Course Of Dermatosis Research Articles

Analysis of factors affecting the course of actinic keratosis

Actinic keratosis (AK) is a photodependent skin impairment with local intraepidermal atypia of keratinocytes, which is manifested by erythematous, erythematous­squamous, papulo­squamous elements with localization mainly in open (for insolation) areas of the body. Objective — to analyze the comorbidity and factors affecting the course of АК in different age groups of the population, taking into account the growing incidence of AK in recent years, especially in the southern regions of Ukraine. Materials and methods. During 2020—2024 under our supervision were 78 patients with AK aged 40 to 83 years, of which 40 were men and 38 were women. Trigger factors and somatic diseases were analyzed, which, according to patients, could affect the course of dermatosis. Results and discussion. The average age of men under our supervision was (54.3 ± 0.3) years, women — (58.4 ± 0.5) years. 54 (69.2 %) patients had a complicated family history of AK, including 3 (3.8 %) people having first­line relatives suffering from malignant skin diseases. 56 (71.8 %) of the respondents identified their past sun exposure as excessive and accompanied by skin burns followed by epidermal detachment. 5 (6.4 %) patients had long­term contact with harmful substances (petroleum products, household chemicals). In the observation group, 45 (57.7 %) patients with nicotine dependence were found. Against the background of AK concomitant pathology was revealed: diseases of the cardiovascular system (coronary heart disease — in 23 (29.5 %) people, hypertension — in 14 (17.9 %)); diabetes mellitus — in 5 (6.4 %) people; autoimmune pathology (autoimmune thyroiditis — in 2 (2.6 %) people, Behçet’s disease — in 1 (1.3 %) woman, ulcerative colitis — in 1 (1.3 %) man); oncological processes of different localization — in 11 (14.1 %) patients from the observation group. Conclusions. As a result of the clinical study, it was established that one of the leading factors in the development of AK, in addition to excessive insolation, is genetic predisposition, the study of the mechanisms of which is an important aspect in the development of new methods for the treatment of dermatosis and prevention of neoplastic transformations; extended oncological screening of patients with AK is etiopathogenetically justified; an increase in the number of people with nicotine dependence in the group of patients with actinic keratosis (57.7 %) compared with the total number of the nicotine dependent in Ukraine (40—45 %) requires further study of the combined effect of excessive insolations and smoking on the development of AK.

SEVERE FORM OF CICATRICIAL ALOPECIA AS A RESULT OF A COMBINED COURSE OF SCALP DERMATOSES: A CLINICAL CASE

The article describes a clinical case of a combined course of dermatoses with damage to the scalp, such as psoriasis and follicular lichen planus (LPP), proceeding like pityriasis amiantacea (PA), with the formation of a severe form of cicatricial alopecia. Clinical patterns of damage to the scalp in these diseases are presented, confirming the possibility of developing cicatricial forms of hair loss, the treatment method is described. This clinical case demonstrates the need to conduct a histological examination in patients with scarring hair loss in order to select the most effective treatment method. The variety of forms of cicatricial alopecia and their common clinical manifestations create difficulties in differential terms and require an integrated approach to their diagnosis. Proper control of inflammation can prevent the progression of cicatricial alopecia.

Characteristics of infectious complications in moderate and severe forms of atopic dermatitis

Atopic dermatitis (AD) is a multifactorial, genetically determined disease with a chronic relapsing course and a predisposition to hyperimmunoglobulinemia E. Abnormal colonization of Staphylococcus aureus, Malassezia furfur, and Herpes Simplex plays a significant role in maintaining inflammation in AD. Objective — to determine the frequency of bacterial, mycotic and viral complications in a group of patients with moderate and severe AD. Materials and methods. From 2018 to 2023, 80 patients with AD (moderate and severe forms) aged from 1 year to 53 years (average age 14.6 years) were under our observation. Patients with a SCORAD index ≥ 25 were included in the study. To confirm the nature of the infectious complication, additional examination methods were used: microscopy, bacteriological culture, amplification methods of research, dermatoscopy, immunoenzyme analysis. Results and discussion. An analysis of the total number of relapses of AD during the year was carried out, depending on the age and gender of the patients. The largest number of relapses was observed in the age group from 6 to 10 years — 9.4 ± 0.6. The frequency of AD relapses had a certain correlation with the severity of the course of dermatosis — the SCORAD index increased to 31.2 ± 0.4 in the group of patients with the highest frequency of disease relapses (9.4 ± 0.6) per year and, as a result, increase in the frequency of infectious complications. The conducted analysis showed that each age group of AD patients had its own characteristic spectrum of bacterial, mycotic and viral complications. The most frequent infectious complications of AD observed in the examined patients were streptostaphyloderma (18.8 %), molluscum contagiosum (11.3 %), mycotic lesions (10.0 %), herpes infection (6.3 %), Coxsackie virus (3.8 %), EBV ­infection (2.5 %). Conclusions. As a result of the clinical study, it was established that infectious complications in AD have age, gender, and topographic features that can change the course and prognosis of dermatosis. Against the background of reduced immunoreactivity, the risk of disseminated, life­threatening forms of infections increases in patients with atopic dermatitis.

Functional state of dermal circulation in patients with lichen planus

Lichen planus belongs to the group of the most common dermatoses. The etiology and mechanisms of development of lichen planus are not fully understood. This dermatosis is characterized by a variety of clinical forms, as well as a chronically relapsing course, and a fairly frequent resistance to traditional therapies. The chronically relapsing course and susceptibility to complications and deterioration in the quality of life of patients with lichen planus give this dermatosis the status of a medical and social problem. Objective — to investigate the state of blood circulation in the areas of skin lesions of patients with lichen planus, depending on the stage of the clinical course of dermatosis. Materials and methods. We observed 37 patients with lichen planus with a typical (classical) clinical form (22 men and 15 women) aged 20 to 44 years. The comparison group consisted of 30 apparently healthy individuals, comparable by sex and age. In 19 patients, the progressive stage of dermatosis was diagnosed, in 18 — the stationary stage. The duration of the course of the disease in the subjects ranged from two weeks to six months. In all the examined patients, the microcirculation index (MI), the mean quadratic deviation of the microcirculation indicators, the coefficient of variation (KV), as well as maximum amplitude of slow oscillations (ALF), maximum amplitude of rapid oscillations (AHF), maximum amplitude of pulse oscillations (ACF) were determined. The first component of the active mechanism of regulation of tissue circulation was calculated according to the formula ALF/PM; the second component — according to the formula σ/ALF; the first component of the passive mechanism of modulation of tissue circulation was calculated according to the formula ACF/σ; the second component — according to the formula AHF/σ. In addition, the intravascular resistance ACF/PM · 100 % and the microcirculation efficiency coefficient ALF/(AHF + ACF) were studied. The study was carried out on a Doppler flowmeter Vingmed SD-100 (Sweden). Results and discussion. The obtained results indicate a low level of tissue perfusion, insufficient functioning of tissue blood circulation modulation mechanisms and reduced vasomotor activity of microvessels in the areas of affected skin of patients with lichen planus. It was also established that the modulation of tissue blood circulation was redistributed in the direction of reducing the passive mechanism, that is, in the direction of disturbances of cardiac and respiratory rhythms of fluctuations. Conclusions. In the examined patients with a typical (classical) form of the clinical course of lichen planus, a stagnant­static type of hemodynamics in the dermis was established during the examination by laser Doppler flowmetry in the skin areas affected by a specific papular rash.It has also been proved that in patients with lichen planus, in particular, in skin areas with specific lichenoid lesions, there is a redistribution of modulation of tissue blood circulation towards a decrease in the passive mechanism, that is, towards cardiac and respiratory rhythm disorders of fluctuations.The established disorders of dermal vascularization in the areas of skin lesions of patients with lichen planus expand the understanding of the pathogenesis of this dermatosis and need to be taken into account when developing the tactics of its complex, individualized therapy, which will contribute to increasing the effectiveness of treatment.

Insulin resistance and chronic inflammatory dermatoses

Recently, the impact of insulin resistance (IR) on the possibility of increasing the risk of skin diseases has attracted increasing attention of scientists. The causes of comorbid conditions have not been finally clarified. Determining the role of IR in the mechanism of development of dermatoses can affect the diagnosis and effectiveness of treatment. Objective — to analyze literary sources that highlight research on the relationship between IR and some diseases of the skin and its appendages, as well as to find out possible mechanisms of interaction. Materials and methods. The literature search was carried out using key words (IR, psoriasis, acne, adult acne, androgenetic alopecia, pathogenesis), sources from the databases of V.I. Vernadskyi National Library of Ukraine, PubMed, Web of Science and Scopus. Preference was given to sources published in the last 5 years. Results and discussion. The literature review presents a specific and possible relationship between the development of psoriasis, acne vulgaris, acne tarda, androgenetic alopecia and IR based on updated data. IR is considered as a disturbed biological response of the body’s peripheral tissues (muscle, fat, and liver) to the influence of endogenous or exogenous insulin. Analysis of the literature proved that patients with chronic dermatoses have a high risk of developing IR. There are multiple molecular factors responsible for the close association of IR with the metabolic syndrome. Adipokines play a key role in both conditions. Conclusions. IR is an important independent factor in the development of many inflammatory skin diseases, acting both independently and through associated metabolic disorders. It has been established that excess body weight and obesity are significantly associated with IR and the adverse course of dermatoses, so it is advisable for patients to determine HOMA­IR. The severity of chronic inflammatory dermatoses (psoriasis, adult acne, and AGA) is considered an independent predictor of IR.

RELATIONSHIP BETWEEN THE ACNE CLINICAL COURSE AND SEVERITY AND THE STATE OF MICROBIOTA OF THE SKIN AND LARGE INTESTINE

A high incidence of acne, tendency to its chronic course with the formation of resistance to treatment and frequent development of deep forms determine an important medical and social significance of the problem.
 Aim. To study and evaluate the degree of changes in the microbiocenosis of the skin and large intestine in patients with acne, depending on their clinical course.
 Materials and Methods. We examined 85 patients with acne, aged 18 to 45 years, 49 (57.65±5.36%) women, 36 (42.35±5.36%) men and 35 apparently healthy persons who made up the control group. The composition of microbiota of the skin and large intestine was examined using a bacteriological method.
 Results and Discussion. It was found that there is a significantly lower content of bifidobacteria and lactobacilli, bacterioids and total E. coli count in the large intestine in patients with acne associated with a higher amount of E. coli with enzyme properties, conditionally pathogenic enterobacteria, enterococci and fungi of the genus Candida. When using Friedman's non-parametric analysis of variance, it was found that there is a statistically significant difference between the frequency of detection of normocenosis and the stage of the large intestinal dysbiosis and the development of clinical forms of acne. At that, normocenosis was detected more often in patients with comedonal acne, while papular and nodular acne occurred more often in patients with manifestations of different stages of dysbiosis. An increase in seeding with associations of the alpha-hemolytic streptococcus + Staphylococcus haemolyticus + Micrococcus, beta-hemolytic streptococcus + Staphylococcus aureus + E.Coli + Candida albicans and a significant increase in the growth of alpha-hemolytic streptococcus, Staphylococcus haemoliticus and Staphylococcus aureus were found in the microbiocenosis of the skin in patients with acne. At that, all of the above microorganisms were not cultured in the patients of the control group.
 Conclusion. The qualitative and quantitative changes in the parameters of microbiocenosis of the skin and large intestine, which depend on the clinical course of dermatosis, were found in the examined patients with acne. This indicates the need for additional examination of such patients with the aim of prescribing a pathogenetically substantiated therapy.

Analysis of factors complicating the course of acne

Acne is among the most common conditions encountered in dermatological practice. In recent decades, there has been an increase in severe, complicated forms of acne. Objective — to analyze the factors that affect the deterioration of the clinical course of acne and stimulate the development of moderate and severe forms of acne. Materials and methods. For 3 years (2020—2023) we monitored 95 patients aged 18 to 35 years (45 men and 50 women), suffering from moderate to severe forms of acne. Before starting treatment, all patients completed a special questionnaire developed by us and taking into account known trigger factors. Results and discussion. Factors stimulating the transformation of mild acne into moderate and severe forms of the disease differ in groups of men and women. Among men, stress worsened the clinical course of dermatosis in 5 (11.1 %) cases, in women — in 9 (18 %). Among the factors that influenced the course of acne in women, we can distinguish the use of contraceptives 2 (4 %) and dysmenorrhea in 4 (8 %) people. 2 (4 %) patients clearly noted an improvement in the course of acne after withdrawal of contraceptives. Alcohol stimulated exacerbation of acne in 3 (6.7 %) men. Not sticking to the diet more often contributed to the exacerbation of acne in women — 9 (18 %), compared to only 6 (13.3 %) in men. A significant role in the stimulation of acne activity was played by irrational antibacterial topical therapy: 2 (4.4 %) men and 4 (8 %) women used topical drugs with clindamycin and erythromycin for a long time. There were cases of prolonged use of topical corticosteroids (for more than 3 months), which significantly worsened the clinical course of acne, in one case led to the development of steroid rosacea. 7 (14 %) women and 3 (6.7 %) men associated exacerbation of the disease with the intervention of a cosmetologist who did mechanical cleaning during the activation of acne. 5 (11.1 %) men and 3 (6 %) women were associated with worsening of the course of acne after SARS-CoV-2 infection. Also, the most common factor in acne exacerbation was self-medication: 7 (15.5 %) men and 6 (12 %) women. Some patients were unable to isolate any of the known trigger factors of acne: 9 (20 %) men, 3 (6 %) women. Conclusions. The study made it possible to identify a number of factors that affect the severity of the clinical course of acne. The most common triggers were psycho-emotional stress (18.0 % of women and 11.1 % of men), diet disorders (18 % of women and 13.3 % of men), self-treatment (15.5 % of men and 12 % of women), the COVID-19 pandemic (11.1 % of men and 6.0% of women), the intervention of cosmetologists with irrational aesthetic procedures (6.7 % of men and 14.0 % of women). Thus, the identified trigger factors of acne have gender, nutritional, behavioral characteristics, which requires further study and development of algorithms for their elimination and correction.

New approaches to the treatment of rosacea on the basis pathogenesis factors and clinical forms

Uncovering the molecular mechanisms of the rosacea pathogenesis and treatment are still of great importance. The review encompasses the modern knowledge of rosacea classification, characterization of the severity of the course of the subtypes, and pathogenesis features. Recent methods of rosacea treatment are presented, including the use of botulinum neuroprotein for the correction of the erythematous-telangiectatic subtype of the dermatosis.
 The relevance of this problem is due to the chronic course of the disease and the peculiarity of the localization of rosacea manifestations that leads to a traumatic effect and often causes social exclusion of patients.
 The rise of the rosacea incidences, along with other reasons like characteristics of the course of dermatosis, accompanied by frequent long-term relapses, is due to the resistance to generally accepted methods of drug therapy, often resulting in shortened clinical remission. All the factors lead to decreasing of patients life quality that require the search for effective therapy approaches. Among modern rosacea therapy, the application of botulinum neuroprotein is widely used; however, the clinical studies confirming the effectiveness of this technique are not presented enough.

Efficacy of narrow-band medium-wave phototherapy in correcting the cytokine status of eczema patients

Background: Eczema is one of the most common skin diseases. Despite the success of systemic and local pharmacotherapy, effective treatment of patients with eczema is hampered by the lack of clear ideas about the etiology and the multifactorial nature of the disease pathogenesis. The research results available to date indicate that it is possible to increase the effectiveness of treatment of eczema patients using phototherapy methods. Aim: To evaluate the possibilities of narrow-band phototherapy with a wavelength of 311 nm (UVB-311 nm) in increasing the effectiveness of drug therapy in patients with eczema. Methods: The dermatological index of the symptom scale (DISS) was used to assess the clinical manifestations of eczema. Serum levels of cytokines – interleukins (IL) -1β, -2, -6, -10, interferon gamma (INF-γ), tumor necrosis factor alpha (TNF-α) were determined by solid-phase enzyme immunoassay. UVB-311 nm therapy procedures (25 sessions) were performed with the Dermalight®1000 device (Germany). The results of the treatment were evaluated after 2 and 4 months from the beginning of treatment. Results: The study included 66 patients with eczema (mean age 58.6±3.4 years, 44 males, 22 females), randomized into 2 groups. Group 1 included 33 patients who received only basic drug therapy (BDT). In the 2nd group, there were 33 patients who, in addition to BDT, received narrow-band phototherapy UVB-311 nm (РT+BDT). In the BDT group, the indicators of DISS after 2 months decreased by 1.33 times (p=0.01), while in the РT+BDT group - by 1.95 times (p<0.001). The level of cytokines in the BDT group did not change significantly (p>0.05) after 2 months. In the РT+BDT group, after 2 months, the level of IL-1ß decreased by 1.25 times (p=0.001), IL-2 - by 1.44 times (p<0.001), IL-6 - by 1.69 times (p=0.001), INF-γ – by 1.28 times (p=0.001), TNF-α – by 1.29 times (p=0.002);the level of IL-10 increased by 1.22 times (p=0.002). Conclusions: Basic drug therapy contributes to a moderate decrease in the DISS by 1.33 times, but does not provide a significant decline in the pro-inflammatory cytokine potential of the blood. The use of UVB-311 nm phototherapy contributes to a more significant decrease in the levels of the complex of proinflammatory cytokines (IL-1β, -2, -6, TNF-α, INF-γ) and an increase in anti-inflammatory IL-10, which favorably affects the clinical course of dermatosis, manifesting by a decrease in the DISS by 1.95 times.

Significance of insulin and insulin-like growth factor-1 in the pathogenesis of acne

Background. The potential involvement of insulin and insulin-like growth factor-1 in the pathogenesis of acne may be due to direct stimulation of sebaceous gland cells, an increase in androgen synthesis in the endocrine glands, activation of 5-reductase, and an increase in the sensitivity of androgen receptors in tissues.
 Aim. To study the level of insulin and insulin-like growth factor-1 in women of fertile age suffering from acne; to identify the dependence of these indicators on the clinical and anamnestic features of the disease and the nature of the nutrition of patients.
 Material and methods. 60 patients suffering from acne (mean age 23.90.92 years) were examined. Clinical indices, reflecting the severity of the skin process and quality of life, were calculated, hormonal status indicators (insulin, insulin-like growth factor-1, total testosterone, estradiol, progesterone) and blood plasma glucose levels were studied. The blood of 30 healthy women (mean age 25.91.04 years) was examined as a control. Groups were compared using Student's t-test and odds ratio calculation, correlation analysis was performed using Spearman's rank correlation coefficient.
 Results. Patients with acne showed a significant increase in the level of insulin-like growth factor-1 (p=0.0002) and total testosterone (p=0.005). The correlation of the insulin-like factor content with the indices that determine the severity of the skin process and the quality of life of patients was closer than that of the total testosterone. A lower concentration of insulin-like growth factor-1 was noted in the blood of acne patients who followed a diet with restriction of milk and dairy products, foods rich in easily digestible carbohydrates and saturated fats. The level of insulin in patients with acne did not differ from that in the control group.
 Conclusion. In women suffering from acne, an increase in the content of insulin-like growth factor-1 in the blood plasma was revealed; at the same time, its level has a closer relationship with the severity of the course of dermatosis and the quality of life of patients in comparison with the indicator of total testosterone.

Options for treatment correction in children with atopic dermatitis

Background. Atopic dermatitis (AD) treatment is based on clinical recommendations (CR, 2021). It is reasonable to use other effective treatment methods due to continuous and often relapsing course of dermatosis, and thus physiotherapy treatment is important.Objective. The aim of the study is to evaluate the efficacy of chromotherapy with a spectrum of 470 nm (blue spectrum) in children with AD complicated by secondary infection.Methods. The study included 40 children aged from 2 to 12 years. All patients received standard treatment regimen according to the current CR and were divided into 2 groups, equal in number (20 patients each): the control group (CG — only traditional therapy), and the experimental group (EG — traditional therapy + blue spectrum chromotherapy (470 nm)).Results. The SCORAD index (the sum of objective and subjective features) before treatment in the whole patient cohort was 32.5 ± 6.99 points, which corresponds to the moderate-severe form of the disease. The positive effect of therapy was registered in all patients (n = 40). Persistent process stabilization on the 7th day 7 of treatment in EG was observed in 8 patients, and in CG — in 2 (40% and 10%, respectively); p = 0.065. After the end of the treatment (10th day) persistent remission prevailed in EG and was registered in 90% (n = 18) of patients, and in CG — only in half of all patients, 55% (n = 11); p = 0.031. The evaluation of the AD severity due to the SCORAD index in patients with residual clinical manifestations clearly indicates that in EG its value corresponded to a mild disease course (p < 0.001), and in CG — the lower border of the moderate-severe and the upper border of the mild disease course (p < 0.05).Conclusion. The use of blue spectrum chromotherapy in treatment of children with AD is the effective and accessible method that can be used as an addition to traditional treatment in cases with secondary infectious complications. Its use has a potential to exclude polypragmasy in this dermatosis treatment.

COVID-19-induced alopecia: a clinical case of diffuse focal alopecia in a patient with generalized pustular psoriasis after a new coronavirus infection

The clinical picture of dermatological diseases in synergy with the pandemic of coronavirus infection demonstrates various, additional, more striking features of the course of dermatoses. The proposed case of observation illustrates the development of diffuse alopecia in a patient with torpid generalized pustular psoriasis, metabolic syndrome, endocrinopathy against the background of a coronavirus infection complicated by polysegmental pneumonia.
 In the presented clinical observation, the severity of the lesion of the skin and skin appendages correlated with the severity of the course of COVID-19, which was the trigger point of the general pathological process ― immune-mediated T-cell inflammation. In the manifestation of psoriasis and its exacerbation, a significant role was played by viral load and a pronounced comorbid background ― autoimmune thyroid disease and metabolic syndrome. Thus, the severe course of COVID-19 with involvement in the pathological process of the microcirculatory bed, coagulopathy, hypoxia of hair follicles as a result, as well as the reduced estrogenic background of the sixty-one-year-old patient contributed not only to the exacerbation of psoriasis, but also led to diffuse hair loss. The degree of hair loss according to SALT criteria was 82%, which corresponded to a severe degree of lesion. The use of prolonged-acting injectable corticosteroids in the complex treatment of various forms of alopecia was an effective method of therapy in this patient, which is associated with the immunosuppressive effect of corticosteroids in autoimmune damage to hair follicles, a decrease in inflammation of the microvascular bed in various infectious and inflammatory conditions. In the presented case, the high efficiency may also have been associated with the mechanisms of reducing the damaging effect of cytokine inflammatory factors, expressed both with the existing background disease psoriasis and with coronavirus complicated infection.
 As numerous observations show, COVID-19 is a potential trigger for many dermatological conditions. Examination and treatment of patients with skin pathology infected with COVID-19 requires a systematic integrated approach.

Метаболічний потенціал лейкоцитарної та тромбоцитарної субпопуляцій клітин периферичної крові та його корекція у хворих на вугрову хворобу

Objective – to increase the effectiveness of treatment of patients with acne, taking into account the peculiarities of the metabolic activity of leukocytes and peripheral blood platelets through the use of pathogenetic therapy. Materials and methods Under our supervision there were 66 patients with acne (39 women and 27 men) aged 18 to 40 years. The duration of the disease ranged from 6 months. up to 14 years old. 42 (63,6%) patients were diagnosed with a mild degree of severity of the course of dermatosis, and in 24 (36,4%) – moderate. In most patients, the pathological process covered two or three topographic areas, that is, it tended to spread. The content of phospholipids and glycogen in neutrophils, monocytes and platelets of peripheral blood was determined by calculating the average cytochemical coefficient (MCC). The control group consisted of 20 healthy individuals. Results and discussion It is proved that in patients with acne there is a probable decrease in the level of phospholipids in peripheral blood neutrophils, which is more pronounced in the moderate severity of the pathological process. The obtained data indicate, respectively, a violation of the structural integrity and inhibition of the energy potential of granulocytes. The content of phospholipids in peripheral blood monocytes was also likely to decrease, more significantly at moderate severity of acne. However, the vector of changes in glycogen levels in these cells had the opposite direction. The results led us to the adjuvant use of platelet-enriched autoplasma, which has a wide range of modulating effects. Conclusions It has been found that in patients with acne, there are various vector changes in the metabolic activity of peripheral blood monocytes, which are manifested by a decrease in phospholipids, combined with an increase in glycogen content, which characterizes the development of intracellular imbalance. It was determined that the metabolic activity of the platelet pool of peripheral blood in acne remains intact, but there is a redistribution of the number of hemoelements with different saturation of phospholipids and glycogen. It is proved that the use of complex therapy of patients with acne using, against the background of standardized drugs, autoplasma enriched with platelets, can significantly improve both short-term and long-term treatment results by significantly correcting the metabolic activity of peripheral blood leukocytes.

The state of the enzyme level of antioxidant protection and its nonspecific correction in patients with eczema

The variety of developmental mechanisms creates significant difficulties in choosing adequate directions of therapeutic tactics. Priority pathogenetic links, in particular, changes in the state of antioxidant protection, remain insufficiently studied.
 Objective — determination of the activity of the enzyme level of the antioxidant protection and the development of nonspecific correction of the established violations.
 Materials and methods. Under observation there were 52 patients with eczema (27 men and 25 women) aged 19 to 57 years. 16 of them were diagnosed with idiopathic, 21 — with infectious (microbial) and 15 — with infectious (mycotic) forms of dermatosis. The control group consisted of 20 healthy persons. The activity of catalase, glutathione peroxidase and superoxide dismutase (SOD) in blood serum was determined.
 Results and discussion. It has been established that patients with eczema have a labile nature of changes in the enzymatic activity of antioxidant protection, depending on the clinical form of dermatosis. Its total suppression was ascertained only in the presence of mycogenic sensitization. To eliminate the identified violations, PRP therapy and tacrolimus (Protopic) were prescribed, the use of which as part of complex therapy made it possible not only to achieve correction of pathogenetic changes, but also to significantly improve the clinical course of dermatosis.
 Conclusions. It is advisable to determine the activity of superoxide dismutase, the activity of catalase and glutathione peroxidase to assess the state of the enzyme link of the antioxidant defense in patients with eczema. The inclusion of PRP therapy and tacrolimus (Protopic) in the treatment allows correcting the state of the enzyme link of antioxidant protection and the clinical course of dermatosis. The activity of catalase, glutathione peroxidase and superoxide dismutase can serve as one of the criteria of the effectiveness of treatment prescribed for patients with eczema.

Features of the cytokine profile and the effectiveness of radical treatment of focal infection in patients with psoriasis

Background. Focal infection (FI) are important trigger factors for the development of psoriasis, which means they can aggravate the course of dermatosis, including due to an increase in certain pro-inflammatory cytokines in the blood.
 Aim. To study the cytokine profile of patients with psoriasis in the progressive period of the disease, as well as to assess the effect radical treatment of focal infection on the course of dermatosis.
 Material and methods. Prospective comparative non-randomized study included 52 patients with psoriasis vulgaris, aged 18 to 65 years, who signed a informed consent. The first group consisted of patients who underwent radical treatment FI (16 people), the second those who did not treat FI (16 people), and the third group consisted of patients in whom FI was not detected (20 people).
 Cytokine concentrations were measured in the progressive stage of the disease in 52 patients with psoriasis and 20 individuals in the control group (healthy individuals).The spectrum of detected cytokines included: IL-1, IL-2, IL-4, IL-6, IL-8, IL-10, IL-17A, as well as INF- and INF-. For the detection of all cytokines, except for IL-17A, reagents from Vector-Best, Russia were used. The Human ELISA MAX Deluxe Set (BioLegend, USA) was used to determine the concentration of IL-17A.
 During the main course of treatment (0, 2 and 4 weeks), as well as the follow-up of patients (12, 24 and 52 weeks), the severity of psoriasis was assessed with the calculation of the PASI index. At the end of the study (week 52), the number of relapses and the total duration of remission were recorded.
 Results. The level of IL-8 was increased in 90,6% of psoriasis patients with FI. In this case, significant differences were obtained in comparison with the group of patients with psoriasis without diagnosed FI and with the control group, in which an increase in the concentration of IL-8 was noted, respectively, in 65% and 30% of cases. A moderate positive correlation was found between the IL-8 level and the PASI index (rs = 0,48; p = 3,6 104). The levels of INF- and IL-6 in psoriasis patients with FI were increased, respectively, in 15,6% and 21,9% of cases and significantly differed from the group of practically healthy individuals (p 0,05), differences from the group of patients with psoriasis without FI was not identified. The concentration of TNF- did not differ in all three groups. The level of IL-17A was significantly increased in comparison with practically healthy individuals both in the group of psoriasis patients with FI and in the group of patients without FI (Me = 3,3 and 4,3 pg/ml versus 0,2 pg/ml). The concentrations of five interleukin cytokines, namely IL-1, IL-2, IL-4, IL-10 and INF-, did not exceed the upper limit of the reference range in all patients of the experimental (patients with psoriasis) and control groups.
 Evaluation of the PASI index during the observation of patients in the first and second groups showed significantly lower values of this indicator for weeks 24 and 52 in the first group (0,2 vs. 7,0; p = 0,02 and 0,1 vs. 7,2; p = 0,002). The relative risk of disease recurrence in the absence of radical treatment for FI was 2,6 (CI 1,1 to 5,2).
 Conclusion. Data were obtained showing the role of IL-8 and focal infection, with the presence of which its increased production is associated, in the worsening of the course of psoriasis with the frequent development of relapses. Important preventive measures leading to a decrease in the number of relapses of psoriasis are timely diagnosis and radical treatment of focal infection.

Pioglitazone in treatment of patients with comoribidity of psoriatic disease and alimentary obesity

An indisputable link between psoriasis and obesity has recently been proven. Alimentary obesity exacerbates systemic inflammation in patients with psoriasis, complicating the course of dermatosis, causing deterioration of the dermatological index of quality of life of patients and frequent exacerbation of psoriasis, which leads to ineffectiveness of standard treatments. PPAR-activated receptors are the link between lipids and inflammation because lipids stimulate the chronic form of systemic inflammation and are ligands that activate PPAR. Thus, PPAR can be used as the main target when choosing a treatment for this comorbidity. To date, the literature has accumulated a large number of prospective observations indicating a positive effect of pioglitazone (PG) on systemic inflammation. The mechanism of action of this drug is aimed at suppressing chronic systemic delayed inflammation of low intensity. The anti-inflammatory effect of PG is associated with its activating effect on nuclear transcription factors of PPAR. Objective — to determine the effectiveness of the inclusion of different doses of pioglitazone in the complex treatment of patients with advanced psoriasis vulgar with concomitant alimentary obesity of I—II degree. Materials and methods. Clinical and immunological study of systemic inflammation. Results and discussion. The results of the study showed the effectiveness of this method of treatment, which depended on the dose of PG and the duration of treatment. The use of PG in the complex treatment of patients with vulgar psoriasis of moderate severity with concomitant alimentary obesity of I—II degree for 26 weeks led to a decrease in inflammation both locally, according to the Psoriatic Area and Severity Index, and at the systemic level due to reduction in the level of systemic inflammation, namely the level of interleukin-33, interleukin-6 and highly sensitive C-reactive protein in the blood serum.Conclusions. Long-term use of PG can be recommended for the personalized and comprehensive treatment of patients with comorbidity of psoriasis and alimentary obesity of I—II degree.

Атопический дерматит у детей и подростков с ожирением и избыточной массой тела: клинические, антропометрические данные, психоэмоциональный статус и предикторы эффективного лечения

The results of a comprehensive analysis of clinical, anthropometric data and an assessment of the psycho-emotional status of 62 children and adolescents (mean age 11.8 ± 3.0 years) with atopic dermatitis and overweight or varying degrees of obesity (the main group) are presented. The control group included 60 patients (mean age 10.1 ± 3.6 years) with atopic dermatitis and body weight corresponding to age and gender standards. In the main group, 45.2% were children and adolescents with overweight, and with first-, second- and third-degree obesity were 25.8, 11.3 and 17.7% respectively. The severe course of dermatosis in the main group was recorded 1.4 times more often than in the control group. With the aid of univariate analysis of the treatment efficacy predictors, it was revealed that weight loss and improvement in psycho-emotional state can significantly increase the treatment efficacy of atopic dermatitis in children and adolescents with overweight and obesity, which indicates the advisability of interaction between a dermatologist, endocrinologist and psychotherapist in the treatment of this category of patients.

Biochemical indicators and course of dermatosis in children with psoriasis depending on the body mass index

The aim. To study the effect of increased body weight in children with psoriasis on the indicators of the biochemical profile and the severity of the pathological process.Materials and methods. The indicators of the biochemical profile were studied in 108 children, namely: the level of total protein, total bilirubin, cholesterol, liver enzymes (ALT, AST, GGT), triglycerides and low density lipoproteins, creatinine, urea, uric acid (UA), depending on the mass index body (BMI). The research materials were statistically processed using parametric analysis methods using the STATISTICA 13.3 software (developed by StatSoft. Inc).Results. Lipid profile indices both in the group of children with normal BMI and in the group of children with increased BMI are within the reference values. Statistically significant differences were found between the average GGT level in the group of children with increased BMI compared with the indicators in the group of children with normal BMI and indicators in the children of the control group. Also, in children with increased BMI, the average UA level is statistically significant higher than in children of the control group and has direct moderate and significant correlations with indices of the severity of the pathological process. In children with increased BMI, psoriasis severity indices correlate with BMI: PGA (r=0.51, p<0,01) BSA (r=0.48, p<0,01), PASI at the beginning of treatment (r=0.41, p<0,05) and PASI at the end of treatment (r=0.67, p<0.001) and percentage of excess body weight: BSA (r=0.34, p<0,05), PASI at the end of treatment (r=0.67, p<0.001). In children with normal BMI, such correlations were not found

Clinical Features of Cutaneous Acute Graft-versus-Host Disease after Allogeneic Hematopoietic Stem Cells Transplantation in Children with Hemato-Oncological Diseases

The graft-versus-host disease (GvHD) is frequent complication, it occurs in 50% of patients after allogeneic hematopoietic stem cell transplantation (HSCT) and it is one of the major causes of mortality not associated with disease recurrence. Skin lesion in the symptom complex of acute GvHD develops within the first 100 days after HSCT, and it is complicated diagnostic and therapeutic problem. Significant immunosuppressive status of children during the posttransplant period enhances and changes the course of dermatoses, infections, drug toxicity. Finally, it can lead to immunoallergic processes with possible development to generalized life-threatening diseases of the skin and mucous membranes. Meanwhile, toxic, allergic and infectious skin lesions can be present simultaneously or develop sequentially. The description of the clinical picture of skin lesions in acute GvHD is really crucial and has scientific and practical significance due to relatively small frequency of HSCT in children with oncology diseases. The article summarizes data on etiology, pathogenesis, clinical forms, diagnostic and treatment methods of cutaneous complications of the early post-transplantation period after HSCT.

Assessment of CLA+T-cell subpopulations in the blood of patients with chronic dermatoses

Background. CLA+T-cell are an important component of skin-associated lymphoid tissue, and thus determine the pathogenesis of many immuno-mediated dermatoses.
 Aims. Determine the relative number of CLA+T-cell subpopulations in the peripheral blood of patients with psoriasis, lichen planus and atopic dermatitis, as well as assess their impact on the severity of dermatoses.
 Materials and methods. We examined 82 patients with psoriasis aged 19 to 62 years, 54 patients with lichen planus (LP) aged 18 to 54 years, 44 patients with atopic dermatitis (AD) aged 18 to 44 years, as well as 20 practically healthy individuals aged 18 to 52 years who were admitted to the clinic for the removal of benign skin neoplasms.
 All patients underwent a standard clinical examination with the determination of indicators that characterize the severity of dermatosis: PASI (Psoriasis Area and Severity Index) for patients with psoriasis, IPSLP (index of prevalence and severity of lichen planus) for patients with lichen planus and SCORAD (Scoring of Atopic Dermatitis) for patients with atopic dermatitis. Defining subpopulations CLA+T-lymphocytes were carried out on a flow cytometer Cytomics FC500 by Beckman Coulter using appropriate combinations of direct monoclonal antibodies and isotopic controls. The groups were compared using the nonparametric Mann Whitney test, and the differences were considered significant at p0,05. To analyze the relationship between the severity of dermatosis and the relative content of subpopulations CLA+T-cells used Spearman's rank correlation coefficient.
 Results. In patients with psoriasis, a significant increase in the percentage of the total number of T-lymphocytes positive for CLA (CLA+CD3+) and T-helpers positive for CLA (CLA+CD4+) (p=0,002 and 8,5104, respectively), in patients with PL and AD only CLA+CD4+ lymphocytes (p=0,028 and 0,003, respectively). In the progressive period of psoriasis, a direct moderate correlation was found between the circulating subpopulation of cytotoxic T lymphocytes positive for CLA (CLA+CD8+) and the PASI index (rs=0,47; p0,001), in the acute period of AD between the CLA+CD3+ subpopulations and CLA+CD4+ cells and the SCORAD index (rs=0,53; p 0,001 and rs=0,57; p0,001, respectively). In PL, the severity of the course of dermatosis was not accompanied by any significant changes in the CLA-positive T-cell subpopulations.
 Conclusion. The results of the study confirmed the important role of CLA+T cell subpopulations in the development of chronic dermatoses. In all groups (psoriasis, LP and AD), an increase in the relative number of CLA+CD4+ T-helpers was noted compared with the control group. The relationship between the severity of psoriasis and the relative number of CLA+CD8+ cytotoxic T-lymphocytes, and the severity of AD with CLA+CD3+ and CLA+CD4+ T-helpers is also shown.