Introduction. Treatment of fungal infection of nail plates is associated with a number of difficulties, such as high expectations, low patient compliance to long-term therapy, irrational selection of antifungal drugs and, as a consequence, the development of resistance. Currently, there are many hardware methods of treating onychomycosis, which can significantly accelerate recovery and increase the effectiveness of therapy.
Discussion. The article describes such methods of physiotherapeutic treatment of fungal nail infection as laser technology, low-temperature plasma, photodynamic therapy, iontophoresis, ultrasound, ultratonotherapy. Some of them contribute directly to the elimination of the mycotic agent from the affected tissues; others allow improving the process of introducing antifungal drugs into the thickness of the nail plate and nail bed. Laser technologies make it possible to combine these pathogenetically significant mechanisms of influence on the disease, which considerably expands the possibility of their use.
Conclusions. At the present, despite the wide variety of methods and treatment regimens for onychomycosis, hardware techniques are a promising field for further research. Based on the analysis of domestic and foreign literature, there is no method, which we can use as monotherapy. However, a combination of drug therapy and hardware methods of treatment can give successful results both in terms of therapeutic efficacy and in terms of anti-relapse expectations. It is necessary to develop precise protocols for the use of physiotherapeutic techniques in order to increase the effectiveness of the management of patients suffering from fungal infection of the nail plates.

Acne vulgaris is a chronic inflammatory disease that not only reduces the quality of life of patients, but also leaves persistent consequences in the form of scars and hyperpigmentation. Early and effective acne treatment is the main method of prevention in scar formation. Today, both topical and systemic medications are used in the treatment of acne, but the development of resistance to antibacterial drugs, the presence of contraindications to drugs, low compliance or ineffectiveness of therapy are pushing for the search for combined treatments. Even though little attention is paid to physiotherapeutic methods in domestic and foreign recommendations, these methods as part of combination therapy reduce the duration of acne treatment, help reduce the severity of cicatricial changes, and ultimately lead to more satisfactory cosmetic results. This article discusses the efficacy and safety of the most popular physiotherapy methods such as laser therapy, light therapy and chemical peels in the treatment of acne.

Introduction. The drug netakimab belongs to the group of IL-17A blockers and has shown high efficacy against all clinical symptoms of psoriasis vulgaris according to clinical trials and real clinical practice. At the same time, data on the effectiveness of netakimab in inverse psoriasis, psoriasis of ‘difficult’ localizations are of a single nature, while these phenotypes, as a rule, proceed torpidly and constantly recur, which makes it possible to attribute them to severe forms and to consider the appointment of genetically engineered drugs in the first line of systemic treatment.
Material and methods. The study included 68 patients with various localizations of psoriasis vulgaris (scalp, palms and soles), psoriatic onychodystrophy and inverse psoriasis. Psoriasis vulgaris with lesions of the scalp was observed in 28 (41.2%) patients, with lesions of the palms and soles – in 24 (35.3%). Inverse psoriasis was diagnosed in 37 (54.4%) patients. Psoriatic onychodystrophy was observed in 44 (64.7%) patients and was combined with both psoriasis vulgaris and inverse psoriasis. All patients were prescribed netakimab.
Results. In the group of patients with inverse psoriasis, 81.1% of patients achieved sPGA scores of 0 after 12 weeks. In 71.4% of patients with psoriasis of the scalp, in 75% of patients with palmar-plantar psoriasis, it was possible to achieve complete control over the disease sPGA 0 points. The number of patients with NAPSI less than 5 points was 70.5%.
Conclusions. The data presented in the article confirm the high efficacy of netakimab in the treatment of scalp psoriasis, palmoplantar psoriasis, with inverse forms and psoriatic onychodystrophy.

 Acne is a chronic disease of the pilosebaceous unit. Much attention is paid to the pathogenesis and optimization of acne therapy. Evidence is emerging about the role of PPARγ receptors in maintaining inflammation and increasing sebum production, as well as an indirect role in the development of pruritus, which may allow for a correlation between the severity of inflammation in acne, the prevalence of pruritus, and the influence of PPARγ receptor expression on these processes. 

A practicing physician always faces a rather difficult task when choosing a topical drug for the treatment of mycoses, while the optimal ratio of efficacy/safety and a wide spectrum of action, including against possible contamination by various pathogens, can be considered a priority factor. Sertaconazole (Zalain) is a highly active broad-spectrum antifungal drug that has fungicidal, antibacterial, anti-inflammatory and antipruritic effects.
Material and methods. On an outpatient basis, under our supervision were 25 patients aged 42 to 76 years with a verified diagnosis of foot mycosis, confirmed by microscopic and cultural methods. All patients were prescribed Zalain cream 2 times a day for 4 weeks.
Results. After therapy (4 weeks), pathogenic fungi (T. rubrum, T. mentagrophytes var. interdigitale) were not sown in 92% of patients during a cultural study. 8% of patients with no laboratory cure were recommended to continue sertaconazole therapy for 2–4 weeks until complete eradication of pathogenic fungi. Long-term results of observations (6 months) showed no recurrence of the disease in 100% of patients.
Conclusions. The high efficacy and safety of Zalain in the treatment of skin mycoses has been proven in numerous studies and confirmed by real clinical practice, which allows us to recommend it for the treatment of patients with this pathology, including in cases of secondary infection and eczematization.

 The article presents clinical cases of treatment of acute generalized pustular psoriasis (GPP) with the use of an interleukin IL-17A inhibitor, secukinumab, which showed a remarkable response with almost complete disappearance of pustules after the first injection. To the best of our knowledge, there are limited data in the literature on evaluating the effectiveness of therapy with genetically engineered drugs in the treatment of GPP. 

Relevance. Rosacea is a chronic skin syndrome that encompasses various combinations of potential signs and symptoms. Global epidemiological studies have found that 5.46% of the adult population suffers from rosacea. Combined methods (drugs and hardware methods, including lasers) in the treatment of rosacea have a high potential. Relevant is the study of the effectiveness of ivermectin and laser technologies in patients with a combination of subtypes of rosacea.
Material and methods. 36 patients with a combination of rosacea subtypes were under observation. Depending on the therapy, the patients were divided into two groups: group 1 (18 patients) – patients received neodymium laser procedures and topical therapy with ivermectin, group 2 (16 patients) – topical therapy using ivermectin. Efficiency was assessed using visioscanning, taking into account the dermatological index GSS (Global Severity Score), the dermatological index of the scale of symptoms (DISHS).
Research results. According to the total index of DISH after 2 months, the highest efficiency in stopping both inflammation and the vascular component was observed in group 1 (75.2%), somewhat lower – in group 2 (49.5%). month, the total DISH index in group 1 decreased by 85.1%, while in group 2 – by 58.5%, after 6 months the total DISH index in group 1 decreased by 91.5%, while in group 2 group – by 65.6%.
Conclusions. The combined use of neodymium laser and ivermectin is a highly effective and safe method of therapy in patients with a combination of erythematotelangiectatic and papulopustular rosacea subtypes.

One of the most common causes of perioral dermatitis (PD) is the use of glucocorticosteroids (topically, intranasally, inhaled, systemically). If PD is caused by topical corticosteroids, they must be canceled (according to the authors, without using a sparing reduction technique: a decrease in the frequency of application of corticosteroids and the strength of corticosteroid activity). With a pronounced withdrawal syndrome, it is advisable to start treatment with ‘zero’ therapy: either a complete rejection of the use of external agents, or a lotion with chamomile (5–10 minutes 2 times a day) followed by the use of dermatolichthyol paste (exposure in increasing from 10 minutes to 40 minutes) for 7–10 days, as well as irrigation with hypochlorite thermal water (5–6 times a day). With mild severity of oral dermatitis, monotopic therapy may be prescribed, including cream with activated zinc pyrithione and calcineurin inhibitors. The duration of therapy is determined individually and averages 1.0–1.5 months. In moderate to severe cases, topical therapy should be supplemented with systemic drugs: tetracycline antibiotics (7–10 days) or low-dose isotretinoin (2–4 months). The duration of therapy is determined individually and averages 2 months.

Patients with congenital epidermolysis bullosa (CEB) are at increased risk of developing skin infections. In this category of patients, infection with the varicella zoster virus (VZV) can lead to such complications.
Purpose of the study. To assess the severity of Varicella (VA) and the immune status of patients with CEB who had a history of VA. To study the efficacy and safety of the varicella vaccine in patients with CEB.
Methods. During the study, two groups were formed: children with CEB who had a history of VO (group 1), children who received one dose of vaccine against VO (group 2). The severity of chickenpox in children from group 1 was assessed based on the survey data. The immune status of participants in groups 1 and 2 was determined by the level of serum IgG antibodies to VZV by enzyme immunoassay. The safety of immunization against varicella in children with CEB was assessed by the number of adverse events in the post-vaccination period.
Results. The study included 16 children with CEB who had a history of chickenpox and 30 children with CEB who were vaccinated against chickenpox. According to the survey, in group 1 5 (31.25%) people had mild chickenpox, 8 (50.00%) children had moderate severity, and 3 (18.75%) children had a severe course of the disease. According to the results of laboratory data, in 15 (94.00%) children, a sufficient level of protective antibodies was formed after the disease. Thirty patients were immunized with the first dose of varicella vaccine. The vast majority of patients developed a level of protective antibodies to the varicella-zoster virus. All patients did not have serious adverse events and worsening of the underlying disease in the post-vaccination period.
Conclusion. The data obtained indicate a good safety profile and efficacy of the first dose of the varicella vaccine and allow us to proceed with further observations after the completion of the course of immunization of children with CEB against this infection.

Purpose of the study. Assess the state of sexual development in children with CEB.
Methods and materials. The study included 50 children aged 8.11 to 17.80 years with CEB who were treated at the National Medical Research Centre for Children’s Health (Moscow, Russia) from December 2020 to April 2022. Anthropometric parameters, the stage of sexual development on the Tanner scale, bone age, the level of pituitary (FSH, LH) and sex (estradiol, testosterone) hormones, additional hormonal parameters (cortisol, DHEA-sulfate, 17OHP, ACTH, prolactin, TSH, T3, T4, insulin), ultrasound of the pelvic organs for girls and ultrasound of the scrotum organs in boys, the results of a psychological and pedagogical examination (questionnaire according to S. Bem, ‘drawing of a person’ by K. Machover, D. Wechsler’s test) were assessed in all patients. The data are presented using median (Me), quartiles of 25 and 75% [Q25; Q75] and standard error (SE). Due to the small number of observations, nonparametric statistical criteria were used to assess the significance of the differences in the obtained indicators.
Results. According to the results of the study, a statistically significant relationship was established between the occurrence of deviations in sexual development in children with CEB and the clinical form of the disease (p < 0,001). The severity of clinical manifestations of CEB according to the EBDASI scale was significantly higher in children in the group with deviations in sexual development (p = 0,000) compared with the group of children with normal sexual development. Anthropometric indicators of BAZ and HAZ in the group of children with deviations in sexual development were statistically significantly reduced (p = 0.000, p = 0.000, respectively) compared with children with normal sexual development, which means a significantly higher incidence of malnutrition in this cohort of patients. Basal levels of FSH and LH (p = 0,000, p = 0,001, respectively), estradiol and testosterone (p = 0,002, p = 0,000, respectively) were significantly lower in children with abnormalities in sexual development compared with children with normal sexual development. A statistically significant relationship was revealed in the studied groups with the stage of sexual development according to Tanner scale (p = 0,032). Among all patients with CEB (n = 50), delay puberty was diagnosed in 7 patients (14%), while all patients suffered from RDEB and had low basal LH levels, reduced estradiol and testosterone values, which allowed them to be diagnosed with hypogonadotropic hypogonadism (HH).
Conclusions. In patients with CEB with the most severe degree of clinical manifestations, accompanied by decompensated malnutrition of multifactorial genesis, there are deviations in sexual development and upon reaching the age of 13 years, girls and boys develop transient (symptomatic).

Severe chickenpox (CP) may occur in immunocompromised patients. The most common complication of chickenpox is bacterial superinfection. In children with congenital epidermolysis bullosa (CEB), infection with Varicella-zoster virus (VZV) increases the risk of skin infectious complications, and also aggravates the course of the underlying disease.
Purpose of the study. To study the safety and efficacy of varicella vaccination in patients with CEB. Based on the data obtained, develop clinical guidelines for immunization of this category of patients against the VZV.
Methods. A group of children was formed with an established diagnosis of CEB and who had previously received the first dose of the varicella vaccine. During the study, immunization with a second dose of vaccine against CP was carried out. Tolerability of vaccination was assessed by the number of adverse events in the post-vaccination period. The assessment of the immune response of the participants was determined by the level of serum IgG antibodies to VZV by enzyme immunoassay.
Results. The study included 23 children with CEB who were immunized with a second dose of varicella vaccine. In all patients, after the introduction of the vaccine, there were no serious post-vaccination reactions and worsening of the underlying disease in the post-vaccination period. In 22 (96%) study participants, IgG to VZV was detected, indicating seroconversion.
Conclusions. The results of the work showed a good safety and efficacy profile of the vaccine, which makes it possible to develop recommendations for vaccinating children with CEB against the VZV.

The procedures of most medical cosmetic manipulations are accompanied by a violation of the integrity of the skin, which primarily increases the risk of infectious complications. Among other risk factors influencing the development of such complications, one can single out the action of the active components of the drugs, violation of the technology for performing procedures. Reactivation of herpes virus infection is one of the complications of minimally invasive cosmetic procedures (laser ablation, injection techniques, microneedling, peeling). Quite a lot of cosmetologists underestimate the increased risks of complications of cosmetic procedures, in particular the reactivation of a herpes infection, and are not aware of the need for preventive courses of antiherpetic therapy, including short-term (episodic) and long-term regimens of suppressive treatment with antiviral drugs. The best strategy for managing herpes virus infection in the context of cosmetic procedures with a potential risk of virus reactivation is prevention. Preventive measures should include a thorough history taking followed by an analysis of the risks of exacerbation of herpes virus infection and the selection of personalized suppressive therapy. In this regard, valaciclovir (Valcicon) is the most reasonable choice and can be recommended for use in wide clinical practice for suppressive short-term and long-term therapy. Therapy for exacerbations of herpes viral infection should include a 2-component scheme for the use of an antiviral systemic drug (valaciclovir) and an external drug (ribavirin).

In accordance with clinical recommendations for acne of any severity, gentle cleansing and moisturizing is recommended using specialized dermatocosmetics that restore the barrier properties of the skin, have an anti-inflammatory effect and do not contain skin-irritating components, as well as comedogenic substances. Gentle skin care should also accompany any topical and systemic acne drug therapy. At the same time, over-the-counter (OTC) skin care products, such as non-comedogenic cleansers and moisturizers, have been successful in both the monotherapy of mild acne and as maintenance therapy. The range of Normaderm dermatocosmetics (Vichy Laboratoires) is specially designed to meet the needs of oily acne prone skin. The composition of Normaderm products includes various active substances that allow solving certain problems with acne by influencing various links in the pathogenesis of the disease. In this article, we provide clinical examples of the use of specialized Vichy Normaderm cosmetics in patients with acne in various clinical situations.

The study is devoted to the study of the content of collagen types I and III, laminin in the epidermis and dermis, insulin-like and vascular growth factors in the skin of women with a preserved menstrual cycle and women in menopause. A study was also made of the content of the same indicators after cosmetic procedures aimed at improving the quality of the skin. The degree of effectiveness of cosmetic procedures for skin regeneration was determined depending on the presence or absence of menopause.

Acquired vascular changes on the skin most often do not cause physical discomfort to a person, but make a significant deterioration in the psycho-emotional state of a person, being a noticeable aesthetic disadvantage. The use of a microsecond neodymium laser Nd:YAG to remove vascular neoplasms of the skin makes it possible to have a sclerosing and damaging effect on the vascular neoplasm, but not to have a pronounced effect on the surrounding tissues.

Postacne is one of the leading problems in aesthetic medicine. Often, the presence of postacne elements is combined with ongoing acne, which together creates conditions for social maladaptation, a decrease in self-esteem, and the patient’s desire for social isolation. Currently, the issue of postacne correction remains open and not fully resolved. The difficulties of correction, in particular atrophic postacne scars, lie in the depletion of the skin after a long inflammatory process and a decrease in skin resources that ensure full regeneration. The thickness of the dermis of the skin of the face and the depth of the postacne scars create a pronounced optical defect, which often demonstrates resistance to correction by fractional laser radiation, chemical and laser peels. In this article, microneedling is considered as one of the options for correcting atrophic scars post-acne, by stimulating the synthesis of collagen in the atrophic scar, hanging the regenerative abilities of the skin, the formation of organotypic healing, and so accelerating the resorption of postinflammatory stagnant spots. Also, the use of microneedling contributes to the resolution of inflammatory elements and the prolongation of acne remission.

Keratolysis pitted (KP) is a poorly studied infectious disease of the skin of the feet, often occurring without subjective sensations. One of the features of the disease is that nine genera of bacteria can cause similar symptoms on the soles. Many dermatologists and general practitioners consider this disease to be mycosis, and prescribe the wrong treatment to the patient for many months. At the same time, against the background of KP, conditions are created for the occurrence of sensitization and the development of microbial eczema.

The defeat of the genitals in scleroatrophic lichen is often accompanied by the involvement of the urethra in the process, which threatens serious complications and, first of all, the development of stricture. Therapy of such cases is difficult and ineffective in the case of topical corticosteroids. The article describes the positive experience of using acitretin at a dose of 25 mg per day for the treatment of scleroatrophic lichen, which occurs with damage to the external orifice and anterior segment of the urethra.

 The assessment of the activities of medical workers is one of the most difficult in the doctrine of criminal law due to the specifics of medical activity, especially in relation to circumstances excluding the criminal liability of medical workers.