Controlled Phase III clinical study. In the study, 213 patients with moderate-to-severe plaque psoriasis were randomly assigned to one of three study groups. In the first two groups of patients, after weekly drug administration, received netakimab at a dose of 120 mg every two or four weeks. In the third group the patients received placebo. During 12-week double-blind study period the efficacy were evaluated based on the proportion of patients achieved PASI 75. After that all patients were switched to netakimab (once in 4 weeks). Patients who failed to achieve PASI 75 at Week 52 were withdrawn from the study. The open period lasts about 3 years. Herein we focus on the results of 2-year netakimab treatment (120 mg, weekly for 3 weeks, then once in 4 weeks), the recommended per label dose. Taking into account the epidemiological situation (COVID-19) and results limitation due to missing visits, additionally to the efficacy analysis in patients received, at least, one dose of netakimab, analysis in those of them who had relevant data on each visit per Protocol was conducted (ITT and PP populations).

Results. At Year 1, PASI 75/90/100 responses were achieved in 88,7/74,5/56,6% patients, respectively (ITT-population) and in 100/85/66% patients, respectively (ITT-population). In 2 year, 69,3/58,0/40,6% sustained their responses in ITT-population and 93,2/78,2/53,1% in PP-population. Through 2 years, the high quality of life sustained among patients. The safety profile remained favorable and immunogenicity was low.

Conclusions. Treatment with netakimab at a dose of 120 mg every 4 weeks results in high rates of sustained clinical response and quality life improvement in patients with moderate-to-severe plaque psoriasis with remains of a favorable safety profile.

Vestnik dermatologii i venerologii. 2022;98(2):42-52
pages 42-52 views

Efficacy of brentuximab vedotin in patients with CD30-positive lymphoproliferative skin diseases: results of the first prospective study in the Russian Federation

Belousova I.E., Gorenkova L.G., Kravchenko S.K., Kovrigina A.M., Lepik E.E., Shneyder T.V.

Abstract

Background. Primary cutaneous lymphomas are the second most common group of extranodal lymphomas. Unlike nodal lymphomas, where B-cell proliferations dominate, primary cutaneous T-cell lymphomas account for 65–75% of all cutaneous lymphomas. Among T-cell lymphomas of the skin, about 50% of cases are mycosis fungoides (MF), the second place in frequency of occurrence is occupied by CD30-positive lymphoproliferative skin diseases (CD30 LPD), about 10% are rare nosological forms, such as primary cutaneous peripheral T-cell lymphoma, unspecified, Sezari syndrome (SS), etc. During the initiating treatment of patients with MF and Sézary syndrome (SS), carried out on the territory of the Russian Federation, for about 30% of patients are resistant to various therapeutic effects, especially in the later stages. The problem of the treatment of CD30+ LPD is extracutaneous dissemination in case of primary cutaneous anaplastic large cell lymphoma (pcALCL), steadily relapsing course of lymphomatoid papulosis (LyP) without symptom-free intervals. These characteristics of the therapy of cutaneous lymphomas demand for the need to search for new treatment options. Brentuximab vedotin, according to the results of the international randomized ALCANZA trial, has shown high efficiency in the treatment of cutaneous T-cell lymphoproliferative diseases.

Aim. To evaluate the efficacy of brentuximab vedotin application in patients with cutaneous T-cell lymphomas in adverse risk group received at least one line of systemic therapy.

Materials and methods. The study included 21 patients: 16 men and 5 women. The diagnosis of MF was verified in 8 patients, SS — in 5 patients, cutaneous CD30+ LPD — in 6 patients (5 patients — pcALCL, 1 patient — LyP) and a primary cutaneous peripheral T-cell lymphoma, unspecified in 2 patients. The diagnosis of cutaneous T-cell lymphoma was verified on the basis of the anamnesis of the disease, on the character of cutaneous lesions, on histological, immunohistochemical and in some cases on molecular genetic testing of the skin biopsy (the assessment of T-cell receptor gene rearrangement).

Results. The late stages of the disease were diagnosed in 12 of 13 patients with MF/SS. Extracutaneous lesions were diagnosed in 57% of cases. The median of prior lines therapy was 3 (1–8 variants of treatment). The overall response to the treatment was achieved in 91% of cases (in 19 of 21 patients): the complete remission was obtained in 53% of cases, very good partial remission — in 31% of cases and partial remission — in 16% of cases. The progression of the disease was determined in 2 patients (after the first and fourth cycles). Some patients with partial remission as a result of therapy using brentuximab vedotin had the additional therapy (radiation therapy, interferon α, the cycles of systemic therapy) and these acts gave an option of achieving deeper antitumor response. The early relapse was diagnosed in 2 of 19 patients who had responded to the treatment. The treatment tolerability was acceptable, and the toxicity did not exceed the already known one described in earlier studies. Thus, the stable overall antitumor response had been persisting in 89% of patients (the median of the observation was 10 months).

Conclusion. The use of targeted therapy with brentuximab vedotin gave an option of achieving high treatment results in group of patients with advanced stages of the disease and inefficiency of several lines of therapy.

Vestnik dermatologii i venerologii. 2022;98(2):53-62
pages 53-62 views

GUIDELINES FOR PRACTITIONERS

Lichen planus-lupus erythematosus overlap syndrome

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

Abstract

The combination of lichen planus and lupus erythematosus is a rarity: no more than fifty cases of overlap syndrome have been described in the world. The clinical picture of overlap syndrome is variable: patients have discoid foci of lupus erythematosus and typical flat polygonal papules of lichen planus, as well as combined manifestations in the form of lid-red plaques with central atrophy and superficial desquamation. Positive antinuclear factor is found in laboratory examination. The histopathological picture is characterized by a combination of histological signs of lichen planus and lupus erythematosus. In some cases, clinical and immunological signs of systemic lupus erythematosus are found in patients with overlap syndrome. We describe two cases of lichen planus and systemic lupus erythematosus.

Vestnik dermatologii i venerologii. 2022;98(2):63-72
pages 63-72 views

CLINICAL CASE REPORTS

Scleroderma-like form of lipoid necrobiosis in a patient with idiopathic thrombocytopenic purpura

Perlamutrov Y.N., Svishchenko S.I., Pugner A.S.

Abstract

A 33-year-old female patient with idiopathic thrombocytopenic purpura complained of rashes on the skin of the lower extremities, accompanied by moderate itching and a feeling of skin tightness, as well as a histologically verified diagnosis of lipoid necrobiosis. A combined treatment was carried out with the glucocorticosteroid Methylprednisolone at a dose of 32 mg per day in combination with PUVA therapy with 0.3% solution of ammi majus fructuum furocumarines, with a positive effect in the form of a decrease in the color intensity and induction of rashes, under the control of platelet levels. When using the method of PUVA-therapy with 0.3% solution of ammi majus fructuum furocumarines, there was an improvement in the 8th phototherapy procedure, however, due to a decrease in the level of platelets in the blood, the course of phototherapy was suspended.

The method of PUVA therapy with 0.3% solution of ammi majus fructuum furocumarines turned out to be clinically effective in the treatment of lipoid necrobiosis, however, the presence of concomitant pathology in the patient requires an interdisciplinary approach to the choice of treatment tactics.

Vestnik dermatologii i venerologii. 2022;98(2):73-80
pages 73-80 views

Autoaggressive dermatoses in the practice of a dermatovenereologist

Ryabova V.V., Evseeva A.L., Koshkin S.V.

Abstract

The article presents clinical cases of autoaggressive dermatoses from the own practice of authors. In the first case, the patient turned to a cosmetologist for the purpose of aesthetic correction of scars; it was found that she inflicted self-harm unconsciously against the background of long-term depression and psycho-emotional stress associated with instilling a sense of guilt for the absence of children in the family. Against the background of the recurrent nature of the skin process, the patient is strongly recommended consultation and treatment by a psychotherapist.

The following two cases share common features: the presence of “parasites under the skin”, with which patients independently fought with “radical” methods. The first patient was identified retrospectively upon admission to the venereology department, and according to the patient, “he already cured the tick” on his own. In the second case, the demonstrative type of behavior and flaunting his own state attracts attention. This patient with a diagnosis of neurotic excoriations (dermatozoic delusions?), examination by a neurologist and a psychotherapist is recommended.

Vestnik dermatologii i venerologii. 2022;98(2):81-88
pages 81-88 views

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