Vol 98, No 4 (2022)


The role of trauma and isomorphic reaction in the pathogenesis of psoriatic arthritis

Koreshkova K.M., Khismatullina Z.R.


The role of biomechanical stress and trauma in the initiation of inflammation of the joints and periarticular structures in psoriatic arthritis (PA) is currently not fully understood. Soft tissues and joints are the target for constant biomechanical stress and microtrauma, leading to inflammation. There is an opinion that this inflammation in PA is due to an analogue of the skin isomorphic reaction that develops in the skin of psoriatic patients in response to trauma. Some authors have called this reaction the “deep Koebner phenomenon”. It is assumed that the early, preclinical phase of psoriatic arthritis may be based on inflammation of the enthesis as a response to microtrauma, and explained by the proximity of the entheses and the articular membranes. Detection of early changes in entheses in psoriatic patients, including those who do not have complaints from the musculoskeletal system, is of great importance for the early diagnosis of psoriatic arthritis. In the literature review, the sources for the period 2010–2021 were studied, devoted to the role of the isomorphic reaction and microtraumatization in the pathogenesis of PA, as well as the role of various imaging methods for the early diagnosis of enthesitis in psoriatic patients.

Vestnik dermatologii i venerologii. 2022;98(4):17-22
pages 17-22 views

Efficacy and safety of treatment of moderate and severe psoriasis with the interleukin 23 inhibitor risankizumab

Bakulev A.L., Kruglova L.S.


A review of the literature on the use of the genetically engineered biological drug Skyrizi (INN: risankizumab) for the treatment of psoriasis in patients is presented. The problem of high dissatisfaction of patients with the available means (methods) of therapy for this dermatosis is discussed.

Inhibition of regulatory IL-23 seems to be a very promising direction of therapy, which makes it possible to block the immunopathogenesis of the disease.

The IL-23 inhibitor risankizumab is a highly effective GEBA for the treatment of moderate to severe psoriasis in patients. The use of this drug is accompanied by a very rapid and stable therapeutic response in the form of clear or almost clear skin. Long-term use of risankizumab demonstrates the maintenance of a stable therapeutic response without a tendency to decrease.

Risankizumab has a favorable safety profile with a low risk of infections and malignancies. At the same time, such adverse events as the development of tuberculosis or inflammatory bowel disease are not typical for therapy with these GIBDs.

Vestnik dermatologii i venerologii. 2022;98(4):23-30
pages 23-30 views

New aspects of the pathogenesis of psoriasis

Zhukov A.S., Patrushev A.V., Khairutdinov V.R., Samtsov A.V., Kryukov E.V.


Psoriasis is a chronic multi-factorial immune-mediated inflammatory disease of skin and joints. The variety of clinical forms of dermatosis is consistent with various pathogenetic features of the disease progress which have been significantly supplemented and reviewed recently. Knowledge of these mechanisms will improve and personalize the prescribed therapy.

This study places the emphasis on modern ideas about the formation of T cell memory, the role of melanocytes and innate lymphoid cells. Development mechanisms of guttate and paradoxical psoriasis with important distinguishing characteristics are described separately.

Today, knowledge of the molecular basis of the disease progression has led to the creation and introduction of a number of highly effective targeted drugs into clinical practice. Further developments related to the inhibition of resident memory cells, innate lymphoid cells, as well as the study of guttate psoriasis perpetuation and the occurrence of paradoxical psoriasis will significantly increase the effectiveness of the therapy.

Vestnik dermatologii i venerologii. 2022;98(4):31-40
pages 31-40 views


The age at first cutaneous manifestation of psoriasis as a prognostic factor in the timing of psoriatic arthritis diagnosis

Bogdanova E.V.


Background. Psoriatic arthritis is a chronic inflammatory disease of joints, spine and enthesis, which develops in 6–40% of patients with psoriasis and has a significant impact on the quality of life of patients.

Aims. To determine the relationship between age of cutaneous manifestation of psoriasis and the timing of psoriatic arthritis diagnosis; to examine the possibility of prediction of timing of psoriatic arthritis diagnosis depending on age of cutaneous manifestation of psoriasis.

Materials and methods. Data of patients aged 18 years and older with psoriatic arthritis included in the psoriasis patient register were analysed. Inclusion criteria were: patient age 18 years and older; established diagnosis of psoriasis and psoriatic arthritis. Exclusion criteria were: psoriatic arthritis diagnosed before or simultaneously with cutaneous manifestation of psoriasis; the age of the cutaneous manifestation of psoriasis older than 70 years. The sample included 771 patients.

Spearman's correlation analysis was used to assess the correlation between age of cutaneous manifestation of psoriasis and period from skin psoriasis onset to psoriatic arthritis diagnosis.

The possibility of prediction of the period till psoriatic arthritis was diagnosed depending on age at cutaneous manifestation of psoriasis was established by means of quantile regression analysis.

Results. Mean age at cutaneous manifestation of psoriasis (±SD) was 26.0 ± 13.5 years. The period from the onset of skin psoriasis to the diagnosis of psoriatic arthritis averaged 13.7 ± 10.3 years, its median [interquartile range] was 12 [6–19] years.

According to Spearman's correlation analysis, a moderate (close to strong) negative correlation between varibles was revealed (Spearman's correlation coefficient = –0.490, p < 0.0005).

In accordance to quantile regression analysis, lines of 5, 25, 50, 75 and 95% quantiles were obtained and the dependence of the period till the diagnosis of psoriatic arthritis on the age of onset of skin psoriasis was demonstrated. Based on the quantile equation obtained, a prognostic table for the period from the onset of skin psoriasis to the diagnosis of psoriatic arthritis was compiled.

Conclusions. Statistically significant inverse relationship between age of cutaneous manifestation of psoriasis and period till psoriatic arthritis diagnosis was established: older age at skin psoriasis onset is associated with shorter period till psoriatic arthritis diagnosis. Based on established relationship, presented as an equation, table and graphically, prediction of period till psoriatic arthritis diagnosis is possible. These results can be used in the clinical practice of dermatovenereologists.

Vestnik dermatologii i venerologii. 2022;98(4):41-48
pages 41-48 views

Vulvar lichen planus — clinical spectrum (results of a cross-sectional uncontrolled study)

Parygina O.V., Smirnova I.О., Petunova Y.G., Kabushka Y.S., Zhelonkin A.R.


Background. Lichen planus (LP) is a chronic dermatosis, which can affect vulva. Currently, there are no sufficient data about clinical picture of vulvar LP and a valuation combined lesion on the vulva, oral mucous and smooth skin in patients with different forms of LP.

Aims. Is to study the features of the vulvar LP clinical picture.

Materials and methods. A cross-sectional (simultaneous) uncontrolled study of 46 patients with vulvar LP was performed. We assessed the structure of vulvar LP, the duration and the manifestation of disease, localization of lesions, the involvement of the skin and oral mucosa. LichenSclerosus-Square was used to assess the area of lesions in vulvar LP.

Results. The erosive form dominated in the structure of vulvar LP morbidity, which was diagnosed in 73,9% of cases. The process in erosive and hypertrophic form of LP was more common than in the typical form of LP. Distinctive features of the erosive form of the disease were the involvement of the inner surfaces of the labia minora and the vestibule (73,5% и 70,6%, p < 0,001). The erosive LP is also characterized by a damage of normal vulvar architectonics (58,8%, p = 0,007).

Lesions in typical LP affected labia majora (66,7%) and labia minora (33,4%), and to a lesser extent the commissure posterior (16,7%). The involvement of labia majora was found in all patients with hypertrophic form LP. The involvement of inguinal folds distinguished the hypertrophic form from other forms of LP and was observed in 33,4% of patients.

Vulva lesions without the involvement of the skin and mucous membranes of other localizations were more typical for patients with erosive and hypertrophic LP (35,4% и 33,3%). Almost half of the patients (47,0%) with erosive LP had the involvement of mucous membranes, 29,0% of them were diagnosed with vulvovaginal-gingival syndrome. In 14.7% of cases, vulvovaginal-gingival syndrome combined with lesions in the scalp (vulvovaginal-gingival-pillar syndrome).

Conclusions. We have identified clinical features of different forms of vulvar LP, which can be used for differential diagnosis.

Vestnik dermatologii i venerologii. 2022;98(4):49-57
pages 49-57 views


Rossolimo–Melkersson–Rosenthal syndrome as a manifestation of lip sarcoidosis

Perlamutrov Y.N., Drobyshev A.U., Olkhovskaya K.B., Miterev A.A., Plehanova E.N.


A 38-year-old female patient complained of lip augmentation. With a preliminary diagnosis of Rossolimo–Melkersson–Rosenthal syndrome (monosymptomatic form), chronic fissure of the lower lip, the patient was sent for examination in order to exclude tumor pathology and vascular malformation. According to the results of a comprehensive clinical and laboratory examination, it was found that lip enlargement is due to the formation of granulomas. Additional follow-up by a pulmonologist confirmed the presence of sarcoidosis of the lungs with involvement of the mediastinal lymph nodes. A comprehensive examination made it possible to verify the diagnosis of multisystem sarcoidosis in a patient with macrocheilitis. As a result of complex therapy using surgical methods and systemic glucocorticosteroids, a rapid dynamics of clinical symptoms was observed and remission was achieved. This clinical case demonstrates a combination of sarcoid lesions of the tissues of the mediastinal lymph nodes, lung parenchyma and lips. It was the presence of macrocheilitis that was the main reason for visiting a dermatovenereologist and was the reason for choosing the subsequent tactics of examination and treatment. As a result of complex therapy using surgical methods of treatment and systemic glucocorticosteroids, carried out entirely within the framework of the program of state guarantees of free medical care for citizens, a stable remission of the disease was achieved.

Vestnik dermatologii i venerologii. 2022;98(4):58-66
pages 58-66 views

The use of urea for skin barrier correction

Albanova V.I., Kalinina O.V., Petrova S.Y.


The review summarizes information about the main causes and pathogenesis of xerosis cutis as one of the conditions indicating a violation of the epidermal barrier. Xerosis cutis is a clinical sign of a decrease in the amount and/or quality of lipids and/or hydrophilic substances in the stratum corneum of the epidermis. The modern approach to the treatment of dermatoses accompanied by violations of the epidermal barrier includes basic moisturizers. Urea not only moisturizes the skin. It is involved in the regulation of barrier function and antimicrobial protection. It is a low-molecular regulator of protein synthesis in keratinocytes, such as filaggrin, loricrin, involucrin and transglutaminase 1, cathelicidin, beta-defensin-2, water and urea carrier proteins into the cell, as well as proteins that promote the synthesis of intercellular matrix lipids. The main dermatotropic pharmacological effects of urea (hydration of the epidermis, strengthening of the barrier function of the skin, keratolytic effect, increased penetration of drugs into the skin) have been used in dermatological practice for many years. External agents with urea are used to treat skin diseases accompanied by dryness and excessive keratinization, to correct the deformation of nail plates of various genesis, to facilitate the local penetration of medicines. The use of topical UrocrEM5, UrocrEM10, Uroderm ointments containing 5%, 10% and 30% urea, respectively, is effective and safe.

Vestnik dermatologii i venerologii. 2022;98(4):67-75
pages 67-75 views


Squamous cell carcinoma in a patient with lichen planus of the oral mucosa

Kubanov A.A., Svishchenko S.I., Dontsova E.V., Mikhina V.A.


Lichen planus refers to dermatoses with frequent, often isolated, lesions of the oral mucosa. In the presence of rashes only on the oral mucosa, the diagnosis is difficult. At the same time, erosive-ulcerative forms of the disease present the greatest differential diagnostic difficulties. Cases that do not heal for a long time and are not amenable to treatment should be especially alert to the doctor due to the risk of malignancy.

The article describes a rare clinical case of squamous cell carcinoma of the oral mucosa in a 52-year-old patient with an erosive-ulcerative form of lichen planus of the oral cavity, characterized by a chronic long-term course, torpidity to therapy and simultaneous damage to the genital mucosa. The presented case emphasizes the importance of a thorough clinical examination, with a histological examination of the biopsy in order to monitor changes in the lesions.

Vestnik dermatologii i venerologii. 2022;98(4):76-84
pages 76-84 views

Annular elastolytic giant cell granuloma in a patient with Ehlers–Danlos syndrome

Gaydina T.A., Patsap O.I., Tairova R.T.


The article presents a clinical case of annular elastolytic giant cell granuloma (AEGCG) in a young patient with a vascular type of Ehlers–Danlos syndrome. The first clinical manifestations of AEGCG appeared on the skin in the right subclavian area about two years ago. Subsequently, new rashes appeared on the skin of the upper and lower extremities up to four new foci per year. The patient underwent ambulatory therapy as a solution of calcium gluconate 10% 5.0 ml No 10 i/v in every other day; a solution of chloropyramine hydrochloride 1.0 ml No 10 i/m every other day; betamethasone + salicylic acid ointment applied to the affected areas of the skin 2 times a day for 2 weeks. The treatment was ineffective, the rashes did not regress. External therapy with tacrolimus was carried out next, 0.1% ointment 2 times a day in the form of applications for 24 weeks but also without effect. The patient by herself started to take a dietary supplement containing 400 mg of collagen in 1 tablet; 3 types of amino acids 20 mg; vitamins B2 1.1 mg; B6 1.5 mg; calcium pantothenate 5 mg 2 tablets a day during meals. A month after the start of the application, she noticed a slight paling of the rashes. At the moment, the patient is under follow up.

Vestnik dermatologii i venerologii. 2022;98(4):85-94
pages 85-94 views

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