Aging, and in particular aging changes in skin, are increasingly giving cause for concern to the mankind, especially given the fact that the life expectancy is extending. Skin aging is not only a problem that concerns skin sagginess, but rather it is a complex problem caused by many factors, from immune deficiency to the lifestyle, which affects both the maintenance of the skin’s barrier function and the well-being of the stem cells that support the organ. The structure and amount of lipids in the stratum corneum changes over time, the epidermis becomes thinner, which leads to decreased barrier function of the skin. These changes also cause increased loss of transepidermal fluid. The aging-associated processes in the dermis lead to a loss of skin elasticity and a decrease in hydration. The increased levels of cytokines and histamine in the skin can cause itching and scratching, which will lead to a further increase in skin inflammation. All this can be manifested by severe xerosis, peeling and other unpleasant symptoms. It is impossible to defeat aging, but to minimize its manifestations is an achievable goal. Our experience allows us to recommend care products with pronounced nutritional and moisturizing properties, which contain panthenol, prebiotics and probiotics, sodium hyaluronate and a natural complex of glycoceramides, cholesterol and phospholipids. Panthenol has a regenerating and softening effect, nourishes and relieves irritation, contributes to the increasing strength of collagen fibres. Sodium hyaluronate is responsible for deep hydration of the skin, improving its tone and elasticity. The ceramide complex compensates for the lack of lipids and helps to retain moisture in the stratum corneum. Regular care helps to minimize xerosis, itching, skin tightness and maintain quality of life in aging patients.

Undifferentiated connective tissue dysplasia (UCTD) is a genetically determined condition with a progressive course characterized by defects in the fibrous structures and the basic connective tissue substance, leading to impaired formation of organs and systems, which determines the features of the associated pathology, as well as the pharmacokinetics and pharmacodynamics of drugs. In dermatological and cosmetological practice, the issue of UCTD is very topical, as individual external presentations of the connective tissue dysmorphogenesis among young people can reach 85.4%. In recent decades, a real revolution has taken place in aesthetic medicine, which is associated with the emergence of new injectable products, development of hardware, cellular and thread techniques. Every year mew methods of treatment emerge and the existing ones are improved. Statistics of the past years show that minimally invasive non-surgical interventions are becoming more and more popular in all countries, their number significantly exceeds the number of surgical operations. To date, there are 2 groups of methods aimed at collagen stimulation: hardware techniques and injection methods. The effectiveness of the use of polylactic acid drugs as the first-line drugs for the correction of UCTD in order to prevent premature ageing was evaluated in the presented clinical cases. Patients with a cosmetology profile were treated according to the complex protocols that included amino acid replacement therapy, IV therapy, contour correction with drugs containing polylactic acid and hardware techniques (microneedle RF lifting with insulated and non-insulated needles, ultrasonic SMAS lifting, ablative laser techniques, Ipl-therapy). As a result, an algorithm for managing a patient with UCTD was developed in the cosmetology practice. The provided clinical cases show that the detection of signs of UCTD can significantly improve the patient’s quality of life and prevent premature aging.

Scars are an urgent issue for many areas of practical medicine, especially for dermatovenerologists, cosmetologists and plastic surgeons. Every year, 100 million patients develop new scars and about 11 million of them are keloid. The issue of differential diagnosis of keloid and hypertrophic scars is still the subject of discussion among specialists. Despite the wide variety of available methods of treatment of keloid and hypertrophic – surgical excision, injections of glucocorticosteroids, laser therapy, cryotherapy, compression therapy and silicone bandages are the most effective and pathogenically rationalised methods for the correction of pathological scars. Promising methods of therapy are: injections of interferon, recombinant human TGF-β3 polypeptide, platelet-rich plasma, calcium channel blockers, lipofilling, the use of angiotensin-converting enzyme inhibitors, creams based on imiquimod and resiquimod, growth factors, stem cells. The article presents an up-to-date view on the processes of physiological and pathological scarring, the most important aspects of the differential diagnosis of keloid and hypertrophic scars, the understanding of which is important for choosing the right therapeutic strategy. Particular attention is paid to the pathophysiological mechanisms of action, the advantages and features of the use of silicone dressings. The authors present the clinical experience of successful two-stage correction of keloid scar – post-acne with the use of injection therapy with hyaluronidase and silicone dressings.

The relevance of microbic eczema is caused by prevalence of a disease, a long chronic current, frequent, is long the proceeding recurrence, insufficiently studied pathogeny and difficulties of the choice of effective treatment. Microbic eczema – the chronic recurrent dermatosis which is characterized by evolutionary polymorphism of elements of rash, wet an itch and a peculiar allergic reaction of the sensibilized skin to decomposition products of microorganisms and their toxins arising against the background of it is long the existing piogenic center at disturbance of the major regulatory systems of an organism. At patients with microbic eczema disbioz skin it is shown by reduction of a share of S. epidermidis, Bifidobacterium spp., Lactobaccilus spp. and significant increase in opportunistic and pathogenic flora, associations of mushrooms quite often meet representatives of obligate flora. Allergenic action of S. aureus and fungal microflora, in particular, of C. Albicans at microbic eczema considerably amplify in the conditions of a mikstinfektion. In recent years microbic eczema tends to a heavy current with a frequent long recurrence, considerable distribution of process on skin and is characterized by resistance to the standard methods of treatment. Elimination of action of microbic, mycotic dissimination and normalization of a biocenosis of skin at microbic eczema are the key principle of treatment of patients interfering recuring of chronic eczema. The article focuses on microbial eczema, as the most difficult type of eczema in therapy, presents our own clinical observations of the course of microbial eczema of various localization and severity, and also shows the effectiveness of the Russian-made topical drug Akriderm GK, containing a micronized form of betamethasone dipropionate, gentamicin sulfate and clotrimazole in the complex therapy of patients with microbial eczema.

Psoriatic disease is a condition characterised by the development of a progressive chronic inflammatory process caused by various immunological pathways, among which the IL-23/Th17 axis plays a key role. Therefore, the efficacy of IL-23 p19 inhibitors is currently being actively studied. To date, quite a large number of therapeutic options among genetically engineered biological drugs (GEBDs) exist for the treatment of psoriasis, but in real clinical practice patients may lose efficacy or suffer from adverse events, resulting in the need to switch to other classes of GEBDs. Guselkumab is a fully human IgG1λ monoclonal antibody that binds selectively to the p19 subunit of interleukin 23 (IL-23) with high specificity and affinity. The implementation of the drug into clinical practice has improved the efficacy, safety and survival rate of genetically engineered biological therapy for psoriasis. Finding optimal approaches to the treatment of psoriatic disease by analysing data from clinical trials and actual practice is the real challenge for practicing clinicians. However, a current problem is the lack of sufficient information on the use of guselkumab in real clinical practice when it is initiated subsequent to administration of other classes of GEBDs – anti-TNF-α, anti-IL-17 and/or anti-IL-12/23. This article provides a review of the existing literature, as well as our own clinical observations of non-bionaive patients with successful therapy switching to the IL-23 inhibitor guselkumab. Understanding the basic aspects of GEBD therapy for psoriasis will help to achieve successful control of the disease and improve the quality of life of patients in general.

Photodermatoses represent a heterogeneous group of disorders characterized by the development of pathological skin reaction to solar radiation. The development or intensification of inflammatory skin reaction after exposure to ultraviolet or electromagnetic spectrum that is visible to the human eye is a distinctive feature of all photosensitive photodermatoses. Although photodermatoses are less common in children than in adults, they are often associated with genetic or congenital metabolic disorders, and may also point to diffuse connective tissue diseases. Paediatric photodermatoses are often the result of genetic or congenital metabolic disorders, and may also indicate diffuse connective tissue diseases. The epidemiological studies have showed that the global prevalence of photodermatoses diagnosed with photopatch tests is above or equal to 5.7%. The authors presented a modern classification of photosensitive dermatoses according to the etiological factor. The article provides up-to-date information about photosensitive dermatoses, including statistical epidemiological data, pathogenesis features, and also emphasis is placed on the issues of the quality of life of children and their parents. The authors described the clinical presentations of the most common paediatric photosensitive dermatoses and the basic principles of their therapy. Among topical glucocorticosteroids, methylprednisolone aceponate has proven itself in the treatment of paediatric photodermatoses as it has not only a pronounced anti-inflammatory effect, but also is easy-to-use. The timely diagnosis of paediatric photosensitivity will help to minimize the development of complications associated with delayed treatment and insufficient prevention (photoprotection).

In recent years, there has been an increase in the proportion of AFA in the structure of acne incidence. The etiopathogenesis of the disease is multicomponent and has not been fully elucidated. It is assumed that hormonal factors and chronic activation of innate immunity are involved in the process against the background of genetic predisposition, which are stimulated by external environmental factors: daily stress, Western-style diet, tobacco use, hormonal drugs, cosmetics. The article presents a modern classification of the clinical course of AFA and scales for assessing the severity of the course of the disease: GEA (Global Acne Severity Scale) and AFAST (Adult Female Acne Scoring Tool). AFA is predominantly characterized by a mild or moderate course. Treatment requires a personalized approach with particular attention to the individual needs and characteristics of adult women. When choosing a topical therapy, the doctor should consider the less pronounced oiliness of the skin, the slow progression of the disease with the outcome in hyperpigmentation and scarring. Modern acne treatment regimens include systemic and topical therapy along with proper basic skin care. The most effective topical agents include retinoids, which can induce a specific biological response by binding and activating retinoic acid receptors. Comedonal and mild papulopustular acne are indications for adapalene monotherapy for acne in adult women. Adaklin (0.1% adapalene) cream is a highly effective first choice for the pathogenetic treatment of AFA. Rational mono- and combination therapy with adapalene is the key to successful external therapy of mild and moderate AFA and prevention of post-acne. The review provided up-to-date, evidence-based information on the clinical presentation, etiopathogenesis, and treatment of adult female acne (AFA).

Currently, psoriasis occupies a leading position in the structure of chronic recurrent dermatological diseases. The modern view on the etiopathogenesis of psoriasis allows us to consider this disease as a systemic, genetically determined, immune-mediated process, which manifests itself not only in the form of damage to the skin, but also leads to the development of various comorbid conditions (lesion of the musculoskeletal system, cardiovascular system, excretory system , metabolic disorders, etc.). This fact radically changes the approach to the treatment of patients with psoriasis, to the selection of a systemic drug. The main points in the management of patients with psoriasis, especially of moderate and severe course: interdisciplinary examination of the patient, prevention of the development of comorbid conditions and irreversible (sometimes disabling) changes in internal organs and systems, timely administration of systemic therapy. The article presents modern aspects of the etiopathogenesis of psoriatic disease, the advantages of genetically engineered biological therapy, and a clinical case of treating a patient with severe psoriasis. A 48-old-patient E. who had been suffering from extensive psoriasis vulgaris for 16 years, which manifested after pregnancy and childbirth, was proscribed the systemic therapy. In July 2022, the patient reported oedema that developed in the lower extremities and face while taking methotrexate, and was examined by a nephrologist. Microalbuminuria nephropathy was diagnosed, which served as a reason for adjusting the systemic therapy for psoriasis. The patient had to be switched to the genetically engineered biological therapy. After 3 subcutaneous injections of netakimab at a dose of 120 mg/week, psoriasis went into a steady-state showing the trend towards a regressing stage. The psoriasis severity index scores decreased by the end of the initiating course of therapy.

Acne is one of the most common dermatoses, especially among young people. The worldwide prevalence reaches up to 80% of young people aged 15 to 17 who have symptoms of acne, and the condition often persists into adulthood. In the pathogenesis of acne, in addition to pathological hyperkeratosis and inflammation, an important role is played by such factors as massive microbial contamination, species composition, biological properties of pathogens, in particular, their drug resistance. For the treatment of acne of moderate and severe severity, antibacterial drugs are used – tetracycline, erythromycin, doxycycline. These drugs have a bacteriostatic effect on Cutibacterium acnes by inhibiting the synthesis of bacterial proteins. Antibiotics for acne demonstrate antimicrobial and anti-inflammatory effects and act in two directions: they reduce the colonization of C. acnes and inhibit the production of inflammatory mediators associated with С. acnes. Side effects in antibiotic treatment are rare, but the main problem in their appointment is resistance, the frequency of which is increasing every year. The review part of the article presents the literature data of domestic and foreign authors on the formation of С. acnes resistance to antibiotic therapy in acne patients in the process of therapy evolution. Cause-and-effect relationships of the formation of resistance in the application of antibacterial drugs of various classes are described. The strategy and tactics of a doctor to limit the spread of C. acnes antibiotic resistance are considered. A special place in the article is given to the important role of benzoyl peroxide, clindamycin and the synergistic effect of the fixed combination of clindamycin / benzoyl peroxide in overcoming the resistance of С. acnes and achieving the effectiveness and safety of therapy. The second part of the article presents our own clinical observations of the effectiveness of the domestic combined preparation of the Klindavit Combo gel (clindamycin / benzoyl peroxide) in the treatment of patients with papulopustular acne who are on outpatient treatment by a dermatologist.

Introduction. Psoriatic arthritis is a chronic inflammatory disease that is characterized by cellular infiltration and production of pro-inflammatory cytokines and can be initiated by excessive activation of endosomal toll-like receptors (TLRs), particularly TLR2. Studying the TLR2 gene expression patterns can help choose a therapy for patients with psoriatic arthritis.
Aim. To study the pattern of TLR2 gene expression in blood mononuclear cells of patients with psoriatic arthritis to assess its potential pro-inflammatory role.
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 gene was analysed using a real-time PCR method.
Results and discussion. The comparative analysis of the expression levels of patients with psoriatic arthritis and healthy volunteers showed that the expression level of TNF in patients with psoriatic arthritis was 63 times higher than the expression level in healthy volunteers.
Conclusions. A high level of TLR2 gene expression can indicate its role in the inflammatory process and become a marker of possible joint injury in patients with psoriasis.

Introduction. Androgenetic alopecia (AGA) is the most common type of alopecia, characterized by diffuse progressive thinning of the hair in the fronto-parietal area in patients with a genetic predisposition. Topical minoxidil remains the primary pharmacological treatment for AGA both in men and women. The efficacy in hair regrowth is reported to be between 40 and 50%.
Aim. To evaluate prognostic factors of minoxidil response in AGA patients.
Matherials and methods. The prospective open study was carried out. Thirty participants with AGA were enrolled and completed the study (twenty one women I–II Ludwig stage and nine men I–III Hamilton – Norwood stage). Primary outcomes consisted of measuring of hair density, telogen hair rate, the percentage of vellus hairs and hair diameter at baseline and repeated at 4 months. The SULT1A1 enzyme activity and the concentration of ATP in plucked hairs were measured at baseline. Patients were treated with 5% topical minoxidil applying daily for 4 months. In order to investigate prognostic factors in groups of responders and non-responders to minoxidil treatment these measured morphometric and biochemical characteristics were assessed.
Results. After 4 months of treatment 77% of patients demonstrated hair regrowth and improvement of hair density, hair diameter and decrease of vellus hairs level. The SULT1A1 enzyme activity (p = 0.0008), the concentration of ATP (p = 0.004) in plucked hairs and baseline total hair density (p = 0.01) was significantly lower in group of non-responders compared to group of responders. The study demonstrated strong positive correlation between SULT1A1 enzyme activity and increase of total hair density (r = 0.7, р = 0.00002); moderate positive correlation was founded between concentration of ATP and increase of total hair density (r = 0.6, р = 0.0004).
Conclusion. The negative prognostic factors for minoxidil treatment of AGA include SULT1A1 enzyme activity, concentration of ATP in plucked hairs and low total hair density at baseline.

The main manifestations of COVID-19 are primarily interstitial pneumonia and respiratory failure. No less than 20% of patients have variable skin rashes, which try to be interpreted as markers and predictors of the peculiarities of the course of coronavirus infection. In addition, hair loss is a characteristic manifestation of COVID-19, and the salivary follicles are regarded as a target for SARS-CoV-2. The most common variants of alopecia in patients with a new coronavirus infection or vaccine-induced alopecia are acute telogenic, nondescript, and androgenetic alopecia. This review provides information on the most common variants of hair loss in patients with SARS-CoV-2 infection, the features of their manifestations, and possible mechanisms of development. Acute telogenic hair loss is the most common variant of SARS-CoV-2-induced alopecia, is characteristic of patients with subacute course of COVID-19 and can be combined with trichodynia, anosmia and aguvia, which are markers of nervous syste damage. Given the variability in the time of onset after infection, a heterogeneous pathogenesis of alopecia can be assumed. Nested alopecia after COVID-19 is often a relapse of the disease, its severity and frequency do not correlate with the severity of the infectious disease, and its prevalence in women indicates the importance of hormonal factors in its development. Androgenetic alopecia may be a predictor of high risk of infection, severe course, and recurrence of COVID-19. The first two variants of alopecia may be associated with COVID-19 vaccination, and the latter is a predictor of inadequate immune response to vaccine administration. The mechanisms of the damaging effects of SARS-CoV-2 on hair follicles have not been fully deciphered and are most likely complex, with different leading links in different types of hair loss. Deciphering these mechanisms may provide prerequisites for understanding the mechanisms of COVID-19 damage to other tissues and organs.

Atopic dermatitis is an inflammatory skin disease that is most frequently occurred in children, but also common in adults. The disease is characterized as chronic, but only 20% of children have severe atopic dermatitis, while the other 80% achieve a longterm remission by the age of 8 and earlier. The article summarizes the main details about atopic dermatitis including statistical epidemiological and pathogenetic data, and places special emphasis on the issues of patients’ quality of life and steroidophobia. It is known that combination treatment regimens are often used in the treatment of atopic dermatitis. The article highlights approaches to the tactics of choosing topical therapy according to the European guidelines for the treatment of atopic dermatitis 2018. Despite the fact that topical calcineurin inhibitors were made available for the treatment about 15 years ago, this group of drugs take the lead in the treatment of atopic dermatitis due to a pronounced anti-inflammatory mechanism of action with a steroid-sparing effect. The review presents the main mechanisms of action of topical calcineurin inhibitors and their effect on the skin’s barrier function. Literature data on the proven efficacy and high safety profile of Tacrolimus, the very first drug from the topical calcineurin inhibitor group, are presented. In the article, the authors described examples of the successful use of Tacrolimus, which can suppress the T-lymphocyte activation and reduce the production of pro-inflammatory cytokines in patients with moderate to severe atopic dermatitis, as well as with other chronic allergic dermatoses. The use of Tacrolimus in the presented clinical cases led to a reduction of severity of subjective and objective symptoms of the inflammatory skin diseases.

Atopic dermatitis is the most common chronic inflammatory skin disease in children, that significantly affects quality of life. Clinical manifestations are genetically determined and caused by skin barrier dysfunction and development of immune reactions. Atopic dermatitis is characterized by early onset, recurrence, and presence of treatment resistant forms. It is important to prescribe treatment that controls the symptoms and reduces the risk of severe forms of this disease. Topical corticosteroids are the mainstay of atopic dermatitis management, although the prolonged treatment can lead to development of side effects. The treatment option, that has high efficacy and high profile of safety, is the basis for disease remission and overcoming corticosteroid phobia. Methylprednisolone aceponate meets all criteria for topical corticosteroids and has high efficacy and high profile of safety. It can be recommended for patients with atopic dermatitis from the age of 4 months. This paper shows up-to-date data on methylprednisolone aceponate, that confirm the optimized efficacy/safety profile and minimal local or systemic adverse effects. Recent studies demonstrated the efficacy of new Russian product – methylprednisolone aceponate (Komfoderm K).

Atopic dermatitis is a chronic inflammatory skin disease characterized by a recurrent course, difficulty in individual selection of therapy, especially in patients with severe course. When examining and treating such patients, one of the routine diagnostic methods is to determine the level of total immunoglobulin E in the blood serum. The article is devoted to the analysis of available world practice data on published clinical cases of the use of biological therapy with dupilumab in real clinical practice in patients with severe atopic dermatitis, in whom high and very high levels of immunoglobulin E. The appointment of biological therapy for this cohort of patients often raises significant concerns. However, the use of a monoclonal antibody against IL-4/IL-13 proved effective, did not lead to serious adverse reactions in such patients and was accompanied by a decrease in the level of immunoglobulin E during treatment. It was noted that immunosuppressive treatment prior to biological therapy led to the development of adverse events in these patients. A separate group of patients with genetically determined hyper-IgE syndrome and severe atopic dermatitis is described, in which the positive experience of using dupilumab is also noted. The author presents his own clinical case of a patient with severe atopic dermatitis and a high level of immunoglobulin E receiving successful targeted therapy after a preliminary thorough examination except for lymphoproliferative and autoimmune diseases. Against the background of dupilumab therapy, there was a pronounced clinical regression of skin symptoms, a decrease in the level of immunoglobulin E, an increase in the patient’s quality of life, and the absence of side effects.