Consilium Medicum

Isotretinoin is a systemic retinoid and a vitamin A derivative. Since the 1980s, it has established itself as a highly effective treatment for severe acne. The drug acts on several pathogenesis links, reduces the size of the sebaceous glands and sebum production, and has an anti-inflammatory and immunomodulatory effect. The dosing regimen may vary, but multiple studies have shown that the best effect is achieved with 0.5–1 mg/kg daily up to a cumulative dose of 120–150 mg/kg per course. The duration of therapy is usually 8–12 months. For 15 years now, we have been using isotretinoin, manufactured using LIDOSE technology (Aknekutan), to treat moderate to severe acne. LIDOSE technology is a significant improvement of the drug, which made it possible to increase its bioavailability and reduce the food effect, which increased the compliance of therapy and reduced the number of relapses. The author’s observations showed that relapses occur several months after the end of the isotretinoin treatment course. Risk groups include patients with a history of gynecological diseases and surgical interventions. It is important to note that the disease has less pronounced clinical manifestations in case of relapse. To minimize the risk of exacerbation, women are recommended to take oral contraceptives in combination with isotretinoin after completing the course of therapy. Topical therapy is usually sufficient for patients after surgery; only in 3% of cases, a short course of isotretinoin may be required. It should be mentioned that isotretinoin therapy may be associated with side effects like dry skin and mucous membranes and, in some cases, a change in liver function tests. However, these side effects are successfully treated with moisturizers and hepatoprotectors, respectively.

Background. Telogen effluvium is the most common form of hair loss, which is manifested by the loss of more than 100 hairs in the telogen phase per day. There are various causes of hair loss, the main one being nutritional deficiencies, micro-, macronutrients and vitamins (zinc, iron, vitamin D, essential amino acids). Currently, there are no generally accepted clinical guidelines for the treatment of telogen effluvium, which makes it difficult to choose a therapeutic algorithm.

Aim. Conduct a comparative analysis of the outcomes associated with monotherapy and combination therapy that incorporates oral Pantovigar in patients experiencing telogen effluvium.

Materials and methods. The research included 29 female participants aged between 27 and 50 years, all diagnosed with telogen effluvium. The participants were randomly assigned to three distinct groups. The first group was treated with Pantovigar orally, in conjunction with a topical lotion designed to combat hair loss, which contained the active ingredient Microxidil. The second group received solely the topical lotion with Microxidil. The third group underwent treatment with Pantovigar orally and also utilized the topical lotion against hair loss containing the active complex Microxidil, and a course of mesotherapy with a placental preparation.

Results. The therapy exhibited significant clinical efficacy, evidenced by a decrease in hair loss, a reduction in the number of hairs in the telogen phase, and an increase in hair growth density per square centimeter as observed in the control phototrichogram. Additionally, the Pull-test yielded negative results. Patients reported enhanced volume and improved strength of their hair structure. The diagnostic procedure phototrichogram was performed twice during the study (at the start of therapy and after 3 months). Treatment was carried out for 3 months. In addition, patients were offered questionnaires on tolerability and assessment of the effectiveness of therapy.

Conclusion. The application of combination therapy involving the drug Pantovigar, along with a lotion containing the active complex Microxidil and mesotherapy using a placental product for skin rejuvenation, demonstrates a significant therapeutic effect when compared to the control group, which consisted of patients not receiving Pantovigar. The findings of this study offer compelling evidence supporting the use of targeted nutritional supplementation in the management of telogen effluvium.

Background. Alopecia is a common dermatological condition associated with significant psychological stress, particularly in women. Anxiety frequently accompanies this condition, negatively impacting quality of life and treatment outcomes.

Aim. To assess anxiety levels in women with androgenetic and alopecia areata and their dynamics during therapy with the anxiolytic drug temgikoluril (Adaptol).

Materials and methods. The study included 42 patients in the main group and 40 in the control group. Anxiety levels were assessed using the Hospital Anxiety and Depression Scale-Anxiety Subscale at baseline, 6 weeks, and 12 weeks. The main group received temgikoluril in addition to standard alopecia therapy.

Results. In the main group, anxiety levels significantly decreased at 6 weeks and continued to decline at 12 weeks. In the control group, anxiety reduction was less pronounced. Both groups showed positive trichological dynamics, but the main group reported better emotional state and reduced focus on hair loss issues.

Conclusion. Anxiolytic therapy with temgikoluril significantly reduces anxiety levels in patients with alopecia, improving treatment satisfaction, which highlights the importance of a comprehensive approach to alopecia management.

Background. Dermatological pathology, which includes a wide range of nosologies, is a common problem in geriatric patients. Currently, more and more attention is being paid to the importance of cholecalciferol deficiency in the pathogenesis of dermatoses, especially among the elderly. Vitamin D₃ is known for its ability to modulate immune responses and perform many functions at the cellular level, including influencing the proliferation and differentiation of keratinocytes. Given the inevitable age-related changes in vitamin D₃ metabolism and the increasing prevalence of dermatoses among geriatric patients, the present study aims to analyze the role of cholecalciferol deficiency on the course of dermatoses in this category of people.

Aim. The aim of the study was to evaluate the role of cholecalciferol deficiency in the development of dermatological pathology and effectiveness its order in complex therapy in geriatric patients.

Materials and methods. A prospective cohort study of 100 geriatric patients aged 67 to 95 years with verified skin diseases (chronic eczema, allergic dermatitis, microbial eczema, intertriginal dermatitis) was conducted. A Visually analog pruritus scale and the EASI index (Eczema Area and Severity Index) were used to assess the condition of patients at the entrance to the study. At the initiation stage of therapy, all patients underwent an analysis of serum cholecalciferol levels, according to which a vitamin-containing drug was prescribed. The assessment of the clinical effect and effectiveness of treatment was analyzed by the dynamics of the severity of clinical and subjective symptoms of Visually analog pruritus scale and EASI dermatoses after 2, 4, 12 weeks of therapy.

Results. In the course of the study, it was found that: 100% of geriatric patients with dermatoses had a pronounced deficiency of serum vitamin D₃ levels; evaluation of therapy for various dermatoses has demonstrated an improvement in clinical conditions in patients receiving vitamin D₃ in addition to the main treatment

Conclusion. The results of the study allowed us to establish: vitamin D₃ deficiency is a common problem in geriatric patients with dermatoses, which can worsen the manifestation of diseases; recommendations to normalize vitamin D₃ levels may be critical to maintaining dermatological health and overall well-being in geriatric patients.

Respiratory infections are among the most common infectious diseases. The influenza epidemic and the coronavirus pandemic have demonstrated how quickly respiratory diseases can spread, causing serious social and economic consequences. Respiratory infections have multiple effects on various parts of the immune system; they can aggravate chronic diseases and contribute to the exacerbation or onset of autoimmune diseases, including skin conditions. Any infectious process activates the immune system, triggering an inflammatory response. In autoimmune diseases, such as psoriasis, the immune system is already overactive, and additional stimulation can lead to increased inflammation in the skin and exacerbation of symptoms. Induction of psoriasis guttata was previously described only by a tonsil infection caused by Streptococcus pyogenes. Currently, evidence has been accumulated on the effect of various viral infections, including SARS-CoV-2, on the course of psoriasis. Cases of the onset of psoriasis guttata and common plaque psoriasis, which is resistant to topical therapy after coronavirus infection, have been reported. A clinically significant problem is the exacerbation of psoriasis and its transformation into more severe and resistant forms. Given the presence of comorbidities in most patients, it is necessary to develop an individual approach to achieve the key goals of a modern therapeutic approach – its maximum effectiveness and safety. The article presents a literature review and a clinical case demonstrating the torpid course of psoriasis with onset after a coronavirus infection.