Rosacea is a chronic inflammatory disease that affects the facial skin. This pathology is characterized by hyperaemia, erythema, telangiectasia and other manifestations. It is also accompanied by a group of unpleasant symptoms, such as burning sensations, itching, and skin tightness. The pathogenesis of the disease has not been sufficiently studied. But it is generally accepted that it is based on  abnormalities in the immune system. In addition, excessive Demodex colonization and exposure to ultraviolet radiation may play a role in the development of rosacea. The incidence rate of rosacea worldwide reaches 5%. It is emphasized that some ethnicities face a greater risk of this disease than others. It is a very difficult task to treat rosacea for a specialist. The therapeutic approach differs in different forms of the disease. There is a wide range of treatments available for papulopustular rosacea, including systemic and topical medications and even physiotherapy. However, the therapy of erythematous rosacea mainly centres around the use of dermatocosmetic care. For patients with rosacea, it is important to choose products that, first of all, can effectively reduce skin redness and discomfort and will be well tolerated. A dermo-cosmetic composition has to have an anti-inflammatory effect and the ability to repair damaged skin. This article presents our own experience of using such drug in the monotherapy of erythematous rosacea and in the complex treatment of papulopustular disease. A significant effect had been achieved at 3–4 weeks of complex therapy in patients with papulopustular rosacea. We present a clinical case report of a 46-year-old patient N. as an example of the effectiveness of therapy.

The latest advances in the research of the effect of skin microbiome on the occurrence of acne raised the need for the development of new effective treatments for the long-term use in persistent or recurrent disease. The review presents an analysis of foreign and domestic studies on the issues of pathogenesis and treatment of acne. The latest data on the role of skin microbiome imbalance in the occurrence of acne are presented. The Cutibacterium acnes phylotypes diversity loss acts as a trigger for innate immunity activation and chronic inflammation in acne. We show the main directions in the treatment of  acne based on international and Russian clinical guidelines. Today, a  new solution in  acne therapy lies in a multimodal approach to the impact on various links in the pathogenesis of acne to increase therapeutic efficacy, safety, and patient adherence to therapy. The place of topical fixed-dose combination drugs in the treatment of mild to moderate acne has been determined. Due to the growing resistance to antibiotics and their more limited use, it was observed that there is a need to develop new effective treatments for the long-term use. The studies showed that the fixed combination of adapalene/metronidazole is a highly effective treatment for moderate to moderately severe papulopustular acne. The comparative analysis of the use of fixed-dose combinations of adapalene/metronidazole and adapalene/clindamycin in the treatment of patients with acne revealed the comparable efficacy and good tolerability of both combinations. The findings of foreign and domestic studies have proved that the adapalene/metronidazole combination is an effective and safe drug to treat mild to moderate acne.

Psoriasis is an immune-mediated skin disease associated with an increased risk of comorbidities and a significant negative impact on the quality of life of patients. In moderate and severe forms of psoriasis it is necessary to assign systemic therapies. The newest paradigm of treatment has become possible as a result of constant deepening of knowledge of pathophysiology of the disease. A clear mechanism is finally known down to the molecular level as to which cytokines are involved in the pathogenesis of psoriatic disease. Interleukin (IL)-23 mediates the activation of the Th17 pathway, which is hypothesised to be a major contributor to  he inflammation observed in psoriasis, as proven, among other things, by the high efficacy of IL-23 inhibitor biological agents. It is obvious that great progress has been made in the field of genetically engineered biological therapy for psoriasis, both in terms of safety and efficacy. However, the issue of selecting a biologic drug individually in each patient is pressing, including in the case of initiation of the first genetically engineered biological drug in bionaive patients. The article provides an overview of the key points in the process of biological drug selection depending on the present comorbidities, and also describes a clinical case of successful therapy of a bionaive patient with concomitant depressive disorder in the anamnesis against the backdrop of a severe course of psoriasis. Successful use of IL-23 inhibitor (Guselkumab) allowed to achieve persistent remission and improve the quality of life, which in turn had a positive effect on the patient’s comorbid profile. This observation allows us to conclude that the use of guselkumab as the first biological agent is a rather effective, safe and promising option in the treatment of severe psoriasis.

Contact dermatitis is one of the most common skin diseases in many countries, especially among occupational dermatoses. This pathology is considered as an inflammatory skin disease caused by direct exposure to environmental factors. Obligate irritants have a direct damaging effect on the cells of the epidermis and, due to the activation of the predominantly innate immune system, lead to the development of dermatitis in any person. The action of facultative irritants is associated with a delayed type IV cell-mediated allergic reaction, which causes the development of the disease when exposed to substances with sensitizing properties in predisposed individuals. The severity and nature of the symptoms of contact dermatitis depend both on the type of irritant and on the individual characteristics of the organism. A necessary condition for the effectiveness of the treatment of contact dermatitis is the elimination of the allergen. To suppress the inflammatory response, topical glucocorticosteroids are the first-line drugs. The ease of use and the speed of relief of the symptoms of the disease can lead to the uncontrolled use of this group of drugs, in this regard, the article provides an analysis of the necessary conditions and rules for the use of topical glucocorticosteroids. Attention is focused on the risk of developing skin xerosis when they are prescribed. A modern method for the prevention of epidermal barrier dysfunction based on the use of preparations containing topical glucocorticosteroid in combination with ceramides is described. We present our own clinical observations of patients with contact dermatitis treated with this drug, while demonstrating a pronounced positive dynamics of the skin pathological process and regression of subjective symptoms without the development of side effects.

In the past few years, our formulation of the role of Cutibacterium acnes in the pathophysiology of acne has undergone a paradigm shift. According to modern concepts, this disease is caused by not C. acnes hyperproliferation, but an imbalance between various phylotypes of this microorganism that develops due to changes in the skin microbiome composition.

Antibiotics are medicines that are usually used to treat this disease. However, the need to use them for a long time, which causes skin dysbacteriosis, increasing resistance to antibiotics, as well as new understanding of the pathophysiology of acne encourage to change the direction of acne treatment. The use of topical benzoyl peroxide and antibiotic combination products not only improves the effectiveness of therapy, especially for inflammatory acne, but also prevents the development of antibiotic resistant pathogenic microflora. Benzoyl peroxide is a lipophilic substance that concentrates in the skin inside the sebaceous hair follicles, producing benzoic acid and reactive oxygen species. Benzoyl peroxide as an oxidizing agent can suppress the synthesis of proteins and nucleotides, activities of mitochondria in microorganisms through inhibiting their growth and reproduction. The combination of this component and antibiotics contributes to the synergy of their action, and effectively reduces inflammation and acne. As examples, we present the clinical case reports of a 20-year-old patient S., who complained of rashes on the facial skin at puberty, as well as an 18-year-old patient A. with rashes on her face. These cases showed that the topical drug was well tolerated, and the only undesirable side effect reported was a feeling of skin tightness.

Introduction. Scalp psoriasis is a common disease that has a long, recurrent course with severe desquamation, dryness and itching of the skin. The location of the pathological process in an aesthetically significant area, constant therapy leads to low satisfaction and adherence to treatment and, as a result, to a pronounced decrease in the quality of life.

Aim. To study the efficacy and safety of netakimab in psoriasis of the scalp.

Materials and methods. 52 adult patients (n = 52) with psoriasis of the face and scalp were under observation. The severity of the psoriatic lesion of the scalp was determined using the PSSI index (Psoriasis Severity Scalp Index). The assessment was carried out before the start of treatment, in the first week, and then every 4 weeks up to and including 52 weeks. The Dermatological Quality of Life Index (DLQI) – were determined by questionnaires before the start of treatment, at the 12th and 52nd weeks. All patients on an outpatient basis received netakimab monotherapy at a dose of 120 mg in the form of two subcutaneous injections of 1 ml (60 mg) of the drug, each administered once a week at weeks 0, 1 and 2, then 1 time every 4 weeks. The total duration of treatment for each patient was 1 year (52 weeks). The safety of netakimab was evaluated based on the development of adverse events and local reactions to the administration of the drug.

Results. The results of the study (n = 52) for 52 weeks showed high efficacy of netakimab. 48% of patients achieved PSSI 90 by the week 12 of treatment and 77% of patients achieved PSSI 90 by the week 52, itching of the scalp significantly decreased and the quality of life improved. During the 52 weeks of the study, there were no cases of early withdrawal due to adverse events and cases of serious adverse events.

Conclusion. Based on the study results we recommend netakimab for medical use among patients with moderate and severe scalp psoriasis.

Alarmins are a group of immune activating proteins/peptides that initiate an inflammatory process by interacting with immune cells. The alarmins are biosynthesized as a result of cell injury, often due to proteolysis of native proteins. Most often, the alarmins are released into the extracellular matrix as a result of infection, burn or trauma. Several studies have been conducted recently to determine the role of alarmins in the pathogenesis of autoimmune diseases. This work was aimed to assess the clinical potential of alarmins and characterize their role in the pathogenesis of psoriasis. The proposed review analysed 6 groups of alarmins with increased expression in the skin of patients with psoriasis: defensins, CAMP/LL-37, amphoterin/HMGB1, interleukin-1 (IL-1)-like cytokine family members (IL1 and -33) with alarmin properties, heat shock proteins, and proteins of the S100 family. The presented work also discusses the therapeutic potential of alarmins: the possibility to use them as the drug therapy target, as well as to establish diagnosis and monitor the progress of psoriasis. The further experimental studies are supposed to pay considerable attention to alarmin receptors, as well as members involved in the signalling pathways they initiated. These work findings help to obtain biologically active compounds that will be able to specifically and effectively inhibit the physiological effects of alarmins, as well as control the inflammatory process they induced. It seems certain that the use of alarmin antagonists in clinical practice will prove useful in the treatment of both psoriasis and other chronic autoimmune diseases, especially in cases where the most commonly used therapies are not effective enough.

Introduction. Psoriatic arthritis is a common inflammatory disease affecting the joints and it is usually accompanied by plaque psoriasis. The pathogenetic link between psoriasis and psoriatic arthritis well reflects the mechanistic hypotheses of disease pathogenesis. Psoriatic arthritis is characterized by chronic inflammation which results in bone erosion and bone loss, as well as new bone formation around the affected joints. The exaggerated inflammatory response leads to enthesitis with the crucial contribution of IL-17 producing T cells and entheseal resident cells, expressing IL-23R. Studying the IL-17 gene expression patterns can help choose a therapy for patients with psoriatic arthritis.

Aim. To study alterations in IL-17 gene expression in immune cells of paediatric patients with psoriatic arthritis.

Materials and methods. Mono nuclear cells were isolated from the peripheral blood of 45 patients with psoriatic arthritis and 20 healthy controls. The IL-17 gene expression was analysed using a real-time PCR.

Results and discussion. Mononuclear cells were isolated from whole peripheral blood for subsequent analysis of IL-17 gene expression by quantitative RT-PCR. The comparative analysis of the expression levels of patients with psoriatic arthritis and healthy volunteers showed that the expression level of IL-17 gene in patients with psoriatic arthritis was 345 times higher than the expression level in healthy volunteers.

Conclusion. Patients with psoriatic arthritis are characterized by a very high level of IL-17 gene expression in immune blood cells. The high IL-17 gene expression level confirms its significant role in the inflammatory process in patients with psoriatic arthritis.

Patients with rare diseases, particularly skin conditions, can be particularly problematic for doctors of intensive care units. The present study shows the features of the course of sepsis in bullous pemphigoid in terms of clinical case management. A 66-year-old patient with polymorbid pathology was admitted for scheduled hospitalization to the Endocrinology Department with a diagnosis of non-insulin-dependent diabetes mellitus with multiple complications, and examined. She complained of pain in the small of the back and abdomen irradiating to the inguinal region, and increased oedema of the lower extremities. A few hours after admission to the Endocrinology Department, she was transferred to the intensive care unit due to the deterioration of her condition. Analysis of the severity and prognosis assessment of her condition was performed: 9 scores according to SOFA, 20 scores according to APACHE II. The patient underwent clinical, laboratory (biochemical, immunological, bacteriological, cancer markers, blood gases), instrumental methods of examination (Doppler ultrasonography of the lower extremity veins, brain MRI, chest MRI, lumbar puncture). A skin biopsy for morphological study was taken. The analysis of test results showed a critical condition of the patient with a high risk of death, which was prognostically dangerous. Bullous pemphigoid diagnosis was established by morphological and immunological assays. The patient was prescribed therapy with due account for her polymorbidities: prednisolone 80 mg orally, antibiotic therapy, later on she was transferred to the mechanical ventilation. A session of substitutive renal therapy CVVHD using the Prismaflex system was performed. After treatment, improvement was observed. Over the 3-month follow-up care, the patient's condition has been stabilised. It is critical for doctors of various specialties to identify signs of bullous pemphigoid in a timely manner, assess the risk of developing sepsis and take appropriate therapeutic measures in case of secondary infection, as the polymorbidity of pathological conditions can lead to death.

Introduction. Cosmetic care occupies an important place in the correction of visible involutive skin changes. Existing high-tech methods of preserving and delivering active ingredients to the skin allow us to create unique ampoule concentrate, in particular Anti-Aging Reviving Elixir from LaCabine, the main components of which are snow algae powder, probiotics and chamomile extract.

Aim. To study the effect of Anti-Aging Reviving Elixir by LaCabine on the main morphofunctional skin parameters (hydration, elasticity, pigmentation, fine wrinkles, sensitivity) and evaluate the organoleptic properties and ease of use. e for 28 days. Using the Aramo ASW device, the following skin parameters were determined before and after the course: hydration, elasticity, pigmentation, fine wrinkles, sensitivity. For a  general visual assessment, photography was carried out in  the aesthetics mode with the FotoFinder device.

Results. The organoleptic properties, adverse events, as well as the ease of use of the properties were evaluated by an oral survey of each patient. The results showed that the course use of Anti-Aging Reviving Elixir by LaCabine leads to enhanced appearance of the skin, improved morphofunctional parameters, in particular hydration and elasticity, and reduced fine wrinkle severity. Due to ease of use and good organoleptic properties, the product is characterised by a high level of compliance.

Conclusion. Anti-Aging Reviving Elixir by LaCabine can be recommended for home care as part of anti-aging skin care programs.

Introduction. Sustained stress can promote the secretion of proinflammatory cytokines, such as INF-ɣ, which leads to inflammation and results in apoptosis, cell senescence, and disruption of hair growth cycles. It is important to know that a somatic disease itself can become a stress factor. In our case it is a hair loss, which provokes a reactive anxiety-depressive state (nosogenic reaction), often affected by predominant anxious fears for one's health.

Aim. To study the efficacy and tolerability of the updated composition of ALERANA® 5% topical spray combined with ALERANA® Serum BIO active complex for hair growth containing minoxidil for the treatment of stress-induced nonscarring alopecia.

Materials and methods. A study of ALERANA minoxidil products was conducted. All patients (50 people) underwent comprehensive clinical and laboratory examination and trichoscopic diagnosis. Signs of psycho-emotional distress were diagnosed in 56%, symptoms of autonomic disorders (palpitations, hot flushes, red dermographism, hyperhidrosis) in 21%, sleep disorders in 48%, change in appetite in 18%, muscle tension, spasms in 12%.

Results. The amount of hair significantly increased during complex therapy. In the first 3 months of therapy, the average gain was 17%. The appearance of new hair in the parietal and temporal areas, as well as a decline in the number of single follicular units were also observed. ALERANA® spray is highly effective, well tolerated by patients and can be prescribed both as a monotherapy as well as in combination with systemic and local drugs.

Conclusion. Identification of mental disorders in patients with chronic types of hair loss, such as alopecia areata and androgenetic alopecia, appears to be an important stage during examination of this group of dermatological patients. The condition for the choice of optimal therapy for a patient is rooted in understanding the pathogenetic factors and correction of possible causes of hair loss. The key to successful treatment of diffuse alopecia is a comprehensive, multifactorial and personalized approach. 

Introduction. Atopic dermatitis (AD) is among a comorbid conditions in alopecia areata (AA), that influence the risk of development, severity of AA and the immunologic profile of the perifollicular inflammatory process. Narrowband UVB-311 nm, which has been successfully used in AD, is considered as a treatment for AA with limited efficacy, but may contribute to AA regression when combined with other therapies. The anti-inflammatory effect combined with the relative safety make it relevant to study the possibility of using this method in the treatment of AA in children.

Aim. To evaluate the efficacy of NB-UVB 311 nm in the complex therapy of pediatric patients with coexisting diseases: AA and AD.

Materials and methods. We conducted an open cohort comparative study with 49 patients 5–12 years old (mean age 7.4 ± 0.38 y.o.) with different clinical forms of AA. Group 1 included 22 patients with concomitant AD, group 2 consisted of 27 patients without AD. All patients received standard therapy of AA with topical glucocorticosteroids; patients of the first group also received a course of total NB-UVB 311 nm for the treatment of AD. The response to treatment was evaluated after 3 months and was considered as positive when hair regrowth was more than 30%.

Results. In group 1 there was a significant predominance of patients who responded to treatment (77%) compared to group 2 – 48% (OR 3.7; CI [1.05;12.8] p = 0.045); the mean percentage value of SALT index in group 1 decreased by 46% from baseline values, in group 2 – by 26.6%; when comparing the groups by the percentage of alopecia regression p = 0.027.

Conclusions. Combined treatment of AA including NB-UVB 311 nm, contributes to the tendency to more intensive hair regrowth. NB-UVB 311 nm can be considered as an additional option in the treatment of AA, associated with AD.

Introduction. Recent decades have witnessed significant progress in the dermatocosmetic industry, driven by increased knowledge of  skin physiology, development of  new active ingredients and products based on well-studied action mechanisms. Dermatovenerologists actively use dermatocosmetics in inflammatory skin diseases, which include psoriasis. Even in mild forms, psoriatic rashes can be accompanied by itching and flaking. A significant proportion of patients have lesions on exposed skin, and the disease has a severe psychosocial burden. Full and successful control of psoriasis requires the use of adjuvant agents, which can be used alone to maintain remission or as an adjunct to medication, also reducing the negative effects of treatment. The Kertyol P.S.O. Ducray range is represented by products containing active components with anti-inflammatory, antipruritic, keratoregulatory action.

Aim. To evaluate the effectiveness of including the Kertyol P.S.O. Ducray range of products in the treatment regimen of patients with psoriasis.

Materials and methods. 20 patients with localization of psoriatic rashes on smooth skin and scalp were included in the study. Kertyol P.S.O. Ducray concentrate in combination with calcipotriol was recommended for smooth skin rashes, and daily skin care was corrected; Kertyol P.S.O. Ducray concentrate and regenerating shampoo in  combination with calcipotriol/betamethasone dipropionate were recommended for scalp skin.

Results. At the 4th week of therapy the average reduction of PASI index in the complex evaluation of clinical manifestations amounted to 89.6%; antipruritic effect was determined by the dynamics of VAS – the average reduction of the index at the 4th week amounted to 90.6%. Dermatologic life quality index (DLQI) decreased by 89.5% at the 4th week of therapy.

Conclusion. Kertyol P.S.O. Ducray products can be recommended as an effective adjuvant therapy for smooth skin and scalp psoriasis.