For the past years, there have been lots of minimal invasive methods developed regarding to the anti-aging therapy, and, according to practical experience, many of them can be safely and effectively combined. Complex approaches in patients’ treatment allow to achieve the most optimal results. In this work we described issues of effective combinations of thread implantology and injection technologies, safety of these combinations, performance efficacy and algorithms for the case management.

Hypomelanosis is an idiopathic guttate process with the appearance of small struts of hypopigmented, rounded patches on the skin. Despite the high caution of diseases among the population, this dermatosis, as a rule, remains unrecognized throughout life, and it is also difficult to consider this moment of therapy, remaining a cosmetic defect throughout life. This article provides information on the epidemiology, pathogenesis, manifestations, differential diagnosis and therapy of idiopathic guttate hypomelanosis.

In recent years, issues of the complex use of phototherapy methods and drugs in the treatment of patients with rosacea and acne have been actively developed and studied. Due to the wide range of therapeutic effects, IPL therapy has theoretical prerequisites for use in these diseases. However, many issues of efficacy and safety of the combined use of topical drugs and broadband pulsed light remain open and require further study. The article presents data on the effectiveness of combined methods. The study included 45 patients diagnosed with rosacea with a combination of erythematous-telangiectatic subtype and papulo-pustular subtype. All patients received the following therapy: Mirvaso® Derm – one time per day in the morning, Solantra® – 1 time per day at night, specialized Cetaphil® dermatocosmetics. All patients underwent IPL-therapy one time in 3 weeks, the average course was 4–6 procedures. In accordance with the dynamics of Dermatological Index Scale of Symptoms (DISS), 37 (82.2 %) patients managed to fully control the process, 8 (17.8 %) showed significant improvement. It should be noted that not a single patient interrupted treatment, which indicates the high safety of the complex method of therapy. Also under observation were 19 patients with papulopustular acne of moderate severity, who were prescribed complex therapy: A fixed combination of BPO + adapalene (Effezel®) – one time per day in the evening, specialized Cetaphil® dermatocosmetics on an ongoing basis and IPL therapy a time per day for a four week period, the course consisted of four procedures. The dynamics of the total APSEA score was 74.6 %. Thus, all patients noted the high efficiency of the complex method, which was confirmed by a pronounced positive effect on the quality of life. These own data confirm the feasibility of an integrated approach in the treatment of patients with both rosacea and acne.

Therapy of patients with hypertrophic scars is a rather difficult task, and the amount of treatment methods directly depends on the duration of the existence of the scar, its size and localization. There were 34 patients under observation (mean age 37.4 ± 4.2 years) with hypertrophic scars (the average duration of the scar was 6.7 ± 2.3 months), who were prescribed two procedures of pneumokinetic therapy with glucocorticosteroid and 5-fluorouracil with at intervals of 2 months, a month later, laser therapy was performed using a neodymium laser. in patients with hypertrophic scars after the use of a combined physiotherapy technique, there were significant changes in the parameters of ultrasound scanning: An increase in the thickness of the epidermis by 1.5 times (with the restoration of the architectonics of the epidermal layer), a decrease in the thickness of the dermis by 2.1 times. The acoustic density of the dermis increased by 2.5 times.

Xerosis is one of the most common dermatological side effects of anticancer drug therapy. The present observational study included 34 patients, among them 19 women, 15 men, mean age was 37.9 ± 3.5 years. All patients had skin xerosis, as well as various class-specific skin toxic reactions for drugs from the EGFR group (acne-like rash, paronychia, and others). With regard to skin toxic reactions, a thorough assessment of the severity was carried out and adequate therapy was prescribed in accordance with Russian clinical guidelines. In order to stop xerosis, all patients were recommended Lipikar Baume AP+М, Lipikar Syndet AP+, Cicaplast Baume B 5, Anthelios Invisible Fluid on an ongoing basis. As a result of observation (8 weeks), all patients noted the excellent organoleptic properties of La Roche-Posay products and the comfort of their use. All patients managed to control xerosis and other skin toxic reactions), none of the patients required dose reduction or withdrawal of anticancer therapy.

The aim of the study was to study the efficacy and tolerability of the sequential use of the fixed combination of clindamycin + BPO in various clinical situations in real practice. Under our supervision there were 32 patients with mild-to-moderate and severe acne of papulo-pustular acne. Among them, 21 (65.6 %) female patients and 11 (34.4 %) male patients. The patients were divided into two groups: group 1 (teenage acne) of 17 people, group 2 (adult acne) of 15 people. The therapy algorithm included the use of a fixed combination of clindamycin + BPO (Zerkalin Intensive) for 4–5 weeks with a sequential transition to the use of a topical agent with adapalene for 6 months. All patients were prescribed specialized dermatocosmetics on an ongoing basis. As a result of therapy, after a week, there was a significantly significant change in all clinical symptoms of acne. So VAS (comedones) at the end of therapy decreased by 88.9 % (p < 0.01) and by 90.5 % (p < 0.01) in groups 1 and 2, respectively. Similar dynamics was noted in relation to inflammatory elements (papules, pustules). VAS (papules) in groups 1 and 2 decreased by 85.4 % (p < 0.01) and by 88.1 % (p < 0.01), VAS (pustules) – by 100 %. Thus, the use of a fixed combination of clindamycin + BPO causes a high therapeutic effect in relation to all clinical symptoms of acne.

Objective. To evaluate the effectiveness of upadacitinib for improving the quality of life and correcting psycho-emotional disorders in patients with eczema.

Material and methods. The study included 64 patients with eczema (mean age 58.5 ± 3.4 years, men – 43, women – 21), randomized into two groups. Patients of group 1 (n = 33) received basic drug therapy (BDT), group 2 (n = 31) – in addition to BDT, the Janus kinase 1 inhibitor upadacitinib (UPA) 15 mg per day for 2 months. The values of the patients' dermatological symptom scale index (DISS), Dermatology Life Quality Index (DLQI), anxiety, depression, functional state of patients on the WAM (wellbeing, activity, mood) scale were evaluated in dynamics after 2 months after the start of treatment.

Results. In the BDT group, the value of DISS in patients after 2 months from the start of treatment decreased by 1.33 times, while in the UPA + BMT group it decreased by 2.17 times. In the BDT group, the DLQI index decreased by 1.26 times, while in the UPA + BDT group – by 1.66 times. The level of anxiety in patients in the BDT group decreased by 1.34 times, in the UPA + BDT group – by 1.64 times. The level of depression in the BDT group decreased by 1.22 times, in the UPA + BDT group – by 1.67 times. Indicators of the functional state of the WAN scale in patients with BMT increased only by 1.06, 1.03, 1.05 times, and in the UPA + BMT group, respectively, 1.4, 1.5, 1.6 times.

Conclusions. BDT, while improving the clinical status of patients, at the same time has an insufficient corrective effect on the severity of anxiety, depression, WAM indicators and a reduced quality of life. Additional appointment of upadacitinib to patients was accompanied by a more pronounced positive effect on the levels of anxiety, depression, indicators of the functional state of patients, which contributed to an improvement in the quality of life compared to the results of BDT.

Clinical methods for assessing the severity of the condition in epidermolysis bullosa are the most accessible means at the first stage of diagnosis, help to establish a clinical diagnosis, substantiate the need of consultations of specialists, and optimize the subsequent routing of the patient. In addition, the availability of tools helps to validate data, consistently assess the severity of the disease and record the therapeutic response in randomized trials of new pathogenetic treatments.

Facial skin lesions in psoriasis, one of the most common dermatoses, are traditionally considered a relatively rare manifestation of the disease, especially in adult patients, but according to modern data, it is observed in at least 40 % of patients. It is believed that facial skin lesions are more typical for young patients with severe widespread skin lesions, involvement of the nail plates and a protracted course. Localization of rashes on the skin of the face – in a cosmetically and socially significant area – is accompanied by significant impairments in the quality of life of patients. The treatment of facial psoriasis is difficult, and few algorithms have been developed for the management of patients with facial psoriatic lesions. We present a patient with psoriasis involving facial skin that first developed after discontinuation of systemic therapy with an IL-17A inhibitor (ixekizumab). During the follow-up of the patient, it became necessary to re-administer systemic biological therapy with the potential risk of an escape effect. In the article, we discuss the clinical manifestations of facial psoriasis and the impact on the quality of life of patients. A description of the observation of a patient with lesions of the facial skin in severe plaque psoriasis and the role of biological therapy in this direction is presented.

Material and methods. The article presents the data of a histological study of biopsy material at the site of implantation of the thread, thread and the use of the IPL system on days 14th, 35th. Paraffin sections 5–7 μm thick were made from ready-made paraffin blocks and stained according to the Weigert – Van Gieson method. Using a microscope with a Sony digital photo attachment, 12-megapixel resolution, five photographs were obtained from each histological preparation. Microphotographs using the ImageView, Image Tool 2.00 (GistMorph) programs were used to evaluate the inflammatory response, evaluate the cellular composition, evaluate collagen and elastic fibers, and identify the percentage of collagen type.

Research results. In the biopsy specimen from the site of the implanted thread and IPL technology (Palomar, nozzle 1540, parameters 15, 60, three passes each), when examining histological slides stained according to the Weigert – Van Gieson method, the presence of elastic fibers was revealed, both in the thickness of the dermis and in connective tissue layers of subcutaneous fat. The relative area of elastic fibers in the dermis averaged 13.28 % (min 8.50 %, max 15.50 %). The relative area of elastic fibers in the subcutaneous adipose tissue averaged 2.28 % (min 1.30 %, max 4.80 %). In the biopsy specimen from the site of the implanted thread, the study of histological slides stained according to the Weigert – Van Gieson method revealed the presence of elastic fibers, both in the thickness of the dermis and in the connective tissue layers of the subcutaneous fat. The relative area of elastic fibers in the dermis averaged 13.16 (min 9.70 %, max 15.00 %). The relative area of elastic fibers in the subcutaneous adipose tissue averaged 14.98 % (min 12.20 %, max 16.70 %).

Conclusions. Thus, the study of samples revealed the predominance of type I collagen both in the skin and subcutaneous fat, however, it was less pronounced than with the combined method (implanted thread and IPL technology).

Atrophic post-acne scars are severe manifestations of the post-acne symptom complex, which occur as a result of inflammation due to the loss of collagen fibers and subcutaneous fat during the healing of inflammatory acne elements. The incidence of post-acne scars has been little studied, but according to some authors, about 90 % of patients with severe and moderate acne suffer from them. The aim of the study was to study the effect of the combined use of IPL- and PRP-therapy, fractional microneedle radiofrequency therapy and PRP-therapy, as well as microneedling of autologous plasma with cells on the clinical symptoms of atrophic skin scars, taking into account the duration of the pathological process, based on the dynamics of the indicators of the Manchester Assessment Scale of Scar Deformations. Complex methods showed higher efficiency than the use of hardware techniques in relation to all clinical signs of atrophic scars.

Genitourinary syndrome of menopause (GSM) is a set of symptoms of atrophy, the main cause of which are evolutive changes in the vulvovaginal and urethral regions. GSM is a common condition affecting up to 90 % of menopausal women. The main symptoms encountered in this syndrome include: dryness of the vulvovaginal area (more than 90 %), dyspareunia (78 %), itching (57 %) and burning (57 %). These symptoms, according to various questionnaires, strongly affect the quality of women’s life, as well as their sexual life. A review of GSM therapy with plasma therapy (PRP) and injection with hyaluronic acid was performed. The clinical observation and the process of managing patients with manifestations of GSM are described in detail. An analysis of the effectiveness and safety of injection techniques in GSM is considered.

This article provides an overview of contemporary views on the conservative treatment of patients with chronic rhinosinusitis with nasal polyps, based on etiology and pathogenesis of the disease. The review includes data from foreign and domestic researchers, which allow us to assess trends in modern approaches to the treatment of chronic rhinosinusitis with nasal polyps. Particular attention is paid to the mechanism of type 2 inflammation, which is predominant in the pathogenesis of chronic rhinosinusitis with polyps in the Caucasian population. Also, biological therapy that affect different links in the pathogenesis of CRSwNP are considered.

Topical retinoids are the first line treatment for mild to moderate acne. Although the drugs of this group are very effective in the treatment of acne, their use often causes irritant dermatitis – xerosis, peeling and other unpleasant symptoms. These adverse events reduce adherence to the therapy and, consequently, the effectiveness of the treatment. However, as shown by foreign clinical experience and our own observations, the use of moisturizers in combination with topical retinoid therapy can reduce the risk of irritant dermatitis. Preference should be given to moisturizers, whose components not only maintain a high level of skin hydration, but also can enhance the effect of the main drug.

Today, the development and implementation of modern physiotherapeutic treatment options, including those safe for home use by patients, is promising.

Purpose of the study. Studying the safety and effectiveness of transcranial magnetotherapy with mild and moderate severity of atopic dermatitis.

Material and methods. The study was attended by 104 patients, aged 5 to 16 years, with a prescription of the disease from 2 months to 16 years. Patients were divided into groups: the 1st group received standard therapy, in the 2nd group they combined standard therapy and placebo in physiotherapeutic treatment, patients of the 3rd groups used transcranial therapy in monotherapy, participants of the 4th group were on combined therapy – transcranial magnetotherapy and standard.

Results. According to the study, the effectiveness of transcranial magnetotherapy is based on a positive effect on the state of the central nervous system and its autonomic department, which is accompanied by the relief of clinical symptoms, itching and helps to improve psychoemotional status.

Conclusions. The use of transcranial magnetotherapy in a complex with standard therapy helps to relieve clinical symptoms of atopic dermatitis and the quality of life of patients.