Vol 94, No 4 (2018)

The article describes modern views on predisposing factors, histological and genetic changes, the role of ATP2C1 encoding a mutant gene, localized on chromosome 3 in the pathogenesis of Hailey — Hailey disease. Diagnostic criteria, differential diagnostics with other diseases and methods of modern treatment of this disease are presented.

Oral lichen planus (OLP) is included in the category of potentially malignant diseases. Benign processes are differentiated from malignant ones by the nature of cell proliferative activity. The aim of the present study was the comparative study of proliferative activity in OLP and leuk oplakia cells, as well as the cells of oral squamous cell carcinoma.
Materials and methods. Biopsy specimens from 16 patients with OPL, 13 with leukoplakia, and 7 with oral squamous cell carcinoma were investigated. Immunohistochemical studies were performed using Ki67 monoclonal antibodies.
Results. The average Ki67 index in OPL cells was 9.3 ± 2.3 %. Proliferating cells were located exclusively in the basal epidermis layer. In leukoplakia cells, the average Ki67 index was 20.5 ± 6.1 %; the proliferating cells were located in the basal layer and lower parts of the spinous (suprabasal) layer of the epidermis. In squamous cell carcinoma, the average Ki67 index was 57.4 ± 2.04 %. Proliferating cells were located diffusely over all cell complexes from the lower to the highest layers of the epidermis. Differences in the proliferation level were significant for the leukoplakia/OPL pair (p = 0.003) and squamous cell carcinoma/OPL pair (p < 0.001), while for squamous cell carcinoma/leukoplakia pair the difference was not significant (p = 0.211).
Conclusion. The differences in the proliferation level and in the nature of the proliferating cell distributionin through the epidermis can be applied in the differential diagnosis of OPL and leuk oplakia.

The aim of the study is to present a successful case in treating primary cutaneous anaplastic large cell lymphoma (PCALCL) occurring with common lesions of the skin and lung tissue.
Materials and methods. For the verification of the diagnosis in a patient with three types of skin elements (spot, thin plaque with and without ulceration), differential diagnosis was performed between ulcerative pyoderma gangrenosum, PCALCL, large-cell transformation of mycosis fungoides, and secondary skin lesions under the nodal ALK-negtaive ALCL. A complex of studies, including histological, immunohisto - chemical, cytogenetic studies of skin tumor biopsy, allowed the verification of the PCALCL diagnosis. For the treatment of the patient, intensive induction chemotherapy was used followed by high-dose consolidation and autologous transplantation of hematopoietic stem cells.
Results. The selected treatment tactics allowed a long-term complete remission of the disease to be achieved in a patient from the poor prognosis group.
Conclusion. An algorithm for the differential diagnosis and tactics of treating is presented for a patient with primary anaplastic large cell lymphoma with a widespread skin lesion and extradermal foci.

Microbial eczema is a chronic recurrent dermatosis characterized by evolutionary polymorphism of the elements of the rash, sputum, itching, allergic reaction of the sensitized skin to the products of the decay of microorganisms and their toxins, developing against the background of a long-existing pyogenic focus in violation of the most important regulatory systems of the body.
Purpose: to study the biocenosis of the skin in patients with microbial eczema and to evaluate the clinical efficacy and safety of the cream “Tetraderm” in such patients.
Materials and methods. Patients with microbial eczema were observed, randomly selected into two groups. All patients studied biocenosis of the skin before and after treatment. Patients of the study group received topical therapy with the cream “Tetraderm”. External therapy for patients of the comparison group was carried out with cream of mometasone furoate in combination with erythromycin and clotrimazole ointments. The effectiveness of the therapy was evaluated taking into account the clinical dynamics of the skin process, bacteriological data on the content of pustules and detachable erosion, calculation of the EASI and DIJ indices.
Results. A comparative analysis of the biocenosis of microbial eczema foci in patients of both groups at the end of therapy showed a higher severity of disbiotic changes in the comparison group. As a result of our study found that patients who used the cream “Tetraderm”, there was a more rapid regression of dermatosis, almost complete suppression of pathogenic bacterial flora, a significant improvement in the quality of life.
Conclusion. The biocenosis of the skin of patients with microbial eczema was characterized by a high degree of contamination of Staphylococcus aureus and Staphylococcus epidermidis, against the background of the average verification of Streptococcus spp., Candida spp. The combination of pronounced anti-inflammatory, antibacterial, antimicotic and regenerating effects of the cream “Tetraderm” causes its high efficiency and prospects of use as a drug of choice of topical monotherapy of microbial eczema.

In this literature review data regarding impact of topical therapy with topical corticosteroids (TCS) and tacrolimus ointment on morpho-functional characteristics of epidermal barrier is analyzed. Whereas TCS has profound negative impact on nearly all epidermal barrier parameters, including epidermal structure and thickness, integrity and cohesion of stratum corneum, protease activity, hydration, pH, differentiation, lipid lamellae structure etc., tacrolimus ointment (Protopic®) exerts positive effect on the majority of the aforementioned parameters, thus allowing to compensate deleterious effect of TCS. These data allow defining recommendations upon optimization of topical therapy of atopic dermatitis with stepwise switching from TCS to Protopic® ointment.

The article is devoted to a rare hereditary disease from the group of phak omatoses with an autosomal dominant type of inheritance — Pringle — Burnevill disease. The questions of the prevalence of the disease, the variability of the clinical picture, the timeliness of the clinical diagnosis are considered. Particular attention is paid to skin manifestations and their differential diagnosis. A clinical case of this disease is described.