Дифференциальная диагностика келоидных и гипертрофическихрубцов, основанная на различиях в кожной чувствительности

A study of different types of skin sensitivity in patients with keloid and hypertrophic scar tissues was conducted in order to optimize clinical diagnostics of scar hypertrophy of the skin. A symmetrical area of unaffected skin was examined as control. The revealed results suggest a sharp increase of deep skin sensitivity with simultaneous reduction of other types of sensitivity, which was observed in 97% of subjects, as a new differential sign of keloid scar tissues.С целью оптимизации клинической диагностики рубцовых гипертрофий кожи было проведено исследование различных видов кожной чувствительности у пациентов с келоидными и гипертрофическими рубцами. В качестве контроля исследовали симметричный участок непораженной кожи. Выявленные результаты позволяют предложить в качестве нового дифференциального признака келоидных рубцов резкое повышение глубокой кожной чувствительности на фоне снижения других видов чувствительности, которое наблюдалось у 97% обследованных больных

Diagnostic aspects of atopic dermatitis

Atopic dermatitis (AD) is a chronic recurrent inflammatory skin disease that is often familial. Atopic dermatitis leads among all dermatological diagnoses that pediatricians give their patients. There is a tendency to over diagnosis of this dermatosis, which, in turn, determines the vector of research aimed at developing more accurate algorithms for making the correct diagnosis. Currently, there are various diagnostic schemes based on the summation of major and minor AD criteria. If patients have major signs of the disease, the diagnosis of AD does not cause any particular difficulties, however, current diagnostic trends are associated with focusing on minor criteria, that are especially important in subacute, chronic course and incomplete remission. This article presents relevant data on the role of genetic factors in AD development. It describes in detail the AD pathogenesis, where the main role is played by epidermal barrier lesion due to filaggrin protein mutation and body immune dysfunction, and, as a result, the predisposition of patients with AD to skin infection with pathogenic microorganisms. It gives a brief description of AD clinical picture depending on the age of the patient. Special attention is paid to various diagnostic algorithms for AD, among which the most recognized are J.M. Hanifin and G. Rajka diagnostic criteria (1980). All minor AD criteria from this algorithm are described in detail, authors also proposed additional signs of the disease that will help pediatricians to diagnose AD more accurately and select therapy for patients. Considering the fact that skin barrier dysfunction is the basis of this dermatosis, the article shows the high importance of emollients and regenerating agents, affecting the main pathogenesis links. © 2020, Pediatria Ltd.. All rights reserved

Синдром Роуэлла в дерматологической практике (клиническое наблюдение)

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.Синдром Роуэлла - редко встречающийся симптомокомплекс, для которого характерны клинические проявления красной волчанки и многоформной экссудативной эритемы (МЭЭ). За последние 100 лет в научной литературе описано около 100 случаев данного синдрома, что может быть связано с ошибочной интерпретацией симптомов и, как следствие, неточной диагностикой по причине его манифестации высыпаниями по типу МЭЭ. Важное значение в диагностике синдрома Роуэлла имеет выявление положительного ревматоидного фактора, антиядерных антител и других маркеров эритематоза, а также дополнительные методы исследования, в частности прямая иммунофлюоресценция. В статье дано описание клинического наблюдения синдрома Роуэлла у пациента 16 лет. Установление диагноза вызвало затруднения по причине манифестации кожных проявлений по типу МЭЭ и потребовало дополнительной лабораторной диагностики, а также динамического наблюдения. При постановке диагноза синдрома Роуэлла опирались на клинические проявления, а также на такие диагностические критерии, как положительные пробы на ревматоидный фактор и антиядерные антитела, гистологические и лабораторные изменения, присущие эритематозу. Пациент находился в стационаре и получал следующее лечение: инфузионная терапия (преднизолон 2,5 мг/кг/сут в течение 7 дней), хлоропирамин (1 мл 2 раза в день внутримышечно в течение 5 дней), гидроксихлорохин (суточная доза 6,5 мг/кг, длительность - 5 дней), магния аспарагинат / калия аспарагинат (1 таб. (166,3 мг/ 175 мг) 3 раза в день в течение 7 дней), наружно крем метилпреднизолона ацепонат 1% (1 раз в день в течение 7 дней). В результате проведенного лечения у пациента отмечена положительная динамика в течении кожного процесса и улучшение общего состояния. На примере настоящего клинического наблюдения показано классическое проявление синдрома Роуэлла, имеющее как лабораторное, так и клиническое обоснование, учитывая наличие кожных проявлений красной волчанки и высыпаний по типу МЭЭ

Клинические проявления инфекции простого герпеса у детей, страдающих атопическим дерматитом

Atopic dermatitis is a disease of early childhood. Most children are infected with the herpes simplex virus at this age. The changes in the congenital and adaptive immunity in children with atopic dermatitis create precondition for the development of infectious complications, including those caused by herpes viruses. The authors of the article discuss details of various clinical manifestations of herpes infection in children with atopic dermatitis and they carry out differential diagnostics. Particular attention is paid to herpes eczema - the severe complication of atopic dermatitis in the course of disseminated herpes infection.Атопический дерматит - болезнь раннего детского возраста. В этом возрастном периоде большинство детей инфицируются вирусом простого герпеса. Изменения врожденного и адаптивного иммунитета при атопическом дерматите создают предпосылки для развития инфекционных осложнений, в том числе обусловленных герпесвирусами. В статье подробно рассматриваются разнообразные клинические проявления герпетической инфекции у детей с атопическим дерматитом, проводится дифференциальная диагностика. Особое внимание уделено тяжелому осложнению атопического дерматита при реализации диссеминированной герпетической инфекции - герпетической экземе

Herpetic eczema in children with atopic dermatitis: Prognosis, clinical and immunological diagnostics and management tactics

Herpetic eczema (HE), being a manifestation of disseminated herpetic infection, mainly complicates the course of atopic dermatitis (AtD). This is a potentially life-threatening infection for children, the mortality of which, according to the literature, reaches 9%. Early diagnosis of HE helps to reduce the incidence of adverse outcomes and improve treatment quality for these patients. The goal is to improve the management tactics of children with herpetic eczema based on the patient-oriented algorithm for monitoring children with AtD risk groups, taking into account the predictors complex of disease development and severity. Material and methods: the single-center prospective observational study included 150 children aged from 4 months to 18 years with AtD. The main group consisted of 113 children with HE caused by AtD, the comparison group – 37 children with AtD in the exacerbation period not combined with HE. HSV infection is confirmed by determining the virus DNA in blood by the method of polymerase chain reaction. The diagnosis of AtD in children was verified according to the criteria proposed by J. Hanifin and G. Rajka. The severity of AtD at the time of inspection was assessed according to the SCORAD scale. Results: the main predictors of HE development in patients with AtD are: age up to 1 year (increase in relative risk (IRR) 2,86, 95% confidence interval (CI) 7,91/0,68, p<0,001), autumn-winter period (IRR 1,68, 95% CI 5,3/0,15, p=0,018), close relatives with combination of pollinosis and asthma (IRR 2,56, 95% CI – 9,95/–0,16, p<0,001), moderate or severe form of AtD (IRR 0,91, 95% CI – 2,11/–0,17, p<0,001). Laboratory immunological signs of HE developing risk in children with AtD include eosinophilia more than 3•109/l (p<0,001); an increased level of IL8 more than 2 times the norm value (p<0,001); prediction of a severe course of the disease — an increase in total IgE level to 850 kE/l (p<0,017) and an increase TNFα serum concentration above 2 pg/ml (p<0,001). Conclusion: the combination of at least 3 risk factors allows to classify a patient with AtD as a high risk group for HE development with recommendations for nonspecific prophylaxis, namely: separation from patients with manifest HSV infection. If a child has a high risk of HE adverse course, differentiated therapy is necessary, сonsidering the possible accession of a secondary infection and the exacerbation of AtD after HE regression. © 2019, Pediatria Ltd.. All rights reserved

Modern aspects of rendu-osler-weber disease

Rendu-Osler-Weber disease (hereditary hemorrhagic telangiectasia) is a rare hereditary disease that develops in childhood, characterized by vascular dysplasias, multiple telangiectasias of the skin and mucous membranes, and hemorrhagic syndrome of different localization. One of the first and most noticeable signs of the disease is spider veins on the skin and nasal mucous membranes. With lesions of nasal mucosa and gastrointestinal tract, the disease proceeds with frequently recurring bleeding. In chronic blood loss, iron deficiency anemia develops, and in acute cases, a fatal outcome is possible. The article provides a brief historical summary of Rendu-Osler-Weber disease description, etiopathogenetic mechanisms of the disease development, clinical picture with the most typical manifestations, as well as modern diagnostic and treatment criteria. Particular attention is paid to the early diagnosis of the disease. In conclusion, the authors cite their own observation of an 11-year-old patient with Rendu-Osler-Weber disease. © 2019, Pediatria Ltd. All right reserved

Peutz-Jeghers' syndrome in pediatric dermatological practice [Синдром Пейтца-Егерса в детской дерматологической практике]

Peutz-Jeghers' syndrome is a rare hereditary disease inherited by an autosomal dominant type, manifested by a characteristic clinical picture of skin lesions and hamartomas of the gastrointestinal tract. Complications of the disease include bleeding from polyps, anemia, intussusception and intestinal necrosis, as well as a high likelihood of developing malignant tumors. For the first time the syndrome was described at the beginning of the last century, and it is of interest to dermatologists, gastroenterologists, oncologists and surgeons due to the clinical heterogeneity of intestinal and skin manifestations. The article describes a clinical case of a 5-year-old girl with the Peutz-Jaegers syndrome. The patient complained of periodic dull abdominal pain that worsened after eating solid food. During the examination of the skin and mucous membranes the doctors discovered rashes on the face: perioral area, on the red border of the lips and on the mucous membrane of the lips, inside the cheeks, hard palate. Esophagogastroduodenoscopy (EGDS) revealed a polyp on a pedicle in the prepyloric part - it was removed during repeated EGDS under endotracheal anesthesia. Fibrocolonoscopy revealed hyperpigmentation of the dome of the cecum. To confirm the diagnosis, the doctors carried out DNA testing which found a mutation of the STK11 gene. Pigmentation of the perioral area is an early symptom of Peutz-Jeghers' syndrome suggesting optimal examination. Early recognition of the syndrome in children is important in the context of reducing the risk of developing intestinal obstruction, bleeding, and cancer complications in the future. © 2021 National Academy of Pediatric Science and Innovation. All rights reserved

Clinical manifestations of herpes simplex virus infection in children with atopic dermatitis [Клинические проявления инфекции простого герпеса у детей, страдающих атопическим дерматитом]

Atopic dermatitis is a disease of early childhood. Most children are infected with the herpes simplex virus at this age. The changes in the congenital and adaptive immunity in children with atopic dermatitis create precondition for the development of infectious complications, including those caused by herpes viruses. The authors of the article discuss details of various clinical manifestations of herpes infection in children with atopic dermatitis and they carry out differential diagnostics. Particular attention is paid to herpes eczema – the severe complication of atopic dermatitis in the course of disseminated herpes infection. © 2018 National Academy of Pediatric Science and Innovation. All rights reserved