Vol 86, No 1 (2010)

Commentary

The article presents data on new approaches to the postgraduate education for dermatologists and venereologists, its contents and quantitative determination of the independent work of doctors in terms of their advanced professional training.

The article describes the current concepts of patient management tactics for patients suffering from atopic dermatitis. It also shows the leading role of the external therapy with the step-by-step administration of moisturizing and softening drugs of the baseline therapy, topical glucocorticoids and calcineurin inhibitors.

Psoriasis is a chronic skin disease - according to numerous studies, about 2% of the population suffer from it. Psoriasis degrades the life quality, and such concomitant pathologies as metabolic disorders, cardiovascular diseases and depression shorten the life expectancy of psoriasis patients. Substantial progress has been achieved today in understanding the mechanisms of the disease, searching for new treatment techniques and standardizing the disease severity According to the recent studies, psoriasis belongs to immune-dependent diseases with genetic predisposition to its development. Dendritic cells and T lymphocytes play an important part in psoriasis development. Their interaction launches a number of mechanisms ultimately leading to the inflammatory process development and formation of psoriatic skin affections. Such cytokines as IL-12, IL-23, IFN-y and TNF-a secreted by immunocompetent cells serve as mediators during such processes. An advanced therapeutic approach to the treatment of psoriasis means creating pathogenetically important cytokine specific monoclonal antibodies and placing them into the body Today there are drugs successfully blocking the development of psoriatic skin affections by means of specific binding of IL-12, IL-23 and TNF-a cytokines. Drugs called ustekinumab and ABT-874 confirmed their therapeutic activity with regard to psoriasis at Phases 2 and 3 of clinical trials. In the course of further trials, ustekinumab also demonstrated a safety profile comparable to that of placebo.

Biosamples (skin tissue samples taken from affection foci and blood serum) from 22 patients suffering from severe to medium psoriasis (8 women and 14 men) aged 19-57 treated with Infliximab were analyzed. As for skin tissue samples, the molecular structure of genes TNF-a, TNF-R-I and TNF-R-II, contents of cytokine TNF-a and its soluble receptors (sTNF-RI and sTNF-RII) and proteome composition was analyzed in skin tissue samples; contents of TNF-a, IL2, IL4, IL6, IL-8 and IL-10 were analyzed in the blood serum. The homozygous TT genotype of TNF-R-II gene at the 676 locus and high IL10 level in the blood serum (>2.7 pg/ml) was associated with the high intensity of the psoriasis patient response to treatment with Infliximab; the homozygous GG genotype of TNF-R-II gene at the 676 locus and low level of IL10 in the blood serum (<1.0 pg/ml) was associated with a weak response or no response to treatment with Infliximab. These results laid the basis for developing a method to forecast the treatment efficacy in psoriasis patients based on a genetically engineered biological drug - Infliximab. Pilot results indicating a possible mutual relation between the composition of the skin proteome and psoriasis patient's therapeutic response to treatment with Infliximab have been obtained.

The article provides information about the pathogenic role of different immunocompetent cells in forming an immune inflammation in the skin of psoriasis patients, which is one of the most important factors in the development of psoriatic eruptions in case of exacerbation of the disease. The contents of CD4+ helper lymphocytes, CD8+ suppressor/cytotoxic lymphocytes, CD1a+ Langerhans cells and HLA-DR+ cells in the affected skin in psoriasis patients were analyzed. It was revealed that the development of an immune inflammation in the skin of psoriasis patients involves cells of congenital (CD1a+ Langerhans cells) and adaptive immunity (CD4+ and CD8+ Т lymphocytes), and their number grows.

As many as 27 women aged 40-65 were enrolled in a 12-week study to evaluate the effect of fractional photothermolysis on the skin biophysical indices and clinical signs of facial photodegradation. Such indices as epidermis moisture level, transepidermal water loss, elasticity and clinical signs of skin photopathy were assessed dynamically According to the study results, a set of three procedures had a positive effect on the skin elasticity: U (cutometry index) reliably increased after the third procedure. The skin texture parameters substantially improved, and pigmentation and wrinkle depth reduced by Week 12 of the follow-up period. Thus, the new fractional photothermolysis technology (Sellas) is an efficient and well-tolerated procedure. It is recommended to make it a part of the comprehensive face rejuvenation program in cosmetology

Rationale of the study As previously demonstrated, epigallocatechin-3-gallate (EGCG) accelerates the formation of the collagenous matrix and at the same time prevents any extraordinary collagen synthesis in the course of wound healing. In addition, EGCG is one of the most potent antioxidants and can inhibit cyclooxygenase-2, which in general lays the basis for studying the possibility to use it as an anti-inflammatory drug after dermabrasion procedures as well as to prevent pathologic cicatrization. Materials and methods. Forty women were divided into two groups (21 patients in the group treated with Egallohit, 10% EGCG, and 19 patients treated with Pantoderm Cream, 5% dexpanthenol). The drugs were applied twice a day for 50 days. Dermabrasion was performed on Days 1, 12 and 24. The patients were examined at Days 3, 15, 27, 36 and 60 of the treatment. Each of them filled in a questionnaire about the facial skin pain and itching. The facial skin humidity, fatness and pigmentation as well as number and depth of wrinkles were also measured. The total skin photodegradation index (by a blinded appraiser) was also assessed at the first and last visit. Results. No statistically significant differences in the number and depth of wrinkles, intensity and duration of facial skin pain and itching as well as skin photodegradation index between the groups both prior to and after the treatment were revealed. Conclusions. EGCG (10% Egallohit Gel) is as efficient for skin protection after microdermabrasion procedures as conventional drugs (5% cream with dexpanthenol).

Abbreviated title of the article: Morbihan disease. A description of a case of Morbihan disease is presented in the article. This disease is chronic and is characterized by the absence of any specific laboratory and histology changes as well as treatment resistance. Issues of differential diagnostics are discussed. A review of literature is given.

On the 80th anniversary of the Chair of Dermatovenerology, St. Petersburg State Pediatric Academy