This article describes the structure of morbidity in the vulvar area in women 45–72 years old, and analyzes the frequency of discrepancies in diagnoses among dermatovenerologists and gynecologists. It has been established that nonspecific vulvitis / vulvovaginitis (23%), lichen sclerosus (20%), genitourinary menopausal syndrome (20%), contact dermatitis (12%), lichen planus (7%), atopic dermatitis (6%), vulvar itching (5%), psoriasis (2%) predominate in the structure of vulvar pathology in women.

Localized scleroderma (LoS) is an autoimmune connective tissue disease with a variety of clinical manifestations. The dermatologist faces the difficulties of establishing a diagnosis and choosing the most appropriate therapy due to the relatively rare prevalence. This review article explores the challenges of classification, diagnosis, and treatment, as well as the factors that contribute to their occurrence. The greatest difficulties in diagnosing LoS that affected the prognosis and progression of the illness are: a delay in diagnosis, including early detection; omission of the active stage of LoS; difficulties in differential diagnosis; lack of association with Lyme borreliosis; low diagnostic value of laboratory and histological tests; limited use of sensitive instrumental methods for diagnosis; and monitoring the activity of LoS in a doctor’s practice. The main difficulties in treatment are the delay in starting treatment; the use of therapy methods with low evidence-based effectiveness; the rare prescription of highly effective approaches; the insufficient effectiveness of systemic drugs and phototherapy; difficulties in determining the volume, timing, and regimen of therapy for each subtype of LoS; the difficulty of achieving a remission; dependence of treatment approach on the doctor’s specialization; the lack of targeted drugs with evidence-based effectiveness in LoS; the lack of high-level evidence-based effectiveness and safety of therapy in LoS; difficulties in the correction of complications of Lo S.

Onychomycosis is an infectious disease of the nail apparatus, caused by pathogenic fungi, manifested in the form of changes in color, configuration of the nail plate, as well as inflammatory processes in the soft tissues adjacent to the nail. Classic therapy in the form of systemic antimycotics is not suitable for everyone (for example, elderly patients with severe liver disorders or concomitant chronic diseases); itraconazole and terbinafine are not combined with a large number of drugs. Therefore, the use of auxiliary non-drug treatment methods becomes extremely important. This article discusses the method of podological treatment of nail plates, proving its effectiveness and safety.

Currently, the microbial community of the skin is considered as a dynamic functional system that develops synergistically with the body in general and the skin in particular, participates in the regulation and implementation of its functions, contributes to skin aging and the pathogenesis of chronic inflammatory dermatoses. Understanding the contribution of skin dysbiosis to skin aging and the pathogenesis of chronic dermatoses has provided the basis for the development of strategies aimed at correcting the skin microbiota, or bacteriotherapy. The latter includes the use of allogeneic or autologous living bacteria, as well as inactivated microorganisms, components of their cell wall, signaling molecules and metabolites. The latter are included in products for external use, including dermatocosmetics. Among the bacteria that are considered as potential sources of active ingredients for cosmetics, lactic acid bacteria deserve special attention. Not only are they members of the normal microbiota of the skin and gastrointestinal tract and produce antimicrobial compounds such as organic acids and bacteriocins, but they are also widely used as probiotics. The article discusses the importance of the skin microbiota for the implementation of its functions normally, including in the age aspect, as well as the prospects for using methods of bacteriotherapy with products for external use containing inactivated Lactobacillus, Lactococcus, Bifidobacterium and the prebiotics inulin and trehalose, using the example of atopic dermatitis and age-related skin changes.

Psoriasis is a chronic immune-mediated systemic disease that is closely associated with comorbid depression and anxiety disorders. Today, a new direction of therapy is represented by biological therapy. One of the effective and safe drugs is the IL‑23 inhibitor guselkumab.

Purpose of the study. To study the effectiveness of therapy with the interleukin‑23 inhibitor (guselkumab) and the dynamics of indicators of symptoms of anxiety and depression in patients with moderate and severe psoriasis.

Material and methods. A retrospective study of 25 patients diagnosed with widespread vulgar psoriasis was conducted. Initial indicators were assessed using the PASI, BSA, sPGA, DLQI, and VAS (itching scale) indices. Anxiety and depression scores were assessed using the HADS and GAD‑7 scales. All patients received treatment with guselkumab according to the standard regimen. The effectiveness of therapy was assessed by the dynamics of PASI, BSA, sPGA, DLQI, VAS, HADS, GAD‑7 indicators after 12 weeks of therapy with the interleukin‑23 inhibitor (guselkumab).

Results. Biological therapy with guselkumab resulted in significant reductions in all parameters at 12 weeks for each patient (p < 0.0001). Only improvement in PASI was significantly correlated with lower depression and anxiety scores (p < 0.0050), whereas decrease in DLQI was not (p > 0.9550).

Conclusions. Biological therapy with the interleukin‑23 inhibitor guselkumab is highly effective in both reducing disease severity and alleviating symptoms of depression and anxiety in psoriasis.

Introduction. Acne is a common chronic inflammatory disease, which is accompanied by severe social stress and reduces the quality of life of patients. Isotretinoin is the gold standard for the treatment of severe and moderate forms of acne, and is also used when there is a risk of developing a post-acne symptom complex and when previous treatment methods are ineffective.

Purpose of the study. To determine the effectiveness and safety of various isotretinoin regimens at a dose of 0.4–0.8 mg/kg in patients with moderate to severe acne vulgaris and in patients with adult acne.

Materials and methods. A single-center, prospective, parallel, controlled study involved 139 patients with acne vulgaris and adult acne, who were divided into 3 groups. 72 patients with acne vulgaris of moderate severity according to the IGA scale (group A1) and 37 patients with adult acne (group B) received isotretinoin (Accutane) at a dose of 0.4 mg/kg/day (cumulative dose 100 mg/kg) for 8 months. 30 patients with severe forms of acne vulgaris (group A1) received Accutane at a dose of 0.8 mg/kg/day (cumulative dose 120 mg/kg) for 8 months. The study lasted 24 months. and consisted of 4 visits (1st visit, 4, 8 and 24 months), at each visit photocontrol was performed, the number of inflammatory and non-inflammatory elements was calculated, the DAI index and the degree on the IGA scale were determined.

Results. All 139 patients achieved ‘clear’ or almost ‘clear’ skin according to the IGA scale after 8 months of therapy. There was also a statistically significant decrease in non-inflammatory and inflammatory elements in all groups after 4 and 8 months. (p < 0.001). The total DIA score after 8 months was reduced in group A1 by 89.2%, in group A2 by 83.78% and in group B by 80.3%. Acne recurrence after 24 months was determined in five patients.

Conclusions. Various regimens of Accutane for moderate and severe acne vulgaris, as well as adult acne, have demonstrated high efficacy and a favorable safety profile.

Published research results indicate the high effectiveness of sertaconazole in the treatment of mycoses of the skin. According to a number of studies, it is superior to other antifungal agents in terms of cure rate and speed of action, and also has anti-inflammatory and antipruritic activity.

Material and methods. The aim of the observational study was to evaluate the effectiveness of Zalain cream (sertaconazole 2%) in patients with mycosis of the smooth skin of the groin area. We observed 21 patients (13 men and 8 women) aged from 37 to 72 years with a verified diagnosis of mycosis of smooth skin, confirmed by microscopic and cultural methods. In patients, during a cultural study, a mixed fungal-bacterial infection was isolated in various combinations: 14 (66.7%) – Trichophyton rubrum and Staphylococcus, 7 (33.3%) – Candida albicans and Staphylococcus. Of the concomitant pathologies, the following diseases were most often diagnosed: hypertension (52.4%), obesity (BMI > 30) (47.6%), type 2 diabetes mellitus (42.9%), gastrointestinal diseases (23.8%), diseases of the hepatobiliary system (19.1%). The effectiveness was assessed taking into account the VAS index (erythema, infiltration, desquamation, cracks, itching, burning) and special methods (microscopic and cultural) of the study at control points B1 (before therapy) and B2 (after 4 weeks of therapy). Long-term results of observations (disease relapse) were assessed after 6 months.

Results. The total VAS at control point B 2 decreased by 94.9% (p < 0.01). After therapy (4 weeks), in 18 (85.7%) patients, pathogenic fungi (Trichophyton rubrum, Trichophyton mentagrophytes var. interdigitale) were not sown during cultural examination. Patients with no laboratory cure were recommended to continue therapy with sertaconazole for 2–4 weeks until complete eradication of pathogenic fungi. Long-term results of observations (6 months) showed relapse of the disease in 28.6% of patients with concomitant metabolic syndrome and type 2 diabetes mellitus. Also, among patients with relapses, males predominated – 66.7%.

Conclusions. Sertaconazole has a wide spectrum of antimycotic activity, which makes it possible to quickly achieve clinical and mycological recovery in patients with mycosis of smooth skin in the groin area.

Objective. Due to the growing number of patients with various diseases of the vulva, there is a need to evaluate the available diagnostic tools. Vulvoscopy is one of the widely used methods, the diagnostic sensitivity and specificity of which varies significantly.

Purpose of the work. Based on the analysis of publications to determine the diagnostic significance of vulvoscopy.

Material and methods. The data of modern research and publications were used in the preparation of the work.

Results. The authors of a number of publications warn against considering vulvoscopy as a variant of colposcopy. A high percentage of false positive results when performing tests with acetic acid may be due to a variety of reasons and is not highly specific for papillomavirus infection. The use of the test with toluidine blue is not recommended due to low sensitivity.

Conclusions. A positive aspect of vulvoscopy is the ability to examine the vulva area with optical magnification, in a position convenient for examining the patient, which makes it possible to identify areas to be biopsied. The use of additional tests with acetic acid should be limited, and tests with toluidine blue and Lugol solution are not recommended due to low sensitivity.

Combined procedures can be performed during one appointment to solve several problems for the patient. However, some treatments should be planned over several consecutive sessions to avoid complications and achieve optimal results. The purpose of our study was the scientific substantiation and development of an algorithm for the complex use of microneedle radiofrequency lifting and injection fillers based on hyaluronic acid in patients with involutive changes in the facial skin, taking into account the data of the pathomorphological research method. The patients were divided into three groups, depending on the treatment methods. In order to assess the effectiveness of therapy, a histological examination was carried out in five patients from each group, and a morphometric assessment was carried out. The histological picture and morphometric assessment of microslides from patients from different study groups indicate that microneedle RF lifting entails scar-type changes, which thins the thickness of the epidermis. However, the use of hyaluronic acid smoothes out these changes and leads to faster tissue restoration. At the same time, in the complex treatment group, better regenerative potential was noted than in the monotherapy groups, which is confirmed by the maximum value of basal epidermocytes per unit length.

In acne, a microbial imbalance compared to a normal distribution in healthy tissues is thought to be involved in the pathophysiology of inflammatory acne. Extended metagenomic sequencing has shown that the skin microbiota of acne patients differs from the microbiota of people without acne at the level of a virulent-specific lineage. Acquired DNA sequences and bacterial immune elements may be involved in the virulence of C. acnes strains. Acne-associated strains produce significantly higher levels of pro-inflammatory metabolites, porphyrins, which generate reactive oxygen species and induce inflammation in keratinocytes. In light of these data, restoration of the skin microbiome in acne is one of the main goals of therapy. Specialized cosmetics that allow restoring skin microbiocenosis is a pathogenetically substantiated option for the complex treatment of patients with acne. To solve this problem, the scientists of the laboratory of La Roche-Posay have created an innovative range of products EFFACLAR H ISO-BIOME. The products effectively reduce all side effects caused by the use of topical and systemic drugs, and also normalize the skin microbiome by activating the growth of commensal microorganisms.

The search for modern and affordable methods for the treatment of dermatoses remains an urgent problem in domestic dermatology. The results of recent studies indicate the high therapeutic efficacy of various types of magnetotherapy. The course application of a local low-frequency magnetic field reduces the inflammatory response and helps to restore the structure of the epidermis and dermis in the affected areas of the skin.

Purpose of the study. To study the safety and efficacy of local magnetic therapy in a limited form of spongiotic dermatosis with a violation of the skin barrier in children and adolescents.

Material and methods. The study involved 44 children aged 5 to 16 years. The patients were divided into two groups: the first group combined external therapy and local low-frequency magnetotherapy, the patients of the second group received external therapy and placebo in physiotherapy treatment.

Results. According to the study, the efficacy and safety of local magnetic therapy in focal pruritic dermatosis in combination with basic external agents and a faster treatment result with prolonged remission are confirmed.

Conclusions. The use of local magnetic therapy in combination with standard external therapy contributes to the relief of clinical symptoms of local eczematous dermatosis and improves the quality of life of patients.

Striae distensae, commonly known as stretch marks, are visible linear atrophic scars. Despite quite numerous studies, the lack of a unified approachto the problem of treating atrophic scars, a detailed clinical and morphological classification leads to the fact that doctors empirically choosepatient management tactics, which leads to unreliability or even lack of effect, the need for numerous repeated courses of therapy, and significanteconomic costs. The article presents data on studying the effectiveness of various methods of therapy. Depending on the method of therapy,patients were divided into three groups by simple randomization. The study used a visual analogue scale (VAS) to assess the clinical symptomsof AR. The combined use of fractional ablative laser and PDT with the topical photosensitizer chlorin e6 is highly effective in the treatment ofatrophic scars lasting more than a year (VAS dynamics – 74.9 %), fractional ablative laser is moderately effective in long-term atrophic scars (VASdynamics – 65.6 %), while PDT in the form of monotherapy is insufficiently effective (VAS dynamics – 45.6 %).

Many methods of therapy for GR are currently insufficiently studied in terms of a high evidence base, and the data are contradictory, which determinesthe relevance of research aimed at developing and studying the effectiveness and safety of new methods that can influence the main links in thepathogenesis of pathological scars. The aim of our study was to scientifically substantiate and develop a combined method of therapy for patients withsevere hypertrophic scars lasting up to 1 year using a neodymium laser and pneumokinetic therapy with 5-fluorouracil and durant corticosteroid basedon a study of hemodynamic processes. The study group included 34 patients with hypertrophic scars who underwent two procedures of pneumokinetictherapy with GCS and 5-FU, with an interval of two months. After another one month, laser therapy with a neodymium laser (1064nm) was performed.The results of the LDF study confirmed the early results obtained on the initial changes in the microcirculatory bed in hypertrophic scars, as well as dataon the high efficiency of the developed method of pneumokinetic therapy of GCS + 5-FU and the sequential use of a neodymium laser (1064 nm).

The aim of the study. A retrospective analysis of the results of complex therapy of moderate papulo-pustular acne with minocycline 50 mg per day orally and 15 % azelaic acid gel topically under natural ultraviolet irradiation.

Materials and methods. In a retrospective study, data from outpatient charts and the results of studying the morpho-functional parameters of the facial skin of 61 people (31 acne patients and 30 healthy individuals) were analyzed. Patients received oral minocycline (Minolexin®) 50 mg per day for 6 weeks and topically 15 % azelaic acid gel 2 times a day for 12 weeks in the period from April to September.

Results and discussion. The therapy was effective: clinical cure occurred in 90.3 % (n = 28), clinical remission – in 9.7 % (n = 3) patients. Rapid regression of papulo-pustules was achieved through the use of minocycline, which had antibacterial and anti-inflammatory effects. After treatment, elevated values of sebumetry, skin relief, pore size, and pigmentation were normalized in the group of patients with acne, due to the action of a topical gel, as well as the absence of photosensitizing effect in minocycline. Systemic and local adverse events registered in outpatient records were of a temporary nature and did not require discontinuation of therapy.

This article provides a review of the literature on the prevalence of Merkel carcinoma, the features of its clinical, dermoscopic, pathomorphological diagnosis and therapy. In the light of the presented data, two of our own clinical observations of Merkel carcinoma are described: a clinical and dermoscopic description, a pathomorphological and immunohistochemical picture, the treatment performed and its long-term results are given. In the presented clinical observations, Merkel carcinoma was detected in two women aged 70 and 83 years at stage I, which determined a favorable prognosis. Clinically, the tumor was presented in the form of a dense, non-ulcerated nodule or a pink-red nodule; all neoplasms were localized on the head. The dermoscopic picture was different, in one case it was represented by globules and dots of red color against a background of milky pink and white areas, individual linear and convoluted vessels, there were white structures (like chrysalids), and in another case – structureless areas of pink color with tree-like vessels and white structures in the form of chrysalids. Histologically, the small round cell type of structure predominated. An IHC study in both cases revealed a pronounced expression of cytokeratin 20 and chromogranin A, the Ki‑67 index was above 70 %.

Purpose of the study. To establish patterns of changes in the duration of the remission period in patients suffering from severe psoriasis after discontinuation of targeted therapy.

Materials and methods. The work was carried out in the design of an open randomized interventional prospective study and was carried out in two successive stages. To calculate indicators of the expected duration of the remission period, Kaplan – Meier ‘survival’ analysis was used with the construction of ‘survival’ tables and curves assessing the significance of differences using the Mantel – Cox log-rank test. Significant factors presumably influencing the increase in the cumulative risk of relapse were determined by multivariate Cox regression.

Results. The longest period of remission was typical for patients who were prescribed systemic therapy with guselkumab – 33.5 weeks, the second longest period of remission was ustekinumab – 29.1 weeks, the third – secukinumab – 24.7 weeks. The average duration of remission after discontinuation of adalimumab used for a year was 17.4 weeks. The worst disease-free period was recorded for apremilast – 6.9 weeks (p < 0.001 for all comparisons). Significant predictors of early onset of psoriasis relapse were the following factors: the presence of a family history, failure to achieve the PASI 75 indicator by the 16th week of treatment, delayed prescription of targeted therapy (more than 3 years after the diagnosis of ‘severe psoriasis vulgaris’), high values of the PASI index at the time of initiation of systemic therapy and long duration of illness.

Conclusions. Resumption of systemic treatment was required in 25.8 %, 35.3 %, and 12.1 % of patients within the first 6 months after discontinuation of ustekinumab, secukinumab, and guselkumab, respectively. When patients received adalimumab, re-prescription of targeted therapy was required in 33.3 % of cases 4 months after discontinuation, and when prescribed apremilast – in 64.5 % of cases already 2 months after discontinuation. Among all systemic drugs examined, the IL‑23 inhibitor (guselkumab) was associated with the longest period of psoriasis remission after discontinuation of targeted treatment. The identified predictors of early disease relapse indicate the importance of personalized targeted therapy and open up the possibility of prognostic assessment of the expected duration of the disease-free period after discontinuation of systemic treatment.

Green nail syndrome is a bacterial nail disease caused by Pseudomonas aeruginosa, which is characterized by discoloration of the nail plate, onycholysis and proximal paronychia. Despite the prevalence of the pathology and the increase in incidence, today there are no clinical recommendations for the management of patients with chloronychia. This article discusses the etiology, pathogenesis, risk factors, and therapeutic options for managing these patients.

The new coronavirus infection COVID‑19 both by itself and restrictive measures related to the pandemic (prolonged isolation, compliance with sanitary and epidemiological restrictions, etc.) have a pronounced negative impact on the psycho-emotional state of patients. The article presents the results of a study of the initial psychological state of patients who have undergone a new coronavirus infection COVID‑19, justifies the use of various psychocorrective methods in the conditions of patients’ stay in a sanatorium-resort organization.

The purpose of the study. To identify gender differences in the dynamics of the development of professionally significant skills during sports activities.

Results. Male judoists demonstrate greater speed and accuracy of their own movements, and also improve this skill faster than female judoists. It was also revealed that the development of the ability to anticipate the opponent’s movements proceeds more slowly (over the year, the value of the indicator in the group of men improved by 1.59 times, p < 0.05) than the development of the accuracy of perception of their own movements, which is noticeable after six months of training.