The paper highlights modern views on the metabolism of vitamin D in the human body. The analysis of the literature data on the mechanisms of the effect of vitamin D deficiency on the pathological processes occurring in the skin with psoriasis is carried out. It is known that psoriasis is associated with a high prevalence of metabolic syndrome, diabetes mellitus, and cardiovascular diseases. There is a direct correlation between a decrease in vitamin D levels and an increased risk of developing metabolic syndrome and cardiovascular mortality, including in patients with psoriasis. Data on the possibility of using vitamin D in dermatology are presented. Based on international and Russian clinical recommendations, the place of oral colecalciferol preparations in the prevention and correction of vitamin D deficiency and deficiency has been determined. The use of oral vitamin D for the simultaneous treatment of psoriasis and metabolic syndrome reduces the risk of cardiovascular diseases and type 2 diabetes mellitus. We analysed the international and domestic recommendations for the treatment of vitamin D deficiency and insufficiency, the use of which makes the oral administration of vitamin D3 (cholecalciferol) optimal for the treatment and prevention of vitamin D deficiency, as the results of several studies showed a higher efficacy of vitamin D3 vs vitamin D2. Vitamin D3 is found in vitamin D-fortified foods and is available as dietary supplements and drugs. The bioavailability of vitamin D in dietary supplements may differ depending on the used vehicle substance.

Atopic dermatitis is a chronic inflammatory skin disease linked to a genetic predisposition and accompanied by acute inflammatory manifestations that develop due to abnormality of skin barrier properties and changes in both innate and adaptive immune responses. The high risk of developing complications of this disease caused by skin and systemic infections is one of the most urgent problems of modern health care. However, infectious complications of atopic dermatitis may include skin and soft tissue infections, herpetic eczema, bacteremia, osteoarthritis, myelitis, septic arthritis, and endocarditis. Skin barrier defects, type 2 immune-mediated inflammation, Staphylococcus aureus colonization, and skin dysbiosis are main predisposing factors for an increased incidence of infectious complications of atopic dermatitis. The development of infectious complications of atopic dermatitis may be prevented by comprehensive treatment of exacerbations of the underlying disease, sanitation of chronic infection foci, as well as restoration and maintenance of the skin barrier function. The use of special moisturizers and emollients for skin care during exacerbation and remission is an important and integral part of therapeutic and preventive measures.

Emollients are medical cosmetic products that are close to the natural lipid skin barrier in composition. They not only effectively soften and moisturize the skin, but also restore damaged protective properties. Additional components of emollients with anti-inflammatory and antimicrobial activity are an optional, but desirable condition to prevent recurrence of the disease and reduce the risk of developing a secondary infection. Thus, not only special skin care drugs, but also products for patients with atopic dermatitis, can contribute to the development of antibacterial protection and prevent the development of infectious complications.

Introduction. So far, a large number of skin scars treating methods have been proposed and tested. The use of platelet-rich plasma (PRP) is currently being considered as one of the most promising approaches to skin scar treatment.

Aim. Clinical efficacy and safety evaluation of complex treatment of post-acne scars using PRP.

Materials and methods. An open, randomized, prospective study was conducted in parallel groups. The study included 78 patients with post-acne scars, then randomized into 2 groups. Group 1: 36 patients receiving platelet-rich plasma (PRP); group 2: 42 patients receiving complex treatment with PRP and fractional radiofrequency ablation (PRP + FRF). PRP procedures using the micro-papular technique in group 1 were carried out 5 times with an interval of 2 weeks. The combination of PRP + FRF in group 2 was performed according to the following: the first procedure – FRF, two weeks later – PRP using the micro-papular technique. Then after 2 weeks FRF was performed again, and so on. The total number of procedures of both techniques was 10.

Results and discussion. As a result of the treatment, in all patients with post-acne, the clinical indicators of the severity of skin scarring changes decreased significantly, while the most noticeable dynamics were common for patients in group 2. The scars assessment using the Vancouver scale showed that 6 and 12 months after treatment, the severity of objective components and the severity of subjective sensations decreased in most patients. The severity of their own attitude to persistent defects also decreased. Analysis of the frequency of adverse reactions during treatment and in the early period showed that there were no significant intergroup differences in individual adverse reactions. The overall frequency of adverse events in the long-term period also did not significantly differ.

Conclusion. The results of the study indicate that the use of PRP in the complex treatment of scarring is a clinically effective and safe method of treatment and allows you to expand the range of therapeutic approaches for scarring skin deformities.

Hand eczema is a common disease – up to 5% in the general population. In addition, eczema is closely related to atopy and, like atopic dermatitis, to a mutation in the FLG gene. In addition to genetic factors, eczema is caused by external irritants and toxic substances. Eczema often occurs in families with atopic diseases, including asthma, allergic rhinitis/hay fever (and food allergies), and atopic dermatitis. These diseases share a common pathogenesis and often occur together in the same person and/or family. Eczematous rashes are often accompanied by itching. This symptom can lead not only to sleep disturbances but also to secondary infections. According to some data, the rate of infections in eczema can be more than 70%. In such cases, the drugs of choice are combined glucocorticosteroids (GC), which in addition to GC contain an antimycotic and an antibiotic. Our practical experience shows the high effectiveness of the combination of beclomethasone dipropionate, gentamicin, and clotrimazole not only in cases of eczema complicated by secondary infection but also in patients with other infected chronic dermatoses. This article reviews these and other practical aspects and problems in the treatment of hand eczema, discusses the etiological factors that lead to the development of the disease, and presents current data from clinical recommendations and guidelines for the treatment of eczema.

Psoriasis is a chronic immune-mediated inflammatory disease in which the pathological process quite often involves the nail apparatus. Psoriatic onychodystrophy is considered a serious psychological and social problem, as nail lesions are not only a cosmetic defect, they can also complicate daily activities, including employment, ability to work and generally impair the quality of life of patients. In addition, numerous studies and clinical practice show that nail lesions in psoriasis are also associated with a more severe course of the skin process, and are rather torpid to therapy. Moreover, psoriatic onychodystrophy is considered as a form of enthesitis, which is in fact an important predictor of the development of psoriatic arthritis. Various topical, systemic and physiotherapeutic options have been recommended in the therapy of psoriasis with nail plate damage, but the effectiveness of these therapeutic methods is in most cases insufficient and the search for highly effective treatment is of great clinical importance at present. Taking into consideration the critical importance of interleukin (IL)-17 in the pathogenesis of psoriasis, its inhibitors allow to achieve a stable remission of cutaneous and joint processes, thus, it is promising in the therapy of psoriatic onychodystrophy. The article presents the literature data on epidemiology, clinical picture of nail changes in psoriasis, the review of effective pathogenetic methods of psoriatic onychodystrophy therapy and personal clinical observations of patients with severe psoriasis with nail plate damage treated with Russian interleukin 17A inhibitor – Netakimab. These observations allow to draw a conclusion about high efficacy of netakimab in the therapy of patients with psoriasis including the presence of such hardtop-treat localizations as nail lesions.

Hand eczema is a common multi-etiological disease manifested by evolutionary polymorphism of rashes. Hand eczema develops against the background of altered reactivity and genetic predisposition under the adverse effects of endogenous and exogenous factors. Hand eczema has a chronic course and is characterized by a wide range of clinical manifestations. The prevalence of eczematous lesions of the hands among the adult population is 1–2%, and among all skin diseases – 30–40%. The disease has an extremely negative impact on the quality of life, ability to work, career prospects and the social status of a person. The long course of eczematous lesions of the hands can be complicated by a secondary infection: bacterial and mycotic flora. Therefore, choosing the right and effective treatment for hand eczema is a particularly difficult task for a dermatologist. In recent years, a multicomponent drug based on gentamicin sulfate, dexpanthenol, mometasone furoate and econazole nitrate has been widely used for the treatment of hand eczema due to its high efficacy, tolerability, and safety. The use of this multicomponent drug in monotherapy for hand eczema is effective, leads to clinical remission and restoration of the quality of life of patients and is not accompanied by side effects and complications. This review focuses on the epidemiology, clinical features, and treatment options for hand eczema. Clinical experience with the use of a multicomponent drug in patients with hand eczema complicated by infection is also given.

Introduction. Psoriasis is a common chronic immune-mediated inflammatory disease that affects the skin, nails, and joints. Despite the presence of many scientific and clinical studies, the problem of the prevalence of concomitant pathology in children with psoriasis, depending on the age category, remains poorly understood.

Objective. Study of the type and frequency of detection of concomitant diseases in children and adolescents with psoriasis, depending on the age category.

Materials and methods. Were examined 68 children with psoriasis from 5 to 18 years old, of both sexes, receiving treatment in a multidisciplinary clinic at the clinic of the Tashkent Pediatric Medical Institute. Anamnestic data were studied, general clinical studies were carried out, including biochemical and hormonal studies, depending on the type of concomitant pathology.

Results. Studies have shown that most often concomitant diseases in psoriasis in children are characteristic of the adolescent group of patients, and the most common diseases were endocrine diseases (61.8%) in combination with metabolic disorders in the form of obesity of varying degrees (22.06%) and hyperlipidemia (16.2%). At the same time, in adolescents, the incidence of thyroid pathology is 1.7 times higher than in children from the younger age group, against the background of a high incidence of chronic diseases of the upper digestive tract (28.9% versus 17.4%). At the same time, malabsorption syndrome was more typical for children of the younger age group (13% versus 4.4%).

Conclusion. The most common concomitant diseases are endocrine pathology (61.8%) against the background of metabolic disorders (38.2%), as well as chronic diseases of the gastrointestinal tract (25%), and the incidence of these pathologies increases with the age of children. These facts should be taken into account when carrying out complex medical and recreational work with these patients in an outpatient setting.

The concept of the exposome, formulated more than fifteen years ago, is increasingly discussed in the modern scientific literature. The term “exposome” is understood as a cumulative measure of the impact of environmental factors on an individual throughout his or her life (from the prenatal period to death) and the biological response associated with it. The sum of these factors has a significant impact on the occurrence, course, and treatment efficacy of multifactorial diseases. The skin is a border organ and is constantly exposed to environmental influences, i.e., it is a target for the exposome. The influence of the latter components has been described in skin aging, atopic dermatitis, and malignant skin neoplasms. Acne is one of the most common chronic inflammatory dermatoses. Over the past decade, the worldwide increase in the incidence of acne, its early onset and a prolonged course, affecting adult men and women, has been noted. The review presents an analysis of the data on the effects of the components of the exposome – diet, medications, stress, and pollutants - on the course of acne. Particular attention is paid to the few data on the nature of interaction between the components of the exposome and the skin microbiome, which, on the one hand, is involved in the pathogenesis of dermatoses, including acne, and, on the other hand, is changed under the influence of exposome factors, acting as an intermediary between the environment and the human body. The search for environmental factors has at least two objectives: the discovery of potential pathogenetic links, the strength of their relationship with the clinical manifestations of the disease to develop new therapies aimed at new targets; and the creation and recommendation of a protective regime for factors with a proven effect on the course of the disease, for patients suffering from acne.

Psoriasis is an immune-mediated, chronic inflammatory skin disease, which is currently regarded as a systemic process given its association with multiple comorbid conditions. In psoriasis, there is a complex interaction between T cells and keratinocytes. The pathogenesis of psoriasis is not fully understood, but the IL-23/Th17 pathway is known to play the key role in the development

of the disease. With the advent of genetically engineered biological drugs (GEBD), the treatment of psoriasis has undergone significant changes due to their high efficacy through targeted effects. Guselkumab is the first drug for the treatment of moderate to severe psoriasis to target the p19 subunit of interleukin (IL) 23. The efficacy of guselkumab has been demonstrated in a number of clinical trials. To date, only a few case studies from actual clinical practice have been published in the literature reflecting the use of guselkumab in severe psoriasis, including long-term drug survival and continued efficacy in patients with comorbidities. The article reviews the results of key efficacy studies of guselkumab and presents its own clinical case studies of successful use of the drug. It is noted that guselkumab is able to replicate the results obtained in studies in real clinical prachttps tice. However, the cases presented are also of interest in view of their concomitant metabolic syndrome, obesity, which often makes it difficult to respond to therapy. This group of patients is usually characterised by a particularly torpid course of psoriasis and a certain refractoriness to the ongoing treatment. Thus, guselkumab has an effective and safe profile, in addition it is convenient to use, and the improvement in the quality of life of patients during therapy makes it promising as a first-line GEBD therapy in the treatment of psoriasis.

The post-treatment period plays a great role in the prevention of complications and shortens the rehabilitation time. The article provides up-to-date international statistics on the number of cosmetic procedures performed annually according to the International Society for Aesthetic and Plastic Surgery (ISAPS). A successful clinical experience of using a repair cream con taining oat plantlets extract, l-ALA-l-GLU dipeptide and hyaluronic acid as post-procedure care on the example of 2 patients is described. In the first case, a 32-year-old patient presented with postacne scars underwent a fractional radiofrequency ablation procedure followed by application of a cream with oat plantlets extract on the left side of the face, and a cream with dexpanthenol on the right side for 10 days. 5 minutes after application on the left side, the patient noted a pronounced reduction in burning, tingling, itching and soreness sensation. The entire post-treatment period also was faster and more comfortable on the side of the face, where the cream with oat plantlets extract was applied and ended successfully by the 8^th day after the procedure. On the comparison side, the full rehabilitation process took 10 days. In the second case, a 27-year-old patient with acne, after a chemical peeling procedure, as a final remedy and further post-procedure care used the cream with oat plantlets extract on one side of the face, and a cream recommended by the manufacturer of peeling systems on the other side. When re-examined after 7 days, there was also a faster regression of inflammatory elements, post-procedural erythema and edema, dryness and discomfort after peeling were less pronounced on the side of the face where the cream with oat plantlets extract was applied. Repair cream containing oat plantlets extract, l-ALA-l-GLU dipeptide, and hyaluronic acid showed excellent efficacy and tolerability, had synergistic efficacy (moisturizing, healing, preventing aesthetic defects). The authors consider to recommend it as a mean of post-procedural rehabilitation.

Introduction. Colonization of the skin with S. aureus and S. epidermidis in children with atopic dermatitis leads to the initiation of inflammation and worsening of the disease. The control of overcolonization with S. aureus is an important issue in pediatric dermatological practice. At the same time, to achieve a controlled level of colonization, it is preferable to prescribe non-steroidal external agents. Activated zinc pyrithione has a wide range of complementary pharmacodynamic effects, including anti-inflammatory, pro-apoptogenic, antimicrobial, and antifungal. The article presents the results of the use of zinc pyrithione in mild IgE-independent atopic dermatitis in children. The results of the main clinical studies confirming the effect of zinc pyrithione on the microbiome in AD and the severity of the disease were analyzed.

Aim. To evaluate the therapeutic and microbiological efficacy of activated zinc pyrithione as monotherapy in patients with IgEindependent atopic dermatitis.

Materials and methods. 30 patients aged 2 to 8 years with mild atopic dermatitis in the acute stage were divided into 2 groups. Group 1 received activated zinc pyrithione, group 2 received a combined topical steroid.

Results. Both groups showed a significant reduction in S. aureus skin colonization. In both groups, in comparison with the initial state, a significant decrease in the severity of clinical manifestations of AD was obtained. The therapeutic efficacy of zinc pyrithione was 93.3%, clinical remission was observed in 73.3% of cases.

Conclusion. The totality of currently available data on the clinical efficacy and safety of activated zinc pyrithione allows us to recommend it as one of the effective agents for external therapy of mild IgE-independent atopic dermatitis. The use of activated zinc pyrithione showed a rapid, pronounced positive result of treatment, a decrease in the risk of secondary infection in observed children with IgE-independent atopic dermatitis.

The article considers the topical dermatological issue concerning the breach of the integrity of the skin’s barrier in patients with allergic dermatosis. The horny layer of the skin in such patients can be broken as a result of numerous external causes: excoriations, injuries, allergens, irritants, etc. These factors, in turn, contribute to the activation of endogenous dermal proteases and decrease in the synthesis of epidermal lipids, which leads to reduced elasticity of corneocytes, increased intercellular spaces, and facilitates access for antigenic stimulants that promote the development of inflammation. The decrease in the skin’s barrier is accompanied by the development of immune inflammation, production of pro-inflammatory cytokines that inhibit the generation of antimicrobial factors, induce hyperplasia and apoptosis of keratinocytes. The integral approach plays a leading role in the treatment of the disease due to the specifics of the pathogenesis and course of allergic dermatoses. In the practice of a dermatologist, topical glucocorticosteroids occupy an important place. With their help, it is possible to quickly cope with the symptoms of inflammation in many dermatoses.

The introduction presents current literature data on the role of skin ceramides in the restoration of the epidermal barrier. It is indicated that the epidermis of patients suffering from various dermatoses is characterized by a decrease in the production and dysfunction of physiological lipids, and, therefore, is prone to an increase in the incidence of pathological skin changes. Therefore, in allergic dermatoses, it is preferable to use products containing ceramides in their composition, which reduce transepidermal moisture loss, strengthen the structures of the epidermal barrier, and allow further elimination of relapses of the disease and improve the quality of life of patients.

In recent decades, industrialized countries have recorded a steady increase in the incidence of atopic dermatitis (AD). The pathogenesis of AD is complex and diverse and includes hereditary determinism leading to a disruption of the skin barrier, as well as the Th2 immune response, which is supported by a wide range of pro-inflammatory mediators released by immunocompetent and epithelial cells, which play a key role in the activation and maintenance of inflammation in the skin. Progress in the treatment of immunoinflammatory diseases, including in the skin, has been achieved with the advent of a new class of targeted synthetic oral immunomodulatory drugs, Janus kinase inhibitors. Janus kinases are part of the JAK – STAT intracellular signaling system; STAT proteins are responsible for signaling more than 60 cytokines, hormones and growth factors that regulate key cellular processes. Currently, second generation JAK inhibitors have been developed, such as upadacitinib (trade name Rinvoq), which distinguish them from non-selective JAK inhibitors by their selectivity for certain JAK isoforms. In June 2021, the Ministry of Health of the Russian Federation approved the use of upadacitinib (UPA) for the indication “treatment of moderate to severe atopic dermatitis in adults and children aged 12 years and older who are indicated for treatment with systemic drugs”; the drug can be used in monotherapy or in combination with topical therapy in adults at a dose of 15 or 30 mg per day depending on the individual characteristics of the course, in adolescents weighing at least 40 kg – at a dose of 15 mg per day. Results from a Phase 3 clinical trial program involving more than 2500 patients worldwide in three global key studies: Measure Up 1, Measure Up 2 (UPA monotherapy at a dose of 15 mg or 30 mg per day) and AD Up (UPA in the same doses in combination with topical glucocorticosteroids (TGCS) demonstrated high efficacy and favorable benefit/risk profile of UPA both in monotherapy and in combination with TGCS in patients with moderate to severe AD.

The present study discusses the etiopathogenetic theories of the occurrence of eczema – a chronic recurrent allergic skin disease often encountered in the practice of a dermatovenerologist, formed under the influence of exogenous and endogenous trigger factors, characterized by the appearance of polymorphic rash, inflammatory reaction, disorders of various systems and organs that contribute to the debut or examination of the pathological process. Among the causal influences, various exogenous factors are also noted: infectious agents – resident and transit symbionts – bacteria and fungi, viruses, as well as physical and chemical direct and indirect effects, food products, some medicines. a variety of immunological disorders are described, a modern classification of eczema with the isolation of clinical forms is indicated, a description of the clinical stage-by-stage course of eczema, features of efflorescence in acute and chronic eczema and their variants of evolution in various clinical cases the standard treatment regimens are considered – the appointment of general-acting drugs and local dosage forms. We have described in this publication various clinical cases of treatment of patients suffering from chronic microbial eczema, against the background of their somatic health or with comorbid burden using traditional therapy regimens with the inclusion of combined external agents containing a corticosteroid, an antibiotic and an antimycotic, in accordance with clinical recommendations. All patients at the end of the course of prescribed therapy noted a significant improvement in the form of almost complete relief of erythema, significant leveling of itching, disappearance of wetness, the presence of papular and papulovesicular rashes and manifestations of infiltration, peeling and lichenization of the affected areas of the dermis.

The article provides basic information about nickel-associated allergic contact dermatitis (NACD). Nickel is a common metal that is commonly used in alloys for jewelry, accessories and household items. Contact with this metal often leads to the development of allergic contact dermatitis in sensitized individuals. The prevalence of NACD among the population is high: up to 19% among adults and about 10% among children and adolescents. It is noted that in female’s sensitization to nickel is observed several times more often than in males. On the risk of developing an allergic reaction to nickel, the integrity of the skin barrier, the frequency of contacts with nickel-containing household items, the presence of piercings, high humidity and hyperhidrosis are of decisive importance. Nickel ions entering the body through the alimentary route are capable of both sensitizing the body and forming tolerance to it. The pathogenesis of NACD is based on the classic delayed-type hypersensitivity reaction. The main clinical forms of this allergic dermatosis, as well as the characteristic features of the course of the disease are presented. The features of the course of NACD in patients with atopic dermatitis (AD) are analyzed in detail. The presented data clearly demonstrate that contact allergy to nickel can not only maintain, but also significantly aggravate the course of AD. The main criteria for the differential diagnosis between simple contact and allergic contact dermatitis are shown schematically. The need for early identification and termination of contact with nickel-containing household items is noted as the initial stage of NACD treatment. The main treatment for NACD is local therapy with topical glucocorticosteroids.

This review presents current data on immunopathogenesis, the role of cytokines in inflammation in atopic dermatitis (AD). The pathogenetic phenotypes of the disease associated with various abnormalities of immune mechanisms and dysfunction of the epidermal barrier are considered. The inflammatory processes in atopic dermatitis were shown to be implemented mainly through Th2-lymphocytes and IL-4 and IL-13 produced by these cells, which play a key role in the allergic cascade. It is the effects of IL-4 and IL-13 cytokines that determine the main pathophysiological mechanisms, such as decreased expression of epidermal barrier proteins and suppression of terminal differentiation of keratinocytes, microbiota disturbances, tissue remodelling, immunoglobulin isotype switching by B-lymphocytes and IgE synthesis, degranulation of mast cells and basophils, trafficking of inflammatory cells into tissues, itching. Moderate and severe forms of AD require administration of systemic therapy, which has been represented until recently by non-selective immunosuppressive drugs with moderate efficacy and pronounced side effects if they are used for a long time. Modern targeted therapy of atopic dermatitis provides for the use of monoclonal antibodies against both pro-inflammatory cytokines and their receptors. Directional action on the key mechanisms and targets of immune inflammation can minimize possible side effects of immunosuppressive therapy. Clinical trials on the efficacy and safety of IL-4 and IL-13 inhibitors in the treatment of atopic dermatitis are described.