Vol 95, No 3 (2019)

Seborrheic keratosis (SK) is a common benign epithelial skin tumor that exists in a variety of clinical op - tions. The color of the tumor varies from yellow to dark brown, which leads to diagnostic errors. There is аlittle data about pigmentation of the SK in the literature. There is no consensus on the content of melanocytes in the SK.

Objective: to study the nature of the distribution of melanin in the SK and its relationship with the number of melanocytes.

Materials and methods. An analysis of 130 histological preparations with a verified diagnosis of SK and immunohistochemistry (IHC) test with monoclonal antibodies to Melan A (clone A103 ready-to-use) have been performed. Material sampling was performed in 130 patients with SK at the age of 46–77. In 48.5 % of the material was taken from places that are easily exposed to sunlight, 51.5 % — from places that are often closed, less prone to exposure to UV-radiation.

Results. As a result of histological examination, three types of pigmentation of the SK were identified, depending on the accumulation and location of pigment in the tumor. IHC test with monoclonal antibodies to Melan A in all cases of SK revealed a significant decrease in the content of melanocytes (0.7–5 %), compared with the unaffected epidermis (10.7–14.3 %) (р = 0.001). The greatest number of melanocytes (3–5 %) was recorded in SK, which were removed from places exposed to UV radiation.

Conclusions. A significant decrease in the content of melanocytes (less than 3 % of tumor cells) in the most pigmented SK (p = 0.0003), the lack of activation of melanogenesis in the tumor under the influence of UV radiation indicates the accumulation of pigment due to its slow utilization, due to aging and a de - crease in metabolismtumor cells.

Aim: to assess the efficacy and side-effect risk of the surgical treatment of seborrheic k eratosis (SK) using a copper vapour laser (CVL).

Patients and methods. 3980 patients (1214 men and 2766 women aged 20 to 78 years) suffering from SK were treated using a CVL (Yakhroma-Med model, Russian producer) equipped with a laser pen and a scanning nozzle. The laser treatment was performed without anaesthesia in one to four sessions. During the treatment procedure, the following radiation parameters were applied: wavelengths ranging from 511 to 578 nm (in the ratio of 3 to 2), an average power of 0.6–1.2 W and an exposure duration ranging from 0.2 to 0.4 s. The diameter of the light spot on the skin surface was 1 mm. The follow-up observation lasted 24 months.

Results. The computer simulation of tissue heating by CVL and other laser systems showed that CVL is an optimal treatment choice for seborrheic keratosis in terms of the energy deposition depth. According to our clinical data and the results of computer simulation, the CVL is established to be the safest and the most effective for seborrheic keratosis treatment.

This paper describes a clinical case of secondary syphilis, which was manifested exclusively by syphilitic alopecia.

We describe the details of the clinical picture, as well as a differential diagnosis of syphilitic alopecia and alopecia areata on the basis of trichoscopy data.

For a patient with scalp lesions typical of syphilis (focal form of alopecia), the trichoscopic picture was represented by hairs broken at different heights from 1 to 5 mm, “empty” follicles (“yellow” dots), anisotrichosis due to the loss of terminal hair. The eyebrow trichoscopy showed “yellow dots”, vellus hairs, hair thinning due to the loss of bristly hair. A comparison of the trichoscopic pictures for alopecia areata and syphilitic areata have revealed the absence in the latter of a number of signs typical of the former, such as pencil-point, ex clamation-point, zigzag, monilethrix and tulip hairs.

Patients with a clinical picture of focal, diffuse or mix ed alopecia should be tested for syphilis using serological methods.

The article deals with ethiopathogenetic factors of origin of progredient symmetric erythrokeratodermia of Gottron which is mainly characterized by autosomal dominant mode of inheritance and is classified as a disorder of cornification with extra epidermal cellular proliferation.

Clinicopathologic criteria on the basis of which this pathology can be verified are described here, such as: onset of a disease at an early age, strictly divided polycyclic, fixed, hyperkeratotic plaques with a narrow erythematic crown and a clean-cut, sometimes hyper pigmented edge, which are symmetrically located on skin on head, buttocks, limbs and are not prone to quick peripheral growth; large frequency of palmoplantar keratoderma and also histological changes typical of erythrokeratodermia.

The article describes a rare clinical case of autosomal-recessive progredient symmetric erythrokeratodermia of Gottron which is distinguished by seasonal changes of skin pathological process — emergence of rash in winter and complete remissions in summer.

Netakimabis original monoclonal antibody against IL-17. This article outlines the key results of a phase II open-label extension trial of netakimab 80 mg and 120 mg in patients with moderate-to-severe psoriasis.

The main aim of the trial is to estimate efficacy, safety and immunogenicity of long-term treatment with netakimab 80 mg and 120 mg in patients with moderate-to-severe psoriasis.

Materials and methods. The BCD-085-2-ext study is a comparative, open-label phase 2 clinical study of the effi - cacy and safety of netakimab in patients with moderate-to-severe plaque psoriasis who had finished BCD-085-2 (NCT02762994) trial. Main efficacy endpoints includePASI75, PASI90, PASI100, sPGA = 0–1 on week 38 of the trial, long-term PASI75/90/100 retention, efficacy keeping after switch from once every 2 week regimen to once every 4 week regimen. Safety endpoints include adverse events, serious adverse events number and their profile.

Results. 103 patients were included. PASI75 at week 38 was reached by 98.06 %, PASI90 — by 92.23 %, PASI100 — by 59.22 % of patients. There were no cases of serious adverse event, early with drawal due to adverse events and cases of grade 4 toxicity according to CTCAE 4.03. There were no cases of binding antibodies to netakimab during the 38 weeks of the study.

Conclusion. The first Russian original IL-17 inhibitor netakimabis promising modern medicine for moderate-to-severe plaque psoriasis treatment. Netakimabshowed high efficacy, favorable safety profile and low immunogenicity during one year of the treatment.