Severe Dermatosis Research Articles

<i>DSG4</i> Gene Variants as a Cause of Hypotrichosis in the Child with Severe Atopic Dermatitis: Clinical Case

Background. Hypotrichosis is a heritable form of alopecia that causes almost complete scalp hair loss in childhood. The diagnosis is typically established according to medical history and clinical picture. Genetic testing is an additional diagnostic method that allows to establish “hypotrichosis” in cases of ambiguous or subtle clinical signs of the disease, as well as to perform differential diagnosis of this condition with others commonly associated with atopic dermatitis (focal and diffuse alopecia). Clinical diagnosis of hypotrichosis in patients with severe dermatosis is challenging.Clinical case description. The girl, aged 2 years 4 months, was hospitalized with complaints on extended rash on the body with severe itching, and changes in hair thickness, quality of hair shaft, and hair loss. Severe atopic dermatitis and hypotrichosis were diagnosed. The diagnosis of atopic dermatitis was established clinically (SCORAD — 65), the diagnosis of hypotrichosis (type 6, monilethrix-like hypotrichosis) was confirmed via molecular genetic testing (nucleotide variant c.699C>T in exone 13 of the DSG4 gene (OMIM # 607892)). Patient's mother, brother, and two sisters were diagnosed with the nucleotide variant chr18:31409487C>T in heterozygous state in the DSG4 gene. Mother and brother had no clinical manifestations, while both sisters had mild scalp hair damage, as well as eyebrows and eyelashes, since birth. There were no clinical manifestations of atopic dermatitis in parents and other children in the family.Conclusion. Hypotrichosis clinical signs can be subtled, smoothed, or imitate the symptoms of other comorbid conditions, especially in patients with comorbidities or severe dermatosis. Also worth noting is that changes in certain genes can aggravate the course of atopic dermatitis. In this clinical case, mutation in the DSG4 gene leads to epidermal barrier failure by disrupting the synthesis of desmosomes transmembrane components. Thus, geneticist consultation and genetic testing (search for changes in certain genes) are crucial in such cases.

Case Report and Literature Review: A Severe Case of Pyoderma Gangrenosum Approached with Regenerative Medicine

Pyoderma gangrenosum (PG) is a challenging autoinflammatory neutrophilic dermatoses (ND) condition characterized by painful skin alterations leading to ulceration and tissue necrosis. Regenerative medicine (RG) offers promising strategies for addressing these challenges. Diverse therapies including mesenchymal stem cells (MSC), MSC-exosomes, tilapia skin grafts with fibroblast growth factors (FGF), and antioxidants like Vitamin C (VitC), have demonstrated effectiveness in promoting wound healing, reducing inflammation, and restoring tissue function. This paper offers comprehensive insights into the pathogenesis, epidemiology, and conventional treatment approaches for PG, while also providing a concise review of pertinent RM therapies. In this case report, a severe case of PG is managed with a combination of RM therapies, with remarkable results. A 73-year-old patient experienced persistent ulceration, pain, and edema despite conventional treatments. The administration of IV (Intravenous) MSCs, MSC-exosomes, tilapia skin graft, FGF, and VitC resulted in significant improvement in wound healing, pain reduction, and inflammation control. This case demonstrates the potential use of RM therapies in managing complex dermatological conditions like PG. The integration of regenerative approaches provides hope for patients with challenging conditions, potentially leading to enhanced outcomes and reduced recovery times. As PG remains a difficult-to-treat condition, RM holds promise as a valuable alternative therapy option for patients facing these severe dermatoses conditions.

273 Long-term efficacy and safety of investigational autologous gene-corrected skin sheets (EB-101) for recessive dystrophic epidermolysis bullosa (RDEB)

RDEB is a rare, severe dermatosis caused by mutations in type VII collagen (C7), a major component of structural attachments between the basement membrane and dermis. Manifestations include large, chronic wounds and blisters, increased squamous cell carcinoma (SCC) and early death. Currently, there are no approved therapies. We report long-term outcomes of a Phase 1/2a trial to treat large, chronic RDEB wounds with 35cm2 autologous skin sheets (EB-101) gene-corrected with a retroviral vector (RV).

Роль генетических факторов при семейном случае акне

Acne is one of the most common dermatoses. A prominent genetic component for this disease has been reported and the manifestation in first-line relatives is considered an important risk factor. Here we present a clinical case illustrating the relevance of particular genetic polymorphisms mapped to NCF1, CD3E, ORAI1, IGHM and TAZ in patients with severe forms and burdened family history of the disease. Genetic examination identified the same allelic variants in five candidate target genes (NCF1, CD3E, ORAI1, IGHM and TAZ) in two closely related patients (father and son) with severe acne. The identified genetic configuration may interfere with the oxidase activity and promote defects in mitochondrial function along with reduced T cell proliferation and imbalanced immunoglobulin production. The findings may provide an important reference point for further clinical investigation and treatment of severe torpid dermatoses.

Особливості якості життя у хворих на акантолітичну пухирчатку згідно результатів аналізу опитувальників SF-36V2 та дерматологічного індексу якості життя на фоні глюкокортикостероїдної терапії

The purpose of the study was to carry out a comparative assessment of the parameters of the quality of life in patients with pemphigus vulgaris according to the results of the analysis of the SF-36V2 questionnaires and the dermatological index of the quality of life against the background of glucocorticosteroid therapy. Materials and methods. The results of the study are based on the data of a comprehensive study and further follow-up of 47 patients with pemphigus vulgaris (of which 30 are the main group and 17 are the comparison group) who were hospitalized at the Zaporizhzhya Regional Skin and Venereal Clinical Dispensary, Zaporizhzhia. At the time of observation, the majority of patients were aged 61-70 years old. As a control group, 20 apparently healthy people were examined, randomized by age and sex. Results and discussion. Pemphigus vulgaris is a severe systemic dermatosis, which, according to the literature, accounts for about 1% in the structure of dermatological pathology, the main pathomorphological sign of which is acantholysis. Although the share of pemphigus vulgaris in the structure of dermatological pathology is 0.6 per 100 thousand people per year, the severity of the disease and its outcome determine the relevance of further study of the pathogenesis of dermatosis and the search for new effective therapies. The etiology of true pemphigus still remains unclear. The obtained results of questioning the patients with the SF-36V2 questionnaires and the dermatological index of quality of life indicate a significant negative impact of pemphigus vulgaris on the key parameters of the quality of life of patients in the main group and in the comparison group before treatment – the ability to perform their daily duties, work or study, have personal relationships, and also on the desire to be treated and adhere to all the rules of the therapy. Patients with pemphigus vulgaris in the group of monotherapy with glucocorticosteroids had statistically worse indicators of the quality of life after treatment than patients with additional use of Armadin, which was characterized by a low level of physical activity, an increase in the role of physical and psychoemotional problems in everyday life, general discomfort and subjective health. Conclusion. Evaluation of the quality of life of patients allowed for a more qualified study of the health disorders of patients with pemphigus vulgaris, to see the essence of the clinical problem, to select the most optimal treatment regimen for each patient, and also to assess the expected results in terms of parameters that are on the verge of a scientific approach and evidence-based medicine on the one hand, and also the subjective point of view of patients with pemphigus vulgaris on the other hand

Leading typological characteristics of temperament and psychodynamic personality traits in men with psoriasis without and taking into account the somatotype

Annotation. One of the most important problems of modern dermatology is the individualization of programs for diagnosis, treatment and prevention of skin diseases. The success of its solution largely depends on how fully, systematically will be described and somatic and mental components of the patient’s personality, taking into account the full range of biological and mental factors that affect his health. The aim of the study was to establish the features of the leading typological characteristics of temperament and psychodynamic personality traits between healthy and psoriatic men without taking into account somatotype and representatives of mesomorphic and endo-mesomorphic somatotypes. Men aged 22 to 35 years, patients with psoriasis (n=100, including 32 with mild and 68 with severe) conducted an anthropometric examination according to V. V. Bunak Somatotype was calculated according to the mathematical scheme of J. Carter and B. Heath. The PASI (Psoriasis Area and Severity Index) was used to clinically assess the severity and area of psoriatic lesions. The control group consisted of anthropometric data of 82 practically healthy men of the same age group from the data bank of the research center of National Pirogov Memorial Medical University, Vinnytsya. Evaluation of the leading typological characteristics of temperament was determined by G. Eysenck, psychodynamic personality traits – by C. D. Spielberger in the modification of Y. L. Khanin Statistical processing was performed in the license package “Statistica 5.5” using non-parametric evaluation methods. When comparing the studied indicators between groups with different disease course, significantly higher and tendencies to higher values of the percentage were found: persons with potential introversion among patients in general (19.12 %) and endo-mesomorphs (22.22 %) with severe course compared to healthy subjects without taking into account the somatotype (8.54 %) and the control group of a similar somatotype (0 %); persons with a low level of neuroticism among patients in general (50.00 %), mesomorphs (46.43 %) and endo-mesomorphs (75.00 %) with mild psoriasis compared with patients without somatotype, mesomorphs and endo-mesomorphs with severe dermatosis (19.12 %., 18.18 % and 11.11 %); persons with an average level of neuroticism among patients in general (22.06 %) and mesomorphs (20.00 %) with severe psoriasis compared with patients without somatotype and mesomorphs with mild dermatosis (3.13 %, 3.57 %); persons who answered insincerely, among patients with mild psoriasis (87.50 %) compared with patients with severe psoriasis (66.18 %); persons with a low level of situational anxiety among patients in general (12.50 %) and mesomorphs (14.29 %) with a mild course of psoriasis compared with patients without somatotype and mesomorphs with a severe course of dermatosis (2.94 % and 3.04 %); persons with a low level of situational anxiety among patients in general (21.88 %) and mesomorphs (17.86 %) with a mild course of psoriasis compared with patients without somatotype and mesomorphs with a severe course of dermatosis (8.82 % and 5.45 %). When comparing the studied indicators between groups with different body type, significantly higher and tendencies to higher values of the percentage of people with an average level of situational anxiety among endo-mesomorphs with mild and severe psoriasis (100 % in both cases) compared with mesomorphs. the corresponding severity of the disease (63.64 % and 46.43 %); persons with a high level of situational anxiety among mesomorphs with severe psoriasis (30.91 %), compared with endo-mesomorphs with a corresponding severity of the disease (0 %); persons with a low level of personal anxiety among endo-mesomorphs suffering from severe psoriasis (22.22 %), compared with mesomorphs suffering from dermatosis of similar severity (5.45 %); persons with a low level of personal anxiety among healthy endo-mesomorphs (46.15 %) compared with healthy mesomorphs (12.82 %); persons with an average level of personal anxiety among healthy mesomorphs (71.79 %) compared with healthy endo-mesomorphs (30.47 %). Thus, our study, conducted using a constitutional approach, allowed us to describe systemic portraits of patients with psoriasis, including the strengths and weaknesses of their morphological and mental organization, necessary to justify differentiated approaches to planning health and prevention measures.

Indicators of the level of subjective control in men with various forms of eczema

An actual and popular area of research in psychodermatology is to conduct comprehensive studies that comprehensively reveal the mental characteristics of patients with different forms and types of eczema. This will allow in the future to optimize work with patients of this profile and to plan psychotherapeutic measures in the key of a personalized constitutional approach. The aim of the study was to examine the differences in the level of subjective control between healthy and/or eczema patients depending on the severity of dermatosis. Men aged 22 to 35 years, with a diagnosis of true (n=34) and microbial (n=38) eczema, were assessed by the level of subjective control on the basis of the J. Rotter scale edited by E.F. Bazhin et al. (1984). As a control from the data bank of the research center of National Pirogov Memorial Medical University, Vinnytsya indicators of the level of subjective control of 82 practically healthy men of the same age group were selected. Statistical processing of the results was performed in the license package "Statistica 5.5" using non-parametric evaluation methods. Patients with true eczema, compared with the control group, have a higher level of subjective control in the field of general internality, achievements, educational (professional) relations (mild course) and interpersonal relations (severe course). At patients with a microbic eczema of mild and severe course in comparison with healthy investigated size of level of subjective control is smaller in the field of failures and interpersonal relations. Patients with true eczema compared to patients with microbial eczema found significantly higher levels of subjective control in the field of general internality, failures, educational (professional) and interpersonal relationships. In patients with severe dermatosis compared with patients with mild dermatitis there is a decrease in the level of subjective control in the field of educational (professional) relations (true eczema) and interpersonal relations (microbial eczema). Thus, the peculiarities of the level of subjective control in men with various forms of eczema can serve as psychological predictors of exacerbations and exacerbations of eczema, which is certainly important for both clinicians and health care providers in particular.

Корекція порушень ремоделювання кісткової тканини при довготривалій кортикостероїдній терапії

Актуальність. При тяжких дерматозах зазвичай призначаються препарати кортикостероїдних гормонів досить тривалими курсами і навіть довічно, у зв’язку з чим діагностика виникнення побічних ефектів від тривалого використання системних глюкокортикостероїдів (ГКС), зокрема порушень кісткового обміну, а також їх профілактика є важливою складовою комплексної терапії тяжких дерматозів. Тому розробка методів ранньої діагностики, лікування і профілактики появи порушень ремоделювання кісткової тканини під впливом тривалої глюкокортикостероїдної терапії у хворих на тяжкі дерматози вкрай актуальна для сучасної дерматології. Мета дослідження — підвищення ефективності та безпечності лікування хворих на тяжкі дерматози шляхом запобігання або мінімізації розвитку побічних ефектів лікування глюкокортикостероїдними гормонами. Матеріали та методи. У дослідження було залучено 134 хворих на тяжкі дерматози (акантолітична пухирчатка, бульозний пемфігоїд, дерматоз Дюрінга, еритродермія тощо). Використовувалися клініко-анамнестичні, біохімічні, цитологічні, імуноферментні, інструментальні та статистичні методи дослідження. Результати. У хворих у результаті тривалої системної глюкокортикостероїдної терапії виявлялося вірогідне зниження кісткової фракції лужної фосфатази у 2,1 раза, рівня остеокальцину — у 6,6 раза і підвищення рівня С-кінцевого телопептиду у 2,2 раза. За даними ультразвукової денситометрії, остеопенію було виявлено у 35,5 %, остеопороз — у 64,5 % пацієнтів. Для корекції ремоделювання кісткової тканини призначалися препарати кальцію з вітаміном D3 та антирезорбтивний засіб. У результаті відзначалося підвищення зазначених показників, що свідчило про відновлення процесів остеосинтезу та нормалізацію процесів резорбції кісткової тканини, що підтверджувалося підвищенням мінеральної щільності кісткової тканини в 1,8 раза. Для запобігання розвитку порушень процесів ремоделювання кісткової тканини в комплексному лікуванні призначалися препарати антирезорбтивної дії, кальцію і вітаміну D3 в поєднанні із системними ГКС протягом усього курсу терапії. Висновки. Проведене дослідження дозволило підвищити ефективність та безпеку терапії хворих на тяжкі дерматози шляхом запобігання або мінімізації розвитку побічних ефектів лікування глюкокортикостероїдами.

大剂量静脉注射免疫球蛋白在重症皮肤病治疗中的应用进展

大剂量静脉注射免疫球蛋白在重症皮肤病治疗中的应用进展

Gottron’s carcinoid papillomatosis of skin (features of clinical course, diagnosis and treatment, own clinical observation)

Objective — to study the features of the clinical course, diagnosis and rational approach to the treatment of Gottron’s carcinoid papillomatosis of skin.Materials and methods. The article presents current data on the clinical course, pathomorphological criteria, diagnosis and treatment of Gottron’s carcinoid papillomatosis of skin. The authors’ own clinical observation is given.Results and discussion. Gottron’s carcinoid papillomatosis of skin is dermatosis that is quite rare in medical practice. The disease is characterized by a long course with a permanent progression of the pathological process. In the vast majority of patients, this pathology develops against the background of other chronic dermatoses such as psoriasis, eczema, lichen planus, pemphigus. In addition, these patients are diagnosed with concomitant multiorgan somatic pathology, which causes not only severe course and recurrence of this dermatosis, but also requires a comprehensive approach to the treatment of these patients, taking into account the identified somatic pathology.Conclusions. Gottron’s carcinoid papillomatosis of the skin is characterized by a long course against the background of permanent progression of the pathological process.Treatment of patients with Gottron’s carcinoid papillomatosis should be comprehensive and individualized, taking into account the severity of dermatosis and concomitant pathology, which is predominantly multiorgan in nature and in some cases causes severe dermatosis and resistance to traditional therapy. This clinical case indicates a significant regression of clinical manifestations of dermatosis in patients with long­term disease, provided the correct diagnosis and adequate therapy.

Норвежская чесотка у детей: особенности течения и сложности диагностики

In this article, we report two cases of Norwegian scabies in a 12-year-old girl and a 4-year-old boy. Norwegian scabies is an exceedingly rare variant of widespread parasitic dermatosis. In both patients, the diagnosis was challenging for pediatricians, dermatologists, and allergists due to specific disease pattern and clinical manifestations. We demonstrated the difficulties associated with diagnostics, as well as the importance of thorough examination of patients with severe dermatoses that can mask this variant of scabies. Patients with comorbidities, particularly those using topical corticosteroids for a long time, can be considered as a high-risk group for this highly contagious parasitic dermatosis with severe complications (erythroderma, sepsis, etc.). Awareness of dermatologists and other healthcare specialists, compliance with examination algorithms will ensure timely diagnosis of Norwegian scabies, prevent iatrogenic errors, and improve the epidemiological situation. Key words: children, Norwegian scabies, Down syndrome, diagnostic difficulties

Clinical observation of two cases of Gottron skin carcinoid papillomatosis

The article presents modern and historical data of domestic and foreign literature on rare severe dermatosis Gottron skin carcinoid papillomatosis. Two own clinical observations of Gottron skin carcinoid papillomatosis in a young woman of 48 years proceeding against the background of malignant neoplasm of the ovary, and a man of 70 years with a concomitant vascular disease of the lower extremities are described.

Part II: Accuracy of Teledermatology in Skin Neoplasms

Teledermatology has been proving to be of great help for delivering healthcare, especially now, during the SARS-CoV-2 pandemic. It is crucial to assess how accurate this method can be for evaluating different dermatoses. Such knowledge can contribute to the dermatologists' decision of whether to adhere to teledermatology or not. Our objective was to determine the accuracy of teledermatology in the 10 most frequent skin neoplasms in our population, comparing telediagnosis to histopathological report and in-person dermatologists' diagnosis. A retrospective cohort study was conducted in São Paulo, Brazil, where a store-and-forward teledermatology project was implemented under primary-care attention to triage surgical, more complex, or severe dermatoses. A total of 30,976 patients presenting 55,012 lesions took part in the project. Thirteen teledermatologists who participated in the project had three options to refer the patients: send them directly to biopsy, to the in-person dermatologist, or back to the general physician with the most probable diagnosis and management. In the groups referred to the in-person dermatologist and biopsy, we looked for the 10 most frequent International Statistical Classification of Diseases and Related Health Problems-10 (ICD-10) of skin neoplasms, which resulted in 289 histopathologic reports and 803 in-person dermatologists' diagnosis. We were able to compare the ICD-10 codes filled by teledermatologists, in-person dermatologists, and from histopathological reports. The proportion of complete, partial, and no agreement rates between the in-person dermatologist's, histopathologic report, and the teledermatologist's diagnosis was assessed. We also calculated Cohen's kappa, for complete and complete plus partial agreement. The mean complete agreement rate comparing telediagnosis to histopathological report was 54% (157/289; kappa = 0.087), being the highest for malign lesions; to in-person dermatologists was 61% (487/803; kappa = 0.213), highest for benign lesions. When accuracy of telediagnosis for either malign or benign lesions was evaluated, the agreement rate with histopathology was 70% (kappa = 0.529) and with in-person dermatologist, 81% (kappa = 0.582). This study supports that teledermatology for skin neoplasms has moderate accuracy. This result reassures that it can be a proper option for patient care, especially when the goal is to differentiate benign from malign lesions.

Part I: Accuracy of Teledermatology in Inflammatory Dermatoses.

Teledermatology is assuming a progressively greater role as a healthcare delivery method, especially now, during this pandemic time. It is important to know how accurate this tool is for different skin diseases. Most of the studies have focused on skin neoplasms or general dermatology. Studies based on a large number of inflammatory dermatoses have not yet been performed. Such knowledge can help dermatologists to decide whether endorsing this method or not. Our objective was to determine the accuracy of teledermatology in inflammatory dermatoses in a robust number of cases. A retrospective cohort study was conducted in São Paulo, Brazil, from July 2017–18, where a store-and-forward Teledermatology project was implemented under primary-care attention to triage surgical, more complex, or severe dermatoses. A total of 30,976 patients presenting 55,012 lesions took part in the project. Thirteen participating teledermatologists had three options to refer the patients: directly to biopsy, to the in-person dermatologist or back to the general physician with most probable diagnosis and management. In the group referred to the in-person dermatologist, we looked for the 20 most frequent International Classification of Diseases and Related Health Problems- 10th revision (ICD-10) of inflammatory dermatoses, which resulted in 739 patients and 739 lesions. As patients had been triaged by teledermatology previously, we were able to compare ICD-10 codes filled both by teledermatogists and by in-person dermatologists. The proportion of complete, partial, and no agreement rates between the in-person dermatologist's and the teledermatologist's diagnoses was used for accuracy. We also calculated Cohen's kappa, a statistical measure of inter-rater agreement, for complete agreement. The mean complete agreement rate for all twenty dermatoses was 78% (31–100%) and kappa = 0.743; partial agreement 8%; and no agreement 14%, presenting variability according to the disease. Our study showed that teledermatology for inflammatory dermatoses has a high accuracy. This result reassures that it can be a proper option for patient care.

Coordination of integrative relations of dermatovenereological industry with primary unit at the stage of reform of domestic health system

Objective — to determine the scope and algorithm of cooperation between dermatovenereologists and family medicine doctors in providing medical services for skin diseases and sexually transmitted infections (STIs).Materials and methods. Analysis of the dynamics of the incidence of skin and sexually transmitted diseases in Ukraine and the virtual creation of an epidemiological situation in the absence of integration relations between individual health services.Results and discussion. The algorithm, scope and rational approaches to provision of services to patients at the primary and specialized level are offered. Diagnosis and treatment of patients with severe and infectious dermatoses, like STIs, should be carried out at a specialized level. Permanent monitoring of patients with chronically recurring and common dermatoses in the inter-relapse periods is carried out by family medicine doctors.Сonclusions. The provision of medical services to patients with a dermato-profile should be carried out with the preservation and use of significant positive experience of the domestic industry. The practical neglect of the well-organized dermatovenereological service may prove to be a fatal mistake of the health authorities. The mechanical transfer of the European experience of the activities of their primary care workers, the so-called «goalkeepers» of medicine, to our socio-economic soil and the specific conditions of personnel and material support may not be justified at all. The effectiveness of the provision of medical services to patients with a dermatological profile at the present stage will largely depend on clearly coordinated actions of the primary and specialized units. Previously well-planned and implemented quality training for primary care physicians is necessary. The proposed algorithm, integrated volume and rational approaches can become the key to a successful fight against dermatovenereological problems. The development of effective cooperation between primary and specialized dermatovenereological units can serve as material for summarizing best practices in the form of guidelines or medical recommendations for its further successful application.

Patients\u2019 out-of-pocket expenses analysis of presurgical teledermatology

BackgroundThis study undertakes an economic analysis of presurgical teledermatology from a patient perspective, comparing it with a conventional referral system. Store-and-forward teledermatology allows surgical planning, saving both time and number of visits involving travel, thereby reducing patients’ out-of-pocket expenses, i.e. costs that patients incur when traveling to and from health providers for treatment, visits’ fees, and opportunity cost of time spent in visits. to The study quantifies the opportunity costs and direct costs of visits for adults waiting for dermatology surgery.MethodThis study uses a retrospective assessment of 123 patients. Patients’ out-of-pocket expenses of presurgical teledermatology were analyzed in the setting of a public hospital over 2 years. The teledermatology network covering the area served by the Hospital Garcia da Horta, Portugal, linked the primary care centers of 24 health districts with the hospital’s dermatology department. The patients’ opportunity cost of visits and direct costs of visits (transport costs, and visits’ fee) of each presurgical modality (teledermatology and conventional referral), were simulated from initial primary care visit until surgical intervention. Two groups of patients, those with Squamous Cell Carcinoma and those with Basal Cell Carcinoma, were distinguished in order to compare the patients’ out-of-pocket expenses according to the dermatoses.ResultsFrom a patient perspective, the conventional system was 2.12 times more expensive than presurgical teledermatology. Teledermatology allowed saving €0.74 per patient and per day of delay avoided. This saving was greater in patients with Squamous Cell Carcinoma than in patients with Basal Cell Carcinoma. Although, the probabilistic sensitivity analysis corroborates the results of the base case scenario, only a prospective study can substantiate these results.ConclusionIn the Portuguese public healthcare system and under specific cost hypotheses, from a patient economic perspective, teledermatology used for presurgical planning and preparation is the dominant strategy in terms of out-of-pocket expenses, outperforming the conventional referral system, especially for patients with severe dermatoses.

THE LEVEL AND STRUCTURE OF MORBIDITY OF DISEASES OF SKIN AND SUBCUTANEOUS TISSUE

According to research in Russia in 2016, the prevalence of diseases of the skin and subcutaneous tissue was 5871 cases per 100000 people, the incidence was 4259 cases per 100000 people. Severe chronic dermatoses significantly reduce the quality of life of patients and their families, the patients’ self-esteem suffers, their habitual lifestyle is disturbed. The purpose is to study the level dynamics and structure of the incidence of diseases of the skin and subcutaneous tissue of the population of the Republic of Bashkortostan for the period 2008-2017. The analysis of the structure and dynamics of the prevalence and the incidence of the ICD-10 class “Diseases of the skin and subcutaneous tissue” (L00-L99) in the Republic of Bashkortostan was carried out according to the FSN form No. 12 for 2008-2017, and a simulated forecast of the incidence rate up to 2022 was compiled. The study revealed a steady downward trend in the prevalence and the incidence of these diseases in the Republic of Bashkortostan for the period 2011-2017. Considering the prediction data, the trend towards a decrease in the incidence rates of skin diseases until 2022 will continue. On this background, the level of the prevalence of atopic dermatitis and psoriasis tends to increase, the incidence of atopic dermatitis tends to increase, and the incidence of psoriasis tends to decrease. The proportion of severe chronic dermatoses increased 1.5-2 times in all age groups. Thus, the analysis makes it necessary to improve the work on the organization of medical care for patients with chronic dermatoses and methods for their prevention.

Evolution of the understanding of psoriasis and therapeutic approaches used to manage such patients. BCD-085 is the first Russian genetically-engineered biological preparation for the treatment of patients suffering from psoriasis

This review paper discusses the systemic character of psoriasis. For medical specialists, it is of crucial importance to understand that psoriasis is not exclusively a skin disease; rather, it is pathogenetically connected with the development of a number of comorbid conditions. This fact has a practical significance in terms of choosing therapeutic strategies for managing patients with medium and severe dermatoses characterized by relapses and comorbid conditions. The long-term use of systemic medications in such cases, including genetically engineered biological ones, seems to be theoretically reasonable, since it facilitates control over the main clinical manifestations of the disease.This paper presents information on the innovative Russian drug — BCD-085-inhibitor IL17 — and its effects on the key stages of psoriasis immunopathogenesis. The efficacy and safety of this drug for patients with moderate and severe psoriasis are discussed.BCD-085 is found to exhibit a fast and high therapeutic response in terms of the PASI75, PASI90, PASI100 and sPGA indexes during the first 12 weeks of therapy. According to the available data, BCD-085 is characterized by a favourable safety profile and the absence of immunogenicity from the clinical standpoint.

Profound consequences of hidradenitis suppurativa: a review.

Hidradenitis suppurativa (HS) influences patients' lives in many ways. The most troublesome symptom of HS is chronic pain, of mild-to-moderate intensity, which is reported by almost all patients. With reference to psychosocial evaluation, HS appears to be a highly debilitating disease. The major factors influencing patients' well-being are disease severity, the number of flares or affected skin areas, and the lesion location. The mean Dermatology Life Quality Index scores of 8·3-12·7 points obtained among patients with HS are typical for severe dermatoses, which have a large impact on patients' quality of life (QoL). HS not only affects skin-related QoL issues, but also has a profound impact on general QoL measures - it causes substantial deterioration of both physical and mental health. Considering the impaired QoL due to HS and HS-associated, nonpsychiatric comorbidities, it is not surprising that patients with HS experience psychological disturbances. In both observational and registry studies, depression and anxiety were significantly related to HS. The prevalences were estimated as 1·6-42·9% and 0·8-3·9%, respectively. HS was also linked to feelings of loneliness and stigmatization. Moreover, these patients have a significantly increased suicide risk (hazard ratio 2·42). HS, with its frequent involvement of the genital area, causes a pronounced impairment of sex life (66·7% of patients with HS reported sexual difficulties). Finally, HS causes significant financial burden, not only through the costs of healthcare, but also due to a substantial impact on patients' professional careers. This is a reason for absenteeism from work for approximately half of patients, and a relatively high unemployment rate.

Study of the Blood Count in Hospitalized Patients in the Dermatology Department of the CNAM

The blood count is the biological examination that aims to identify, count and observe the figured elements of the blood. In dermatology, the hemogram is an index of the evolution of the dermatosis and the general state of the patient. The blood count is the refore an examination that is of diagnostic and prognostic value in the management of dermatological conditions. Our objective was to determine the place of the blood count in the management of dermatosis in hospitalized patients of the CNAM. This was a descriptive cross-sectional study of all cases of hemogram performed in all hospitalized patients in the dermatology department of the CNAM during the period from January 1, 2015 to December 31, 2017, ie 3 years. The inclusion criteria were as follows: all inpatient records containing the hemogram results regardless of age and sex during the study period. Out Of the 133 cases included, 112 had abnormal blood counts, 84.2% of cases. Females accounted for 51.9% (69) and males 48.1% (64). The age of the patients ranged from 2 years to 90 years with an average age of 54.34 years. Among the hematological disorders observed: Anemia accounted for 86.6% of cases. It was hypochromic and microcytic in 80.4% of cases, normochromic and normocytic in 16.5% of cases and macrocytic normochromic in 3.1% of cases. This anemia was associated with chronic ulceration in almost 100% of cases, autoimmune bullous dermatosis (Pemphigus and Bullous Pemphigoid) in 72.7% of cases, erysipelas in 81.8% of cases, severe toxidermias in 75% of cases. erythroderma in 60.4% of cases, cutaneous carcinoma in 87.2% of cases. Leukocytosis accounted for 59.8% of cases. This leukocytosis was predominantly neutrophilic in 44.6% of cases, eosinophilic in 16.5% and lymphocytosis was observed in 14.6% of cases. This leukocytosis was associated with chronic ulceration in almost 44.2% of cases, with autoimmune bullous dermatoses (Pemphigus and Pemphigoid bullosa) in 81.6% of cases, with erysipelas in 63.6% of cases, with severe toxidermias in 74.5% of cases, with erythroderma in 60.2% of cases, cutaneous carcinomas in 66.3% of cases. the blood count remains the essential biological examination for the management and monitoring of severe dermatosis requiring hospitalization and our study could be a preliminary to other studies to elucidate its impact on the evolution of the dermatological disease.