Introduction. Psoriatic disease is a heterogeneous inflammatory disease with different clinical manifestations, including plaque psoriasis and psoriatic arthritis. It has been shown that elevated levels of TNF-α are observed in both psoriatic arthritis and psoriasis. Studying the TNF-α gene expression pattern can help in the differential diagnosis between psoriatic arthritis and psoriasis.

The objective is to study the TNF-α gene expression pattern in blood mononuclear cells of patients with psoriatic arthritis and psoriasis for possible differential diagnosis between these two diseases.

Materials and methods. Mononuclear cells were isolated from the peripheral blood of 31 patients with plaque psoriasis, 45 patients with psoriatic arthritis and 20 healthy controls. The expression level of the TNF-α gene was analysed using a real-time PCR method.

Results and discussion. As a result of the comparison, the expression level of TNF-α in patients with psoriatic arthritis was found to be 179 times higher than the expression level in healthy volunteers. The expression level of TNF-α in patients with psoriasis was also significantly (106 times) higher than the expression level in healthy people. We managed to identify a significant difference between patients with psoriatic arthritis and psoriasis.

Conclusions. Patients with psoriasis in terms of TNF-α gene expression level in mononuclear cells are close to the condition of patients with psoriatic arthritis. A high level of TNF-α gene expression can become a marker of possible joint injury in patients with psoriasis and a signal to revise the therapeutic approach to a particular patient. 

Introduction. Post-acne post-inflammatory hyperpigmentation most often develops in patients with moderate to severe acne. Post-acne pigmentation can be persistent and last from months to several years, which has a negative impact on the patients’ quality of life. It occurs at any age with the same frequency in men and women.

Aim. To evaluate the effect of dermatocosmetic products – a triple effect serum (containing thiamidol, salicylic acid and lycochalcone A) and SPF30 fluid for problematic skin on the skin condition in patients with moderate and severe post-acne post-inflammatory hyperpigmentation.

Material and methods. A total of 57 patients with post-acne post-inflammatory hyperpigmentation localized on the facial skin were under observation. The age of the patients was 22.4 ± 2.7 years. 32 patients were diagnosed with mild post-acne PIH, 25 patients – with moderate post-acne PIH. All patients used dermocosmetic products such as the triple effect serum (containing thiamidol, salicylic acid and lycochalcone A) and SPF30 fluid for problematic skin. Efficacy was evaluated with due account for mexametry findings, GSS, dermatology life quality index. Digital data were processed using standard medical statistical methods: calculation of the arithmetic mean value (X), square deviation (σ), Student’s t-test (t).

Results. After 12 weeks the mexometric index decreased: 92.7 and 85.9% in mild and moderate post-acne PIH, respectively. The DLQ index reduced by 84.9 and 83.8% by the end of the treatment,

Conclusions. The use of innovative dermocosmetic products containing salicylic acid and licochalcon A effectively reduces post-acne pigmentation. All patients noted good organoleptic properties: skin application comfort and excellent tolerability of the products.

Psoriatic onychodystrophy affects up to 50% of patients with psoriasis and up to 80% of patients with psoriatic arthritis, with an estimated lifetime risk of nail plate changes in this patient population of up to 90%. Nail psoriasis is characterised by a variety of morphological changes resulting from the inflammation in the nail matrix or nail bed, leading to functional impairment and negative impact on patient’s quality of life. Psoriatic onychodystrophy is a distinct therapeutic problem, as its localization is torpid to the current treatment. The limited penetration of topical agents through the nail plate together with the poor adherence to treatment make them typically ineffective. Systemic therapy is often regarded by dermatologists as inappropriate for patients with limited cutaneous lesions. Many systemic drugs, especially biologics, are effective in treating nail psoriasis, but with delayed and less pronounced effects compared to the improvement of skin manifestations. Efficacy for nail changes should be evaluated after 3–6 months of therapy. Recent studies demonstrate that the best effect is achieved after 1 year of treatment. This article presents the main clinical features of psoriatic onychodystrophy and provides information about the interleukin 17A (IL-17A) inhibitor drug netakimab as a promising therapeutic agent for patients with nail psoriasis. It also describes our own clinical experience of using netakimab in the therapy of patients with psoriasis coupled with onychodystrophy. Our experience of using netakimab in two cases of resistant psoriasis accompanied by nail lesions demonstrates its high efficacy in treatment of patients with both plaque psoriasis and psoriasis with “difficult”, hard-to-treat locations, such as nail plate lesions. 

Introduction. Mild acne is the most underestimated form of the disease.

The aim of the study was to compare the results of external combination therapy with 15% azelaic acid gel + 1% clindamycin gel and benzoyl peroxide + clindamycin for mild papulopustular acne.

Material and methods. An open comparative prospective observational study in parallel groups (12 weeks) included 96 people, 65 patients with mild papulo-pustular acne and a control group of 30 healthy individuals. Group I received 15% azelaic acid gel +1% clindamycin gel, group II – benzoyl peroxide gel + clindamycin. The number of acne elements, morphofunctional indicators of the facial skin, side effects were recorded.

Results. As a result of treatment, the indicators of sebumetry significantly decreased: in group I in the T-zone 47.5 ± 11.3 units (p = 0.043) and in the U-zone 57.5 ± 6.3 units (p = 0.037), and in group II in the T-zone 37.1 ± 5.8 units (p = 0.015) and in the U-zone 48.7 ± 5.6 units (p = 0.027). The pore sizes decreased significantly: in group I in the T-zone 0.052 ± 0.010 mm (p = 0.046) and in the U-zone 0.054 ± 0.009 mm (p = 0.049), and in group II in the T-zone 0.039 ± 0.011 mm (p = 0.064) and in the U-zone 0.047 ± 0.013 mm (p = 0.041). In patients in group I, pigmentation indicators in the T-zone of 17.0 ± 2.8 units (p < 0.001) and the U-zone of 17.0 ± 2.8 units (p = 0.048) were normalized. In patients in both groups, there was a significant (p >< 0.05) decrease in the number of papulopustules.>˂ 0.001) and the U-zone of 17.0 ± 2.8 units (p = 0.048) were normalized. In patients in both groups, there was a significant (p ˂ 0.05) decrease in the number of papulopustules.

Conclusion. When comparing the results of therapy with 15% azelaic acid gel + 1% clindamycin gel and benzoyl peroxide + adapalene for mild papulopustular acne, comparable efficacy and safety were revealed. 

As numerous scientific data show, despite the fact that patients with severe psoriasis have a high risk of coronavirus infection, COVID-19 in this group proceeds quite easily. However, many specialists have encountered an unusual exacerbation of the psoriatic process already after the infection, the reasons for which may be several. On the one hand, the skin is one of the target organs for SARS-CoV-2, on the other hand, exacerbations may be caused by the immune system response to the infection. The influence of specific therapy on the course of the psoriatic process is also not excluded. But interleukin status of patients with psoriasis is of the greatest interest. It is known that interleukin-6 (IL-6) plays an active role in pathogenesis of COVID-19 and cytokine storm arising at infection. It is also regarded as an indicator of inflammatory activity in psoriasis. In addition, IL-6 is involved in lipid and hepatobiliary disorders in this group of patients. It is also associated with IL-17, the role of which has been well studied in psoriasis and autoimmune hepatitis. Patients with psoriasis often have changes in biochemical blood parameters, similar to those seen with COVID-19. Combinations of all these factors can lead to exacerbation of psoriasis with predominance of erythroderma and toxic component. In our opinion, in such cases it is necessary to include in the therapy a systemic hepatoprotective drug containing glycyrrhizic acid. It has a pronounced anti-inflammatory effect, inhibits IL-6 production and allows to achieve significant improvement of psoriatic process in a short time. 

Acne is a very common skin disease that has a significant impact on the psycho-emotional status of patients. This disease affects various areas of patients’ lives, leading to problems in body image, socialization, and sexuality. The change in appearance and the psycho-emotional stress associated with the development of acne can also affect other aspects of  patients’ lives, including educational attainment, social activity, and a decline in academic performance and ability to work. Interpersonal problems in acne patients can occur not only with acquaintances and colleagues, but also within the family. The presence of  a  pronounced cosmetic defect, along with acute psycho-emotional problems, leads to a sharp decrease in quality of life, which is often exacerbated by comorbid psychiatric pathology: anxiety, depression, dysmorphophobia, self-injurious behavior, which certainly requires timely, effective and safe therapy for the underlying skin disease. Isotretinoin is an effective medication for the treatment of severe and treatment-resistant forms of acne. This drug has an  effect on all four pathophysiological factors of acne development. Isotretinoin reduces sebum production, regulates hyperkeratosis in the estuaries of sebaceous follicles, reduces the number of Propionibacterium acnes on the skin and is thought to have certain immunological and  anti-inflammatory effects. This is why the introduction of this drug into clinical practice has been recognized as an incredible triumph in the treatment of vulgar acne. However, the presence of  some undesirable side effects may limit its widespread use. In 1982, for example, the FDA issued a warning about the possible risk of depression and the occurrence of suicidal thoughts and attempts while using isotretinoin. However, this warning was not subsequently confirmed. 

Dermatitis of head and neck, also known as “head-and-neck dermatitis” (HNAD), is one of the specific manifestations of atopic dermatitis (AD) in adolescents and young adults. The epidermal barrier dysfunction, skin pathological immune responses, a direct damaging effect of the malassezial flora through the synthesis of virulence factors and mediated by maintaining immune inflammatory responses, as well as the attachment of secondary bacterial flora caused by scratching form the basis of pathogenetic mechanisms of this condition. The properties that define the HNAD rash is a focus on the seborrheic areas (a face, front surface of the neck, décolleté on the chest), severe itching, prolonged course, exacerbation characterized by excessive sweating. It appears that fungi of the genus Malassezia can play a role in the development of the disease. While they are considered to be part of the normal skin microbiome, a significant increase in the severity of atopic dermatitis was observed in patients with Malassezial flora, which was the reason for the theories devoted to the role of Malassezia spp. as a trigger of the disease. Atopic dermatitis can also develop as a side effect of using targeted therapy with IL4/13 blockers, which is explained at the present day by a shift of the immune response towards a Th-17-mediated reaction. The combination of both infectious and immune-mediated lesions in HNAD determines the necessity of an integrated approach to the therapy, in particular the use of topical combination drugs as  the first-line therapy. The topical glucocorticosteroid (TGCS) therapy is aimed at suppressing the immune reactions that are responsible for inflammation in the skin, antifungal therapy is required to suppress the activity of the malassesial flora, and, finally, a secondary bacterial infection requires the prescription of topical antibacterial drugs. 

Case of possible comorbidity in dermatological practice is presented in the article. Skin infections are known to be common in patients with chronic eczema and may be bacterial, fungal or viral in nature. The surface layer of the epidermis is damaged with eczema. This moment is usually hereditary and leads to a violation of the protective and barrier functions of the skin. There are violations of the lipid mantle of the skin, transepidermal loss of water, a shift in the pH of the skin to the alkaline side. These changes increase the probability of developing not only a skin infection, but also increased sensitization to an infectious agent. In clinical practice, infectious dermatitis is rarely combined with other allergic skin diseases, more often developing against the background of metabolic and vascular disorders, however, such clinical combinations are possible. The article describes a case of chronic eczema and infectious dermatitis. This comorbid pathology is of particular practical interest to clinicians, as it requires a more detailed approach to diagnostics and treatment. Along with systemic therapy in external treatment, combined topical glucocorticosteroids are the drugs of choice. 

The most common localization of dermatoses of combined etiology are intertriginous areas. In recent years, an increase in the number of patients suffering from dermatoses of combined etiology has been recorded. The reasons for this situation can be both irrational therapy and background comorbidities in the patient, as well as a number of anatomical and physiological prerequisites for the formation and maintenance of an inflammatory infectious process with localization, namely in the area of skin folds. The article describes in detail the anatomical and physiological features of these areas, the causes of the development of dermatosis of the combined etiology of the fold area. Epidemiological and statistical data on the distribution of a combination of acute, chronic, infectious and non-infectious dermatoses, the causes and frequency of their occurrence are given. Particular attention is paid to the microbiocenosis of the skin in various dermatoses with an emphasis on intertriginous localizations. Approaches to the treatment of such conditions involve the use of combined external agents containing topical corticosteroids, antimicrobial and antifungal components. The article presents data available in the literature on the effectiveness of the use of a multicomponent preparation – Tetraderm cream (consisting of an antibiotic-aminoglycoside + tissue repair stimulant + GCS for local use + an antifungal agent – econazole nitrate) for various dermatoses localized in intertriginous areas. We present our own clinical observations of the effectiveness of the use of this polycomponent preparation Tetraderm in the treatment of patients with skin lesions of combined etiology in the area of folds in atopic dermatitis, allergic dermatitis, mycotic, staphylo-streptococcal infections occurring in combination. 

Bacteriophages are a large group of viruses that can selectively affect bacteria. Bacteriophages and their ability to regulate the growth and activity of pathogenic microorganisms were discovered by scientists at the beginning of the 20th century. Further studies of the properties of bacteriophages led to the construction of the modern concept of virus activity and formed the ground of molecular genetics and biology. To date, more than 6 000 phage species are known to be ubiquitous, but a prerequisite for their existence is the presence of a bacterial host cell, proteins and energy resources serve as the basis for further viral replication. The ability of bacteriophages to selectively destroy bacterial host cells is of particular importance for the therapy and prevention of dermatoses with a potential risk of bacterial infection or pathogenetically aggravated by the activity of the bacterial flora. Such dermatoses include atopic dermatitis, acne, eczema, psoriasis, pyoderma. The article highlights the main advantages and features of bacteriophages, presents data from some of the currently available studies on the use of phages in dermatovenereology. To illustrate the possibility of using bacteriophages in dermatology, a clinical case of successful relief of exacerbation of IgE- independent atopic dermatitis with a high risk of secondary infection in an 8-year-old child is presented. In this case, as an additional to the recommended standard external anti-inflammatory therapy, a gel for external use was prescribed based on a complex of more than 70 virulent bacteriophages capable of inhibiting the growth of actual bacterial strains, among them Staphylococcus spp. (including S. aureus), Streptococcus spp. (including S. pyogenes), Cutibacterium acnes, etc. The range of bacteriophages in dermatovenereology can be expanded due to the constant growth of antibiotic resistance. The use of bacteriophages in routine dermatological practice requires further clinical trials.