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

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

Disease severity, treatment patterns, and quality of life in patients with moderate-to-severe psoriasis routinely managed with systemic treatment: results of the CRYSTAL observational study in Central and Eastern European countries

Psoriasis is a common, life-long skin disease with a significant negative health and societal impact. Data on rates of disease control and treatment strategies are lacking in Central and Eastern European countries. We aimed to describe the real-world disease severity, control, and treatment strategies for psoriasis in patients from Central and Eastern European countries. CRYSTAL (EUPAS36459) was a cross-sectional, retrospective study in adults (18–75 years) from Bulgaria, Estonia, Hungary, Latvia, Lithuania, Romania, and Russia. We enrolled patients with moderate-to-severe psoriasis receiving continuous systemic treatment for ≥24 weeks. We used the Psoriasis Area and Severity Index (PASI) to describe disease severity and the Dermatology Life Quality Index (DLQI) to assess quality of life (QoL) and collected other outcomes [psoriasis work productivity and activity impairment (WPAI-PSO), patient satisfaction] at enrollment. Analyses were descriptive. A total of 690 patients were included in the analyses. Median disease duration was 11.8 years. Current treatment was monotherapy for most patients (95.8%) with either biological (BIO group; 88.4%) or conventional (NON-BIO group; 7.4%) agents. Mean (± standard deviation) absolute PASI scores were 3.5 ± 5.7, 3.1 ± 5.3, and 6.6 ± 7.4 in the overall population, the BIO group, and the NON-BIO group, respectively. Among patients treated with monotherapy, absolute PASI scores ≤1, ≤3, and ≤5 were observed for 44.1%, 72.0%, and 82.6% of BIO patients and 21.6%, 33.3%, and 49.0% of NON-BIO patients. Mean DLQI total score was 3.3 ± 5.1; higher scores were noted for higher absolute PASI. The most impacted WPAI-PSO domain was presenteeism; for all domains, impact increased with increased absolute PASI. A total of 91.8% of BIO patients and 74.5% of NON-BIO patients were satisfied with the current treatment. We observed a better disease control in BIO than NON-BIO patients. However, around half of BIO patients did not reach clear skin status and reported an impact on QoL. An improvement in treatment strategies is still needed in Central and Eastern European countries to optimize outcomes of moderate-to-severe psoriasis

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

Phototherapy combined with systemic agents for mycosis fungoides

The choice of tactics for managing a patient with mycosis fungoides is determined by the stage of the disease. In the early stages of mycosis fungoides, a treatment approach using external therapy and various ultraviolet irradiation spectra (UVB-311 nm and PUVA therapy) is preferable. With insufficient efficiency and / or short remissions in some patients, it is possible to use combined methods in the early stages: PUVA therapy or UVB-311 nm therapy. in combination with systemic therapy, including interferon (IFN) 2b preparations, methotrexate and retinoids. The results of original studies demonstrate an increase in the overall response rate when combining PUVA therapy with IFN- or retinoids in patients with stages IB-IIB. The effectiveness of combined treatment regimens using UVB-311 nm remains insufficiently studied.</jats:p

Congenital epidermolysis bullosa: modern methods of diagnosis and therapy. Prospects for regenerative medicine

Congenital epidermolysis bullosa is a clinically and genetically heterogenous group of hereditary skin diseases characterized by the formation of bullae and/or erosions in response to insignificant mechanical effect. The variety and severity of clinical manifestations of the disease determine the early disablement of patients and the decrease in the quality of life, which requires the development of pathogenetic and etiological methods of treatment. Methods of gene therapy are the most promising direction to study, since they can affect the cause of congenital epidermolysis bullosa.</jats:p

Possibility of combined therapy with an oral phosphodiesterase-4 inhibitor (apremilast) and dihydrofolatereductase inhibitor (methotrexate) in patients with psoriatic arthritis plaque psoriasis

Background: Data on the possible combinations of apremilast with other types of psoriasis therapy is limited.&#x0D; Description of clinical cases: We present the data on the efficacy and safety of combination therapy of the selective phosphodiesterase 4 inhibitor and dihydrofolatereductase inhibitor (methotrexate) for the treatment of psoriasis and psoriatic arthritis in patients with moderate-to-severe plaque psoriasis and active psoriatic arthritis with lack of efficacy of methotrexate in the anamnesis. The selective phosphodiesterase 4 inhibitor (apremilast) was administered according to the prescription. The severity psoriatic arthritis of was estimated by PASI. The effectiveness of therapy was evaluated at week 14. Due to the lack of effect, methotrexate was added subcutaneously at week 14. The effectiveness of combination therapy was assessed at week 26. In both cases, the significant clinical improvement was reached (patients reached PASI 75 and PASI 90), a decrease of the psoriatic arthritis activity according to the DAS28 and DAPSA.&#x0D; Conclusion: These clinical cases demonstrate the efficacy and safety of combined therapy with methotrexate and apremilast inpatients with active psoriatic arthritis and moderate to severe plaque psoriasis.</jats:p

Erythema nodosum as Leprosy reaction

Purpose.To present a clinical case of leprosy exacerbation on the background of ongoing therapy.&#x0D; Materials and methods.A 52-year-old patient with a diagnosis of "lepromatous (cutaneous) leprosy, leprosy LL" (multi-bacterial leprosy, lepromatous form, active stage), has an exacerbation in the form of nodular erythema at 3.5 years after the start of treatment. Due to the exacerbation of the leprosy process, dexamethasone therapy was performed intravenously in a dose of 4 mg/ml 3.0 ml + 0.9% NaCl 200.0 ml daily No. 10.&#x0D; Results. An exacerbation was diagnosed leprosy nodular erythema. The prescription of adequate therapy led to a complete regression of clinical manifestations.&#x0D; Conclusion.The described case is presented in connection with the rarity of this dermatosis.</jats:p

Dermoscopy in the diagnosis of mycosis fungoides

Mycosis fungoides is a primary epidermotropic T-cell lymphoma of the skin, characterized by the proliferation of small and medium-sized T-lymphocytes with cerebriform nuclei. Mycosis fungoides accounts for 60.6% of the total number of all cases of primary T-cell lymphomas of the skin. Diagnosis of mycosis fungoides remains a big challenge in dermatology: the average time for diagnosis from the onset of the disease is 5 years. The difficulty of differential diagnosis with chronic inflammatory dermatosis is due to the similarity of their clinical characteristics, especially in the early stages of the mycosis fungoides. The search for new methods aimed at early diagnosis of skin T-cell lymphoma is one of the most important tasks in dermatooncology. A number of morden studies aimed at assessing the capabilities of dermatoscopy as an additional method for diagnosing mycosis fungoides. Specific dermoscopic pattern of mycosis fungoides were identified: fine short linear vessels, orange-yellowish patchy areas and vascular structure resembling spermatozoa. Description of this dermoscopic pattern can influence the accuracy of diagnosis and timeliness of diagnosis, the prescription of effective methods of therapy in the early stages of the disease, improving the quality and increasing the life expectancy of patients. The article provides an overview of the most up-to-date information on the dermoscopic pattern of mycosis fungoides

Application of biomedical cell products in the treatment of congenital epidermolysis bullosa

Congenital epidermolysis bullosa is a phenotypically and genetically heterogeneous group of genodermatoses, which are characterized by decreasing of skin’s structural protein production up to complete absence or violation of the structure as a result of mutation. Congenital epidermolysis bullosa clinically manifests by the development of blisters on the skin and mucous membranes after mechanical injury. The presence of long-term erosive and ulcerative defects in patients with congenital epidermolysis bullosa reduces the quality of patients’ life and also leads to malignancy of the lesions, as a result of constant stimulation of regenerative processes. Currently, in the treatment of patients with congenital epidermolysis bullosa symptomatic therapy, including prevention of secondary infections, use of pain medication and atraumatic non-adherent wound dressings and correction of complications, is widely used. Nevertheless there are a lot of publications describing the use of skin substitutes, three-dimensional tissue-engineered structures based on auto- and allogeneic cells that promote rapid epithelization of wounds in patients with congenital epidermolysis bullosa. Tissue-engineered skin substitutes can be categorised based on their cellular composition: epidermal substitutes consist of an epidermal layer of stratified keratinocyte sheets with or without an underlying acellular dermal layer containing scaffolding; dermal substitutes contain fibroblasts embedded within a scaffolded dermal matrix; composite substitutes are composed of an epidermal layer of stratified keratinocyte sheets and an underlying scaffolded dermal layer containing fibroblasts. The most prospective and at the same time the least studied direction of congenital epidermolysis bullosa treatment is the use of a combined skin equivalent created on the basis of keratinocytes and fibroblasts, which mixes the advantages of epidermal and dermal grafts