Vol 98, No 3 (2022)

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.

Background. The recently discovered regulatory T-cells CD4+CD25+FOXP3+CD127low (T_reg-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 T_reg-cells in VP pathogenesis and to show the possible use of the T_reg-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 T_reg 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. T_reg peripheral blood levels in VP patients and in HD were 2.84 ± 1.00% and 4.02 ± 0.73%, respectively. The T_reg 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 T_reg 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 T_reg 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 T_reg 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 T_reg 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 T_reg levels in VP patients compared to HD and revealed correlation between T_reg-cells level in VP patients and VP phases, duration and the severity of the clinical picture. We demonstrated T_reg feasibility as a laboratory indicator of VP therapy treatment with the example of 311 nm UVB and as a predict factor of remission duration.

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.

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.

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.