Vol 23, No 8 (2021)


Pyoderma gangrenosum: current state of the problem

Adaskevich U.P.


Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that presents with rapidly developing, painful skin ulcers hallmarked by undermined borders and peripheral erythema. Epidemiological studies indicate that the average age of PG onset is in the mid-40s, with an incidence of 3–10 cases per million person-years. PG is often associated with a variety of other immune-mediated diseases, most commonly inflammatory bowel disease and rheumatoid arthritis. The cause of PG is not well understood, but PG is generally considered an autoinflammatory disorder. Studies have focused on the role of T cells, especially at the wound margin; these cells may support the destructive autoinflammatory response by the innate immune system. PG is difficult to diagnose as several differential diagnoses are possible; in addition to clinical examination, laboratory tests of biopsied wound tissue are required for an accurate diagnosis, and new validated diagnostic criteria will facilitate the process. Treatment of PG typically starts with fast-acting immunosuppressive drugs (corticosteroids and/or cyclosporine) to reduce inflammation followed by the addition of more slowly acting immunosuppressive drugs with superior adverse event profiles, including biologics (in particular, anti-tumour necrosis factor agents).

Consilium Medicum. 2021;23(8):603-608
pages 603-608 views

Late acne in women: patients of gynecologists, endocrinologists or dermatologists?

Golousenko I.Y.


The article raises the problem of late acne in women. As a result of observation of 326 patients aged 20 to 40 years, evaluation of the data of a significant number of laboratory and instrumental tests, it was found that 257 (79%) women had hyperandrogenism of various etiologies. On the basis of which, 6 groups of patients were identified, which allows applying etiological treatment. It is concluded that only the cooperation of dermatovenerologists, gynecologists, endocrinologists can help an increasing number of such patients.

Consilium Medicum. 2021;23(8):609-611
pages 609-611 views

Aesthetic medicine without hematomas: myth or reality

Mashkina A.S.


Background. Invasive aesthetic medicine is associated with various rehabilitation manifestations: hematomas, edema, pain after the procedure. Hematomas are an unpleasant, but often inevitable for the patient. In this case, hematomas appear when a vessel is directly injured by a needle during the procedure, which is always associated with skin trauma and an increased risk of infection.

Aim. Application of an effective treatment regimen without pronounced side effects for minimizing rehabilitation phenomena after aesthetic procedures.

Materials and methods. The study involved 50 patients, 25 of whom received anti hematoma therapy with external and systemic forms of Arnica montana (Boiron) before and after the procedure. 25 remaining (control group) did not receive therapy before the procedure, as well as during rehabilitation after the procedure. The analysis of the course of the rehabilitation period was assessed using a questionnaire, which contained questions on assessing the degree of intensity of such adverse events after the procedure as pain, edema, hyperemia, the size of hematomas according to a scale from 0 to 5, where 0 – no manifestations, 5 – significantly pronounced manifestations.

Results. An analysis of many clinical cases shows the effectiveness of antihematoma therapy with Arnica montana preparations in various forms [Arnica montana C9 (Boiron) and Arnigel®] before and after procedure, manifested in a faster resolution of hematomas, a decrease in edema, a decrease in pain after the procedure, as well as an overall reduction in the rehabilitation period by at least 2–3 days compared with the course of rehabilitation without the appointment of anti-hematoma therapy.

Conclusion. Based on the above data, confirmed by numerous studies, we can conclude about the effectiveness of prescribing Arnica drugs [Arnica montana C9 (Boiron) and Arnigel®] before and after invasive aesthetic procedures.

Consilium Medicum. 2021;23(8):612-616
pages 612-616 views

Androgenetic alopecia and coronavirus infection

Melnichenko O.O., Sakaniya L.R., Piruzyan A.L., Korsunskaya I.M.


Androgenetic alopecia (AA) is a non-scarring hair loss in men and women caused by the effect of androgens on hair follicles which occurs in genetically predisposed individuals. The disease has chronic and progressive course and affects millions of people worldwide. AA treatments are limited, and understanding of the underlying pathophysiology is still is developing. Along with genetic predisposition and complex biochemical processes occurring in hair follicle cells, the role of new novel coronavirus infection COVID-19 in AA is widely discussed. Today, information on the epidemiology, clinical manifestations, prevention and treatment of coronavirus infection COVID-19 is constantly being updated. COVID-19-associated cutaneous manifestations have been described, including angiitis, acrodermatitis (acroangiitis), papular-vesicular eruptions, papular-squamous eruptions, pityriasis rosea, measles-like rash, toxicoderma, exacerbation of chronic dermatoses, artifactual skin lesions and, finally, hair loss. A number of studies demonstrate a link between androgens involved in the pathogenesis of COVID-19 and the possible occurrence of AA.

Consilium Medicum. 2021;23(8):617-620
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Pharmacotherapy for diffuse alopecia

Shperling N.V., Shperling M.I., Rudenko M.A., Chaplygin A.V.


Background. Diffuse alopecia (DA) is a pathological hair loss associated with damage to the hair follicle, usually associated with a trigger factor. An important role in the development of this condition is played by the violation of the cyclicity of the phases of the hair follicle – anagen, telogen and catagen. The basis of pathogenetic therapy for DA is the induction and prolongation of the anagen stage (including through inhibition of catagen). The use of medicines based on natural ingredients can get a positive effect on the course of the disease.

Aim. To evaluate the effectiveness of complex therapy with Selencin in the treatment of DA.

Materials and methods. The study was conducted on 80 patients with the proved diagnosis of DA (telogenic/anagenic). The treatment was carried out with Selencin in tablet form and external form (peptide lotion) for 2 months. The effectiveness of the drug was assessed 2 and 4 months after the start of treatment (immediately after the end of the course and 2 months later).

Results. The high clinical efficacy of the therapy has been shown in a significant reduction in hair loss, as well as restoration of their structure and increase in volume. Also, after 2 and 4 months from the start of treatment, there was a normalization of the dermatoscopic picture of the scalp and an improvement in the results of special tests (PULL test).

Conclusion. The use of a combination of drugs Selencin in the management of DA has a pronounced therapeutic effect. The drugs can be used as the primary treatment for this disease.

Consilium Medicum. 2021;23(8):621-625
pages 621-625 views

Artificial intelligence: how it works and criteria for assessment

Shlivko I.L., Garanina O.Y., Klemenova I.A., Uskova K.A., Mironycheva A.M., Dardyk V.I., Laskov V.N.


Artificial intelligence is a term used to describe computer technology in the modeling of intelligent behavior and critical thinking comparable to that of humans. To date, some of the first areas of medicine to be influenced by advances in artificial intelligence technologies will be those most dependent on imaging. These include ophthalmology, radiology, and dermatology. In connection with the emergence of numerous medical applications, scientists have formulated criteria for their assessment. This list included: clinical validation, regular application updates, functional focus, cost, availability of an information block for specialists and patients, compliance with the conditions of government regulation, and registration. One of the applications that meet all the requirements is the ProRodinki software package, developed for use by patients and specialists in the Russian Federation. Taking into account a widespread and rapidly developing competitive environment, it is necessary to soberly treat the resources of such applications, not exaggerating their capabilities and not considering them as a substitute for a specialist.

Consilium Medicum. 2021;23(8):626-632
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Evaluation of the sexual and age structure of infestation by the Demodex mite and percentage of complications of acne-related dermatoses with secondary demodicosis, depending on their severity

Zhiltsova E.E., Politov S.A., Bakovetskaya O.V., Kochetkova D.L., Egorova E.A.


Background. The article provides a detailed review of the etiopathogenetic, clinical and diagnostic aspects of demodectic skin of the face, considers the modern classification of this pathological condition, provides statistical data on the sex and age structure of population invasion by a tick of the genus Demodex, as well as the percentage of complications with secondary demodicosis of acneform dermatoses (rosacea and perioral dermatitis).

Aim. To reveal the percentage of complications of the course of acneform dermatoses (perioral dermatitis and rosacea) with demodicosis, depending on the severity of the underlying disease, as well as the sex and age structure of the invasion among the patients of the study group.

Materials and methods. In our own study, we assessed the sex and age structure of the Demodex mite infestation and the percentage of complications of rosacea and perioral dermatitis with secondary demodicosis, depending on their severity. The severity of clinical manifestations of rosacea was assessed using the rosacea diagnostic assessment scale; the PODSI index was used for perioral dermatitis. Before the start of the course of therapy and after its completion, all patients underwent a microscopic examination of scrapings from the skin of the face in order to detect a diagnostically significant number of individuals of the Demodex genus tick (5 or more). If a tick was found in scrapings, along with standard therapy drugs, patients were locally prescribed 1% ivermectin cream once a day for a course of 2 to 4 months, depending on the severity of the clinical manifestations of dermatosis.

Results. It was found that the incidence of Demodex invasion in the study group increased in direct proportion to the severity of the clinical manifestations of dermatoses and the age of the patients. It was also found that among the patients of the study group, demodicosis was registered in women almost twice as often as in men. Topical use of 1% ivermectin cream has shown a high profile of the efficacy and safety of this drug.

Conclusion. After the completing the treatment course, complete elimination of Demodex, confirmed by laboratory, was achieved in 100% of patients with demodicosis in the study group. There were no adverse events or side effects while taking the drug.

Consilium Medicum. 2021;23(8):633-636
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Keloid scars. Modern aspects of diagnosis and treatment

Taganov A.V., Bragina A.V.


Cicatricial skin hypertrophy includes keloids and hypertrophic scars. Keloid scarring is thought to result from an imbalance between increased synthesis of collagen and extracellular matrix and decreased degradation of these products. Current knowledge of keloid pathophysiology prompts clinicians to investigate new methods for the diagnosis and treatment of keloids, as well as their prevention.

Consilium Medicum. 2021;23(8):637-652
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Optimization of approaches to the management of adult patients with severe atopic dermatitis: analysis of real clinical practice outcomes

Fomina D.S., Serdotetskova S.A., Chernov A.A., Lebedkina M.S., Nurtazina A.I., Gadzhieva M.K., Mukhina O.A., Bobrikova E.N.


Atopic dermatitis (AD) is a multifactorial genetically determined immune-mediated skin disease. It is difficult to treat and significantly affects patients’ quality of life. The development of an integrated approach focusing on atopic multimorbidity, implementation of validated control tools and distinction of clinical parameters specific for different phenotypes of severe forms of disease is especially relevant to patients resistant to standard therapy techniques. Dupilumab, a biologic, is approved for the treatment of the resistant group of patients with moderate to severe AD in the Russian Federation. Dupilumab inhibits the functions of two key cytokines of T2-mediated inflammation – IL-4 and IL-13. The article presents personal experience of the authors concerning individual approach to the choice of therapy for the management of this cohort of patients in routine clinical practice. The disease aggravating criteria were determined, which are fundamental for the formation of individual patient portrait for the biologic (dupilumab) treatment for severe AD.

Consilium Medicum. 2021;23(8):654-661
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New possibilities of therapy of T2-associated diseases

Hutueva S.H., Shogenova M.S., Alieva I.Z., Shogenova L.S.


New opportunities for the treatment of T2-associated diseases in recent years, the number of patients with atopic dermatitis (ATD), having a moderate and severe form of course, has been increasing. According to research, 30% of the world's population suffer from allergic diseases, such as bronchial asthma (BA), ATD, food allergies, anaphylaxis, chronic polypous rhinosinusitis. The development of these diseases is based on the pathophysiological mechanism of T2-mediated immune inflammation, where cytokines IL-4 and IL-13 play a key role. Diseases based on this type of inflammation belong to the group of T2-associated diseases. Thanks to targeted therapy with dupilumab, which affects the main links of pathogenesis, it is possible to effectively cope with the main manifestations of severe and moderate ATD and BA.

Aim. To evaluate the effectiveness of biological therapy with dupilumab 300 mg subcutaneously for 52 weeks of T2-associated diseases, including a combination of severe ATD and BA, uncontrolled course in a teenager C. (born 2006).

Materials and methods. The analysis of the medical history of the patient C., born in 2006, who received therapy with dupilumab 300 mg subcutaneously every 2 weeks for 52 weeks with the diagnosis “Main: ATD, common form, severe course. Secondary diagnosis: BA, persistent course, uncontrolled, moderate severity”. Dynamic monitoring of the total blood count with the calculation of the absolute number of eosinophils in peripheral blood was performed. The allergological examination included the determination of specific IgE-AT to 300 allergens using ALEX2 technology. Criteria for the effectiveness of ATD therapy were evaluated on the SCORAD scale in dynamics, an AST test was used for BA, as well as a study of the function of external respiration before treatment and during therapy.

Results. The study showed high efficacy and safety of biological therapy with dupilumab 300 mg subcutaneously every 2 weeks for 52 weeks of T2-associated diseases, including a combination of severe ATD and BA, uncontrolled course in patient C. (born in 2006). The conducted allergological examination with the help of the ALEX2 Allergochip made it possible to establish the molecular components of the primary causal allergens, predict the course of an allergic disease, and carry out successful elimination measures against food allergens, preserving the maximum set of nutrients in the patient's diet.

Conclusion. Therapy with dupilumab 300 mg subcutaneously every 2 weeks for 52 weeks of T2-associated diseases, with manifestations of severe ATD and BA, uncontrolled course leads to clinically significant improvement in the course of diseases, control of symptoms of diseases. ATD shows a decrease in itching of the skin, normalization of sleep, improvement of quality of life. With BA, a significant reduction in exacerbations, normalization of respiratory function indicators, complete control of the disease has been achieved. The targeted biological drug dupilumab has a targeted effect on the key links in the pathogenesis of ATD and BA and reduces the burden of severe diseases. Therefore, the use of dupilumab in ATD and BA contributes to achieving disease control and improving the patient's quality of life.

Consilium Medicum. 2021;23(8):662-667
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Acute conditions in dermatology: toxic reactions and their treatment

Sakaniya L.R., Plieva K.T., Denisova E.V., Korsunskaya I.M.


Acute severe conditions caused by the use of various drugs are of particular difficulty in dermatological practice. Toxicodermic reactions include DRESS syndrome, Stevens–Johnson syndrome, toxic epidermal necrolysis, acute generalized exanthematous pustulosis and erythroderma of various origins. These disorders are characterized not only by skin lesions, but also toxic reactions in internal organs, which if untreated properly can be life-threatening. The first choice drugs for such reactions are systemic glucocorticosteroids, in particular betamethasone derivatives. Our own experience and numerous studies confirm the effectiveness of such drugs. However, it should be remembered that uncontrolled or prolonged use of systemic glucocorticosteroids can aggravate the patient's condition and lead to unwanted adverse reactions.

Consilium Medicum. 2021;23(8):668-671
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Basic genetic and biological markers of psoriasis

Melnichenko O.O., Denisova E.V., Zhukova O.V., Potekaev N.N.


Background. Psoriasis is a chronic inflammatory autoimmune disease characterized by an excessively aberrant hyperproliferation of keratinocytes. The pathogenesis of psoriasis is complex, and the exact mechanism, despite numerous studies, is still unclear. Complex genetic relationships play an important role in the pathogenesis of this skin disease. A large number of genes that are also associated with other diseases are involved in the development of psoriasis. The variety of comorbidities in patients with psoriasis often present challenges to the treatment for dermatosis. Understanding the role of certain genes in the pathogenesis of psoriasis will contribute the development of more effective targeted therapy aimed at blocking the corresponding inflammatory signaling pathways and molecules.

Aim. To analyze and systematize the basic genetic and biological markers of psoriasis.

Materials and methods. The study included research articles on the genetic analysis of psoriasis. The ResNet, PubMed and eLibrary databases were used.

Results and discussion. Basic genetic and biological markers were identified by analysis of literature sources devoted to psoriasis. Attention is paid to the role and effects of single nucleotide polymorphisms, which make it possible to establish a clear association of a number of genes involved in the development of psoriasis. Genes with altered expression in the psoriatic process were considered separately.

Conclusion. The identified biomarkers can be used in targeted biological therapy of psoriasis using biological modulators that block signaling.

Consilium Medicum. 2021;23(8):672-675
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Comparative evaluation of the therapeutic efficacy and the safety of the Tetraderm® cream in comparison with the Triderm® cream in patients with allergic dermatoses, complicated by secondary infection

Kasatkin E.V., Givirovskiy S.E., Pisarev V.V., Merkulov M.E., Storozheva K.V., Fedotova O.V., Doshchuk N.A.


Often allergic dermatoses complicated by a secondary infection. The main causative agents of pustular skin infections are gram-positive cocci. The goals of external therapy are to eliminate the inflammatory reaction and subjective sensations, eliminate secondary bacterial and fungal infections, reduce dry skin and protect against adverse environmental factors. The effectiveness of local therapy is ensured by properly selected dosage forms of drugs. The aim of this study was to conduct a comparative assessment of the therapeutic efficacy and safety of Tetraderm® cream and Triderm® cream in patients with inflammatory dermatoses with concomitant bacterial and mycotic infections. The study involved 128 patients, depending on the drug used, the patients were divided into 2 groups. Efficacy was assessed by the relative number of patients (%) with the achieved therapeutic success (by index EASI), the relative number of patients (%) with the achieved therapeutic success on the scale of total clinical judgment of a physician relative number of patients (%) with the achieved improvement in the change in dermatology life quality index – DLQI, as well as according to the objective methods of investigation. Safety was evaluated on the basis of monitoring and registration of adverse events, data from clinical laboratory tests. Both drugs demonstrated similar therapeutic efficacy and did not differ in any of the efficacy criteria, both in the ITT population and in the PP population, and also proved to be equally safe.

Consilium Medicum. 2021;23(8):676-681
pages 676-681 views

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