According to the current concepts, pathogenesis of acne includes signifcant morphological and functional changes and hypercolonization of C. acnes of the sebaceous hair follicle. But most important input into pathogenesis of acne gives permanent inflammation, previously considered as a secondary pathophysiological reaction. Recently, much attention has been given to pruritus associated with acne lesions. This literature review analyzes the data concerning the pathogenetic role of neurogenic inflammation in acne; the clinical importance of itch in the overall presentation of the disease is underlined, and its influence on psychosomatic correlations is presented.

Ultraviolet radiation has a proven damaging and carcinogenic effect, while the blue spectrum of visible light has now been proven to contribute to damage to skin cells. Blue light causes an antiproliferative effect associated with oxidative stress, disruption of the permeability of the epidermal barrier, activates inflammation and the appearance of pronounced, prolonged hyperpigmentation. In this regard, when developing photoprotective agents, it is necessary to take into account the damaging effect of blue light. The frst full spectrum photoprotector is TriAsorB, which allows full protection of the skin from photodamage.

Severe forms of acne vulgaris are accompanied by a pronounced decrease in the quality of life and lead to scarring. Early and effective acne therapy is the prevention of the formation of persistent cosmetic defects.

Aim. To identify risk factors and predictors for the development of severe forms of acne vulgaris.

Materials and methods. Article searches were performed in PubMed, Google Scholar and the Cochrane Central Registry of Controlled Trials over the period from 15 years to 10/25/2021 for the keywords ‘severe acne’, ‘predictors’ and ‘risk factors’. A meta-analysis was prepared using the Review Manager software (RevMan 5.4.1), The Cochrane Collaboration (2020) in line with international guidelines for systematic reviews and meta-analyzes (PRISMA).

Results. 38 publications were included in the review. Risk factors for the development of severe forms of acne vulgaris can be divided into nonmodifable (presence of acne in close relatives, male gender, oily skin type, changes in genes) and modifable (increased BMI, consumption of dairy products, Fast digesting carbohydrates, etc.) In the meta-analysis, a statistically signifcant increase in the risk of severe forms of acne vulgaris in the presence of a history of acne in a close family member was found to be 2.54 times (95 % CI [1.63, 3.91]). It was also found that men have a higher risk of developing severe forms than women (1.16 times {95 % CI [1.04, 1.30]}). People with a BMI higher than 25 (2.54 times {95 % CI [1.63, 3.91]}) and those who consume dairy products 1.59 times more often than three times a week (95 % CI [1.37, 1.85]).

Conclusion. Understanding the main risk factors for the development of deep forms of acne vulgaris will help to suspect a severe course of the disease in the early stages and to prescribe effective therapy in time. Male gender, family history, elevated BMI, and dairy consumption suggest a high likelihood of early development of severe acne.

Vulvar dermatosis is an inflammatory condition that manifests itself in a variety of symptoms that cause severe discomfort to a woman and signifcantly reduce the quality of life. The main symptoms are dyspareunia, dysuria, itching, dry skin and mucous membranes in the vulva. The clinical picture may be limited only to the vulva, or associated with extragenital localization. It is diffcult to overestimate the importance of the differential diagnosis of vulvar dermatoses, since most of them are clinically very similar to each other. Not only the cure for a specifc disease depends on the correct diagnosis, but also the prevention of the development of oncology, because some nosologies can become malignant. For example, lichen planus and lichen sclerosus can develop into squamous cell carcinoma. The most common method of therapy is topical glucocorticosteroids, but in the last few years more effective and complex ones have appeared, incl. combined methods for the treatment of dermatoses of the vulva, such as CO 2 laser, Er: Yag, Prp, biorevitalization, etc.

This article discusses modern guidelines for the treatment of papulo-pustular acne, of moderate severity, describes the duration of treatment and effectiveness criteria. Information is also provided on the possible maximum terms of use of drugs, in particular, systemic antibiotics. The treatment regimens of patients using systemic isotretinoin are considered, undesirable effects and ways to combat them are described. The results of observation of 25 patients with papulo-pustular acne who were prescribed systemic isotretinoin (Sotret) at a dose of 0.5–1.0 mg/kg and subsequent maintenance therapy with a topical drug containing adapalene (Adaclean) are presented. A clinical example of a patient with papulo-pustular acne of moderate severity is given.

Therapy of moderate-to-severe atopic dermatitis (AD) is associated with a number of diffculties due to the propensity of the disease to a chronic relapsing course, the tendency to develop in childhood and young age. However, a new selective JAK1 inhibitor, which suppresses cytokineinduced inflammation in the skin, has been added to the arsenal of AD systemic therapy.

Objective. To evaluate the effcacy, antipruritic activity, impact on quality of life, levels of anxiety and depression, and safety of upadacitinib treatment of moderate-to-severe AD in adult patients.

Material and methods. The inclusion criteria were the presence of moderate-to-severe AD, age over 18 years, signed informed consent of the patient to participate in the study. Effcacy was assessed based on clinical indices. All patients received upadacitinib (RANVEK) 15 mg once daily with or without food, topical corticosteroids (if needed), and emollients.

Results. The number of patients with an IGA score of 0 or 1 was 50%. The dynamics of the maximum intensity of pruritus according to NRS during 16 weeks of therapy was 56.4%. The proportion of patients with an improvement in the assessment of the maximum severity of itching according to NRS ≥3 points at week 16 relative to the baseline was 77.8%. The dynamics of the EASI index in percent was 65.3%, and the number of patients who achieved an EASI-50 response at week 16 was 83.3%, EASI-75 was 61.1%. The dynamics of the overall SCORAD index as a percentage of the initial value for 16 weeks was 76.9%. The DLQI decreased by 68.9%. The number of patients with HADS less than 7 points on a scale of both anxiety and depression was 88.9%.

Conclusions. Thus, upadacitinib demonstrates high effcacy in terms of the effect on rashes and pruritus, favorably affects the quality of life and psychosomatic characteristics of patients, and has a favorable safety profle in the treatment of moderate and severe AD in adults.

Therapy of onychomycosis today presents a number of diffculties, and the effect does not always meet the expectations of patients.

The purpose of the study. To study the tolerability and safety of the use of the drug Exilac(terbinafne hydrochloride + econazole nitrate), medical nail polish for external use.

Methods. Eighteen volunteers participated in a pilot, prospective, monocentre, open-label tolerability and safety study. The study lasted 6 weeks and consisted of screening and fve visits, at each visit a visual examination, laboratory and instrumental examination methods were performed.

Results. Eighteen healthy volunteers aged 18 to 34 participated in the study. Adverse events associated with the application of the study drug Exilac were observed in 1 (5.56%) volunteer, in the form of signs of delamination of the nail plate of the 1st fnger. This phenomenon is associated with mechanical damage to the nail plate when removing the old layer of the study drug and was regarded as a minor adverse event of mild severity. The remaining adverse events were not related to the use of the drug.

 Conclusion. The combined drug Exilac, when used twice daily for 6 weeks, demonstrated a high level of tolerability and safety. 

When choosing the frst drug for genetically engineered biological therapy (GEBT), the following are taken into account: the psoriasis phenotype, diagnosed PsA or predictors of its development, the presence of comorbid pathology, contraindications, dosing regimen, the rate of onset of the effect, and the ‘survival rate’. With the advent of new classes of GEBT-drugs, the concept of ‘treat to target’ has been formed, in accordance with which the importance of achieving clear or almost clear skin as a goal of psoriasis therapy has been noted, since studies have shown that achieving clear or almost clear skin (PASI 90, 100) correlates with higher indicators of health-related quality of life. The concept is reduced to the long-term prescription of highly effective and safe therapies (methods) with a high level of evidence in medicine (A, B). The evolution of GIBT has led to the emergence of a new class of anti-IL-23 drugs. The article presents data from clinical studies on the effcacy and safety of the use of the interleukin-23 blocker guselcumab. Own clinical cases are presented with a discussion of the choice made in favor of guselcumab as the frst genetically engineered drug.

Conclusions. Data from clinical trials on the high effcacy, ‘survival rate’ and safety of guselcumab in patients with psoriasis and psoriatic arthritis allows, including those with comorbid pathology, to consider it as a starting therapy using genetically engineered drugs. The data of our own results of observation allow us to conclude that guselkumab is highly effective in psoriasis of smooth skin, as well as in lesions of the scalp, anogenital area, with involvement of the nail plates in the process, which justifes its appointment as the frst GIBT drug.

Aim. To evaluate the effectiveness of low-intensity laser blood irradiation for the correction of the cytokine profle and violations of the skin barrier function in the complex treatment of children with atopic dermatitis.

Material and methods. The study included 65 children with atopic dermatitis (AtD) (mean age 8 ± 2,9 years) and 30 healthy children (control group). The patients were divided into two groups depending on the treatment: group 1 – basic drug therapy (BDT), group 2 – BDT in combination with supravenous laser blood irradiation (NLBI). Blood cytokine status indicators were assessed – levels of interleukins (IL) -4,-10,-13,-18, tumor necrosis factor-alpha (TNF-α), indicators of skin barrier function (skin pH, skin moisture, transepidermal water loss – TEWL) before treatment, after 1 and 3 months from the start of treatment.

Results. Basic drug therapy had the least effect on the cytokine profle of the blood of patients and parameters characterizing the barrier function of the skin. The inclusion of NLBI was accompanied by an anti-inflammatory effect, signifcantly enhanced the regulatory effect on blood cytokine activity, signifcantly improved the barrier function parameters studied (skin pH, skin moisture, TEWL) and reduced the frequency of disease relapses.

Conclusions. Basic drug therapy did not have a statistically signifcant corrective effect on the parameters of the immune status and skin barrier function in children with AtD. The combined use of NLBI and BDT increases the effciency of correction of the blood cytokine profle and violations of the skin barrier function in children with AtD, leads to a decrease in the frequency of disease relapses, which indicates the advantage of this method compared to monotherapy with basic drugs.

The pathology of the hepatobiliary system in psoriasis may be the result of taking hepatotoxic drugs, the result of a systemic inflammatory process. In this connection, it is necessary to consider the issue of including hepatoprotective drugs in psoriasis treatment regimens. There were 69 patients under observation, which, depending on the severity and prescribed treatment, were divided into 4 groups. In the B1A subgroup, a 75% reduction in PASI was observed in all patients, with PASI100 reaching 87.5% of patients. In subgroup 1B, a 75% decrease in PASI was observed in 87.5% of patients, while PASI100 reached 68.7% of patients. The DIQI index reduced in the 1A subgroup by 72.9%, in the 1B subgroup – by 66.3%. All patients of group 1 were diagnosed with non-alcoholic fatty liver disease. After therapy, in patients of subgroup 1A (therapy included a course of phosphogliv), the number of transaminases signifcantly decreased, in subgroup 1B there was no dynamics. In subgroup 2A, a 75% decrease in PASI was observed in 90% of patients, while PASI100 reached 60.0% of patients. In subgroup 2B, a 75% decrease in PASI was observed in 70.6% of patients, while PASI100 reached 47.1% of patients. The DIQI index reduced in the 2A subgroup by 77.0%, in the 2B subgroup – by 60.2%. The inclusion of phosphogliv in the therapeutic complex can increase the effectiveness of the treatment and reduce the risk of developing druginduced liver damage against the background of the use of potentially hepatotoxic drugs.

The article presents the results of evaluating the effectiveness of isotretinoin as the main drug therapy in patients with persistent and severe forms of seborrheic dermatitis.

Materials and methods. 20 patients used systemic isotretinoin at a dose of 10 mg every second day for 12 weeks. The assessment of the quality of therapy was carried out by taking into account the dynamics of indicators at the 8th and 12th weeks. To assess the effectiveness of therapy evaluation scales of the dermatological index of the symptom scale and questionnaires of the dermatologists’ quality of life index DLQI (Dermatologists’ Quality of Life Index) were used.

Results. According to the assessment of the scale of the dermatological index of symptoms, the greatest effectiveness of the drug was manifested in a decrease in skin erythema as a percentage from 76% at the 8th week of treatment to 91% at the 12th week of treatment from their initial manifestations. In addition, a pronounced effect was found in indicators of itching symptoms from 83% to 97% and desquamation from 79% to 95%, respectively. In addition, based on the DLQI questionnaire (Quality of Life Index in Dermatology), the data obtained demonstrated a distinct improvement in the quality of life of patients: both at the 8th week of treatment and after completion of therapy at the 12th week. From 79% at week 8 to 97% after treatment.

Conclusions. The use of low doses of systemic isotretinoin proved to be an effective method of drug therapy for severe seborrheic dermatitis.

The article presents the results of clinical studies and real practice of the effectiveness and safety of the use of a new genetically engineered biological drug Risankizumab. Skyrizi (risankizumab) is an innovative drug, it is a humanized monoclonal antibody – immunoglobulin class G1 (IgG1) – which specifcally inhibits the cytokine IL-23 by binding to its subunit p19. It is believed that cytokine IL-23, involved in inflammatory processes, is associated with a number of chronic immune-mediated diseases, including psoriasis. According to direct comparative randomized clinical trials, risankizumab is superior in effectiveness in the short term and, most importantly, in the long term most genetically engineered biologic drugs, including TNF-α inhibitors, secukinumab, ustekinumab. In the ultIMMa-1 and ultIMMa-2 studies, sPGA 0/1 and PASI 90 (p < 0.001) were achieved after 16 weeks of treatment with Skyrizi. After 16 weeks of treatment in both studies, the majority of patients achieved sPGA 0/1 (88% and 84%, respectively), and PASI 90 in both studies reached 75% of patients receiving Skyrizi. According to the LIMMitless open extended study, after completion of ultIMMa-1 and –2 (based on LOCF analysis), the proportion of patients receiving Skyrizi up to 2.5 years (136 weeks) withholding PASI 90 and PASI 100 was 87% and 63%, respectively. One of the potential advantages of IL-23 inhibitors is also the long-term maintenance of the achieved effect after treatment cessation. During patient management in the course of randomized controlled trials of phase 3, data were obtained on the high safety of the drug and the absence of signifcant risks in relation to serious infections, cardiovascular events, malignant neoplasms. The drug is effective in case of insuffcient response to adalimumab, ustekinumab, secukinumab. The article presents two clinical cases of the use of risankizumab in patients of different ages with severe psoriasis, with ineffciency or intolerance to systemic therapy, as well as in connection with the eluding effect of previously conducted treatment methods. PASI 90/100 was achieved in all patients. No adverse events were observed.

Sensitive skin is a common condition, affecting about half of the general population. This condition is characterized by a number of unpleasant skin symptoms (tingling, burning, pain, and itching) that occur in response to triggers that usually do not cause such reactions. Severe dryness of the skin is often observed in patients with sensitive skin. Nowadays, treatment of the condition of sensitive dry skin comes down to the use of moisturizing care products. We conducted a study of the clinical effectiveness of moisturizing products, which included 50 volunteers. According to the study data, a signifcant effect was achieved by the 21st day of using moisturizers. However, long-term use for more than 2 months allowed to maintain normal values of corneometric parameters even after cancelation moisturizers.

Pediatric patients with psoriasis, in order to maintain long-term remission, as a rule, need long-term therapy with genetically engineered biological drugs (GEBDs), which they continue after reaching adulthood. However, over time, there is a decrease in the effectiveness of biological therapy up to the complete loss of the therapeutic response, resulting in the need to change the biological therapy. In this regard, the study of the survival rate of biological therapy and the conditions and factors influencing it is becoming an urgent topic for research, which will make it possible to implement a personalized approach to prescribing GEBA and improve the effectiveness of the treatment. This article provides information on the main aspects of the survival of biological therapy in children with psoriasis, as well as the results of research on this issue.

Atopic dermatitis is a chronic dermatosis most often encountered in the practice of a pediatric dermatologist. Often, the skin process is difficult to treat, which may be due to gluten intolerance caused by celiac disease, and therefore requires the complete exclusion from the diet of products based on gluten-containing cereals: wheat, rye, barley. The article presents data indicating a high incidence of celiac disease among children with atopic dermatitis, exceeding the frequency in the general population. Given the above, patients with atopic dermatitis, especially those with persistent, torpid course, need to be screened for celiac disease, and if it is confrmed, they additionally need to be consulted by a nutritionist.

Inherited epidermolysis bullosa is distinguished by a wide range of clinical manifestations: from single blisters and erosions, mainly with acral localization, which insignifcantly affect the quality and life expectancy of patients with a mild course of the disease, to severe disabling forms with a high mortality rate from multifactorial malnutrition, septicemia in early age and high risk of developing squamous cell carcinoma of the skin in adult patients. According to research studies, in children suffering from chronic diseases, there is often a delay of puberty. To date, there are no reliable data on the incidence of delayed puberty in children with inherited epidermolysis bullosa, which is of interest for further research in order to more individualized approach to treatment and improve the quality of life of patients.

Basal cell skin cancer most often requires differential diagnosis in patients with neoplastic skin lesions, both pigmented and non-pigmented. The cytological examination is simple to perform and is widely used for the initial examination of patients with skin tumors, both non-pigmented and pigmented. This article discusses in detail the history of the use of cytological examination, technique, diagnostic criteria for basal cell skin cancer. Particular attention is paid to the objective diffculties in the application of the method, the rather high specifcity of cytological examination in the diagnosis of basal cell skin cancer is illustrated.

Candidiasis is a mycosis of the skin and mucous membranes caused by a conditionally pathogenic fungus, and the lesion of skin folds is one of the most widespread forms of this mycosis. A feature of the course of the skin process in this form, in the absence of adequate therapy and the presence of exogenous or endogenous predisposing factors, is the inevitable addition of secondary bacterial infection and the development of pyoderma. The article presents a clinical case of candidiasis of large folds complicated by secondary pyoderma, discusses the principles of external and systemic therapy of two related diseases.

The use of dermal fllers based on calcium hydroxyapatite has become widespread among cosmetologists. These fllers are considered highly effective in the fght against age-related skin changes, have a high safety profle and are not prone to cause an autoimmune response of the body. Due to specifcs of the fller, calcium hydroxyapatite provides both restoration of soft tissue volume loss and stimulation of neocollagenesis. Having a long experience of use, the fller has frmly taken its place in aesthetic medicine and is successfully used by many doctors around the world. However, with the increase in the use of fllers, the number of side effects also increases. Currently, there are no clear guidelines for the treatment of complications of injection by calcium hydroxyapatite, unlike fllers based on hyaluronic acid. Despite the low risk of developing serious complications as a result of unintentional vascular occlusion, a number of doctors are afraid to use calcium hydroxyapatite preparations due to lack of knowledge on its elimination. This article describes the basic principles of therapy for occlusive syndrome and can help doctors to take effective and timely therapeutic measures to correct it.

The article deals epidemiology, pathomorphological picture, trigger factors of development, peculiarities of treatment with the use of botulinum therapy for rosacea. A clinical case is presented.

Purpose of the article. Consider the pathogenesis of rosacea, investigate the molecular mechanism by which botulinum toxin improves the condition in rosacea.

Material and methods. The article presents clinical examples of botulinum therapy in the treatment of patients with rosacea. The epidemiology, pathomorphological picture, developmental trigger factors, diagnostic features and approaches to the treatment of rosacea in modern conditions are considered.

Results. Case study results show that intradermal botulinum toxin injections are safe and effective in reducing erythema and flushing in rosacea.

Conclusions. Botulinum therapy – may be an alternative therapy for patients with refractory to standard treatment of persistent erythema. The effect after botulinum therapy lasts for 2–4 months. Further research is needed on the effcacy and safety of this technique in patients with different subtypes of rosacea, including those with a combination of subtypes.

A clinical observation of the dermal integration of low-concentration products based on hyaluronic acid produced by KPM and IPN-Like technologies is presented. KPM technology is a method of obtaining a cohesive poly-compacted gel matrix of hyaluronic acid, which determines the peculiarity of distribution in the skin due to particles of different densities in one product. On the one hand, the drug remains at the injection site after injection due to dense particles, on the other hand, translocation of loose particles into a more modifed part of the dermis. The clinical effect is manifested in the form of full integration of the drug into the dermis, imitating natural volumes. IPN-Like technology involves the preparation of a hyaluronic acid preparation from two monophase chains with low and high elasticity. Interpenetrating stabilized chains are obtained under pressure. Partial independence of IPN structures is necessary for the predicted integration and distribution of the drug in tissues, whereas the increased density of cross-linking nodes strengthens the intensity of the chemical bond, strengthens the fxation of the drug at the injection site. The study was conducted on seven patients using ultrasound scanning before the procedure, during the procedure to control the introduction into the required layer, 15 minutes after the procedure and 2 months later. To objectify the data, skin proflometry was used and photodocumentation in the designated time frame. In the presented clinical case, when comparing the distribution of fllers based on hyaluronic acid, it was revealed that all drugs are well distributed in the surface layers of the dermis, which makes it possible to safely inject drugs created using IPN-Like technology in the same techniques and to the same depth as the drug with CPM technology. According to ultrasound of the skin, drugs produced by IPN-Like technology showed greater effectiveness in terms of dermis thickness after 2 months.

The use of lasers in medical cosmetology today is widespread. The effects of laser techniques are pronounced and persistent. It is known that skin microcirculation increases after the procedures, renewal of keratinocytes and fbroblasts is stimulated, but there is little information about the molecular basis of the action of ablative lasers, about the mechanisms underlying the formation of new tissues (various types of collagens, laminin, vessels of the microvasculature).

Purpose of the study. Formation of a detailed understanding of the mechanisms underlying the regenerative processes of the skin after ablative laser exposure.

Results. After ablative laser exposure, the amount of interleukin-1α signifcantly increases, which leads to stimulation of the formation of type I and III collagens, laminin. There is an increase in vascular, fbroblast growth factor, which also helps to stimulate the proliferation of fbroblasts, increase its blood supply.

Conclusions. Based on the data obtained, it can be concluded that fractional photothermolysis improves the elastic properties of the skin, enhances skin trophism and activates the metabolism of the skin. The prolongation of the effects of a single procedure is due to the activation and stimulation of the skin’s own regenerative resources, which contributes to an increase in its own fbroblasts, collagens, vessels of the microvasculature, cells of the epidermis and dermis.