Vol 23, No 8 (2021)

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).

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.

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.

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.

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.

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.

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.