Features of the course of atopic dermatitis with facial and neck lesions (head and neck)

Dermatitis of head and neck, also known as “head-and-neck dermatitis” (HNAD), is one of the specific manifestations of atopic dermatitis (AD) in adolescents and young adults. The epidermal barrier dysfunction, skin pathological immune responses, a direct damaging effect of the malassezial flora through the synthesis of virulence factors and mediated by maintaining immune inflammatory responses, as well as the attachment of secondary bacterial flora caused by scratching form the basis of pathogenetic mechanisms of this condition. The properties that define the HNAD rash is a focus on the seborrheic areas (a face, front surface of the neck, décolleté on the chest), severe itching, prolonged course, exacerbation characterized by excessive sweating. It appears that fungi of the genus Malassezia can play a role in the development of the disease. While they are considered to be part of the normal skin microbiome, a significant increase in the severity of atopic dermatitis was observed in patients with Malassezial flora, which was the reason for the theories devoted to the role of Malassezia spp. as a trigger of the disease. Atopic dermatitis can also develop as a side effect of using targeted therapy with IL4/13 blockers, which is explained at the present day by a shift of the immune response towards a Th-17-mediated reaction. The combination of both infectious and immune-mediated lesions in HNAD determines the necessity of an integrated approach to the therapy, in particular the use of topical combination drugs as  the first-line therapy. The topical glucocorticosteroid (TGCS) therapy is aimed at suppressing the immune reactions that are responsible for inflammation in the skin, antifungal therapy is required to suppress the activity of the malassesial flora, and, finally, a secondary bacterial infection requires the prescription of topical antibacterial drugs

Efficacy of adding systemic glucocorticosteroids to standard therapy in adolescents with severe acne: a randomized controlled trial

Introduction. Isotretinoin is the first-choice drug in the treatment of severe forms of acne vulgaris. The combination of systemic retinoids with durant corticosteroids helps to reduce the likelihood of developing “retinoic” dermatitis and exacerbation of acne in the initial stages of isotretinoin therapy.Purpose of the study. Determination of the effectiveness of the combined use of isotretinoin and a durant corticosteroid in the treatment of severe forms of acne vulgaris.Materials and methods. Twenty six patients with “severe” or “very severe” grade on the IGA scale were included in this randomised, controlled comparative study. Thirteen patients (group A) were treated with isotretinoin 0.5 mg/kg/day (cumulative dose from 120 to 150 mg/kg) for 8 months and 2 injections of betamethasone dipropionate + betamethasone sodium phosphate at dose 1 ml (2 mg + 5 mg/1 ml) at first month (1 injection per two weeks) and thirteen patients (group B) were treated with combined therapy with isotretinoin at a dose of 0.5 mg/kg/day (cumulative dose from 120 to 150 mg/kg) for 8 months and assessment was based on the IGA scale, counting the number of inflammatory and non-inflammatory elements, indicators DIA (dermatological index of acne) and DLQI and was done at baseline, 1, 4 and 8 months of treatment.Results. At month 8, compared to group B, group A showed more significant decrease in IGA score and 76% patients achieved “clear” or “almost clear skin” degree (76% vs. 30%). The reduction in the number of inflammatory and non-inflammatory elements showed a marked clinical improvement in group A (89.2% vs 22.3 % for nodules). The decrease in DIA was 88.3% in group A and 71.3% in group B. Exacerbations of acne were recorded in 0% (group A) vs 38.0% (group B) of patients. We also found a relationship between the achievement of a 2-point reduction in the degree on the IGA scale after 8 months and the presence of exacerbations while taking isotretinoin (p = 0.012). Analyzing the DLQI between the two, we were unable to identify statistically significant differences.Conclusions. Combines use of long acting steroid with isotretinoin provides synergic effect while minimizing the side effect of isotretinoin (decreases the number of exacerbations), demonstrates a visible effect to patients within a month, thereby increasing compliance, improving the quality of life and reducing the risk of scarring

Eczema: tactics of choice external therapy

The therapeutic effects of synthetic tannins are based on their binding action, as well as on their anti-pruritic, antimicrobial and anti-inflammatory effects. Materials and methods. A clinical study of Neotanin spray, Neotanin lotion (suspension) and Neotanin cream was carried out in 8 clinical centres during the period from June, 2017 to January, 2018. The study had an open and non-comparative character. The study included 68 patients of both sex es aged from 1 month to 80 years suffering from eczema dermatosis in the acute weeping phase, including cases with complications after secondary infections (including eczema elements localized on the face). Before the study, information on the clinical history, demographic data, co-morbidities, physical examination data of the patients was collected. The treatment regimen included 2 stages: 1) Neotanin in the spray or lotion (suspension) form 3–4 times per day during 1–5 days, up to the full drying of eczema elements; 2) Neotanin in the cream form 3 times per day, up to the disappearance of the clinical manifestations of skin dermatosis. The duration of the study ranged from 5 to 14 days: the study was completed when a patient had achieved remission. The criteria for assessing the drug efficacy were as follows: dynamics of subjective complaints, objective assessment of the patient's condition (the presence and severity of clinical symptoms), dynamics of the Dermatology Life Quality Index (DLQI). Results. Neotanin preparations showed a high efficacy in the acute and subacute stages of the inflammatory process as an antipruritic agent. Itching stopped within 5 minutes after the drug application, with the antipruritic effect lasting for an average of 3–4 hours. In 85 % of the patients, marked excoriations were absent on the 3rd day of treatment. Neotanin demonstrated a pronounced anti-inflammatory effect. In 92 % of the patients, the symptoms of erythema and edema were significantly reduced one week after the beginning of treatment, with the manifestations of inflammatory exudation being conclusively decreased. One week following the beginning of treatment, 100 % of the patients demonstrated no oozing lesions. The absence of serious undesirable effects in the patients during the study evidences to the good tolerability and safety of this drug

THE ANGIOTROPHONEUROSES. ERYTHROMELALGIA IN A 11-YEAR OLD CHILD

The article deals with angiotrophoneuroses, a large group of heterogenous disorders with an underlying dysfunction of vascular innervation. A  current classification of vegetovascular neuroses, their triggers and clinical manifestations are described. The main attention is paid to a  rare disease, erythromelalgia that is сharacterized by acute attacks of dilatation of small vessel of the extremities with associated severe pain, skin hyperemia and edema. We present a  clinical case of primary erythromelalgia in a 11-year old child. The complexity of diagnostics and treatment of the case were related to a combination of classical manifestation of the disease with advanced mental problems resulting in autoagressive behavior

Rowell syndrome in dermatological practice (a clinical case)

Rowell syndrome is a  rare cluster of symptoms characterized by clinical manifestation of lupus erythematosus and erythema multiforme (EM). About 100  cases of the syndrome have been reported in medical publications during the last 100 years. This may be related to misinterpretation of the symptoms and subsequent incorrect diagnosis due to its EM-like manifestations. Important clues for the diagnosis of Rowell syndrome are findings of positive rheumatoid factor, anti-nuclear antibodies and other erythematoid markers, as well as additional investigations, in particular, direct immunofluorescence technique. The paper describes a  clinical case of Rowell syndrome in a 16-year old male patient. The diagnosis was challenging due to EM-like skin manifestations and required additional laboratory work-up, as well as the patient's follow-up. The diagnosis of Rowell syndrome was based on the clinical manifestations and on such diagnostic criteria as positive rheumatoid factor and anti-nuclear antibodies, as well as histological and laboratory abnormalities characteristic of the erythematosis. The patient was hospitalized and received the following treatment: prednisolone infusion (2.5 mg/kg/daily for 7 days), chloropyramine (1 mL i.m. twice daily for 5  days), hydroxychloroquine (6.5  mg/kg daily for 5  days), magnesium asparaginate/potassium asparaginate (one tablet (166.3  mg/175  mg) 3  times daily for 7  days), topical methylprednisolone aceponate cream 1% (once daily for 7 days). The treatment resulted in positive changes in the skin lesion and improvement of his general state. This clinical observation gives an example of classic Rowell syndrome proven both by lab and clinical signs, taking into account skin symptoms of lupus erythematosus and EM-like rash