Pathogenetic substantiation of combination therapy for rosacea

Rosacea is a chronic inflammatory dermatosis predominantly damage to the skin of the face, which has a significant negative impact on the quality patients’ lives. The main goal of treatment is to achieve the most complete remission. However, due to the fact that the pathogenesis of the disease is not fully understood, the search for new methods of treatment is especially relevant. Combined use pulsed dye laser and ivermectin drug is presented as alternative pathogenetically substantiated method of therapy. The purpose of the study is to characterize immune disorders and the role of cytokines in the pathogenesis of rosacea, as well as the possibilities of combination therapy based on literature data. An analysis of literature sources from the MedLine, Pubmed, eLibrary databases for the period from 2002 to 2022 was carried out, using the keywords “ivermectin”, “pulsed dye laser”, “rosacea”, “cytokines”, “ivermectin” , “Pulsed Dye Laser”, “rosacea”, “cytokines”

Search for predictors of psoriatic arthritis in patients with psoriasis

Background. Psoriatic arthritis is a chronic inflammatory disease of the joints, spine and entheses that can occur in patients with psoriasis. The prevalence of psoriatic arthritis is 19.7%. In 70% of cases, psoriasis precedes the development of arthritis. It has been proven that a delay in the diagnosis of psoriatic arthritis even by 6 months is associated with a deterioration in long-term radiological and functional results, leading to disability. The problem of early diagnosis of joint damage can be solved by identifying predictors of the risk of developing psoriatic arthritis in patients with psoriasis. Aims. To determine possible predictors for the development of psoriatic arthritis in patients with psoriasis. Methods. The open, uncontrolled, prospective study enrolled 250 patients. The main group consisted of 190 patients diagnosed with plaque psoriasis. The control group consisted of 60 patients with psoriatic arthritis. In order to identify associations of clinical and genetic (HLA-B27 carriage) parameters with the development of psoriatic arthritis, we compared the frequency of occurrence of these parameters in patients with psoriatic arthritis and without. Results. Among 190 patients with plaque psoriasis 128 (67.4%) men, 62 (32.6%) women, aged 18 to 84 years (40.30 ± 15.56), the average duration of psoriasis was 10.09 ± 11.08 years (0–57). Among 60 patients with psoriatic arthritis 39 (65%) men, 21 (35%) women aged 18 to 86 years (44.43 ± 14.15), the average duration of psoriasis was 20.47 ± 13.22 years (2–57), the average duration of psoriatic arthritis was 7.97 ± 9.95 years (0–47). Сlinical predictors for the development of psoriatic arthritis in patients with psoriasis: nail psoriasis (OR = 2.244 [95% CI: 1.245–4.045]); severe psoriasis (PASI ≥ 20) (OR = 2.148 [95% CI: 1.161–3.975]); arterial hypertension (OR = 1.982 [95% CI: 1.031–3.812]); duration of psoriasis over 25 years (OR = 3.365 [95% CI: 1.676–6.756]), р 0,05. Conclusions. The joint consideration of informative predictors will allow us to develop an original multi-parameter mathematical model for calculating the risk of developing psoriatic arthritis in patients with psoriasis

Secukinumab shows significant efficacy in palmoplantar psoriasis: Results from GESTURE, a randomized controlled trial

Background: Plaque psoriasis affecting palms and soles is disabling and often resistant to treatment. Objective: Evaluate the efficacy and safety of secukinumab, an anti-interleukin 17A antibody, in subjects with palmoplantar psoriasis. Methods: In this double-blinded, randomized controlled trial, 205 subjects were randomized 1:1:1 to secukinumab 300 mg, 150 mg, or placebo. The primary endpoint was Palmoplantar Investigator's Global Assessment (ppIGA) 0 (clear) or 1 (almost clear/minimal) response at week 16. Results: At week 16, the percentage of subjects who achieved clear or almost clear palms and soles (or ppIGA 0/1) with secukinumab 300 mg (33.3%) and 150 mg (22.1%) was superior to the percentage achieved with placebo (1.5%, . P < .001). Palmoplantar Psoriasis Area and Severity Index (ppPASI) was significantly reduced with secukinumab 300 mg (-54.5%) and 150 mg (-35.3%) compared with placebo (-4.0%, . P < .001). Dermatology Life Quality Index (DLQI) 0/1 responses from subjects in the secukinumab groups were also significantly higher compared with placebo at week 16 (P < .01) and pain and function of palms and soles was markedly improved with secukinumab as measured by the palmoplantar Quality-of-Life Instrument. Secukinumab 300 mg consistently showed the best outcomes. The safety profile was favorable and similar to previous studies. Limitations: Lack of active comparator. Conclusion: In GESTURE, the largest randomized controlled trial in palmoplantar psoriasis, secukinumab demonstrated the greatest efficacy to date for treating difficult-to-treat psoriasis

A rare form of leishmaniasis, identified in the Russian Federation

Diffuse cutaneous leishmaniasis is a rare form of cutaneous leishmaniasis characterized by an inadequate immune response of the host cells to parasitic invasion (weak T-helper (Th)1 response or Th2 response with the production of interleukin IL-4 and IL-10). The characteristic features of the disease include diffuse nodular eruption, masquerading as leprosy and a frequent association with immunosuppression (HIV co-infection, for example). The Russian Federation is a non-endemic country for leishmaniasis, but this disease can be brought into the country by tourists, immigrants, refugees and military personnel. A clinical case of diffuse cutaneous leishmaniasis and HIV co-infection is presented. The patient was a citizen of Uzbekistan, a country endemic for leishmaniasis. The authors were unable to find domestic scientific publications describing cases of diffuse cutaneous leishmaniasis detected in the Russian Federation. The presented clinical case of diffuse cutaneous leishmaniasis in a patient with HIV is the first in the Russian literature

Narrow-band UVB phototherapy in patients with atopic dermatitis: analysis of the factors determining treatment efficacy

Background. Efficacy the narrow-band UVB phototherapy in patients with atopic dermatitis varies greatly. An important condition for achieving optimal therapeutic effect is the identification of factors that can impact on the efficacy of therapy and considering their influence when prescribing treatment. Aims. The present study aimed to identify the factors which affect the efficacy of narrow-band phototherapy in patients with atopic dermatitis Methods. A prospective, open-label trial was conducted to evaluate the efficacy and safety of narrow-band UVB phototherapy for patients with moderate-to-severe atopic dermatitis. All patients were treated with narrow-band UVB phototherapy four times weekly for 5 weeks. Disease severity was evaluated by SCORing of the Atopic Dermatitis Index (SCORAD) and Eczema Area and Severity Index (EASI). Distribution of patients by the severity of therapeutic effect was evaluated. To compare the efficacy of therapy depending on initial atopic dermatitis severity, initial and cumulative irradiation doses, skin phototype, and smoking status patients were divided into subgroups. Results. 40 patients with moderate-to-severe atopic dermatitis received course of narrow-band UVB phototherapy. After NB-UVB therapy SCORAD and EASI scores reduced from 45.6 ± 11.4 at baseline to 22.6 ± 12.4 (p 0,05) and from 14.4 ± 7.2 at baseline to 4.1 ± 3.9 (p 0,05) respectively demonstrating the efficacy of narrow-band UVB phototherapy in patients with atopic dermatitis. Our investigation showed that tobacco smokers had definitely lower efficacy of NB-UVB phototherapy in comparison with non-smokers. Narrow-band UVB phototherapy had definitely higher efficacy when it is started with an initial dose 0.2–0.3 J/cm2 chosen in compliance with results of MED determing in comparison with an initial dose 0.05–0.15 J/cm2 selected according to skin phototype. Conclusions. Factors that impact on the efficacy of narrow-band UVB phototherapy in patients with atopic dermatitis were identified. It was determined that using higher initial dose is associated with higher efficacy of therapy. The obtained data suggest the opportunity of decrease in efficacy of therapy in smokers with atopic dermatitis

Case report of leprosy in the Russian Federation

A clinical case of leprosy diagnosis in a citizen of the Republic of Chad (lepra-endemic region), а 24 year old male, student is presented. In 2019 the patient received permission to stay in the Russian Federation for educational purposes, entered one of the federal universities, and studied in Moscow, living in a hostel. During these years, he applied to various clinics, complaining of skin rashes and other symptoms characteristic of leprosy, without the effect of the prescribed treatment. In 2023, after contacting the clinic of skin diseases of the I.M. Sechenov First Moscow State Medical University (Sechenov University), was first sent to the The Federal State Research Center of Dermatovenereology and Cosmetology of the Ministry of Health of Russia with suspicion of leprosy. The results of clinical and laboratory studies including bacterioscopic examination of skin scarifications and pathohistological study of the skin confirmed the diagnosis: A30.5 Leprosy, multibacterial form, lepromatous type, active stage. This case presentation testifies to the lack of alertness regarding leprosy, especially among doctors conducting medical examinations of foreign citizens in order to obtain permission to stay in the Russian Federation, which may cause the spread of dangerous infectious diseases on the territory of the Russian Federation

Cutaneous lichen amyloidosis within scratched areas

It is considered that pruritus might be either a predisposing factor of development of cutaneous lichen amyloidosis or its symptom. In this case report we try to elucidate this issue. Case of 27-years old patient of Asian origin with cutaneous lichen amyloidosis is presented. Sites of lesions closely matched the scratched areas. Within the affected area there was a melanocytic nevus, which the patient avoided to touch. The area around the nevus was free from amyloidosis lesions. It proves the role of pruritus followed by scratching in the development of cutaneous lichen amyloidosis patches

The effect of apremilast therapy on skin cytokine levels in patients with psoriasis

Objective — Assessment of phosphodiesterase-4 inhibitor (apremilast) therapy’s influence on skin cytokine levels in patients with moderate-to-severe and severe psoriasis. Material and Methods — An open, uncontrolled study was conducted. 16 patients with plaque psoriasis (13 men, 3 women; mean ± standard deviation (SD) age 35.1±9.7 years, range 21-60) were enrolled. The mean Psoriasis Area and Severity Index (PASI) was 20.7±8.93 (range 10-47). All patients were prescribed apremilast 30 milligrams (mg) per os (PO) Bis In Die (BID). The efficacy of therapy was evaluated by PASI at 14 and 26 weeks of therapy. Lesional skin samples were collected at baseline and weeks 14 and 26. Levels of interleukin (IL)-1β, IL-4, IL-6, IL-10, IL-17A, IL-17F, IL-21, IL-22, IL-23, IL-25, IL-31, IL -33, interferon (INF)-γ, Soluble CD40-ligand (sCD40L), tumor necrosis factor (TNF)-α were measured by microsphere-based suspension array technology (Luminex® xMAP™ system). Results — Levels of cytokines (except IL-4 and IL-33) in lesional skin samples were found to have decreased at week 14 compared with those at baseline. Similar decreases were seen for IL-23, IL-25, IL-31, sCD40L at week 26. In contrast, the levels of other cytokines increased again at week 26, in comparison with baseline. Levels of IL-4 and IL-33 rose throughout the follow-up period. Cytokine levels in lesional skin samples were compared with those of healthy controls both at baseline and during therapy. Conclusion — The results of our study show that administering apremilast therapy to patients with psoriasis can bring the levels of cytokines involved in the IL-23/IL-17 axis in the lesional skin to the level of cytokine in non-lesional skin and to the levels in the skin of healthy individuals

Plasma Zinc Levels in Males with Androgenetic Alopecia as Possible Predictors of the Subsequent Conservative Therapy’s Effectiveness

Androgenic alopecia (AGA) is the most common type of progressive hair loss in man. The search for reliable predictors of the conservative treatment&rsquo;s effectiveness is an urgent problem today. Forty-eight patients with AGA, stages I&ndash;IV by the Norwood&ndash;Hamilton scale, were treated for 4 months with 5% topical minoxidil joints with corrections for trace element and vitamin imbalances. In most cases, the positive therapy&rsquo;s effect was shown in the parietal but not in the occipital area, whereas that effect was observed in others. The attempts to associate the therapy&rsquo;s effectiveness with initially defined genetic, hormonal, and metabolic parameters showed the absence of differences between groups with positive and negative outcomes. Among the studied nutrient parameters (Zn, Cu, Mg, Ca, Fe, and Se, as well as vitamins B12, E, D, and folic acid), differences between these groups was shown in zinc content only. The starting point from a zinc plasma level above 10 &micro;mol/L likely provides the success of the subsequent conservative therapy and correlates with an increase in the hair density and diameter in the parietal area. The integral predictive value of the Zn plasma level was assessed as 72.3% (positive predictive value: &minus;88%; and negative predictive value: &minus;55%)

Analysis of the dynamics of <i>Neisseria gonorrhоeaе</i> resistance to antimicrobial drugs in the Russian Federation for the period 2005–2021

Background. Neisseria gonorrhoeae can rapidly develop resistance to antimicrobial agents due to innate mechanisms for the acquisition of antimicrobial resistance genes. Because of the rapid formation of resistance mechanisms of N. gonorrhoeae to the antimicrobial agents used in gonococcal therapy, the risk of incurable forms of the disease is high. The purpose of the study is to to summarize the results of RU-GASP over a 16-year period and assess the trends of N. gonorrhoeae resistance to antimicrobials used in the regimens of antibiotic therapy of gonococcal infection in Russia. Materials and methods. Study Objective. The study included 5356 isolates of N. gonorrhoeae received from January 2005 to December 2021 in State Scientific Center of Dermatovenerology and Cosmetology, Moscow of the Ministry of Health of Russia under the RU-GASP program from specialized medical organizations of dermatovenerological profile of 37 subjects of the Russian Federation. Primary identification of N. gonorrhoeae was performed using bacterioscopic and bacteriological methods. The cultures identified as N. gonorrhoeae were frozen in a cryogenic medium and transported to SSCDC. Received cultures were verified by biochemical criteria on a VITEK 2 Compact analyzer. For cultures identified as N. gonorrhoeae with less than 99% probability, a time-of-flight ionization mass spectrometer MALDI Microflex (Bruker Daltonics GmbH, Germany) was used for mass spectrometric analysis. Antimicrobial susceptibility testing. Sensitivity testing of N. gonorrhoeae to six antimicrobials penicillin, spectinomycin, ceftriaxone, tetracycline, azithromycin and ciprofloxacin was performed by serial dilution in agar with determination of minimum suppressive concentrations (MSC, mg/L). N. gonorrhoeae sensitivity to antibacterial agents was evaluated according to EUCAST criteria (The European Committee on Antimicrobial Susceptibility Testing, 2022, http://www.eucast.org). Results. The study showed the absence of significant changes in the ratio of sensitive and resistant to the action of antimicrobial drugs strains of N. gonorrhoeae that is a consequence of the effectiveness of the RU-GASP program, which allowed to exclude in time from therapeutic use the drugs for which a high proportion of the identified resistant strains was observed. Conclusion. Analysis of RU-GASP results over a 16-year period confirms the use of third-generation cephalosporins (Ceftriaxone, Cefixime) as the drugs of choice for therapy of gonococcal infection, and the aminocyclic antibiotic spectinomycin as an alternative drug. The continued evolution of the molecular mechanisms of antibiotic resistance of N. gonorrhoeae dictates the need to continue the RU-GASP program