The article presents the data concerning the efficacy and safety of topical corticosteroids (TCS) in psoriasis treatment in the practice of dermatovenerologist. The questions of etiology and pathogenesis of psoriasis are considered; violation of activation of innate and adaptive immunity plays the key role in its development. The basic approaches in psoriasis treatment, based on the international and Russian clinical guidelines, are distinguished. The place of TCS in psoriasis therapy is determined. The authors give the recommendations for the management of patients with psoriasis and the choice of therapy depending on the form and severity of the pathological process with the use of TCS as the first-line therapy of mild and moderate psoriasis on the basis of the modern Russian and foreign recommendations. The article presents the data of own clinical observations of Akriderm SK micronized drug application for treatment of different forms of psoriasis. A detailed description of management tactics and results of therapy in two patients with psoriasis is presented. The high efficacy of topical Akriderm SK drug in mono- and combined therapy in combination with phototherapy in patients with moderate to severe psoriasis has been shown. Based on the analyzed data of foreign and domestic studies, as well as the authors’ own experience, it is shown that the use of Acriderm SK in psoriasis therapy is effective and safe and meets the requirements of modern treatment principles and standards. The experience of its use for treatment of psoriasis patients demonstrated high therapeutic efficacy and low risk of adverse events.

Early diagnosis of skin melanoma is one of the most reliable ways to improve the prognosis for the life of patients with this tumor. Organization of medical care for patients with a high risk of developing melanoma, together with the use of non-invasive diagnostic methods and teaching the patient the principles of prevention and early diagnosis of skin malignancies should improve the survival rates of patients with melanoma. The article discusses the experience of implementing the Organizational model of medical care for patients with skin neoplasms in Moscow, as well as the key rules for managing patients at risk of developing skin melanoma with special emphasis on recommendations to patients for regular self-examination of the skin, lifestyle correction and the use of photoprotective agents.

Allergodermatoses make up the majority of allergic skin diseases in childhood, have a recurrent course and significantly disrupt the quality of life of patients and their families. The constant use of emollients, allowing to lengthen periods of remission and reduce the need for topical drugs, is associated with defects in the skin barrier function. Treatment with topical glucocorticosteroids (TCS) and topical calcineurin inhibitors (TCI), which are the basis of pharmacotherapy, should be carried out differentially, taking into account the localization, stage and activity of the inflammatory process, the area of the lesion, the age of the child and the multifactorial genesis of the disease. The basic principles of rational local therapy include the choice of the degree of activity of the drug, its concentration, dosage form, dosage frequency, duration of use to obtain a therapeutic effect and minimize side effects. In case of severe exacerbation and localization of inflammatory elements on the body and limbs in children, it is necessary to start treatment with class 2–3 THCS. When the process is localized on the face and other sensitive areas of the skin (neck and large folds), it is recommended to use class 7 TCS or give preference to TCI. The duration of a continuous course of TCS therapy in children depends on the severity of the exacerbation and should not exceed 2 weeks. The most effective way to reduce the course steroid load and avoid side effects is the early and correct use of TCS during an exacerbation. The advantages of TCI in comparison with TCS are the low incidence of side effects, the absence of contraindications for use on sensitive skin areas, and the possibility of longer use. The article contains Russian and foreign literature data on the use of THCS and TEC in the treatment of allegodermatosis in children and our own clinical observations of the effectiveness of the use of combination therapy: Comfoderm K cream (methylprednisolone aceponate with ceramides in the base), 0.03% tacrolimus ointment and emollient means - special cream Sensoderm with physiological lipids omega 3–6–9.

Introduction. There is a trend towards rising incidence of psoriasis and increase in the degree of incidence of severe, atypical and treatment-resistant clinical forms of psoriasis in the Russian Federation. In this regard, cases of early disability of patients and deterioration of their quality of life are recorded, which determines the medical and social significance of this disease. In the last few years, a much deeper understanding of the pathogenesis of psoriasis has been gained. This is especially true of the role of T-helper 17 cells, the role of the IL-23 cytokine in the development of the disease, which has resulted in the development of new classes of biological drugs, which creation introduced significant changes in the treatment of psoriasis that has become more effective, safer and convenient for patients. More new biologics undergo clinical trials and receive approvals with each passing year. Among them is risankizumab, interleukin-23 inhibitor, which is a safe and effective drug for the treatment of moderate to severe plaque psoriasis and psoriatic arthritis in adult patients. Interleukin-23 inhibitors are not required to be administered as often as interleukin-17 inhibitors and may have a more favourable safety profile without an increased risk of candidiasis or inflammatory bowel disease. Overall, these highly effective drugs contribute to the improvement of the long-term efficacy of psoriasis therapy due to relief of skin lesions and joint symptoms, as well as to the enhancement of patients’ quality of life and lengthening of remissions.
Purpose. To analyse key information about risankizumab using the results of clinical trials published in the current scientific literature.
Materials and methods. This analysis used literature sources from the international medical databases: PubMed, Cochrane Library, MEDLINE.
Results. Presently, a number of phase III registrational trials of risankizumab in 2,109 patients with plaque psoriasis have been published: UltIMMa-1, UltIMMa-2, IMMvent and IMMhance, as well as an additional side by side comparative study of risankizumab with secukinumab (IMMerge) in 327 patients with plaque psoriasis. The results of these studies were used as the grounds for approval of risankizumab for the treatment of patients with moderate to severe plaque psoriasis and psoriatic arthritis by the Russian Ministry of Health on September 14, 2020. There have also been several reports of interim results of the open-label enhanced LIMMitless study, which included patients from pivotal studies. Our records show that the percentage of patients receiving risankizumab for 3 years (172 weeks) and maintaining PASI 90 and PASI 100 was 88 and 63%, respectively, and the percentage of those maintaining sPGA 0/1 was 88%.
Conclusion. The analysed data showed that risankizumab is one of the most effective target drugs for the treatment of psoriasis and psoriatic arthritis, it has a favourable safety profile and a more convenient dosage regimen as compared with other genetically engineered biologic drugs (GEBD) (the recommended dose of Skyrizi is 150 mg (two 75 mg injections) administered by subcutaneous injection at week 0, week 4, and every 12 weeks thereafter).

The article reports an up-to-date classification of complications of cosmetic procedures and two clinical cases where multicomponent gel based on troxerutin, heparin sodium and depanthenol was used to rehabilitate patients after cosmetic procedures complicated by ecchymosis, hematomas and edema. In the first case a 30-year-old patient had a procedure to give greater volume to her lips and to correct their asymmetry with hyaluronic acid filler. The procedure was complicated by the formation of hematomas and edema. To minimize the edema and hematomas and to avoid the risk of infection the patient was prescribed 0.05% aqueous solution of chlorhexidine bi-gluconate once per day and taking of multicomponent gel based on troxerutin, heparin sodium and depanthenol two times per day for seven days. By the fifth day there was observed a significant decrease in edema of the lip area and almost complete resorption of hematomas. In the second case a 42-year-old patient had a procedure of a biorevitalization with unstabilized hyaluronic acid complicated by the appearance of ecchymosis up to 12 mm in diameter and edema in the periorbital zone. A 0.05% aqueous solution of chlorhexidine bi-gluconate once per day and a multicomponent gel based on troxerutin, heparin sodium and dexpanthenol twice per day for seven days were prescribed as post-procedural rehabilitation. By the fourth day clinical improvement was noted. The edema disappeared, the color changed, the size of the ecchymosis decreased to 4 mm. The ecchymosis disappeared completely on the sixth day. In addition, the main characteristics of troxerutin, heparin sodium and depanthenol as components of a multicomponent gel were considered. A multicomponent gel based on troxerutin, heparin sodium and depanthenol as supportive aid helped to get complications completely cleaned out and significantly reduced the rehabilitation period for these patients. The authors consider it possible to recommend it as a means of post-procedural rehabilitation.

Bacterial skin infections are one of the most common reasons for visiting a dermatologist. A huge number of different microor-ganisms live on the human skin, but sometimes due to some external and internal factors the balance is disturbed, which leads to the predominance of one or more colonies and the subsequent development of the infection. Often staphylococci or streptococci are the cause of pyodermias (this is how skin bacterial infections are usually called). In the treatment of pyodermias, local antibacterial drugs are most often used. But given the free access to antibiotics and their thoughtless use, the sensitivity of many strains of microorganisms to the effects of drugs is reduced, which in many cases makes treatment difficult. According to various data, the sensitivity to fusidic acid remains very high, which makes fusidic acid-based drugs an optimal choice for therapy of bacterial infections. It is worth noting that recent studies have also demonstrated the anti-inflammatory activity of fusidic acid, which has a positive effect on the effectiveness of therapy. In today’s realities, the problem of bacterial skin infections remains as urgent as ever. Prolonged use of personal protective equipment and, in particular, medical masks creates ideal conditions for increased growth of opportunistic microorganisms. In this article, we present a case from our own practice. Impetigo developed in a patient after improper use of personal protective equipment. Fusidic acid topical therapy achieved a good clinical result after only 7 days. Thus, given the prevalence of pyodermias, fusidic acid-based drugs may be the optimal solution to the problem.

Topical corticosteroids are first-line medications in the treatment of an overwhelming number of both acute and chronic inflammatory noninfectious skin diseases. These drugs can be characterized as the drugs of choice in dermatological practice, which is determined by anti-inflammatory, immunosuppressive and antiproliferative effects of corticosteroids. Nevertheless, the use of these drugs in some cases may be limited by the potential risk of adverse side effects, which, in turn, determines a rather widespread corticophobia among patients, as well as among some doctors. In this regard, the current efforts of pharmaceutical companies are focused on the development of topical corticosteroids with the least number of side effects without loss of clinical efficacy. The synthetic carbothioate corticosteroid fluticasone propionate (FP) is a medium strength (class III) synthetic fluorinated corticosteroid for topical treatment of skin conditions. Its molecule has a high degree of lipophilicity, which allows it to be actively absorbed into the skin. The drug has a high affinity to glucocorticoid receptors against the background of the absence of mineralcorticoid activity. In addition, FP is relatively quickly subjected to enzymatic hydrolysis to inactive metabolites. This determines the high clinical efficacy of this drug with minimal risk of both local and systemic adverse events. It is available as cream and ointment with the same efficacy, but with different concentrations (0.05 or 0.005%) of the active substance. This article reviews the pharmacology and safety profile as well as the use of topical FP in clinical practice.

Introduction. Solitary mastocytoma is a rare clinical variant of cutaneous mastocytosis that makes its debut in infancy and early childhood. Сhanges in clinical manifestations at different ages and the rate of regression of the disease are insufficiently covered in the literature.
Aim. To study the clinical manifestations and timing of regression of solitary mastocytoma in children, through retrospective analysis.
Materials and methods. We retrospectively reviewed data from 32 children aged 3 months to 9 years who were on outpatient treatment and observation at the State Budgetary Healthcare Institution “Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology of Moscow Health Department” in the period from 2016 to 2020 inclusive. Diagnosis information obtained from medical records.
Results and discussion. The average age of disease onset was 2.5 ± 0.7 months. Solitary mastocytoma was observed more often in boys than in girls (1.4:1). In 81.2% of children, solitary mastocytoma clinically regressed before the age of 6 years. Delayed regression of rashes in the age range from 6 to 9 years was observed in 18.8% of children. Late correct diagnosis, lack of timely recommendations for care and treatment, traumatization of elements are factors that slow down the regression of the disease. Dermatoscopic examination can be used for dynamic observation of mastocytoma, since the patterns in the foci of regression differ from mature mastocytomas in the absence of yellow-orange areas. A pronounced brown pigment network on a yellow background can be a sign of the activity of the process and a reason for the appointment of symptomatic therapy.
Conclusion. The clinical features of the modern course of solitary mastocytoma are the tendency to multiple rashes, the variety of localization and the long-lasting positivity of the Darier sign. Obviously, clinical monitoring using dermatoscopy and laboratory research methods allows to follow-up the activity of the process and promptly adjust drug treatment. To prevent delayed regression of solitary mastocytoma, traumatization of rashes of any localization should be excluded.

Stress has always been one of the triggers of hair loss. The global pandemic of COVID-19 infection has become such a factor for many people. Considering that the pathogenesis of hair loss in this infection has not been sufficiently studied yet, many authors suggest that, as the infection itself and the associated psychoemotional condition and the therapy can cause diffuse thinning of hair and androgenic alopecia. Several studies demonstrate a link between androgens involved in the pathogenesis of COVID-19 and the possible development of androgenic alopecia. Other researchers have observed many cases of telogen hair loss associated with this infection. In our practice, we also encounter diffuse hair thinning, presumably caused by COVID-19. Often, many patients do not consider necessity of consulting with doctor for hair loss. They look for medical help only when self-medication does not give the expected result. After these attempts to independently conduct therapy in some cases patients develop negative attitude towards certain drugs. In such cases, the doctor’s task is to adequately assess the patient’s condition and offer the optimal therapy in each specific case. Often, diffuse hair thinning of a telogen nature, which has arisen against the background of various infections, can be stopped without the help of drugs. The article describes the experience of applying care products with natural and innovative components in the fight against COVID-19-induced alopecia, which can be applied in the practice of a dermatologist.

Introduction. PPARγ is the most studied PPAR subtype and is expressed predominantly in adipose tissue, heart, colon, kidney, spleen, intestine, skeletal muscle, liver, macrophages, and skin. In the skin, PPARγ controls the genetic regulation of gene network expression involved in cell proliferation, differentiation, and inflammatory responses. PPARγ (Peroxisome proliferator-activated receptor gamma) has only recently come to be considered a key player in the development and pathogenesis of psoriasis and psoriatic inflammatory conditions.
Aim of the study. To study PPARγ gene expression in the affected skin of psoriasis patients in comparison with visually unaffected skin. To study changes in PPARγ gene expression level in psoriasis affected skin in comparison with unaffected skin in patients before and after treatment with low-level laser radiation with a wavelength of 1.27 μm.
Materials and methods. Twelve patients with psoriasis participated in the study. Biopsies from unaffected skin areas were taken at a distance of about 3 cm from the affected skin. Analysis was performed by real-time PCR.
Results and Discussion. We quantitatively measured PPARγ gene expression using RT-PCR in the affected skin of patients with psoriasis in comparison with visually unaffected skin in the same patients before and after treatment with low-level laser radiation with a wavelength of 1.27 μm (the short-wave part of the infrared range). The study experimentally showed a 1.3 ± 0.27-fold decrease in PPARγ gene expression in the affected skin of psoriasis patients on average. Significant increase in over-expression of PPARγ gene up to 2,13 ± 0,47 times was observed after treatment of patients with low-level laser radiation.
Conclusions. PPARγ gene expression may be an indicator of the efficacy of psoriasis treatment at the molecular level, as well as become a new therapeutic target.