Introduction. With the onset of the COVID-19 pandemic the dermatological manifestations of the infection are widely discussed along with the correct management tactics for patients with severe chronic dermatoses, primarily those on immunosuppressive therapy. Immunocompromised patients are overly vulnerable to infections, which is especially important in the context of the pandemic. The article provides up-to-date literature information regarding the general risks of infection in patients receiving systemic immunomodulatory agents for the treatment of psoriasis, as well as evidence based treatment recommendations, including the example of our own clinical experience of using targeted therapy during the COVID-19 pandemic.
Purpose of the study. The aim of the study was to analyze the therapeutic efficacy and safety of the systemic immunomodulatory drugs therapy in the context of the global COVID-19 pandemic.
Materials and methods. The study included 142 patients with psoriasis receiving GEBD and small molecules therapy at the Department of Anti-Cytokine Therapy and Efferent Methods of Treatment of MNPCDK DZM. All patients were examined to determine their level of IgM and IgG antibodies to the SARS-CoV-2 virus strain in the blood serum. All patients continued to receive therapy according to their individual dosing regimen. The study was conducted at a time of high morbidity in the city of Moscow.

Results. The overall morbidity among the studied patients was 13.4% of which the majority were patients with an asymptomatic course of the disease. It should be noted that there was a low incidence rate among patients receiving therapy with IL-17 inhibitors (secukinumab, netakimab).
Conclusion. Our study confirms worldwide records that there is no evidence of an increased risk of COVID-19 among patients receiving targeted therapy for psoriasis. In our opinion, the discuntinuation of the current treatment can lead to unjustified risks, such as a relapse of psoriasis, including with severe manifestations and subsequent possible ineffectiveness when resuming therapy.
Potentially, the termination of therapy that suppresses the production of proinflammatory cytokines will lead to an increase in the “cytokine storm” and a worsening of the course of viral infection when it occurs.

Introduction. The article provides latest data on modern methods of treating rosacea. The results of own clinical observations of patients with moderate to severe papulopustular rosacea receiving combination treatment and a comparative analysis of the efficacy of various therapy regimens are presented.
Objective of the study. The aim of the study was to conduct a comparative analysis of the therapeutic efficacy of combination therapy using the ivermectin 1% topical drug combined with systemic therapy drugs (doxycycline, minocycline, isotretinoin).
Materials and methods. We observed 37 patients with moderate to severe papulo-pustular rosacea subtype. The patients were divided into 4 groups (A, B, C, D). Patients in the control group received monotherapy with 1% ivemectin topical drug, patients in the other groups received combination therapy (1% ivermectin combined with low-dose doxycycline, minocycline and isotretinoin). The efficacy of the therapy was evaluated by measuring rosacea severity on the Scale for Diagnostic Assessment of Rosacea (SDAR), clinical manifestations according to the IGA (Investigator Global Assessment) criteria, and by assessing the patients' quality of life using the DLQI (Dermatology Life Quality Index) questionnaire before and after 3-month treatment.
Results. The comparative analysis of changes in severity indicators of the skin process and quality of life in patients with moderate to severe papulopustular rosacea after topical and combination therapy showed that the results of the treatment in patients receiving combination therapy were more significant than those in the group receiving monotherapy.
Conclusion. The concomitant use of 1% ivermectin and systemic drugs is most effective in patients with severe papulopustular rosacea subtype. The combination treatment tailored to the clinical forms and severity of rosacea allows to optimize the clinical results of the therapy, which significantly affects the patients' quality of life and opens up potential for an individual approach in the algorithms for the treatment of rosacea.

Mycotic infections of the feet are common fungal infections in our time. According to some reports, about 10% of the world's population suffer from these infections. Men suffer from foot mycosis more often than others. Foot mycosis can manifest itself in three clinical forms: interdigital, plantar and vesiculopapular. Foot mycosis is often combined with onychomycosis or becomes a risk factor for its development. Many diseases, such as diabetes mellitus, vascular diseases, obesity are risk factors for foot mycosis. But what is important is that young and middle-aged people who lead an active lifestyle are at risk. It has long been established that public places such as gyms, swimming pools, baths and saunas are a source of mycotic infections. The internal climatic environment of footwear also has a significant impact on the development of foot mycosis. Closed shoes with high internal temperature and humidity create ideal conditions for dermatophyte growth. That is why people who prefer closed, even cloth shoes, or office workers, who are forced to constantly wear closed shoes, often suffer from foot mycosis and other fungal infections.
The main problem in the treatment of foot mycoses is adherence to the prescribed treatment. In our practice, mycotic lesions are more common in people who lead an active lifestyle and are unable to adhere to a long course of therapy. Indeed, the treatment of mycosis often involves a two-week application of some topical antifungal agent. It is optimal to prescribe a single application of terbinafine film forming solution to such patients. This drug ensures the clinical effectiveness of therapy as it keeps antifungi-cidal activity for 13 days from the date of application and high adherence to treatment.

Psoriasis is a chronic inflammatory skin disease that is currently viewed as a systemic process due to its association with many comorbid conditions. With the appearance of genetically engineered biological drugs (GEBDs), the treatment of psoriasis has undergone significant changes due to their high efficiency and favorable safety profile. It has been clinically proven that the use of this type of therapy has a positive effect, including on comorbid diseases. However, it must be highlighted that some types of drugs can have a negative effect on the course of these conditions. The characteristics of each individual drug, such as the rate of onset of remission, long-term efficacy, safety profile and effect on comorbidities are different. A better understanding of these characteristics leads to the correct personalized choice of therapy, hence to improved survival of drugs, patient satisfaction and minimization of the impact of psoriasis on the quality of life of patients.
This article examines the efficacy and safety of biological drugs in patients with psoriasis, discusses their effect on concomitant diseases pathogenetically associated with psoriasis.
To date it is known that the signaling pathway IL-23 / IL-17 plays a key role in the pathogenesis of psoriasis. Promising results are shown by the use of a biological drug aimed at inhibiting IL-23, namely the IL-23 blocker guselkumab. In addition to the high level of therapeutic response in psoriasis, other properties oa the drug have been identified - it has also shown efficacy in patients with concomitant Crohn's disease. Studies describe positive responses in the guselkumab treatment of psoriasis with “difficult” localisations, psoriatic arthritis and Hidradenitis Suppurativa, and its use in patients with cardiovascular risks did not lead to any manifestations of negative dynamics. Thus, further study of the effect of the IL-23 blocker on comorbid pathologies in psoriasis is a promising area.

Over the past decade, dermatological practice has seen an increase in the number of patients suffering from skin and subcutaneous tissue diseases. Annually, 6.4-6.9 million new cases of this group of diseases are registered, which encourages the constant search for new drugs and the continuous improvement of methods and schemes of application of proven drugs. Topical corticosteroids, despite more than 65 years of history of use in the treatment of patients with steroid-sensitive dermatoses, have not lost their relevance. At present, they have no therapeutic alternative in terms of speed of onset and anti-inflammatory activity, so they are essential in the treatment of many skin pathologies. One of the trends in modern pharmacology is not so much the production of new active molecules of TCS or their modifications, as the creation of new pharmacological forms of known molecules - micronized, nanonized, which give the drug the most important property -increased bioavailability. This advanced technology is actively used in the production of domestic topical drugs of Akriderm lines, which make a major contribution to the program of import substitution and drug availability for the population. The optimal combination of ingredients of the foundation of these drugs complements and potentiates the therapeutic effect of steroid. For more than 30 years in clinical practice, a combination of 0.05% betamethasone dipropionate, 0.1% gentamicin sulfate and 1% clotrimazole (Triderm, Akriderm GK) is used. Many years of positive clinical experience of dermatologists using this fixed combination proves the validity of its use in many clinical situations when bacterial and fungal infection is involved. An open randomized comparative study conducted by Russian dermatologists on the efficacy and safety of Akriderm GK (cream) and Triderm (cream) in the complex treatment of eczema showed similar profiles of high clinical efficacy and safety of both drugs.

Introduction. Atopic dermatitis (AD) is one of the most common skin diseases. The prevalence of atopic dermatitis among children is up to 20%, among adults - 2-8%. According to the form, there are mild, moderate and severe AD. Over the past decades, there has been an increase in the incidence of AD, its course is becoming more complicated, and the outcome is becoming more difficult. In this regard, the search for new successful treatment methods, as well as a detailed analysis of the currently used treatment regimens, is an urgent task. Goal. Measure the distribution of patients with AD by type of course (mild, moderate, severe) with a description of the patient's path, including the most important moments of decision-making, drivers of switching, changes in therapy, the main groups of influence and identify the main information requests/needs of patients with AD.
Materials and methods. The study involved 700 patients, including 96 patients with moderate to severe form and 116 with severe form. All patients were diagnosed with AD and had at least one exacerbation in the last year. The age of the patients was 18-60 years. Results. The data obtained show that patients with moderate to severe AD make up about 25% of all patients with AD, including patients with severe ad - about 5%. Antihistamines are most often used by patients with AD, and the drug in this category is most often referred to by patients as the “main” drug for AD. More than half of patients (60%) with moderate to severe AD have used systemic steroids and/or cyclosporins over the past year. Patients with severe AD are significantly more likely than other groups to use steroids and immunosuppressants. The recommendation of a doctor (most often - a dermatologist in a municipal clinic or a skin and venereal clinic) is the most significant factor determining the choice of a drug for the treatment of atopic dermatitis. Conclusions. The data obtained indicate the need to conduct special educational activities with patients such as “schools of atopic dermatitis”, informing patients about the features of lifestyle in AD, theoretical aspects of treatment and skin care.

Atopic dermatitis is a multifactorial genetic inflammatory skin disease associated with disturbances of skin barrier function affected by predisposition to IgE-mediated hypersensitivity, which is characterized by itching, chronic recurrent course of the disease, age-related features of localization and lesion morphology, and requires the long-term and permanent treatment.
Treatment is based on the continuous use of emollients, topical calcineurin inhibitors, topical glucocorticoids, and hygienic skin care.
The mechanisms of the atopic dermatitis development are primarily based on a genetic predisposition to allergies, failure of the normal development of congenital and acquired factors of the immune system, as well as the influence of environmental factors and various trigger factors, such as allergenic (food, indoor, epidermal, fungal allergens, etc.). and non-allergenic (tobacco smoke, pollutants, psycho-emotional stress, concomitant chronic and acute diseases, mainly ARVI, etc.).
It has been established that atopic dermatitis is characterized by the epidermal barrier dysfunction leading to excessive tran-sepidermal water loss, increased permeability of the epidermis, the penetration of allergens and microbial agents via the skin and eventually to sensitization to allergens and the development of specific allergic skin inflammation and atopic march with the sequential development of other atopic diseases.
Modern therapeutic strategies are actively aimed at repairing the epidermal barrier, preventing sensitization and atopic march development. This article describes the features of the epidermal barrier dysfunction in atopic dermatitis, lists the methods of its restoration and ways to prevent subsequent exacerbations using local therapy and emollients, and presents 3 clinical cases.

Throughout human history, women have paid great attention to the beauty of their hair, and modern women are no exception. About 63% of young American women use different nutritional supplements to prevent hair loss. Diffuse hair loss is quite common in women and can occur against the background of various events: pregnancy, pre- and post-menopause, chronic diseases, etc. The most common is telogen effluvium (TE), which begins 2-3 months after the trigger event. Usually, TE process stops on its own, but can also become chronic. For many women, pregnancy and associated psycho-emotional stress become the triggering event, and in 75% of cases hair loss can become chronic.
In fact, TE is a violation of the hair growth cycle. First of all, it is necessary to exclude the trigger factor from the patient's life and only then to start normalizing the hair growth cycle and improve the quality of hair follicle nutrition. The most effective topical remedy for the treatment of diffuse hair loss is minoxidil. The reasons for its clinical effectiveness have not been fully studied, but it is known that it prolongs the hair growth phase. Unfortunately, after cancellation of the drug, hair loss is often renewed. Avoiding these effects is possible with a comprehensive approach to therapy. Inclusion of additional components in the therapy scheme, such as vitamin and mineral complexes, growth stimulants, specialized care products, allows to maintain and improve the results of treatment with minoxidil.

Psoriasis is a chronic immune-mediated disease that is accompanied by a significant number of comorbid pathologies. Damage to the nail plates (psoriatic onychodystrophy) is widespread among patients with psoriasis and is associated with significant functional as well as psychosocial impairments. Despite the fact that nails constitute a small percentage of the surface of the human body, the damage to this particular area can lead to a deterioration in the quality of life and irreversible disability. In addition, studies have shown that nail psoriasis is indicative of a more severe course of the disease and it can also be associated with psoriatic arthritis or it can be a predictor of its development. Current treatment options for psoriasis accompanied by the nail plates damage include many topical and systemic methods, however, patients often report dissatisfaction with the results of treatment due to low efficacy or many side effects. Achieving higher efficiency is possible with the use of biologic therapy. Currently, a wide range of biologics have been developed that modulate key elements in the immunopathogenesis of psoriasis.
The pathogenesis of psoriasis is a multifactorial process, however, it is the IL23 / Th17 signaling pathway that is key in this process. Interleukin-17A is the principal effector of this pathway and overexpression of IL-17A leads to epidermal hyperplasia and an excessive inflammatory response seen in psoriasis. Therefore, interleukin-17A is a promising therapeutic target.
Considering the critical pathogenetic role as well as the high efficacy and safety of IL-17A inhibitors, the study of their effect on the psoriatic onychodystrophy manifestations is of great clinical importance.
Netakimab is the first Russian original IL-17 inhibitor which is a promising modern agent for the treatment of moderate-to-severe plaque psoriasis. The obtained real clinical data indicate the high efficacy and safety of the use of Netakimab in patients with both plaque psoriasis and «severe» psoriasis in difficult to treat localizations, such as damage of the nail plate.

Introduction. Psoriasis is a typical complex multigenic and multifactorial disease with heterogeneous genetic heredity, which requires the interaction of genes both with each other and with environmental factors. STAT3 (Signal Transducer and Activator of Transcription 3) has only recently been considered a key player in the development and pathogenesis of psoriasis and psoriatic inflammatory conditions.

Aim of the study. To study the expression of the STAT3 gene in the affected part of the skin of psoriasis patients in relation to the visually unaffected part. To study the change in the STAT3 gene expression level in psoriasis-affected skin as compared to nonaffected skin in patients before and after treatment with low-level laser radiation at a wavelength of 1.27 pm.
Materials and methods. The study involved 12 psoriasis patients. Biopsies from the unaffected skin were taken at a distance of about 3 cm from the affected skin. Real-time PCR analysis was performed.
Results and discussion. The expression of the STAT3 gene was quantitatively measured using RT-PCR in the affected part of the skin of psoriasis patients compared to the visually unaffected part of the skin of the same patients before and after treatment with low-level laser radiation with a wavelength of 1.27 gm (short-wave infrared). As a result of the study, an increase in the expression of the STAT3 gene in the affected part of the skin of psoriasis patients of an average of 3.96 ± 2 times was experimentally shown. A decrease in gene expression was observed in psoriasis affected skin compared to samples of non-affected areas. After treatment of patients with low-level laser radiation, a significant reduction in the expression of the overexpressed STAT3 gene to 1.75 ± 0.5 times was observed.
Conclusions. The transcription activity of the STAT3 gene can be an indicator of the efficacy of psoriasis treatment at the molecular level and can also be a new therapeutic target.

Introduction. Exogenous, in particular, environmental factors are among the most significant factors affecting the course of a number of dermatoses. A study of the effect of chemical use in agriculture on dermatological morbidity was conducted.
Objective. To assess the features of dermatological morbidity in rural areas, depending on the load of mineral fertilizers per hectare of arable land and per capita.
Materials and methods. The object of the study was persons aged 18 to 68 years living in two rural areas of the Tashkent region: Chinaz district - cotton sowing; Bostanlyk district - horticultural. Our research was used materials of statistical reporting on the volume of mineral fertilizers used, conducted screening testing, clinical examination and history taking.
Results. The incidence of dermatological diseases was 2,5 times higher in the cotton growing area compared with the horticultural region (94,1 versus 38,2, p < 0,001). A comparative analysis of clinical manifestations in persons with dermatological diseases of two rural areas showed a higher degree of activity of the skin pathological process in the cotton growing area especially among people with diffuse and complicated variants of atopic dermatitis.
Conclusion. Allergic diseases predominate in the structure of skin pathology in the examined areas of the Tashkent region. In a cotton-growing area, the manifestations of allergic dermatitis are characterized by a more severe course and frequent relapses. The results of the study show that both the dermatological service and the agricultural chemical management system of the Republic need to apply best practices to improve quality and to ameliorate problems.