Vol 22, No 7 (2020)


Skin manifestations of COVID-19 infection and peculiarities of dermatologic care of patients in the pandemic period

Adaskevich U.P.


The ongoing SARS-CoV-2 pandemic is having a huge impact on dermatological practice including the uncertainties concerning the outcome of COVID-19 infection in patients with common inflammatory disorders such as psoriasis, atopic dermatitis, autoimmune bullous diseases, the increasing need of dermatologists’ involvement in care for COVID-19 patients as well as in search for new scientific approaches to therapy of dermatological manifestations of the infection. Dermatologists all over the world are accumulating data about skin lesions which can be unnoticed symptoms of COVID-19 including various skin rashes. The article presents data by Spanish doctors who describe five various types of skin manifestations of COVID-19 as well as the results of Russian researchers about seven groups of skin eruptions in patients with COVID-19 infection depending on their etiology and mechanisms of development. SARS-CoV-2 is a new pathogen for humans that is highly contagious, can spread quickly, and is capable of causing enormous health, economic and societal impacts in setting. The consequences may continue long after the pandemic resolves, and new management modalities for dermatology may originate from the COVID-19 disaster.
Consilium Medicum. 2020;22(7):9-13
pages 9-13 views

Netakimab in anti-TNF-naive patients with psoriatic arthritis: subanalysis of PATERA clinical trial

Korotaeva T.V., Samtsov A.V., Khairutdinov V.R., Bakulev A.L., Mladov V.V., Eremeeva A.V., Zinkina-Orikhan A.V.


Netakimab (NTK) is a humanized anti-interleukin-17А monoclonal antibody approved for the treatment of psoriatic arthritis (PsA), ankylosing spondylitis, moderate to severe plaque psoriasis. Aim. We aimed to evaluate the safety and efficacy of NTK in anti-TNF-naive PsA patients, using a subanalysis of 24-week results of the phase III PATERA study. Materials and methods. The core population of PATERA study included 194 patients with active PsA and an inadequate response to previous therapy with nonsteroidal anti-inflammatory drugs, conventional or biologic disease-modifying antirheumatic drugs, randomized in a 1:1 ratio to receive subcutaneous 120 mg NTK or placebo. Among them 155 patients, 75 in the NTK arm and 80 in the placebo arm, were anti-TNF-naive and complied with subanalysis inclusion criterion. Results. Subanalysis results are consistent with core population data. 82.7% of patients in the NTK arm and 11.3% of patients in the placebo arm achieved ACR20 at week 24 (p<0.0001). NTK led to significant decline in PsA activity, axial disease, skin manifestations. Treatment-related adverse events (AE) were observed in 14.7% of patients in the NTK arm, 8.8% in the placebo arm and were mainly presented with laboratory abnormalities (hypercholesterolemia, increased alanine aminotransferase), blood and lymphatic disorders (lymphopenia). Most of AEs were mild and moderate. Conclusions. NTK has a preferable safety profile and significantly declines the severity of PsA symptoms when used as the first bDMARD.
Consilium Medicum. 2020;22(7):14-19
pages 14-19 views

Atopic dermatitis and the microbiome: is there a link?

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Review of O.B. Tamrazova speech
Consilium Medicum. 2020;22(7):20-24
pages 20-24 views

What result does the doctor and patient expect when treating psoriasis

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Review of L.P. Kotrehova speech
Consilium Medicum. 2020;22(7):25-28
pages 25-28 views

Biological therapy of melanoma

Kravchenko A.S.


Melanoma is a malignant skin tumor characterized by a high prevalence both in the Russian Federation and around the world, rapid growth, the ability to local and distant metastasis, and high mortality. The discovery and introduction of monoclonal antibodies made it possible to achieve certain successes in the treatment of a number of diseases, including melanoma. High efficiency of using monoclonal antibodies is achieved due to their precisely targeted action on certain molecules, which allowed to increase the overall survival of patients with malignant neoplasms. As a treatment for melanoma, immune control checkpoint inhibitors (CTLA-4 and PD-1), such as ipilimumab, nivolumab, and pembrolizumab, have been shown to be highly effective. The effectiveness of these monoclonal antibodies was confirmed in studies where they were prescribed as monotherapy and combination therapy and was expressed in an increase in the overall survival of patients with skin melanoma. However, monoclonal antibody therapy may be associated with a risk of adverse reactions. The purpose of this review is to generalize current data on the biological treatment of melanoma.
Consilium Medicum. 2020;22(7):29-32
pages 29-32 views

Clinical aspects of the management of patients with psoriasis: can we do better?

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Review of N.S. Rudneva speech
Consilium Medicum. 2020;22(7):33-37
pages 33-37 views

Dermatoscopic BRAAFF algorithm for diagnosis of acral melanoma

Zhuchkov M.V., Sharova N.M., Bol'shakova E.E., Sonin D.B.


The article provides overview data on the use in clinical practice of a little-known but useful in clinical practice algorithm for dermatoscopic diagnosis of acral lentiginous skin melanoma. The BRAAFF algorithm is one of the decision-making tools in the analysis of dermatoscopic images obtained in melanomas of acral localizations.
Consilium Medicum. 2020;22(7):38-41
pages 38-41 views

Chronic pruritus is a multifaceted issue of our time

Piruzyan A.L., Nevozinskaia Z.A., Korsunskaya I.M.


Chronic pruritus still causes difficulties not only for patients, but also for physicians. Dermatological diseases are the major cause of itching, however the list of triggers causing pruritus is much longer. Thus, many chronic diseases can be accompanied by itching, which has its own features. In some liver disorders (cholangitis, viral hepatitis), generalized pruritus often develops. Uremic pruritus in chronic kidney disease occurs in 50% of dialysis patients. Patients with diabetes mellitus also sometimes experience chronic pruritus that gets worse at night. Neuropathic pruritus is often accompanied by other discomforts, such as numbness or mild pain. Also, it should not be ruled out that a drug can become the cause of itching. The reaction to the drug can occur immediately or be delayed. With such a wide list of underlying causes of pruritus, its diagnosis and therapy becomes a complex task and requires the participation of several specialists to select the optimal therapy.
Consilium Medicum. 2020;22(7):42-44
pages 42-44 views

Seborrheic dermatitis: how to help the patient

Paniukova S.V., Piruzyan A.L., Korsunskaya I.M.


Seborrheic dermatitis (SD) is a common disease affecting skin areas rich in sebaceous glands. The disease pathogenesis is not fully understood, but is believed that colonization by the opportunistic Malassezia yeasts plays a certain role in its development. The prevalence of SD in different countries is around 3%. SD most commonly occurs in men, and the risk for the disease increases with age. SD manifests by inflammatory localized plaques with marked desquamation and itching. Apart from physical discomfort, the disease causes an impairment of the patient's psycho-emotional status. It is important to warn the patient that the disease is often chronic, and a stable clinical effect can be achieved mainly with prolonged therapy, for example, with zinc pyrithione. In our practice, we note that patients with SD have alterations in corneometry parameters: increased skin fat content and decreased skin hydration. Therapy with zinc pyrithione combined with moisturizing shampoos shows significant results already after 3 weeks of use and allows you to achieve stable remission and improve the quality of life of patients with long-term treatment.
Consilium Medicum. 2020;22(7):46-48
pages 46-48 views

Onychomycosis and onychodystrophy: differential diagnostics and rational therapy

Torshina I.E.


The article contains a review of modern data on the etiology, pathogenesis and clinical manifestations of onychomycosis and onychodystrophies. The author describes the options for the successful treatment of onychomycosis and onychodystrophies, as well as further care of the nail plates after the completion of therapy. The options for the treatment of onychomycosis and onychodystrophies, further care of the nail plates after the completion of therapy are described. A skilful combination of topical agents of Mycostop®, Mykolept® and Clavio® (line of drugs) allows achieving the rehabilitation of patients with onychomycosis and onychodystrophies of various origins with reliable efficiency.
Consilium Medicum. 2020;22(7):49-53
pages 49-53 views

Rare dermatological diseases: Devergie disease

Plieva K.T., Denisova E.V., Bobrov M.A., Mildzikhova D.R., Korsunskaya I.M.


Devergie disease, or pityriasis rubra pilaris, is a poorly studied and rare disease, which prevalence is estimated at about 1 in 400 thousand. The article provides relevant data on the classification of Devergie disease, features of the course and clinical manifestations of each of the 6 types of the disease, as well as the approximate occurrence of these types. Erythroderma can occur in Devergie disease, but data on the incidence of this manifestation vary significantly. The article presents a clinical case of type 1 Devergie disease. This case is of particular interest, since the disease began not according to the classical scheme, i.e., with appearance of an erythematous spot, but with extensive areas of erythroderma. This case is intended to draw attention to the fact that dermatological diseases do not always develop in a typical way, and the correct diagnosis often requires a histological examination.
Consilium Medicum. 2020;22(7):54-56
pages 54-56 views

Modern possibilities of topical therapy for foot mycosis

Maximov I.S.


Foot mycosis is one of the most common skin diseases. Its prevalence in the general population ranges from 5 to 20%. The main causative agents of foot mycosis are dermatophytes; they account for 80-90% of cases. Terbinafine is an antifungal drug that belongs to the allylamine group, with a wide spectrum of antifungal activity. It has been registered since 1991 in Europe and is included in the WHO Model List of Essential Medicines. The article discusses the features of the use of various forms of terbinafine, depending on the clinical picture of foot mycosis. It presents Russian and foreign data on the efficacy and safety of terbinafine in the topical therapy of foot mycosis.
Consilium Medicum. 2020;22(7):57-59
pages 57-59 views

Skin lesions in thyroid diseases and syndromes associated with thyroid pathology

Troshina E.A.


The article is devoted to the description of various dermatological manifestations which are characteristic of both the thyroid diseases and the syndromes, which they may be part of. Own observations are presented. The emphasis is made on the possible mechanisms underlying skin lesions in these diseases.
Consilium Medicum. 2020;22(7):60-63
pages 60-63 views

Skin lesions in diabetes mellitus: clinical manifestations, diagnosis, differential diagnosis, features of treatment

Tokmakova A.Y., Semenova D.A., Zaitseva E.L.


Diabetes mellitus (DM) is one of the most common chronic diseases, which occurs in about 6% of the population. Various skin changes in individuals with both type 1 and type 2 DM are quite common and can cause certain difficulties in diagnosis and choice of therapeutic tactics. Such patients may need the help of not only an endocrinologist, but also doctors of other specialties - a dermatologist, a surgeon, an allergist. The article presents data on the most common dermatological diseases associated with DM, identifies the main links of their pathogenesis, methods of diagnosis and differential diagnosis. It discusses the possibilities of using the ultrasound skin imaging for the diagnosis and differential diagnosis of one of the most common dermatoses in diabetes, necrobiosis lipoidica. It considers the features of therapy for dermatological diseases in patients with impaired carbohydrate metabolism.
Consilium Medicum. 2020;22(7):64-68
pages 64-68 views

The place of combined hormonal contraceptives in the therapy for acne in women

Uspenskaya Y.B.


Hyperandrogenism plays a very important role in the pathogenesis of acne. Androgens contribute to sebaceous gland hyperplasia, increased sebum production and hyperkeratosis. Excessive effects of androgens on the skin are caused by hyperandrogenism associated with various endocrine syndromes or an increased sensitivity of skin receptors to normal concentrations of male sex hormones and local hyperproduction of androgens. The use of combined oral contraceptives (COCs) has therapeutic potential in the treatment of acne in patients with hyperandrogenism and in women with normal androgen levels. The use of COCs can be an alternative to systemic therapy with antibacterial drugs and retinoids. The decision on the administration of COCs to patients with acne should be made together by a dermatologist, gynecologist or endocrinologist.
Consilium Medicum. 2020;22(7):69-72
pages 69-72 views

Comorbidity of acne and disorders of intestinal microbiocenosis: theoretical and real

Trukhan D.I.


Improving diagnostic capabilities leads to a significant increase in clinical situations, when it is already difficult to talk about the presence of a single disease in a patient - currently, in most clinical cases, there is a combined or concomitant pathology. The review considers the issues of acne comorbidity and disorders of intestinal microbiocenosis in theoretical and practical aspects. In 1930, the gastroenterological mechanism of the relationship between emotional and nervous conditions (anxiety, depression) and skin diseases (such as acne) was formulated and designated as the "gut-brain-skin axis". For several decades, this hypothesis was dormant. However, reviews of the last decade provide numerous facts that indirectly indicate the validity of the “intestine-brain-skin” hypothesis, and are the basis for the theoretical comorbidity of acne and intestinal microbiocenosis disorders. in real clinical practice, this relationship does not seem so obvious and requires further study of the mechanisms and effects of oral probiotics in acne.
Consilium Medicum. 2020;22(7):73-77
pages 73-77 views

Panniculitis in the practice of an internist and a dermatologist (a lecture)

Egorova O.N., Belov B.S.


Panniculitis is a group of heterogeneous inflammatory diseases that involve subcutaneous adipose tissue (SAT) and have common clinical and pathomorphological signs. The rate of panniculitis varies widely in different regions of the world and depends on the prevalence of a particular disease, which is the etiological factor of the pathology discussed. According to the predominance of inflammatory changes in the connective tissue septa or fatty lobules, septal and lobular panniculitis are distinguished. Both types can occur with or without vasculitis. Clinically, panniculitis is characterized by indurations of different colors which are accompanied by varying intensity pain, with a predominant localization on the lower extremities. Changes in laboratory parameters in panniculitis are non-specific, reflecting the presence and severity of the inflammatory process. Histomorphological examination of biopsies of skin, subcutaneous adipose tissue and fascia is the "gold standard" for the diagnosis of the disease, especially lobular forms. During the examination, a number of questions related to the differential diagnosis of panniculitis variants may arise. Treatment of panniculitis has not been fully developed and consists mainly of the treatment for the underlying disease.
Consilium Medicum. 2020;22(7):78-83
pages 78-83 views

The theme of syphilis in fiction XVI-XX centuries

Golousenko I.Y., Medvedev K.I.


Until the beginning of the ХХ century, syphilis was a fairly common disease, which found a bright, memorable reflection in the fiction of those times. This fact has played a great role in spreading knowledge about the consequences of this disease among the reading public, since special medical literature is available only to a small segment of the population, mainly armed with special education.
Consilium Medicum. 2020;22(7):84-86
pages 84-86 views

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