In this literature review we describe factors affecting satisfaction with the quality of cosmetic procedures. We also discuss psychometric scales used in world practice of aesthetic medicine and cosmetology to identify comorbid mental pathology that determines dissatisfaction with the results of medical interventions.

According to the criteria of the world health organization, the geriatric population is people who have reached the age of 60 years. Biological aging is accompanied by a progressive decrease in the functional and reserve capabilities of all structural elements of the skin, is a complex process and the result of the influence of both non-modifiable (chronological aging, ethnicity and natural anatomical changes) and modifiable factors (hypoestrogenation, exposure to ultraviolet rays, stress, etc.) Dermatoses occurring with the defeat of the anogenital region in the geriatric group of patients are a big problem not only for diagnosis and treatment, but also significantly worsen the quality of life of patients. Extensive lesions of the anogenital zone are one of the characteristic clinical signs of limited scleroderma, in particular one of its clinical variants — scleroatrophic lichen. (Lichen sclerosis and atroficus). Scleroatrophic lichen (SL) is a chronic autoimmune dermatosis, occurring with a predominant lesion of anogenital tissues, in 85–93 % of cases in women and men.

Despite advances in understanding the mechanisms of development of chronic urticaria, in a large percentage of cases there are unsatisfied treatment results, there is no possibility of controlling the disease. Currently, the treatment of patients with chronic urticaria is of a staged nature. In 2014, omalizumab was registered in Russia for extended indications, which makes it possible to achieve control of the refractory form of chronic spontaneous urticaria. The article presents data on the effectiveness and safety of omalizumab. According to the results of numerous studies, omalizumab showed a quick and pronounced effect in the treatment of patients with chronic spontaneous urticaria who do not respond to therapy with H1-receptor blockers. The issues of effective dose, safety and tolerability of the therapy, timing of evaluating the effectiveness, duration of the course and tactics of managing patients with a partial response or lack of response were considered.

Relevance. Of particular relevance in recent years has become the problem of psoriasis in children, it is noted an increase in cases of severe psoriasis refractory to traditional drug therapy, which together with a high incidence raises the questions of optimization of therapeutic interventions in this category of patients in the category of social.

The purpose of the study. To study the efficacy and safety of UVB-phototherapy 311 nm, tacrolimus from pediatric patients with psoriasis.

Material and methods. Under supervision there were 26 patients from 5 to 16 years old. All patients received UVB 311 nm phototherapy. The effectiveness evaluated in accordance with the dynamics of the indexes PASI, BSA, Quality of Life.

Results. As a result of the course of UVB-therapy with 311 nm wave-length the number of patients with PASI 100 was 69 %, PASI 90 was 23 %, PASI 75 was 8 %. Index BSA were thus reduced to 81.5 %, DIKE improved by 65.3 %. The tolerance to UVB 311 nm was evaluated as very good. Adverse reactions such as transient erythema was observed in 11.5 % of patients, xerosis in 19.2 %.

Conclusion. UVB 311 nm phototherapy is a highly effective and safe method of therapy of medium-severe psoriasis in children.

Age-related changes in the skin are combined and are associated with both internal and external factors. The study of aging mechanisms contributes to the development and scientific justification of the application of various methods of correction of involutive changes. A special place is occupied by the development of non-invasive methods of exposure, as well as their combination to achieve the best result and increase safety. Electroporation is actively used in cosmetology for the introduction of various active substances into the epidermis and, in some cases, into the dermis. The use of this method in combination with photodynamic therapy allows to achieve excellent aesthetic results and increases patient compliance.

The article presents a case of clinical observation of a patient with connective tissue dysplasia. This pathology, as a result of various genetic disorders, includes an extensive group of different systemic conditions, most of which have certain dermatological pathologies as the main or concomitant symptom. We describe the questions of etiology, clinic and diagnosis of connective tissue dysplasia. This clinical case is interesting to practicing dermatologists and cosmetologists in connection with the high appeal of this category of patients for aesthetic help.

The article represents the results of a prospective analysis of 28 patients with severe plaque psoriasis and advanced psoriatic arthritis with insufficient response to previous systemic therapy, treated with certolizumab pegol at the Tula Regional Clinical Dermatovenerologic Dispensary in years 2017–2019. Certolizumab pegol demonstrated high and sustained efficacy in improving skin disease and manifestations of psoriatic arthritis. Safety profile of certolizumab pegol was consistent with the therapeutic class.

In the treatment of patients with lichen planus of the oral mucosa and identified papillomovirus infection, the appointment of an immunomodulatory drug with antiviral activity is of particular importance.

Aim. To evaluate the clinical efficacy of antiviral and immunomodulatory drug inosine pranobex in the treatment of lichen planus of oral mucosa.

Materials and methods. 49 patients with erosive-ulcerative form (37 women (75.5 %) and 12 men (24.4 %) aged 43 to 68 years, mean age 57.43 ± 2.53 years were under observation. The disease duration ranged from 6 months to 9 (5.58 ± 1.26) years.

Results. Inosine pranobex, used in group Ib, showed high efficiency in the treatment of patients: the number of patients with high viral load decreased to zero, and the percentage of patients with clinically significant HPV decreased by half. Eradication of papillomavirus was recorded as a result of antiviral therapy in 11 (73.33 %) patients, while in group Ia such results were not achieved.

Summary. According to the results of this study, it was found that for patients with lichen planus of oral mucosa with detected PVI, the appointment of an antiviral drug is necessary. This treatment is characterized by high efficiency and allows to increase the rate of epithelialization of pathological elements by almost 25 %, to achieve clinical remission and to stop the pain symptom faster, thereby improving the quality of life of patients.

The article is of an overview nature and contains current data on risk factors for the development of psoriatic arthritis in patients with psoriasis. The data on the diagnosis, clinical picture of PsA and the feasibility of the early appointment of biologics medicines in order to increase efficiency and improve the prognosis of the disease are given.

Entodermoscopy is one of the trends in dermatoscopic diagnosis of skin diseases, which describes specific signs of infectious and parasitic dermatoses. Current article presents a description and illustrations of the most common forms of fungal infection, including tinea capitis, herpes zoster, tuberculosis, leishmaniasis and tungiasis. Dermatoscopic examination is proposed to be used as an additional tool for evaluating the effectiveness of the therapy, allowing to control the restoration of the skin structure and its appendages in the treatment process more precisely.

The mycoses of the skin and nail plates of the feet are the second most common in the human population after pyoderma, and are the fact of a significant decrease in the quality of life of patients. In the present multicenter observational study, the results of the evaluation of the quality of life of 1 674 patients before and after successful treatment of mycosis of the skin and nails with the use of the drug Exifine®: showing a clear correlation between successful eradication of the pathogen and to improve the quality of life of the patient in all age groups. In no case was there any mention of adverse reactions to either the external or the systemic dosage form of the drug.

Scars can adversely affect the physical, mental and social well-being of the patient. Common treatments for scar removal include external treatments, chemical peels, mechanical resurfacing, laser resurfacing, injection techniques, physiotherapy, and surgical excision. The search for combined treatment methods is an urgent and priority direction. Methods of phoresis are in demand in the correction of scars, when changes in the structures of the dermis and hypoderm significantly reduce the penetration of topical drugs and allow to achieve a greater therapeutic effect.

Many years of experience in using fixed combinations of topical glucocorticosteroids in dermatology today seem to be justified not only theoretically (the pathogenesis of immuno-inflammatory and infectious dermatoses), but also from the perspective of optimizing therapeutic measures in this category of patients. From this position, the innovative combination drug Tetraderm® can be regarded as the drug of choice for dermatoses of combined etiology. The composition of the drug includes highly effective components that allow you to affect the inflammatory component, infection and trophic tissue in the lesions. The components of the drug show a favorable profile of antibacterial and antimycotic activity. Highly potent corticosteroid can effectively stop inflammation. The drug has prospects for use in various dermatoses of combined etiology (atopic dermatitis, eczema), in clinical situations when mycoses or pyoderma have signs of eczematization of the process, rashes in large folds, cystic dermatoses and diskeratoses.

Anogenital itching is a serious problem for most women at one or another period of life. The multifactorial nature of dermatoses with localization in the vulva and anus, the lack of knowledge of the pathophysiology of itching, in principle, determine the problem of itching in the genital area as a relevant medical problem. Conducting a rational differential diagnosis and the use of modern treatment that can quickly jugulate a symptom will at the present stage increase the effectiveness of specialized medical care for this category of patients.

The article discusses the peculiarities of the choice of the means of external therapy etiology of lichen sclerosus of the vulva based on recent data on vsini of the skin microflora on the course of dermatitis. The efficacy and safety of the cream containing a combination of mometasone, gentamicin, econazole and dexpanthenol are shown.

Acne therapy, despite the wide range of therapeutic possibilities, continues to be quite a challenge for the medical practitioner. Nowadays in the current clinical recommendations the preference is given to the fixed doses combinations, in particular to Effezel® (also known as Epiduo®) — adapalene 0.1 % and benzoyl peroxide 2.5 %.

Materials and methods. Under our supervision, there were 64 patients with acne. The 1^st group — the patients with severe papulo-pustular acne: they received therapy with the mentioned above fixed combination for 6 months, in some cases (33.3 % of patients) doxycycline at a dose of 100 mg/day was prescribed for the first 4 weeks, then — adapalene 0.1 % and benzoyl peroxide 2.5 % as a maintenance therapy every or every other day for 6 months. The 2^d group — the patients with moderate-severe papulo-pustular acne having formed atrophic post-acne scars: they received the mentioned above fixed combination therapy for 6 months and RF-micro-needle therapy (3 procedures with a 4 weeks interval between them). The 3^d group — the patients with nodular and cystic acne: after a treatment course with a systemic retinoid the patients received the fixed dose combination of adapalene 0,1 % and benzoyl peroxide 2,5 % once a day for 6 months. Patients of all groups used dermatocosmetics Cetaphil PRO* (acne prone skin).

Results and discussion. In the 1^st group, the score IGA = 0 (Investigator Global Assessment with the scores from 0 — clear skin to 4 — severe acne) was found in 85.7 % of the patients, in the 2^d group — in 77.3 % and in the 3^d group — in 81.0 %. According to sebumetria data a significantly positive dynamic was observed in the 1^st and the 2^d groups after a month of therapy (p < 0.05). After 3 months of the therapy a positive dynamics was fixed as more than 50 % in the 1^st and the 2^d groups. In the 3^d group a negative dynamic regarding to sebumetria measurements was not observed during the whole supportive therapy course. Skin hydration was initially reduced in all patients with the meaningful results fixed in the patients of the 3^d group (p < 0.05). In the 1st month of the therapy the skin moisturizing’s measurements were slightly decreased in the 1^st and 2^d groups. The restoration of skin moisturizing was revealed starting from the 2d month of the therapy and by the end of the treatment course, it was considered as normal or increased. In the 3^d group during the transition to the topical therapy the skin moisturizing wasn’t decreased and had a further tendency to be increased.

Summary. The fixed doses combination of adapalene 0.1 % and benzoyl peroxide 2.5 % has demonstrated a clinically proven effectiveness against moderate-severe acne with atrophic post-acne scars, as well as in the treatment of severe papulo-pustular acne both as monotherapy and in combination with oral doxycycline 100 mg/day in the first 4 weeks of the treatment course. The use of a fixed doses combination of adapalene 0.1 % and benzoyl peroxide 2.5 % after a course of a systemic retinoid ensures the maintenance and even improvement of the achieved effect. Specialized cosmetics Cetaphil® PRO (acne prone skin) helps to prevent and reduce the severity of some predictable dermatological side effects of retinoids.

According to some authors, systemic corticosteroids can be used at the beginning of the course of treatment, which helps to accelerate the achievement of a significant effect and reduces the severity of side effects of retinoids. However, many issues of the combined use of isotretinoin and systemic corticosteroids in terms of the methodological approach remain unclear, which determined the purpose of this research.

Material and methods. We observed 84 patients with moderate to severe acne. Among them, 51 (60.7 %) women and 33 (39.3 %) men, the average age of the patients was 17.1 ± 1.8 years. Patients were divided into 2 groups: moderate severe course — 1 group (n = 40), severe acne — 2 group (n = 44). Within the groups, depending on the therapy, the patients were divided into 2 subgroups: A subgroup — received isotretinoin in standard dosages, B subgroup — received isotretinoin also in standard dosages, while the initiation of therapy was carried out while taking systemic corticosteroid (1 month dexamethasone was prescribed at a dose 1 mg / day in 1 dose (in the morning)).

The results of the study. The dynamics of the DICI index, the global IGA score, DICI showed comparable efficacy results in long-term follow-ups and early differences, an advantage was noted in the groups treated with dexetozone.

Findings. Systemic retinoid is effective in preventing the formation of post-acne scars, which allows us to recommend it as the first choice in patients with risk factors for scar development. Important factors in the effectiveness of isotretinoin and the prevention of relapse are individual dose selection, the total cumulative and single dose and the duration of therapy for at least 6 months. The data obtained showed that the administration of a systemic corticosteroid in low doses (1 mg / day of dexamethasone) for 1 month of taking isotretinoin improves the effectiveness of therapy in the early stages of therapy and reduces the frequency / severity of side effects of retinoids.

Materials and methods. 38 patients aged 35 to 55 years old were under the surveillance. Depending on the aging morphotype, all patients were divided into three groups. All the participants of the study were subjected to a biorevitalization procedure (BRV) according to a single protocol prepared ex-temporarily by a mixture of multicomponent and prolonged biorevitalizers (BR).

Results. After the course of BRV from three procedures it was reliably established that skin humidity increased from the initial level by 46.7 % at the absolute number (100.0 %) of patients regardless of morphotype (p < 0.01). Facial color improvement was recorded in 94.7 % of patients (p < 0.01). Length, width and depth of thin surface wrinkles on the face skin in patients with small and mixed morphotypes on average decreased by 41.1 %, 37.9 % and 50.0 %, respectively (p < 0.01). No convincing data have been obtained regarding the increase in skin elasticity, epidermis thickness and dermis. There is also no evident therapeutic effect on telangiectatic changes and non-tumor focal hyperpigmentation of facial skin. Clinical effects following the BRV course are most pronounced in patients with small-scale and mixed mofotypes. According to the patients themselves, the proposed program of injection therapy has high efficiency and safety.

Relevance. Any injection procedure is accompanied by damage to the skin barrier and can lead to sensitivity conversion in patients with sensitive skin, greatly extending the length of rehabilitation. This raises the question of the choice of effective and affordable rehabilitation methods after aesthetic injection interventions.

Materials and methods. 52 patients aged 35 to 55 with sensitive skin syndrome (SSS) were under surveillance. All patients were subjected to combined injection of facial soft tissue correction with hyaluronic acid-based filers and biorevitalizers. After the injection intervention, a placebo controlled study was performed. The patients were divided into two groups: group 1 (25 people) received non-specific external therapy with a pharmaceutical preparation containing panthenol; group 2 (27 people) together with a topic agent received light treatment with polychromatic incoherent polarized light (PIPL). The observation period was 10 days. Effectiveness, safety, and satisfaction with therapy were assessed by VAS, GAIS scales.

Results. By the fourth day of therapy, the total dynamics of sign expression on the VAS scale in group 2 decreased by 92.8 %, in group 1 — by 66.8 % (p < 0.05). Light treatment using a source of PIPL resulted in a 1.5-fold reduction in rehabilitation time (p < 0.05). Side effects were not observed in any clinical case. Patients receiving PIPL were more satisfied with the results of rehabilitation. The GAIS score in groups 1 and 2 was 2.1 and 2.9 (p < 0.01).

The article describes relevant data on the etiology of rosacea and the clinical forms of the disease. A pathogenetic substantiation of the feasibility of using botulinum toxin type A (BTA) with an erythematous-telangiectatic subtype of rosacea is given. A study was conducted involving 30 patients with ETR to treat the manifestations of this dermatosis using BTA injections in mesotechnics. As a result, we established a positive role for the use of BTA in ETP based on the use of a visual analogue scale (VAS), and also obtained data on the distribution of trigger factors and associated pathologies. We came to conclusions about the effectiveness of the botulinum toxin method for rosacea and the feasibility of further studies to optimize the dose and frequency of administration of type A botulinum toxin for a more pronounced and lasting result.

A comparative study of micro-focused ultrasound in monotherapy and combined use with autologous blood cells was conducted. In assessing the effectiveness of the procedures studied the qualitative characteristics of the skin and ultrasound scanning data. All patients (35) with involutional changes of the skin at the procedures were divided into tho groups: combined application of ultrasound macrofocusrange with autologous red blood cells and macrofocusrange ultrasound as monotherapy. The results of the study, data were obtained that showed a more pronounced clinical effect in patients treated with the combined use of ultrasound macrofocusrange with autologous red blood cells.

The article describes the practical aspects of the use of modern injectable preparations rich in platelets with additional activation by autologous thrombin and in combination with hyaluronic acid (Cellular Matrix). Practical recommendations are given on the optimal injection technique, tactics for constructing courses of procedures in a mono version and in combination with hardware cosmetology procedures. The key points of interaction with patients who have indications for aesthetic correction are analyzed.

Dermatofibroma is a benign, often occurring, mesenchymal tumor with extremely low malignant potential. In rare cases, the transformation of this formation into a dermatofibrosarcoma is possible. Dermatofibroma is characterized by a wide range of clinical manifestations due to the abundance of morphological options. Typical variants of diagnostic difficulties usually do not cause. However, atypical forms of dermatofibroma can clinically and dermatoscopically mimic another aggressive tumor, melanoma.

The article is presented in the format of a lecture. The material presents data on the etiology and pathogenesis of Kaposi’s sarcoma, the clinical picture of dermatosis, and modern methods of therapy.