The review highlights the available published data on the etiopathogenesis of early graying, hair involution and restoration methods. Early graying of hair is defined as settlement before the age of 20 in Caucasians, before the age of 25 in Asians and before the age of 30 in Africans. In etiopathogenesis, an imbalance between oxidative stress and the antioxidant system is considered as the leading mechanism, a significant role is played by genetic predisposition, hormonal disorders of the thyroid gland, acute stress; the causes may also be deficiency of vitamin B12, copper, iron. Currently, the active molecule palmitoyl tetrapeptide-20 is used to prevent pigment loss and restore it. The endocannabinoid system in the hair follicle is also considered as a target for stimulation during the restoration of hair growth.

Vitiligo is an autoimmune disease that causes skin depigmentation. The article is a review of the literature with a detailed description of the pathogenesis and the main combinations of therapeutic approaches. The issue of the use of oral and topical janus kinase inhibitors for the treatment of vitiligo was raised.

The article is devoted to current issues of etiopathogenesis, diagnosis and treatment of telogen effluvium. Literature data on rational injection and hardware methods of therapy, including modern fractional laser therapy, are provided. A number of mechanisms of the therapeutic effect of physical factors have been revealed.

Currently, in actual clinical practice, there is an increasing consensus that early administration of a biologically active drug not only prevents the progression of the pathological process in the skin, but also prevents the development of psoriatic arthritis, and also has a beneficial effect on comorbid pathologies and complications associated with systemic inflammation. Early treatment can modify the course of the disease and prevent not only the development of severe forms and disability, but also stop the progression of psoriasis, taking into account all stages of pathogenesis. In this aspect, the prescription of IL-17A blockers is justified.

Material and methods. The study included a total of 16 patients aged 18–35 years with a period of manifestation of skin psoriasis <1 year, who received netakimab at a dosage of 120 mg subcutaneously at 0, 1, 2 weeks and then 120 mg every month for 52 weeks.

Results. By week 4, 68.75% (n=11) of patients achieved PASI 75, 37.5 % (n=6) PASI90 and 18.75% (n=3) PASI100. By week 8, delta PASI75 was observed in 87.5% (n=14) of patients, 68.75% (n=11) – PASI90 and 50% (n=8) – PASI100. By week 24, 100% (n=16) of patients achieved PASI75,

81.25% (n=13) – PASI90 and 68.75% (n=11) – PASI100. By week 52, PASI75 delta was observed in 100% (n=16) patients, 100% (n=16) had PASI90 and 87.5% (n=14) had PASI100.

Conclusions. Patients with a shorter duration of the disease (up to 1 year) during netakimab therapy achieve PASI75, PASI90, PASI100 in a shorter time (comparison with clinical trial data). In the presence of factors for the aggressive course of psoriasis (rapid progression of the process, widespread process upon manifestation, lack of effect from topical therapy, constantly progressive course, risk factors for PsA, subclinical course of PsA), early prescription of genetic engineering biological therapy (netakimab) should be considered as the most appropriate strategy.

One of the sensitive skin types is the “burning scalp” syndrome. It is the most expressed subjective symptom complex of tactile sensations in the projection of the skin of the scalp. The most common manifestations of this syndrome, which significantly reduces the quality of patient’s life, are burning, itching, pain, trichodynia, redness like flushing and persistent erythema, mild exfoliation and hair loss sometimes. The “burning scalp” formation is heterogeneous and can be associated with comorbid dermatoses (seborrheic dermatitis, eczema, atopic dermatitis, psoriasis, rosacea, fungal and bacterial contamination, alopecia, etc.), organ and visceral pathology (diabetes mellitus, multiple sclerosis, tumors of the central nervous system, paraneoplastic conditions, immunodeficiencies, etc.), psychosomatic abnormalities (conversion disorders, sensory hypochondria, somatoform pruritus) and environmental influences (aquagenic pruritus, ultraviolet radiation). Now, there are no general recommendations for the “burning scalp” treatment. For long-term accompanying treatment and prevention, therapeutic cosmetics that normalize the microbiome and have antipruritic and anti-inflammatory effects are promising.

The skin, being a border organ that provides a protective function and is constantly exposed to the environment. In the scientific literature, the generally accepted term “exposome factors” is used to describe exogenous factors. By influencing the skin barrier and skin microbiota, they have a significant impact on the course of acne, which is confirmed by numerous studies. The term “exposure” is understood as the total measure of exposure to the environment and associated biological reactions on a person throughout life. Identification of the most common factors that increase the risk of developing acne and reducing their impact on the skin is an integral part in solving the problem of acne treatment. The article presents data from a literature review and our own research on the influence of exposure factors on the course of acne.

Purpose of the study. To evaluate the effectiveness of the standardized SALT scale to determine the severity of AA patients.

Materials and methods. A one-time retrospective cohort study was conducted. There were 40 patients with AA under supervision. The gender distribution of the patients was as follows: 15 men (36.6%) and 25 (63.3%) women. The average age was 29.4 years in the 18–54 age range.

Results. The AA debut varied widely in age range from 2 to 45 years. The average age at which the pathological process began was 18,2±4,4 years. 22.4% of patients with a scalp hair area of more than 25%, as well as hair loss in other areas of the body and changes in the nail.The beginning of AA is fixed to 10 years. More than two relapses occurred in 54.5% of patients with scalp hair lesions of more than 25% and only 9.2% of cases with foetal AA.The following clinical forms were diagnosed: foetal (12 patients), lenticular (ophiasis, inversive ophiasis) (7 patients), multi-focal (11 patients), total and universal (10 patients). According to the SBN Hair Loss State scale, S1 clinically corresponded to focal alopecia, S2 -S4 – ophazis, multi-focal alopecia, S5 – TA and UA. Partial or complete hair loss has been noted in these areas in 38% of patients with S2-S3 and 67% with S4-S5 clinical forms. The combination of different degrees of body hair loss and dystrophy of nail plates in examined AA patients was observed in 25% of cases.

Conclusion. In determining the severity of alopecia nest principally not only the size and number of lesions on the skin scalp, but also the nature of hair loss on the skin of the eyebrows and eyelashes, as well as the possible combination of hair loss and dystrophic altered nail plates, which is considered an option for a more severe course of the disease. The SBN system effectively evaluates and describes the clinical variant of AA according to a standardized scale, which can help determine clinical management of patients with different manifestations, as well as predict the course of the disease.

Introduction. Acne is a multifactorial chronic inflammatory disease of the pilosebaceous follicle, which manifests itself as open and closed comedones, papules, pustules and nodules.

Purpose of the study. Studying of itch prevalence among patients with acne, as well as assessing its impact on their quality of life and psychoemotional status.

Materials and methods. Under observation were 249 patients diagnosed with acne aged from 12 to 50 years, of which 143 women (57.4%), 106 men (42.6%). Patients were diagnosed based on complaints, anamnesis and clinical picture of the disease. To assess the impact of itching on the quality of life, the Acne Psychological and Social Effect Scale (APSEA), the Dermatological Life Quality Index (DLQI), the Cardiff Social Disadaptation Index (CADI), the Rosenberg self-esteem scale, and a self-developed questionnaire were used to assess the impact of itching on the quality of life. Questionnaire, YOUR itch.

Results. To solve these problems, based on the criteria for inclusion, non-inclusion and exclusion, two clinical comparison groups were formed, comparable in terms of main clinical diagnostic indicators. The first group consisted of patients with itching due to acne (64 people, 26% of subjects), the second group consisted of patients with no itching (185 people, 74% of subjects). According to the results of the study, a statistically significant relationship between the presence of itching in acne and age, gender, the presence of obesity, impaired carbohydrate tolerance, iron deficiency anemia, hyperprolactinemia was revealed, various characteristics of itching in the subjects were described, and a close correlation of the indicators of the indices used was revealed.

Conclusions. Studying the prevalence of itching in acne is a relevant area and allows us to expand our understanding of the role of subjective sensations in the development of acne and further evaluate the impact of this dermatosis on the quality of life of patients.

Aim. To study the characteristics of the course of the disease, quality of life and cytokine profile in patients with psoriasis vulgaris in the stationary stage and depression.

Material and methods. A prospective, cross-sectional comparative study involved 154 patients with vulgar psoriasis in the stationary stage; Of these, two groups were formed: 83 patients with comorbid depression and 71 without comorbid depression. The Hamilton scale was used to determine depressive symptoms and severity.

Result. Patients with psoriasis vulgaris in the stationary stage and depression were characterized by a younger age (p=0.007), a more severe course of the disease according to the PASI index (p<0.001), visual analogue scale (p=0.014), and a higher frequency of relapses (p=0.012) and a lower level of quality of life according to the DLQI questionnaire (p<0.001), as well as higher values of IL-6 and IL-17 in the blood serum (p=0.011; p=0.001, respectively). An inverse correlation was established between the average total value on the Hamilton scale and the age of the patients (r= –0.61; p=0.002), a direct one – with the average total values on the PASI index (r=0.72; p=0.001), visually analogue scale (r=0.63; p<0.001), DLQI (r=0.69; p=0.001) and IL-17 (r=0.62; p=0.012).

Conclusion. In patients with depression, psoriasis vulgaris in the stationary stage is more severe, accompanied by an increase in systemic proinflammatory changes and a more significant decrease in quality of life than in patients without depression. The results obtained must be taken into account when choosing a therapeutic strategy for psoriasis vulgaris, which will personalize treatment and increase its effectiveness.

Alopecia Areata is an autoimmune disease characterized by hair loss mediated by CD8 + T cells. There are no proven effective treatments for alopecia. Recent research on the immunology of hair follicles and recent developments in the field of immunopatogenesis, as well as common ways of developing the disease with other autoimmune disorders have led to research on new treatments, targeted at specific immunological pathways. The so-called JAK-STAT pathway is responsible for transmitting signal from different cytokines to the nucleus of the cell, suggesting that blocking this pathway may be effective in the treatment of alopecia.

Study purpose. Presentation of Clinical Case of Multi-focal Alopecia Treatment in Child Oral Tofacitinib.

Materials and methods. The study was conducted on the basis of the dermatology department with the laser surgery group of the Center for Pediatric Dermatology and Laboratory of Skin Pathology in children FGAU «National Medical Research Center for Children’s Health» of the Ministry of Health of Russia from April 2021 to November 2022. Severity Alopecia Tool (SALT) was used to determine the severity of the disease in participants. The SALT scale takes into account the percentage of affected hair and divides it into 6 subclasses (S 0 %, S1 <25 %, S2 25–49 %, S3 50–74 %, S4 75–99 % and C5100 %).

Results. When oral tofacitinib was administered for 6 months in a 9-year-old patient, full recovery of hair growth on the scalp was observed. No significant abnormalities based on clinical and biochemical blood results were found for the period of treatment and for a year after withdrawal. There was no recurrence of hair loss after the withdrawal of the drug for 12 months.

Conclusion. JAK inhibitors can be effective new treatments for alopecia in children. Additional data from randomized controlled trials are required for safe use of JAK inhibitors.

Congenital epidermolysis bullosa (СЕВ) is a group of genetically and clinically heterogeneous diseases characterized by a tendency to form blisters and/or erosions on the skin and mucous membranes with minimal trauma. Nutritional deficiency stands as the most common complication observed in EB, with its development influenced by a multitude of contributing factors.

Purpose of the study. To construct a predictive model for the development of protein-energy malnutrition in patients with various forms of EB, identify the main features affecting the sensitivity of the predictive model, and evaluate the model’s validity based on retrospective data on the presence of protein-energy malnutrition in this patient category.

Methods. The study involved 101 patients aged 3 to 18 years with simplex (n=25), junctional (n=10), and dystrophic (n=66) СEB. The Birmingham EB Severity Score, laboratory and anthropometric parameters, as well as data on the presence of gastrointestinal complications, were used for the analysis of disease progression and predictive model construction. The Scikit-learn library of the programming language Python was utilized for building the machine learning model.

Results. In the construction of the predictive model, the RandomForestClassifier model showed the best results. The developed machine learning model can correctly determine whether a patient has chronic protein-energy malnutrition (class 1, HAZ < –2) or not (class 0, HAZ > –2) with an accuracy of 92%, sensitivity of 85.7%, and specificity of 100%.

Conclusions. The machine learning model presented in this study predicts the values of the Height-for-Age Z-score (HAZ) and can have practical significance in medical practice and clinical research. The model can be used for early diagnosis of protein-energy malnutrition in patients with EB, which may allow healthcare professionals to timely start nutritional support and prevent possible complications of the disease, as well as develop individual nutrition and treatment plans for patients.

This article provides an overview of modern guidelines for acne treatment. The issues of prescribing both topical and systemic acne therapy are discussed. Particular attention is paid to systemic isotretinoin therapy. Clinical examples of the use of the drug Erase for acne of moderate and severe severity are discussed.

Alopecia areata (АА) is an autoimmune inflammatory disease with an established genetic predisposition, which is based on the lesion of hair follicles, leading to persistent or temporary hair loss. To date, treatment of АA in children, is limited to the use in most cases of external hormonal therapy in the form сream or the prescription of intradermal injections of GCS in outpatient conditions. However, data on the effectiveness of this group of drugs in severe forms of AA flow are not fully studied. There is an open question of the choice of the most preferred drug in patients simultaneously with a severe flow of AA and a severe form of atopic dermatitis. Another interesting variant of treatment of AA is the drug Dupilumab. (blocker IL-4 and IL-13). The mechanism of action of dupilumab at АA remains unknown, and its effect on TH-type 2 is assumed.

Purpose of the study. To conduct a comparative performance characterization of: external GCS (Clobetazole) and injectable GCS (Betamethazone) for treatment of AA in children; Tofacitinib treatment for children with alopecia and the presence or absence of atopic dermatitis in the form of a concomitant disease; use of Dupilumaba to treat children with AA.

Materials and methods. The research sample includes 420 patients. By the nature of the lesion, we considered three types of alopecia: spotted, total and universal. Patient data is taken from the register of AA patients in children. [13]. The effectiveness of the treatment was assessed on the scale SALT [14]. Patients were monitored for six months.

Results. Use of intradermal injections GKS (Betamethazone), more effective than outdoor GKS (Clobetazole). In patients with atopic dermatitis, the efficacy of Tofacitinib for AA treatment is reliably higher than in patients without atopic dermatitis. Dupilumab may be a drug of choice for treating patients with a total and universal form of AA.

Conclusion. Additional randomized controlled trials are needed to assess the long-term efficacy of drugs such as Tofacitinib and Dupilumab.

Rosacea is a common chronic skin disease that significantly impairs patients’ quality of life. Various phenotypic characteristics and the localization on the face can have a negative impact on mental health and socialization, causing anxiety and depression in patients with rosacea. The aim of the study was to determine baseline levels of anxiety and depression in patients with erythematotelangiectatic telangiectatic and papulopustular rosacea and their combination and to compare the effect of combination therapy on patients’ psychoemotional state. We observed 45 patients with a diagnosis of erythematous telangiectatic rosacea and papulo-pustular subtypes of mild and moderate severity and their combination. Patients were divided into three groups according to the choice of combination of treatment methods. In group No. 1: 15 patients received botulinum toxin therapy with topical azelaic acid plus ivermectin. In group No. 2: 15 patients received PDL 595 nm procedure in combination with the topical therapy azelaic acid plus ivermectin. In group No. 3: 15 patients received botulinum toxin therapy with incobotulotoxin in combination with ILC 595 nm and topical azelaic acid therapy in combination with ivermectin. 26.7 % of the patients included in the study showed a deterioration in skin appearance due to emotional strain and stress. All patients showed subclinical manifestations of anxiety and depression according to the Hospital anxiety and depression scale (HADS). In addition, the mental state and anxiety of patients with rosacea can be significantly improved after treatment. Combination therapy with ivermectin, azelaic acid, LC 595 nm and botulinum therapy brings maximum results in normalizing the psychoemotional state. Alleviating the clinical manifestations of rosacea helps to reduce the level of anxiety and depression in patients with rosacea.

The article presents data on the local retinoid of the fourth generation trifarotene. The results of three large trials have been presented, which have proven good efficacy and long-term safety of monotherapy of the drug trifarotene in patients with moderate acne and in patients with severe acne for combination therapy. It has been shown that trifarotene demonstrates high selectivity to retinoic acid receptors RAR-γ, which are predominant in the skin, which provides clinical efficacy in low concentration and good tolerability.

Phototechnologies occupy a leading position in the treatment of patients with rosacea. The most effective technologies are laser: pulsed dye laser (585nm, 595nm) and neodymium laser (1064nm), however, issues of comparative analysis, including in patients with a combination of rosacea subtypes, require further study.

Material and methods. We observed 64 patients with diagnosed rosacea with a combination of subtypes: erythematotelangiectatic and papulopustular. Among them, 48 (75%) were female and 16 (25%) were male. The age of the patients varied widely: from 31 to 57 years, the average age was 39.2±4.6 years. The average duration of the disease was 5.1±2.3 years. Depending on the therapy, patients were divided into 2 groups: group 1 received treatment with a neodymium laser, group 2 – treatment with a pulsed dye laser.

Research results. A cumulative assessment taking into account clinical research methods with a sufficient degree of reliability revealed the advantages of a neodymium laser over a pulsed dye laser, regardless of the clinical picture of rosacea, which was confirmed by the dynamics of the IGA/PGA indices: reduction in group 1 was 79.5%/66.7%, in group 2–63.2%/51.3%, respectively. These data were confirmed by the dynamics of the DIQI index – 81.7% and 61.6%, respectively.

The variety of body shape correction techniques based on liposuction and currently used in plastic surgery is largely due to the desire to achieve the greatest possible cosmetic effect and, at the same time, minimize the possible negative consequences of invasive intervention. The choice of a specific method depends on a number of factors, among which are the treatment plan agreed with the patient, the individual characteristics of the patient being operated on, the presence or absence of medical contraindications to the use of certain techniques, the qualifications of the personnel, the level of material equipment of the operating unit. Liposuction is the aspiration of fat from subcutaneous tissue. It can be used for aesthetic lipoplasty or combined with body contouring surgery. The article is of a review nature and contains modern data on the medical effects of liposuction, VASER (Vibration Amplification of Sound Energy at Resonance) and PAL (Power Assisted Liposuction) techniques, and possible complications after liposuction.

The evolution of methods used in aesthetic medicine includes a transition to less invasive procedures with high safety and minimal recovery time. That is why numerous non-invasive methods for correcting involutive changes in facial skin (thread lifting, hardware techniques) have been studied for effectiveness and safety over the past decades. Such techniques can improve treatment results and avoid or delay surgical intervention.

Material and methods. The work involved a pathomorphological study of material taken by biopsy at the sites of thread implantation and surrounding tissues (1 cm indentation) (Nano spring, Excellence Visage, Excellence Visage HA) within 12 months after thread lifting. Paraffin sections with a thickness of 5–7 microns were made from ready-made paraffin blocks and stained with: hematoxylin – eosin; according to the Weigert-Van Gieson method; Sirius Red paint. Using a microscope with a Sony digital photo attachment with a resolution of 12 megapixels, five photographs were taken from each histological specimen.

Research results. As a result of a pathomorphological study of a flap of skin and subcutaneous fat with a synthetic thread in the adipose tissue, it was revealed that along the periphery of the studied material there was moderate chronic inflammation (giant cells of the type of foreign body cells, lymphocytes, fibroblasts) and weak fibrosis, as well as a predominance type I collagen in the skin, and type III collagen predominated in subcutaneous fat tissue.

Varicose veins are the most common pathology of peripheral vessels. A broader concept is the term chronic venous insufficiency (CVI), which, in addition to varicose veins, includes telangiectasias and reticular veins. Sclerotherapy is considered as the basis of treatment for reticular veins. However, the procedure has its drawbacks and side effects, which indicates the importance of implementing safer treatment methods. An alternative treatment for reticular veins is intense pulsed light. To illustrate the effectiveness and safety of IPL treatment for reticular veins, we present a clinical case of a patient aged 73 years with complaints of dark purple and bluish vessels. After clinical evaluation, diagnosis of reticular veins/telangiectasias was made (C 1 according to the CEAP 2020 classification). Due to the patients’ refusal to undergo sclerotherapy, it was decided to perform IPL procedures (M22, Lumenis). The patient’s reticular veins and telangiectasias were almost completely leveled out after the second session of IPL therapy; there was also no progress of CVI. No side effects were noted. The pathogenetic application of intense pulsed light in the treatment of reticular veins can be explained by decreasing the inflammatory process, integrating extracellular matrix, as well as inhibition of mast cell degranulation.

This article presents the experience of using laser for the correction of periorbital and temporal veins. Clinical cases are presented indicating the treatment parameters used. Mono mode and multiplex modes were used.

The article presents the results of an expert council to discuss the relationship between disorders of the skin microbiome and the course of atopic dermatitis, as well as the key mechanisms of action on the skin of a complex of pro- and prebiotics in dermatocosmetics for use in patients with dermatoses from the perspective of modern clinical protocols.

Emollients are an integral part of the therapy for patients with atopic dermatitis. The most effective will be the new generation of emollients – emollients plus, which normalize the skin microbiome. Their effectiveness can be assessed by determining the parameters of the epidermal barrier (hydratation, sebum level, pH) and skin elasticity.

Objectives. To evaluate the effectiveness and safety of a lipid-restoring cream containing a biotic complex LE SANTI in children with atopic dermatitis.

Material and methods. From August to December, 25 children (9 girls, 36 % and 16 boys, 64 %) aged from 3 to 17 years (average age 9.2 years) with atopic dermatitis participated in an observational program to evaluate the effectiveness and safety of a lipid-restoring cream LE SANTI. For 21 days, patients applied the cream twice a day, they had 6 visits, during which was collected their medical history, adverse events, physical examination, determined indicators of the epidermal barrier (hydratation, sebum content, pH), biomechanical characteristics (skin elasticity), and also severity of disease (SCORAD) and quality of life (CDLQI). At visit 6, patients were assessed for satisfaction with the use of the cream.

Results. All participants of the observation program completed their participation on time. As part of the observational program, there was an increase in skin hydration and sebum level by 3 and 3.5 times, respectively, pH level turned to the acidic values by 18%, an increase in elasticity by 30%, a decrease in SCORAD and CDLQI indices by 1.9 times or more 3 times respectively. The patients did not experience any adverse events; the satisfaction rating from the use of the cream was 4.78/5.

Conclusions. Lipid-restoring cream LE SANTI can be recommended for inclusion in the treatment regimen for atopic dermatitis as a basic external agent that meets all the requirements for effectiveness and safety for children with atopic dermatitis, as well as basic care during remission.