Lichen planus is among the most common chronic anogenital noninfectious dermatoses both in male and female. The disease is characterized by clinical polymorphism, frequent involvement of skin and oral mucosa and protracted course. Typical, hypertrophic and erosive forms are distinguished. Erosive variant is commonly encountered in women and has a prominent tendency for scarring. The most common anogenital form in men is the typical lichen planus, which usually resolves completely. Vulvovagino-gingival and penogingival lichen planus are rare severe disease forms. Evolutional and biological heterogeny of clinical manifestations complicates the disease diagnosis. Lichen planus pathogenesis remains unclear. Pronounced scarring tendency in anogenital cases is believed to be the consequence of epithelial-mesenchimal transition. High-quality clinical trials of various therapeutic modalities in anogenital lichen planus are lacking. Management of such patients is mostly based on case series reports, practical experience and general principles of dermatologic treatment. This review focuses on contemporary views on clinical presentation, pathogenesis, diagnosis and approach to therapy of anogenital lichen planus.

The article is of a review nature and contains up-to-date information on modern attitudes, causes, trigger factors, classification, diagnostics and treatment methods of telogen effluvium. It gives the data on the use of hardware lighting technologies for hair loss treatment.

Autologous fat is a biological substance that attracting increased scientific interest. Autologous fat considered as ideal filler due to its biocompatibility without risk of an allergic reaction or rejection. Likewise, this substance could be obtained easily, and costs are relatively low. Therapeutic indications for use fat grafting appear day by day, as it is recognized as an effective, reliable methodology and enhancing of areas and pathologies of application in medical specialties. The analysis results show that autologous fat transplantation gives a possibility to compensate for aesthetic and functional signs caused by facial scleroderma.

The study of immunopathogenesis has led to the development of new methods of therapy for moderate-to-severe psoriasis. Tumor necrosis factor inhibitors, blockers of IL‑17, IL‑12/-23, IL‑23 are integrated into the therapy regimens for common forms of psoriasis. The results of clinical studies and real practice have shown high efficacy and a good safety profile of biological agents in psoriasis, however, the issues of differentiated use, including depending on comorbid pathology, require further study. Clinical decision-making should be carried out taking into account the most rational approach, as well as taking into account the advantages and limitations of the use of genetically engineered drugs. This article discusses recommendations regarding the choice of first-line biological therapy for patients with psoriasis and various comorbidities and patient-related factors. In addition, the article presents data on the efficacy and safety of using the original IL‑17 inhibitor netakimab in patients with psoriasis and comorbid pathology.

Aim. To evaluate the effectiveness of complex therapy using the regulatory polypeptide selank and combined narrow-band medium-wave and wide-band long-wave ultraviolet (UV) radiation in the correction of the cytokine blood profile and immunoglobulin E (IgE) level in patients with atopic dermatitis (AD).

Material and methods. In a group of 124 patients with medium-heavy AD (61 men, 63 women; average age 23.7 ± 6.06 years), a comparative analysis of the effect of therapy on the interleukins (IL) -1β,-4,-10,-13, immunoglobulin E (IgE) blood levels was performed. We compared the results of basic drug treatment (BT), additional prescription of selank (S), combined UV phototherapy (CFT) in the range of 311 nm and 320–400 nm, as well as complex therapy (S + CFT + BT).

Results. The immune status of AD patients is characterized by high blood levels of IL‑1β,-4,-10,-13 and IgE in comparison with healthy individuals. Standard drug therapy had the least effect on the cytokine profile and level IgE blood of patients. The use of selank increases the anti-inflammatory effect of BT. The regulatory effect on cytokine activity and level IgE is even more significantly enhanced with the use of CFT. The most pronounced immunocorrective effect was demonstrated by complex therapy with the use of combined UV radiation techniques and selank.

Conclusions. The use of a combined narrow-band medium-wave (311 nm) and wide-band long-wave (320–400 nm) UV radiation and regulatory polypeptide drug (selank) causes the most pronounced positive effect on the cytokine blood profile and IgE level in patients with AD, which indicates a greater anti-inflammatory activity of this treatment method (p < 0.001) compared to the monotherapy groups and basic therapy (p < 0.001). 

Psoriasis is a heterogeneous disease characterized by a wide range of clinical manifestations. Patients with psoriasis and psoriatic arthritis have an increased risk of developing comorbid conditions, therefore, when prescribing therapy, it is necessary to take into account aspects of polypharmacy and the risks of developing infections. Apremilast is effective for the treatment of patients with psoriasis and comorbid comorbidity. To increase the effectiveness of apremilast therapy (achieving PASI 90 and PASI 100), it is possible to use a combination with narrow-band medium-wave phototherapy. The combined method allows achieving clear or almost clear skin in the vast majority of patients and is highly safe, as evidenced by the absence of severe side effects. The method is safe when used in patients with impaired glucose tolerance, diabetes mellitus, increased body weight and the risk of infections.

Relevance. Dairy-free diet is the basis of cow’s milk allergy (CMA) patient’s management. Duration of the diet is individual, but some children don’t develop tolerance.

The aim of the study was to investigate health and growth indices in children with CMA depending on tolerance development by the age of five. Materials and methods. 153 children from 1 to 18 months with diagnosed CMA were included in the prospective study (76.5% with IgE-mediated form). The tolerance was determined after 6–12 months of a milk-free diet and at the age of 5 using an open challenge test. Anthropometry indices (Anthro Plus), levels of specific IgE (Immuno CAP 250) and IgG4 (ELISA) to dietary proteins and the presence of allergic diseases in children also were assessed.

Results. 50.3% of children developed tolerance to cow’s milk protein after 6–12 months of a milk-free diet. By the age of 5 63.3% of patients had complete tolerance of dairy products. Partially formed tolerance was observed in 22.9%. 13.8% of patients still had clinical reactions to cow’s milk proteins. Patients with persistent CMA typically had IgE-mediated form, lower growth indices and multiple allergic pathology.

Conclusion. The consideration of tolerance development predictors can allow to personalize the management of CMA. Additional researches are needed to clarify the causes of growth indices decline in children with persistent CMA. 

Objective. To evaluate the effect of low doses of systemic isotretinoin in monotherapy and combination on the qualitative and quantitative composition of the microbiota in patients with acne with moderate papulo-pustular acne.

Materials and methods. 78 patients were monitored on an outpatient basis. Group 1 consisted of 38 patients. This group was divided into two age subgroups: A (12–24 years; n = 18) and B (25–45 years; n = 20). All patients in group 1 received monotherapy in the form of systemic administration of isotretinoin at a dose of 0.5–0.7 mg per 1 kg of body weight per day daily for 6 months. Group 2 consisted of 40 patients who were also divided into two age groups: A (12–24 years; n = 21) and B (25–45 years; n = 19). This group received combination therapy with isotretinoin at a dose of 0.1–0.3 mg per kg of body weight per day daily for 6 months in combination with phototherapy with broadband incoherent light (wavelength 440–950 nm) once every two weeks, a course of 4–6 procedures. To study the features of the qualitative and quantitative composition of the skin microbiota of acne patients, all patients were scraped and smeared with a sterile cotton swab before and after therapy, followed by analysis of microbial markers by chromatography-mass spectrometry.

Results. Against the background of monotherapy in patients of different age groups, there was a positive dynamic in relation to the majority of microbiota indicators, its severity in subgroup A (12–24 years) was statistically more significant (p < 0.05). However, the complete normalization of the composition of the facial skin microbiota in both subgroups did not occur. After combination therapy, there was a pronounced positive dynamics and normalization of most indicators of the microbiota of the skin, regardless of age. However, the number of some targeted microorganisms turned out to be slightly higher than normal and after therapy.

Conclusions. The use of low-dose isotretinoin monotherapy, as well as its combination with broadband incoherent light, does not allow to completely normalize the composition of the microbiota in patients suffering from acne papulo-pustular form of moderate severity, which requires further study and analysis. 

Cancer chemotherapy advanced dramatically. The success in the management of a broad spectrum of malignancies was achieved due to the development of targeted chemotherapeutic drugs, such as inhibitors of the epidermal growth factor receptor (iEGFR). The most common dermatologic side effect of iEGFR therapy is an acneiform rash that occurs in 60–80 % of patients. This adverse event develops during the first 2 weeks of treatment with iEGFR. Diagnostics of acneiform rash may be complicated because of different interpretations by oncologists and dermatologists. Acneiform rash is frequently associated with pain and itch. Skin toxicity affects a patient’s quality of life, including physical and psychological well-being, emotional and social adaptation, may lead to dose reduction and iEGFR discontinuation. The degree of acneiform rash correlates with an iEGFR effectiveness, which is currently confirmed by different data. Thus, the prevention and prompt management of dermatologic adverse events is a pressing issue because they influence the anti-cancer treatment prognosis. This article reviews the current recommendations on the prevention and management of iEGFR associated acneiform rash. The authors present their own clinical case of a patient with acneiform rash during panitumumab (monoclonal antibody against EGFR) therapy.

The escape effect or secondary ineffectiveness of genetically engineered bio-drugs GEBD determines the change in patient management tactics, including switching to another genetically engineered drug. In clinical practice, this is a rather difficult task, which primarily concerns the choice of the next drug. The solution to the problem of secondary inefficiency can be achieved, for example, by switching to a GIBP with a different mechanism of action. In the VOYAGE 1, 73% of patients who did not respond to 48 weeks of adalimumab therapy achieved a PASI response of 90 by the 100th weeks after switching to guselkumab therapy. In the VOYAGE 2 study, 75 and 43% of patients achieved PASI 90 and 100 at week 100 after switching to gumelkumab therapy from adalimumab with failure at 28 weeks. In the NAVIGATE study, the increase in efficacy in patients with an insufficient response to ustekinumab when switching to guselcumab therapy was 27% (p < 0.001) when assessing the proportion of patients who achieved PASI 90 by 52nd weeks of therapy. Thus, the data of clinical trials make it possible to recommend guselkumab as the drug of choice in the case of the “escape” effect or insufficient effectiveness of GEBDs of other classes. The experience of using guselkumab in real clinical practice has shown its high efficiency in patients with the «escape effect» of anti-TNF-α and anti-IL‑17 drugs.

Material and methods. 73 patients with different subtypes of rosacea were under observation on an outpatient basis. To study the effectiveness of the combined method of treatment, all patients, depending on the therapy used by the method of simple randomization, were divided into 2 groups, within the groups into 3 subgroups, depending on the subtype of rosacea. Patients of the 1st group received monotherapy with isotretinoin at a dose of 8 mg per day in a daily regimen for three months, then in a regimen every other day for another 3 months. Patients in group 2 received combined therapy with isotretinoin in combination with phototherapy with broadband incoherent light (wavelength 440–950 nm) once every two weeks, a course of 4–6 procedures. Patients of all groups used specialized dermatological cosmetics throughout the study period.

Research results. The developed combined method, regardless of the subtype of rosacea, is more effective than monotherapy with isotretinoin: with ETPR, the total DISHS index decreased by 91.2%; with PPPR by 89.6%; with a combination of subtypes by 93.8% versus 41.6%, 53.4% and 54.0% in group 1, respectively.

Conclusion. The developed combined method contributes to a more pronounced improvement in the quality of life compared to monotherapy: the DIKI index in group 2 with ETPR decreased by 70.5%, with PPPD by 88.5%, with a combination of subtypes by 95.0%, while in 1 group by 36.3%, 72.4% and 73.8%, respectively. 

Acne is a chronic disease and even reliable therapies do not completely ensure absence of relapses. Acne relapses have a negative psychological impact on patients, as they feel unable to control the disease and achieve complete and long-lasting recovery. Supportive therapy is necessary to prolong the remission of acne achieved with initial successful treatment and to minimize the risk of relapse. According to the literature sources, the most justified as a maintenance therapy is the use of topical retinoids, which have been shown to be effective in the prevention of exacerbations of acne. In the present study 54 patients were involved who after the active therapy used a fixed combination of adapalene 0.1% / BPO 2.5% as maintenance treatment. Only 1 patient (2.9%) with moderate acne and 2 patients (5.8%) with severe acne had a relapse within 6 months of maintenance therapy. The absence of adverse events during the course of treatment was recorded, as well as high adherence of patients to the treatment. During the period of post-treatment observation (6 months after maintenance therapy), among the patients without exacerbations during maintenance therapy, a relapse occurred in 2 (7.1%) patients of group 1 (n = 28) and 2 (8.7%) patients of group 2 (n = 23). The obtained data indicates that maintenance therapy with Effezel® gel can extend the achieved effectiveness of the treatment and prevent the development of relapses.

Objective of the study. To evaluate the effectiveness of systemic interferon alpha‑2b in the complex therapy of lichen scleroatrophic of the penis.

Material and methods. The study involved 26 male patients with a verified diagnosis: lichen scleroatrophic of the penis. The main group was 19 people, the comparison group was 7 men. The duration of the disease in men was from 9 to 12 months. To estimate the area of lesion as well as to estimate their dynamic changes were developed: Scleroatrophic Lichen Area Index (LS-S in men) and Scleroatrophic Lichen Activity Index (LS-A). Treatment in the main group: topical corticosteroid momentasone cream two times a day for 21 days, as well as interferon alpha‑2b suppositories in a dose of 3 million ME two times a day, daily for 10 days, then three times a week for 2 months with subsequent external application of 1–2 times a day for 2 months of ointment with interferon alpha‑2b. In patients with balanopostitis the cream was used in combination with momentazone, economazole, gentamycin and dexpanthenol. Patients from the comparison group received momentazone cream for 21 days, and in case of recurrence of symptoms – the prescription of topical calcineurin inhibitors. Patients of both groups received vitamin E of 200 mg per day for 2 months. The end point of observation for patients of both groups was 3 months after the end of therapy.

Results. Against the background of treatment, improvement was achieved in all patients in the main group within 21 days. Subsequent cancellation of topical corticosteroid and continuation of therapy with suppositories and ointment of the interferon alpha‑2b allowed to maintain positive dynamics of the skin process during the whole period of observation. The control group also achieved a positive effect from therapy with topical corticosteroids (cream with momentazone), but after its cancellation, in the period from 4 to 6 weeks, symptoms were recurrent, which required the continuation of therapy with topical calcinerin inhibitors – tacrolimus ointment 0.1% 1–2 times a day for 4 weeks. The use of the LS-A Index showed that the indices of skin manifestations were the fastest to regress than those of the LS-S index assessing the area of lesion.

Conclusions. 1. The use of system therapy with interferon alpha‑2b, along with topical GCSs, in the complex treatment can reduce the severity of clinical manifestations of GSAL without resorting to prolonged use of topical GCSs. 2. The use of interferon alpha‑2b in the complex treatment of the genital lichen sclerosus has demonstrated its effectiveness in a small group of patients. 3. Application of the developed Lesion Area Index and Lichen Sclerosus Activity Index in men allow to objectively assess the effectiveness of treatment. 4. Lichen sclerosus assessment indices allow to develop an individual plan of rehabilitation measures. 5. It is expedient to continue studies on pathogenetic mechanisms of influence of alpha‑2b interferon in genital lichen sclerosus. 

Atrophic scars are a common pathology that can have a negative impact on the patient’s quality of life. Methods for correcting atrophic scars include chemical peels, dermabrasion, ablative or non-ablative laser resurfacing, filler insertion, and surgical techniques. Depending on the type and severity of the scar, an individual approach is required to obtain satisfactory results. Material and methods. The study included 32 patients with atrophic scars. Depending on the therapy, the patients were divided into two groups in which they received microneedle radiofrequency therapy or fractional photothermolysis. The effectiveness of the methods of therapy was assessed using laser doppler fluometry and ultrasound scanning. Research results. The RF microneedle method and fractional photothermolysis have a positive effect on the epidermal-dermal structure of the skin, which is expressed in the approximation of the acoustic density and thickness of the epidermis and dermis to normal values, and also improve microcirculation. When analyzing the results of correction of atrophic scars, more pronounced positive dynamics was observed after the application of RF microneedles.

Physiotherapy methods of treatment are widely used in modern cosmetology. High tolerance and safety, combined with the absence of skin injuries, make it possible to include this method in the combined protocols for the prevention and treatment of age-related skin changes and aesthetic deficiencies, including hyperpigmentation. The review provides a detailed description of the milling method, as well as its mechanism of action and application features. This article is of interest to practicing dermatologists, cosmetologists and physiotherapists.

Scars can adversely affect the physical, mental and social well-being of the patient. Scar treatment is one of the most difficult and urgent tasks of aesthetic medicine. Due to the individual characteristics of the organism of each patient, it is rather difficult to choose a suitable adequate treatment method and predict the duration of therapy. Common methods for eliminating cicatricial deformities of the skin include external agents, chemical peels, mechanical resurfacing, laser resurfacing, injection techniques, physiotherapy methods, and surgical excision. Unfortunately, the frequency of relapses after monotherapy by any of the listed methods can reach 100%, therefore, the search for combined treatment methods is an urgent and priority direction. Cicatricial deformities lead to a change in the structures of the dermis and hypodermis, which significantly reduces the penetration of topical drugs, therefore, phoresis methods can be used to achieve a greater therapeutic effect. The mechanism of action of phoresis methods is based not only on the local effect of the physical factor and the drug itself, but also on the body’s response to the physiological effect through the mechanisms of neuroreflex and humoral regulation. This method of drug delivery avoids the side effects arising from the systemic use of the same drug. The disadvantages of this method in mono-application are insufficiently high efficiency and duration of the course. Phoresis methods can reduce the frequency of relapses in the treatment of cicatricial deformities of the skin in combination with existing methods. The review presents the main types of phoresis used in the treatment of various scars, as well as examples of the combined use of phoresis methods with other treatment options.

A clinical case of sporotrichosis is described and basic information is provided to help the practitioner. The list of nosologies, including photographs, to which should be differentiated the cutaneous-lymphatic sporotrichosis, is presented.

The diagnosis is the result of the physician’s synthesis of all anamnestic, clinical and instrumental data from the patient’s examination. However, for various reasons, the putative clinical diagnosis is not always supported by laboratory test results. The article discusses the main reasons for such discrepancies, emphasizes the responsibility of the attending physician for reliable diagnosis of the disease.

Microcirculation mechanisms and vegetative-vascular mechanisms have an important pathogenetic significance in the development of allergic inflammation.

The purpose of our study was to assess capillaroscopy and heart rate variability in children with allergic rhinitis (AR), depending on the presence of comorbid pathology. All children were divided into three groups: the main group – 29 children with AR in combination with herpes infection or the presence of pathogenic microflora in nasopharyngeal swabs in the amount of more than 106, the comparison group – 23 children with AR, the control group – 26 healthy children. All children with AR had pronounced changes in the microvasculature, which varied depending on the presence of concomitant pathology, along with reactive changes in autonomic regulatory systems towards an increase in the dominance of central regulation mechanisms and the predominance of parasympathetic tone. Children with AR and concomitant pathology did not have a pronounced parasympathetic effect, in contrast to children with AR and children without concomitant pathology, which should be taken into account when drawing up a plan for personalized treatment and rehabilitation.