Vol 26, No 8 (2024): Дерматология и аллергология

Pityriasis rubra pilaris (PRP, syn.: Devergie's disease) is a rare idiopathic papulo-squamous inflammatory skin disease characterized by follicular papules, palmar-plantar keratoderma, scaling plaques of orange-red color with characteristic foci of unaffected skin. Histologically, the alternating pattern of orthokeratosis and parakeratosis is considered a distinctive feature of PRP (staggered hyperkeratosis). A violation of the regulation of innate immunity is a component of the pathogenesis of PRP. Congenital mutations of CARD 14 or concomitant antigens, which can take the form of iatrogenic lesions, infections or malignant neoplasms, can be the initial triggers of the disease, although the etiology is often idiopathic. There are classically five subtypes of the disease, depending on the age of onset and clinical picture. Type VI PRP is associated with infection caused by the human immunodeficiency virus. CARD 14-associated papulosquamous rash and discoid dermatitis of the face represent new clinical phenotypes of PRP. Devergie's disease has a pronounced negative impact on the quality of life, and those who become ill are at increased risk of depression and suicide. Ixekizumab, methotrexate and secukinumab can be considered as systemic drugs of the first choice. If there is a contraindication to immunosuppressive therapy, high doses of isotretinoin are recommended. Topical agents, including calcipotriene, calcineurin inhibitors, emollients and topical corticosteroids, are used as additional therapy.

Infection is the most common complication of atopic dermatitis (AtD). In particular, some patients with AtD exhibit increased susceptibility to skin infections of bacterial, viral, and fungal etiologies. In some cases, infections can even be systemic. Bacterial skin infections are more common than viral and fungal ones. An especially severe infection caused by the herpes virus is herpetic eczema, which can cause life-threatening complications. Infections of fungal etiology are represented mainly by the Malassezia species, especially in patients with dermatitis of the head and neck. The review focuses on the pathophysiological mechanisms identified to date that are thought to predispose to skin infections. The main ones are impaired skin barrier function, complex immunological changes, as well as poorly understood factors such as environmental exposure and skin dysbiosis. The review also includes the clinical characteristics of patients with various skin infections, as well as appropriate treatment for complications of AtD.

Background. The acne is a chronic inflammatory skin disease that affects all age groups of the population and has a serious impact on the quality of life of patients. Various endogenous and exogenous factors are involved in the pathogenesis of dermatosis. The increasing of usage of digital media and the Internet has an impact on people's sleep habits and, with changes in sleep quality, symptoms of depression, anxiety and stress may increase, which leads to a more severe course of chronic dermatoses, including acne.

Aim. To evaluate the relationship between somnological disorders (SLD) and the frequency of smartphone use before bedtime in patients with mild to moderate acne (MMA).

Materials and methods. A single-center observational prospective study was conducted from 2023 to 2024: 130 patients aged 18 to 30 years (average age 23.32±2.75 years) diagnosed with MMA were observed. The data on the severity of acne were assessed using the Global Acne Grading System (GAGS), the degree of sleep disturbance was determined using the Pittsburgh Sleep Quality Index (PSQI), and the quality of life of patients was determined according to the Dermatology Life Quality Index (DLQI). Taking into account indicators on the use of a smartphone with the iOS or Android operating system included calculating average screen time, assessing addiction and the fact of using a smartphone 1 hour before bedtime. The statistical processing was carried out using the Jamovi version 2.3.21 program.

Results. The SLD were identified in 85 (65.38%) patients with MMA. The dermatosis had a strong impact on quality of life (DLQI>20) in 82.31% (n=107). In group I of patients "poor sleeping" there was a direct correlation between SLD (PSQI) and the severity of dermatosis (ρ=0.533; p<0.001) and the duration of screen time (ρ=0.628; p<0.001) spent on a smartphone per day. The patients of group I had a greater dependence on a smartphone compared to group II of patients "well sleeping": 15.94±1.89 points versus 7.71±1.96 points (p<0.001).

Conclusion. It has been established that the level of SLD has a high incidence in the group of patients with MMA. There is a pronounced correlation between dyssomnia and the severity of dermatosis; in patients with disturbed sleep, a high dependence on the phone and a correlation with the duration of screen time spent on a smartphone per day were revealed. This study demonstrates the need to pay attention to the presence of disturbances in the quality of sleep in people suffering from skin diseases, in particular acne.

Acne and rosacea are frequently encountered in the clinical practice of a dermatologist. These diseases can develop simultaneously in the same patient. Most often, the erythematous form of rosacea is combined with acne. Because of the similarity of clinical manifestations with acne, the diagnosis of rosacea can be easily missed. Common pathogenetic factors in the 2 diseases are thought to be genetics, alterations in the microbiome, immune disorders, and skin barrier dysfunction. There are few works addressing the relationship between acne and rosacea. A recent study identified a number of common differentially expressed genes, including interleukin-1B and matrix metalloproteinase 9, and showed that gamma delta T cells may play an important role in the development of both diseases. Despite the common pathogenesis and the similarity of some clinical manifestations (papules and pustules), acne and rosacea must be distinguished. In rosacea, there is persistent facial erythema induced by vasoregulatory neutropeptides, whereas in acne, the inflammatory process is due to excess sebum and changes in the skin microbiome. Isotretinoin is used for systemic therapy of both diseases. The drug affects the level of some cytokines, including inhibiting the expression of matrix metalloproteinase 9. In addition, it reduces sebum production in acne, and due to its ability to alter the skin microenvironment, it can reduce Propionibacterium acnes in acne and Demodex folliculorum in rosacea. Daily and cumulative doses for rosacea and acne will differ, as will topical therapy for these conditions. For acne, the combination of clindamycin and benzoyl peroxide is well established for the treatment of acne, allowing rapid meaningful clinical effect. In rosacea, metronidazole in cream form, which has better tolerability, is recommended as a topical agent. In patients suffering from both diseases simultaneously, a combination of clindamycin and benzoyl peroxide should be used to relieve acute inflammation, after which it is possible to switch to metronidazole.

The article presents a review of modern information about the structure and function of dermal fibroblasts. The morphophysiology of fibroblasts, their role in the formation of connective tissue of the dermis and its restoration after damage are discussed. Detailed knowledge about proliferative and synthetic activity of fibroblasts seems to be very important in the reasonable choice of methods for correction of age-related skin changes and sequence of invasive procedures.