Vol 98, No 3 (2022)

REVIEWS

Antimicrobial resistance of Neisseria gonorrhoeae and gonococcal infection therapy: yesterday, today, tomorrow

Kubanov A.A., Solomka V.S., Rakhmatulina M.R., Deryabin D.G.

Abstract

Implementation of the Russian version of Gonococcal Antimicrobial Surveillance Programme (RU-GASP) in XXI century is summarized. The chronology of evidence-based updating of national clinical guidelines for the gonococcal infection management is outlined. The reasons for penicillins, tetracyclines, and fluoroquinolones excluding from gonococcal infection treatment regimens is presented, and the dynamics of subsequent changes in the sensitivity of N. gonorrhoeae to these antimicrobials is described. The modern schemes of monotherapy of gonococcal infection with third generation cephalosporins and the chronology of increasing their recommended doses are presented. The spectinomycin indications and restrictions for alternative treatment of the gonococcal infection are characterized. The absence of azithromycin in Russian gonococcal infection guideline versus international experience of this antibiotic usage is discussed. Based on current data on the ongoing spread of antimicrobial resistance genetic determinants in N. gonorrhoeae, proposals have been made to improve the RU-GASP protocols and to select drugs for the modern gonococcal infection etiotropic therapy.

Vestnik dermatologii i venerologii. 2022;98(3):15-23
pages 15-23 views

Barrier function of the skin and the role of fat-soluble vitamins in the correction of its disorders

Petrova S.Y., Albanova V.I.

Abstract

The main function of the skin is to protect the body from negative environmental influences. The physical barrier permeability is mainly represented by the stratum corneum; however, other layers of the epidermis and the dermis are its important components. The mechanical strength of the skin is provided by intercellular contacts in the epidermis and structural proteins of the dermis. The chemical-biological barrier includes lipids, acids, natural moisturizing factor and antimicrobial peptides. Mucosal immunity system creates a barrier against infection. The microflora of healthy skin counteracts its colonization by pathogens and is vital for its immune functions. Physiological processes in the skin are closely related. A violation in one of them often leads to the formation of a whole cascade of pathological reactions affecting all the links of its protection. Vitamins A, D and E are used to correct impaired barrier function of the skin. The most pronounced effect of vitamin A (retinol palmitate) is the proliferation of epidermal cells and synthesis of extracellular matrix structures of the dermis; vitamin D (cholecalciferol) — regulation of differentiation and suppression of excessive proliferation of keratinocytes; vitamin E (tocopherol acetate) — antioxidant effect. The combined use of these vitamins in the composition of Radevit®Active ointment affects all the main elements of the protection of the epidermis and dermis: strengthens the mechanical strength of the stratum corneum and dermis, stabilizes chemical and physical protection, including prevents the penetration of foreign substances and microorganisms, reduces transepidermal loss of water and electrolytes, reduces the damaging effect of UV, increases antimicrobial and antioxidant protection.

Vestnik dermatologii i venerologii. 2022;98(3):24-33
pages 24-33 views

ORIGINAL STUDIES

The peripheral blood regulatory T-cells analysis as a criterion for assessing the therapy efficacy and a prognostic marker for the duration of remission of psoriasis

Olisova O.Y., Gudova V.V.

Abstract

Background. The recently discovered regulatory T-cells CD4+CD25+FOXP3+CD127low (Treg-cells) plays an important role in sustaining immune tolerance. These cells demonstrated a significant tremendous potential in suppressing the pathological immune response associated with various autoimmune diseases, including psoriasis vulgaris (VP).

Aims. To find the role of Treg-cells in VP pathogenesis and to show the possible use of the Treg-cells analysis for diagnosis, remission duration prediction and measurement of therapeutic effectiveness.

Materials and methods. We studied 60 VP patients (35 females and 25 males) aged 18–55. The patients were diagnosed with VP at advanced, remedial and retrogressive phases (28, 19 and 13 participants, respectively). The disease severity was assessed with the PASI (Psoriasis Area and Severity Index). The patients were stratified into two groups based on disease duration (less than 20 years, n = 42; over 20 years, n = 28). The study involved 12 VP patients in the advanced stage, whose Treg level was tested prior and after 311 nm UVB course. We followed up the VP patients for two years following the UVB-311 nm phototherapy course to assess the remission duration and the relapse frequency.

Results. We found lower levels of Тreg in patients in the study group. Treg peripheral blood levels in VP patients and in HD were 2.84 ± 1.00% and 4.02 ± 0.73%, respectively. The Treg levels were 2.59 ± 0.68%, 2.82 ± 1.55% and 3.68 ± 1.62% at advanced, remedial and retrogressive stages, respectively. The patients with the VP history less than 20 years demonstrated Treg level of 3.42 ± 1.11% and 2.31 ± 0.62% for patients with VP history over 20 years. We found an inverse correlation between the Treg subpopulation CD4+CD25+FOXP3+CD127low and the VP severity level evaluated with PASI (r = –

0.39). The UVB-311 nm phototherapy resulted in the significant Treg level increase in 12 patients (2.11 ± 0.61% and 3.43 ± 1.02% prior and after therapy, respectively). Subsequently, we revealed the direct correlation (r = 0.88) between the Treg cell level increase in patients prior and after the phototherapy and the duration of remission in this group of the VP patients.

Conclusions. We found decreased in Treg levels in VP patients compared to HD and revealed correlation between Treg-cells level in VP patients and VP phases, duration and the severity of the clinical picture. We demonstrated Treg feasibility as a laboratory indicator of VP therapy treatment with the example of 311 nm UVB and as a predict factor of remission duration.

Vestnik dermatologii i venerologii. 2022;98(3):34-42
pages 34-42 views

Evaluation of clinical results of combined correction of age-related skin changes using fractional microneedle therapy and platelet-rich plasma activated by autologous thrombin.

Alenichev A.Y., Kruglova L.S., Fedorov S.M., Sharypova I.V., Ast N.A.

Abstract

Background. Involutive processes in the human body are often accompanied by the only visible manifestation - a change in appearance. Against this background, the search for new treatment methods that will focus on timely and rational correction of age-related skin changes and combine the possibility of complex effects on the mechanisms of skin aging is relevant. Hardware physiotherapy technologies and innovative autologous cellular preparations have a powerful regenerative potential, trigger and support physiological tissue regeneration. Despite the substantial amount of data on combined aesthetic correction protocols, there were only isolated data in the domestic and foreign literature on the combined use of fractional needle radiofrequency therapy and platelet-rich plasma activated by autologous thrombin. This was the basis for this study.

Aims. To evaluate the results of a combined method for correcting age-related skin changes based on a combination of hardware fractional needle radiofrequency exposure and injection therapy with platelet-rich plasma activated by autologous thrombin, comparing to monotherapy the same methods.

Materials and methods. Fractional microneedle radiofrequency therapy was carried out three times with an interval between procedures of 3 weeks with the use of a high-frequency electrosurgical device Scarlet RF. Therapy with autologous plasma rich in platelets activated by autologous thrombin (PRP therapy) was performed three times with an interval between procedures of 3 weeks without the use of preliminary topical anesthesia. Combination therapy combined the use of the above methods. Regression of clinical signs of skin aging was evaluated according to digital dermatoscopy and regression of the total value of the dermatological index of the quality of life of patients, as well as improvement of qualitative and functional parameters of the skin. A statistical analysis was carried out.

Results. A comparative analysis of the influence of various methods of correction of involutive changes in the skin of the face showed that the use of combination therapy provides the development of the most significant clinical effect in relation to all the assessed signs of skin aging. Combination therapy was accompanied by a significant increase in the integral index of microcirculation, regardless of age. The reconstructive effect on the morphological structures of the skin according to ultrasonography also turned out to be significantly higher for the combined method of treatment in comparison with radiofrequency therapy.

Conclusions. The combined use of fractional microneedle radiofrequency therapy and PRP therapy provides a more effective and prolonged correction of age-related skin changes compared to the monotherapy.

Vestnik dermatologii i venerologii. 2022;98(3):43-52
pages 43-52 views

GUIDELINES FOR PRACTITIONERS

Assessment of the severity of atopic dermatitis — SCORAD and EASI

Karamova A.E., Chikin V.V., Znamenskaya L.F., Aulova K.M.

Abstract

Atopic dermatitis is one of the most prevalent chronic inflammatory skin diseases, which can vastly influence the patients’ quality of life. Objective assessment of severity is required to select adequate therapy and evaluate its effectiveness. Heterogeneous clinical manifestations with greatly varying severity make it difficult to assess the severity of atopic dermatitis. More than twenty methods are developed for the assessment of this disease’s severity. SCORAD, oSCORAD and EASI are the most elementary and reliable methods allowing to define the severity of atopic dermatitis relatively quickly and accurately. Each of these three methods has its own particularities, that could be advantages or disadvantages depending on circumstances.

Vestnik dermatologii i venerologii. 2022;98(3):53-60
pages 53-60 views

Comparison of methods for assessing acne severity

Aliyev A.S., Mukhamedov B.I., Koldarova E.V., Tashkenbaeva U.A.

Abstract

Background. Given today's standards of care, assessing the severity of acne is very important to the practicing dermatologist. Currently, there are many methods for assessing the severity of acne, however, there is no single generally accepted method of assessment that would satisfy the needs of the practitioner and the specialist researcher.

Aims. The purpose of our study was to compare the two most commonly used methods for assessing the severity of acne — the Global Acne Grading System (GAGS) and the Dermatological Acne Index (DIA) in order to select the most appropriate one for use in the daily practice of a dermatologist.

Materials and methods. The study included 64 patients with acne who applied for an appointment with dermatologists at the consultative polyclinic of the Republican Dermovenereological Clinical Hospital for the period March — June 2019. Of these, there were 26 men and 38 women — 40.6% and 59.4%. All patients were assessed for the severity of acne by two methods GAGS and DIA by three researchers — dermatologists.

Results. In the course of the study, both among men and women, the vast majority of patients with acne were between the ages of 18 and 25 years. When examining patients using the GAGS index, 46.8% of patients were observed with mild severity, 39.1% with moderate and 14.1% with severe acne, with a significant difference only in severe acne between men and women (p < 0.05). When assessing GAGS, more patients were observed with mild severity, and when assessing DIA, moderate severity. There was a good correlation (0.914) between the scores of the two acne severity scales.

Conclusions. Considering that both methods for assessing the severity of acne showed approximately the same results, the method for assessing acne according to the DIA scale, due to the shorter time spent for its implementation, can be used in the daily practice of a dermatologist.

Vestnik dermatologii i venerologii. 2022;98(3):61-69
pages 61-69 views

The results of open-label, randomized, actively-controlled study of the efficacy, safety and tolerability of the novel combined product (terbinafine hydrochloride + econazole nitrate), medicinal nail polish for local monotherapy of onychomycosis

Kovalyova J.S., Kokina O.A., Vedler A.A., Karkhova V.V., Makarenko E.S., Pisarev V.V., Merkulov M.E.

Abstract

Background. Currently, onychomycosis is an urgent and widespread problem in dermatology. The defeat of the nail plates is the cause of a cosmetic defect and a decrease in the quality of life of patients. Systemic antimycotics are effective, but have a number of side effects when used. Thus, a modern and effective approach to the treatment of patients with this pathology is needed.

The aim of the study. To prove the efficacy, safety and tolerability of Ekzilak® as local monotherapy of onychomycosis compared with cyclopyrox monotherapy.

Materials and methods. А randomized open-label study with active control included 172 outpatient subjects: men and women aged 18 to 75 years, with microscopically confirmed onychomycosis of the big toe (one or both feet), a superficial or distal form of onychomycosis with a lesion of no more than 1/3 of the nail length (KIOTOS from 1 to 6). Patients were randomized into two groups: the 1st group of patients applied Ekzilak® locally daily for 6 months, the 2nd group of patients applied Ciclopirox nail lacquer topical solution 8% as follows: 1 time a day for the first month, 2 times a week for the second one and 1 time a week for the months third-sixth. The preparations were applied in a thin layer to the affected nail. The primary efficacy endpoint in the study was the proportion of patients who achieved complete recovery of the target toenail at the end of therapy (clinical + mycological recovery). Secondary endpoints included the proportion of patients who achieved clinical recovery after 6 months of treatment (clinical recovery is a complete restoration of the normal morphology of the affected nail), the proportion of patients who achieved mycological recovery (microscopy with KOH solution) after 3 months of treatment, the proportion of patients who achieved complete recovery of the target toenail in 4 weeks after the end of treatment; IGA (Investigator's Global Assessment), Integrated Medicine Patient Satisfaction Scale (IMPSS); the safety Analysis was carried out throughout the study and included an assessment of adverse events, laboratory data, vital signs.

Results. The results of the study showed that Ekzilak® is superior in terms of efficacy to the registered drug Ciclopirox nail lacquer topical solution 8% as a local monotherapy of onychomycosis. The difference in the proportion of patients who achieved complete recovery between the study drug and the reference drug was 22.09%, 95% CI for the difference in the proportion was [8.21%; 35.97%], the differences between the groups are statistically significant (p=0.002). At the same time, the analysis of safety data, including the assessment of adverse events, laboratory studies and impact on vital signs, did not reveal statistically and clinically significant differences between the treatment groups.

Conclusions. New combination drug Ekzilak® is an effective and safe treatment option for patients with onychomycosis.

Vestnik dermatologii i venerologii. 2022;98(3):70-79
pages 70-79 views

CLINICAL CASE REPORTS

Orphanic diseases: Schimmelpenning — Feuerstein — Mims syndrome

Zaslavsky D.V., Sydikov A.A., Grekova E.V., Gafiatulin M.R., Kovalenko K.A., Bogdanova E.A., Berezkina N.A.

Abstract

Schimmelpenning — Feuerstein — Mims syndrome is a rare congenital hereditary syndrome characterized by the presence of one or more sebaceous nevi, structural and functional disorders of the visual, cardiovascular, bone and central nervous systems. The main marker of Schimmelpenning syndrome is the presence of sebaceous nevi on the skin of the face and neck — a hamart of epidermal-follicular-sebaceous-apocrine origin. The aim of the article is to present our own clinical observation of Schimmelpenning — Feuerstein — Mims syndrome from the orphan diseases group. The syndrome is associated with a wide range of possible congenital pathologies, so such patients need timely interdisciplinary medical monitoring.

Vestnik dermatologii i venerologii. 2022;98(3):80-88
pages 80-88 views

Pityriasis rubra pilaris (Devergie's disease) in a COVID-19 patient

Okladnikova E.V., Kotova K.V., Khorzhevskii V., Ruksha T.G.

Abstract

Pityriasis rubra pilaris (Devergie's disease) is an idiopathic, papulosquamous inflammatory dermatosis characterized by progressive erythrodermia. The etiology of the disease is unknown, and most cases occur sporadically. Viral infections, impaired vitamin A metabolism, medications, autoimmune reactions, and malignancies are most common triggering factors. The diagnosis of Devergie's disease is based on the clinical manifestations of the disease and the results of a skin histological examination. The present paper discusses a clinical case of pityriasis rubra pilaris that occurred in a COVID-19, 40-year-old woman. For the purpose of differential diagnosis of pitiriasis with atopic dermatitis, erythrodermic form of psoriasis, generalized form of urticaria, it is necessary to perform immunohistochemical studies to identify the proliferation of immunocompetent cells. Based on the described clinical case, it seems possible to recommend testing for SARS-CoV-2 if a patient has Devergie's disease against the background of fever and intoxication syndrome.

Vestnik dermatologii i venerologii. 2022;98(3):89-95
pages 89-95 views

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