Vol 98, No 2 (2022)


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.


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


Post-acne symptom complex. Approaches to therapy

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


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


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.


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.


Background. Primary cutaneous lymphomas are the second most common group of extranodal lymphomas. Unlike nodal lymphomas, which are characterized by predominant B-cell proliferation, primary cutaneous T-cell lymphomas account for 65–75% of all cutaneous lymphomas. About 50% of all cutaneous T-cell lymphomas are mycosis fungoides (MF). CD30-positive lymphoproliferative disorders (CD30+ LPD) occupy the second place in the incidence of cutaneous T-cell lymphomas, while 10% are rare disease forms such as primary cutaneous peripheral T-cell lymphoma not otherwise specified (PTL–NOS), Sézary syndrome (SS), etc.

Treatment of MF/SS patients in the Russian Federation shows that about 30% of individuals are resistant to various therapeutic effects, especially in the later stages. The problem of CD30+ LPD treatment is extracutaneous dissemination in the case of primary cutaneous anaplastic large cell lymphoma (pcALCL) and steadily relapsing lymphomatoid papulosis (LyP) without symptom-free intervals. These aspects of the therapy of cutaneous lymphomas highlight the need to search for new treatment options.

According to the results of the international randomized ALCANZA trial, brentuximab vedotin (BV) has shown high efficiency in the treatment of cutaneous T-cell lymphoproliferative disorders.

Study objective. The study aim is to evaluate BV efficacy in the group of poor prognosis patients with cutaneous T-cell lymphomas who has received at least one line of systemic therapy.

Materials and methods. The study included 21 patients: 16 men and 5 women. There were 8 patients with MF, 5 patients with SS; 6 individuals had cutaneous CD30+ LPD (including 5 patients with pcALCL and 1 individual with LyP) and 2 patients were diagnosed with PTL–NOS. Cutaneous T-cell lymphoma was confirmed based on the medical history, nature of cutaneous lesions, as well as histological, immunohistochemical, and, in some cases, molecular genetic testing of the skin biopsy sample (analysis of T-cell receptor gene rearrangement).

Results. Late stages of the disease were diagnosed in 12 out of 13 patients with MF/SS. Extracutaneous lesions were diagnosed in 57% of cases. The median of prior lines of therapy was 3 (1–8 variants of treatment). The overall response to the treatment was achieved in 91% of cases (19 out of 21 patients): complete remission was observed in 53% of patients, very good partial remission was achieved in 31% of individuals, and partial remission was noted in 16% of cases. Disease progression was found in 2 patients (after cycles 1 and 4). Some patients with partial remission after BV therapy underwent additional therapy (radiation therapy, interferon α therapy, and cycles of systemic therapy), which made it possible to achieve a more pronounced antitumor response. Early relapse was diagnosed in 2 out of 19 patients who had responded to the treatment. The treatment tolerability was acceptable, and the toxicity did not exceed that described in the previous studies. Thus, the overall stable antitumor response persisted in 89% of patients (the median follow-up was 10 months).

Conclusion. The use of targeted therapy with BV made it possible to achieve high treatment results in patients with advanced stages of the disease and the absence of response to several lines of therapy.

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


Lichen planus-lupus erythematosus overlap syndrome

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


The combination of lichen planus and lupus erythematosus is rare: the number of overlap syndrome cases described in the world literature does not exceed 50. The clinical picture of the overlap syndrome is variable: patients have discoid lesions of lupus erythematosus and typical flat-topped polygonal papules of lichen planus, as well as joint manifestations in the form of livid-red plaques with central atrophy and superficial desquamation. Laboratory testing reveals positive antinuclear antibody. 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 the overlap syndrome. We describe two cases of lichen planus–systemic lupus erythematosus overlap syndrome.

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


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

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


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.


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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