Acne is one of the most common skin diseases that leads to persistent stigmatization and negatively affects the quality of life of patients. Currently, there are many treatments for this disease, but isotretinoin is the most effective against severe forms of acne and those cases where other forms of therapy have failed. Isotretinoin is an oral retinoid used in clinical practice for about 40 years. This drug affects all the key links in the pathogenesis of acne, which determines its high effectiveness. Many clinical studies have been devoted to the study of the mechanisms of action of this drug, the specifics of its purpose, and undesirable side effects. However, today, both patients and doctors have a number of misconceptions about the use of this drug, which raises concerns about its administration, errors in treatment tactics and low adherence to treatment. This article discusses the main issues about the mechanisms of action of isotretinoin, the specifics of its administration, indications and contraindications for use, undesirable side effects and ways to correct them, as well as the contradictions in the tactics of prescribing this drug that prevent its effective use. Special attention is paid to choosing the optimal therapeutic dose of isotretinoin and the duration of the course of treatment. In addition, the article discusses the main factors leading to failures in systemic retinoid therapy: slowing the onset of clinical response, the development of relapses after treatment, among which are the features of the course of the disease, the age of the patient, his hormonal background, as well as the dosage of the drug and the duration of its administration.

Introduction. Psoriasis and psoriatic arthritis are chronic immune-inflammatory diseases accompanied by a high frequency of cardiovascular comorbidity. Early diagnosis of subclinical atherosclerosis in young patients is of particular importance, when traditional risk stratification scales often underestimate its severity.

Aim. To assess the cardiovascular risk and prevalence of subclinical atherosclerosis in patients with various forms of psoriasis and psoriatic arthritis.

Materials and methods. The study included 106 patients divided into three groups: with pustular palmoplantar psoriasis (n = 31), with plaque psoriasis and psoriatic arthritis (n = 37), with plaque psoriasis without arthritis (n = 38). All patients underwent ultrasound duplex scanning of the brachiocephalic and peripheral arteries, lipid spectrum analysis and risk stratification according to the Framingham-30 scale. Statistical analysis included correlation and regression methods.

Results. Subclinical atherosclerosis was detected in 45.9% of patients with psoriatic arthritis, in 41.9% with pustular psoriasis and only in 23.7% with plaque psoriasis. At the same time, lesions of the arteries of the lower extremities prevailed over changes in the carotid arteries. Patients with pustular psoriasis had higher levels of total cholesterol and LDL, but the atherogenicity coefficient values did not differ between the groups. The Framingham-30 scale demonstrated high sensitivity but low specificity in predicting vascular changes.

Conclusions. In young patients with psoriatic arthritis and pustular psoriasis, the frequency of subclinical atherosclerosis is significantly higher than in isolated plaque psoriasis. The obtained data confirms the necessity to use instrumental methods for assessing vascular status along with traditional risk scales, which will allow for timely identification and correction of cardiovascular risk factors.

Mild acne is one of the most common dermatological conditions, particularly among adolescents and young adults. Despite its generally favorable course, even mild forms of acne can significantly reduce patients’ quality of life and require timely and effective treatment. Azelaic acid, included in modern topical formulations, has well-documented comedolytic, anti-inflammatory, and bacteriostatic properties, without contributing to microbial resistance. This makes it an important component of acne therapy, especially in outpatient clinical settings. This paper presents a review of current approaches to the treatment of mild acne, with a focus on the clinical potential of azelaic acid. In addition, the authors describe clinical experience with the topical medication Skinoclear, available in cream form with a 20% concentration and gel form with a 15% concentration. The product was used in outpatient practice, with photographic documentation of the skin condition before and after treatment. All patients showed a reduction in both inflammatory and non-inflammatory lesions within 4 to 8 weeks. The treatment was well tolerated, with no reported significant adverse reactions or treatment discontinuations. Thus, azelaic acid as part of the Skinoclear formulation demonstrates good clinical efficacy and tolerability, supporting its role as a treatment of choice in the management of mild acne.

Interleukin-23 (IL-23) inhibitors, including guselkumab, demonstrate high efficacy and a sustained clinical response in patients with moderate-to-severe psoriasis. However, in real-world clinical practice, patients often experience unplanned treatment interruptions due to medical, social, or logistical reasons. This review examines the causes of treatment discontinuation, its clinical consequences, and the prospects for remission recovery upon therapy reinitiation. Data from the VOYAGE 2 study and subsequent analyses have shown that discontinuation of IL-23 inhibitor therapy leads to a gradual loss of clinical effect, with the median time to PASI 90 loss ranging from 15 to 27 weeks. Nevertheless, reinitiation of guselkumab therapy restores a high level of clinical response in 80% or more of patients. Sustained remission after treatment interruption is associated with continued suppression of key cytokines along the IL-23/Th17 axis, including IL-17A, IL-17F, and IL-22. Despite the potential for regaining clinical effect, planned discontinuation of IL-23 inhibitors is not recommended due to the high risk of disease relapse and loss of disease control. However, the selective targeting of IL-23 enables modulation of pathogenic Th17 and Th22 cell populations, preserving the possibility of “resetting” the immune response after interruption. Unlike other therapeutic options, IL-23 inhibitors are less likely to deplete immunological memory and rarely result in a permanent loss of response. The accumulated evidence underscores the importance of an individualized treatment approach and the rational selection of therapeutic targets in the management of psoriasis.

Introduction. The pathogenesis of melasma is multifactorial, involving a complex interplay of various factors, including damage to the basement membrane, disrupted autophagy, oxidative stress, and vascularization. To achieve optimal treatment outcomes, a multifaceted approach is recommended, focusing on the normalization of melanogenesis and the suppression of the primary causative factors.

Aim. To confirm the benefits of the combined use of intense pulsed light (IPL) and hyaluronic acid/trehalose injections in patients with melasma.

Materials and methods. The study involved 30 female patients aged 36–60 years diagnosed with melasma, who were divided into three study groups. Group 1 received three procedures of IPL exposure combined with intradermal administration of hyaluronic acid (1.5%) and trehalose (0.03%). Group 2 received three intradermal injections of hyaluronic acid (1.5%) and trehalose (0.03%). Group 3 received three IPL treatments without adjunctive biorevitalization. Skin condition, pigmentation, and telangiectasias were evaluated using validated clinical scales and Antera 3D skin analysis.

Results. A noteworthy finding was the observed decrease in the severity of dyschromia across all study groups. The most significant difference of IGA 1.2 was recorded in Group 1, which received a combination of IPL and biorevitalization. Groups 2 and 3 demonstrated a decrease of 0.4 and 0.2, respectively. In Group 1, the mean IGA score for telangiectasias decreased by 0.8, while Group 2 and Group 3 demonstrated a respective decrease of 0.3 and 0.6. After performing 3 procedures of combined treatment, the patients of Group 1 were more satisfied with the results of the correction performed than the patients from Groups 2 and 3. The absence of adverse events indicated that treatment methods were well tolerated and demonstrated comparable safety profiles.

Conclusion. The findings of the study corroborate the synergistic effect and safety of the combination treatment for melasma. The combination of IPL and trehalose-stabilized hyaluronic acid represents a promising method of treating melasma, with the potential to achieve high clinical efficacy while minimizing adverse effects.

Psoriasis is one of the most common systemic chronic immune-mediated inflammatory diseases. Current treatment strategies for psoriasis focus on relieving symptoms, improving quality of life, and preventing disease progression. In the absence of a positive effect from the initial therapy, the issue of using various biological or low molecular weight drugs that affect certain immune mechanisms underlying the pathogenesis of the disease is considered. Current therapeutic strategies aim to develop new drugs that would block effector cytokine signaling. To date, there are no reliable predictors to predict which patient will respond positively to a particular type of systemic therapy. The search for biomarkers involved in the pathogenesis of the disease and/or reflecting the mechanism of action of drugs can help in answering these questions. The presented article will consider predictive immunological biomarkers of the effectiveness of psoriasis treatment with biological drugs (TNF-α inhibitors, IL-17 inhibitors, IL-23 inhibitors, type 4 phosphodiesterase inhibitors), which can be cytokines, chemokines, adipokines, soluble forms of cell surface receptors, markers of immune activation. In our paper, we do not consider new therapeutic strategies in psoriasis targeting small molecules that target JAK-STAT signaling pathways (Janus kinase inhibitors, tyrosine kinase 2 inhibitors, retinoid orphan nuclear receptor γt) preventing signaling downstream of IL-23 and IL-6. Given that many molecular cell mechanisms of the immune response are involved in the pathogenesis of psoriasis, it seems promising to search for combinations of these markers and draw up appropriate models for predicting an effective response to therapy based on them.

Demodex mites (D. folliculorum and D. brevis) are the most common ectoparasites found on human skin, with carriage rates reaching up to 100% in older age groups. The majority of the population are asymptomatic carriers; however, an increase in Demodex mite colonies, observed with decreased innate immune activity and epidermal barrier dysfunction, can lead to enzymatic damage of pilosebaceous follicle structures, mechanical blockage of sebaceous gland ducts, activation of pro-inflammatory cytokines, and disruption of microbial balance in the skin. These factors are key in the pathogenesis of sebaceous gland diseases. First identified nearly two centuries ago, Demodex mites remain a subject of ongoing debate regarding their role both in the normal skin microbiome and in the pathogenesis of diseases such as acne, rosacea, perioral dermatitis, seborrheic dermatitis, and others. This review presents current scientific data on the etiology, epidemiology, and pathogenetic role of Demodex mites in the development of acne and rosacea – the most common sebaceous gland diseases. Additionally, methods for etiotropic correction of mite hyperinfestation are proposed.

According to the accumulated data, concomitant mental disorders are detected in a significant proportion of patients who initially seek medical care in dermatovenereological institutions. Psychodermatological disorders are a complex group of pathologies, the diagnosis and treatment of which are associated with the need to integrate knowledge from different areas of medicine. Skin symptoms of these diseases can imitate various pathologies, which prolongs the diagnostic search, contributes to the chronicity of the disease and deterioration in the quality of life of patients. An important aspect of treatment is an integrated approach, including dermatological and psychopharmacological therapy. Particular difficulties arise when managing patients with pathomimia (artifactual or artificial dermatitis) – a psychological disorder that is accompanied by self-harming behavior aimed at traumatizing the skin, mucous membranes, hair or nails. Patients with pathomimia conceal or do not realize the autodestructive nature of the rash, which is often accompanied by a refusal to consult a psychiatrist due to embarrassment or doubts about its necessity. Such behavior leads to an increase in the number of doctors involved by the patient in the diagnostic process and the volume of unjustified examinations, while patients often provide specialists with false anamnestic data. The article describes our own clinical observations of patients with pathomimia who had errors in verifying the disease.

An analysis of the features of the anamnesis, differential diagnostic criteria and therapeutic tactics is presented. Attention is focused on the need to include this pathology in the list of differential diagnoses at the initial appointment. The importance of interdisciplinary interaction of doctors in order to form an effective strategy for treating patients with psychodermatological pathology is noted.

The article focuses on a very relevant and difficult topic in dermatology – dermatoses localized in the area of the external genitalia in men. This problem accounts for 5 to 15% of all primary visits of men to a urologist or dermatovenerologist. The article provides a detailed description of the features of the skin of the genitals in men, describes the causes and etiological factors leading to the development of chronic inflammatory dermatoses in this area. A review of domestic and foreign literature on dermatological diseases of the external genitalia in men is provided. Balanoposthitis, genital dermatoses of autoimmune genesis are examined in detail, lesions of the external genitalia in chronic inflammatory dermatoses (inverse psoriasis, lichen sclerosus, lichen planus, pemphigus vegetans) are described. For each dermatosis, the article examines in detail the epidemiology, clinical picture with the peculiarity of manifestations in the area of the external genitalia, differential diagnostics, principles of drug therapy. The article is illustrated by the author’s own clinical observations of various dermatoses localized in the ano-genital area in men. And also, the results of successful complex treatment of patients with the use of the topical drug of Russian manufacture Akriderm GK, containing a micronized form of betamethasone dipropionate, gentamicin sulfate and clotrimazole in a number of chronic dermatoses localized in the area of the external genitalia in men are shown. The peculiarity of the clinical picture in the described patients was a bright specific clinic, however, untimely diagnostics and the lack of adequate therapy significantly affected the quality of life of patients. The article may be of interest to dermatovenerologists, urologists, and other specialists dealing with this problem.

Introduction. Microsporum canis (M. canis) is a zoophilic dermatophyte, causative agent of human and animal dermatophytosis. Scalp mycosis caused by M. canis, accompanied by involvement of a large area of the skin, rarely develops in adults due to physiological peculiarities caused by low pH and high concentration of polyunsaturated fatty acids in sebum. Epidemiological data on the incidence of mycosis in adults vary from 1.5 to 44% in different countries. Late treatment, diagnostic errors and the use of topical corticosteroids contribute to the dissemination of the process. Due to the widespread increase in the number of adult cases of microsporidia infection, the situation necessitates the need to increase awareness of the medical community.

Aim. To analyse the clinical and laboratory features of M. canis infection in an adult patient.

Results. This article describes a case of scalp mycosis with diffuse skin lesions caused by M. canis in an adult patient. Effective treatment was delayed for a year due to incorrect clinical and laboratory diagnosis. In Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology» during the laboratory examination ial the growth of M. canis culture was obtained. Direct microscopy revealed the location of spores as an ectothrix. Treatment with systemic itraconazole according to a continuous scheme gave a positive result within six weeks.

Conclusion. Scalp mycosis with extensive involvement of the trunk and extremities caused by M. canis is clinically uncommon in adults in most regions, emphasising the difficulty in diagnosing widespread dermatophyte infection in this clinical example. In cases presenting with extensive erythema with scaling on the scalp and trunk, fungal infection should be excluded. Careful collection of epidemiological history including migration, animal contact and physical examination for broken hairs, luminescent diagnosis and mycological investigations are required.

Introduction. Netakimab is a humanized anti-interleukin-17 monoclonal antibody, approved for the treatment of moderate to severe psoriasis vulgaris. Available data from the literature on the use and efficacy of this drug in the treatment of psoriasis in difficult-to-treat sites are still limited. However, due to resistance of psoriasis involving difficult-to-treat sites to other drugs, netakimab can be regarded as the drug of choice for the treatment of these forms of psoriasis.

Aim. To evaluate the efficacy and safety of netakimab in the treatment of psoriasis of difficult localizations.

Materials and methods. A total of 50 patients 18 years of age and older with moderate to severe psoriasis vulgaris were included in the study. Patients were screened and randomized with a focus on lesions in difficult-to-treat sites, among which patients with vulgar psoriasis that predominantly affected the inguinal, axillary and inframammary folds (inverse psoriasis) accounted for 28% (n = 14), nails (n = 26; 52%), palms and soles (n = 10; 20%). All patients received netakimab therapy for 52 weeks.

Results. Among 14 patients with inverse psoriasis, 42.9% of patients achieved PASI 90 (n = 6), and 57.1% achieve PASI 100 (n = 8). Netakimab also allowed 34.6% patients with nail psoriasis to achieve PASI 90 (n = 9), and 65.4% to achieve PASI 100 (n = 17), and 20% and 80% patients with predominant localization on the palms and soles to achieve PASI 90 (n = 2) and 100 (n = 8) respectively.

Conclusions. The data presented in the article show that the use of netakimab allows sustained control of the disease and improvement of the quality of life in patients with psoriasis involving difficult-to-treat sites.

Over 20% of patients with chronic wounds have an autoimmune disease. Bullous autoimmune dermatoses hold a special place among the dermatological pathologies associated with chronic ulcers, Wound surfaces in this group of patients quickly become infected without prudent care. Besides, the treatment of ulcers in patients with bullous dermatoses is quite a challenging task, as even minimal skin injury during dressing changes can lead to the development of an ulcer defect. In this regard, a clinical case report of a female patient diagnosed with “pemphigus foliaceus with concomitant rapidly progressive multiple sclerosis” receiving biological therapy appears to have interesting features. The main complaint included chronic ulcerous defects in the intergluteal fold area, which persisted for a long period. In addition to standard therapy for pemphigus foliaceus, the female patient’s wound was treated with LUOFUCON extra silver alginate dressing for 3 weeks, which was changed every 7 days. During the therapy, almost complete epithelialization of the wound surface was achieved by day 12. This case demonstrates the need to pay careful attention to wound hygiene, especially in cases of hard-to-heal ulcers. The antimicrobial dressings, along with the sanitation of the wound surface, can effectively combat infection. Alginate dressings absorb wound fluid and maintain a moist environment, which, together with a powerful antibacterial effect, improves the wound microenvironment and promotes faster epithelialization. At the same time, the dressings neither stick to the wound bed, nor injure it during dressing changes, which is especially important in patients with bullous dermatoses.

Introduction. Lupus erythematosus (LE) is a heterogeneous autoimmune disease, and pro-inflammatory cytokines play important roles in its pathogenesis. Despite numerous studies, the features of the cytokine profile in cutaneous LE (CLE), as well as its changes in response to plasmapheresis, remain unclear.

Aim. To assess the levels of IL-17A, IL-31, IL-13 and IL-10 in patients with discoid (DLE) and systemic (SLE) LE, as well as changes in their levels at different time points after membrane plasmapheresis.

Materials and methods. The study included 30 patients (21 with DLE, 9 with SLE), who were treated at the Moscow Scientific and Practical Center for Dermatovenereology and Cardiology of the Moscow Health Department. Cytokine levels were assessed before treatment, after the first plasmapheresis procedure, and at 14 days. The results were compared with reference values.

Results. Patients with DLE showed elevated levels of IL-17A and IL-31 at baseline. After the first procedure, a decrease in IL-17A and IL-13 with a sharp increase in IL-31 were observed. At 14 days, IL-17A and IL-10 levels continued to decrease, IL-13 levels recovered to baseline, and IL-31 levels remained elevated. In patients with SLE, a moderate decrease in IL-17A and an increase in IL-13 and IL-10 were observed. At 14 days, IL-17A and IL-10 levels decreased, IL-13 levels demonstrated significant fluctuations, and IL-31 levels remained stable in both cases.

Conclusions. Plasmapheresis has been shown to have a modulating effect on cytokine levels in patients with LE. IL-31 and IL-10 can be considered potential biomarkers of disease activity and systemic progression. The data obtained support the feasibility of plasmapheresis in the therapy of resistant forms of LE.

Introduction. Atopic dermatitis (AD) is a chronic inflammatory skin disease that significantly impairs patients’ quality of life. The advent of targeted biologic therapy with dupilumab has become an important milestone in the treatment of moderate-to-severe AD, as confirmed by clinical trials and real-world data.

Aim. To study the dynamics of quality of life in patients with AD receiving dupilumab in real clinical practice.

Materials and methods. A review of current literature, including results from clinical trials and registry data, was conducted, along with an analysis of our own cohort of 38 patients with AD treated with dupilumab. The dynamics of clinical indices (EASI, SCORAD, VAS) and quality-of-life measures (DLQI in adults and CDLQI in children) were evaluated.

Results. Patients’ ages ranged from 6 to 47 years (mean – 20 years), with males accounting for 65.8%. The duration of therapy ranged from 2 to 5 years (mean – 3.4 years). During treatment, the mean EASI score decreased from 39.0 to 5.2 (p < 0.0001), SCORAD from 58.7 to 11.2 (p < 0.0001), and VAS from 7.3 to 2.2 (p < 0.0001). Quality-of-life measures improved markedly: DLQI decreased from 25.1 to 2.3, and CDLQI from 21.1 to 2.4 (both p < 0.00001). These findings are consistent with international studies such as TREATgermany, BioDay, and RELIEVE-AD.

Conclusion. Dupilumab demonstrates high efficacy, significant reduction in clinical manifestations, and substantial improvement in quality of life in both adults and children with AD during long-term real-world use. The combination of evidence from randomized clinical trials and real-world practice confirms that dupilumab is the treatment of choice and may be considered an optimal long-term therapeutic strategy for patients with AD.

Introduction. The search for an effective approach to the treatment of аcne vulgaris is complicated by the complex interaction of factors influencing the course and outcome of the disease.

Aim. To identify key associations of acne development factors and severity by reconstructing a Bayesian network and analyzing the results of treatment with a fixed combination of adapalene 0.1% + metronidazole 1% (Metrogyl® A gel).

Materials and methods. The study was conducted from 2023 to 2025 in Kazan, 650 patients with acne were included, the average age was 23 ± 3.7 years. The independent parameters included: general characteristics, medical history, various clinical parameters depending on independent ones included: laboratory parameters, morphofunctional parameters and composition of the microbiota of the facial skin. The resulting parameters of the model were clinical characteristics and dermatological indices. At the first stage, a nonparametric Bayesian network was reconstructed. At the second stage, a group of patients with mild to moderate acne (n = 56) were treated with adapalene 0.1% + metronidazole 1% gel for 12 weeks.

Results. The factors influencing the development and course of acne were identified, and two clusters of highly related features that describe the influence of hormone-associated and microbial pathogenesis factors were formed. Topical therapy in the group of patients with mild and moderate acne who had disorders of the skin microbiome (n = 56) with adapalene 0.1% + metronidazole 1% gel was effective: сlinical remission occurred in 60.7% (n = 34), significant improvement in 37.5% (n = 21). Local adverse reactions were characterized by mild severity and did not require drug withdrawal.

Conclusions. The present approach is useful for visualization of complicated relationships between factors and clinical outcomes for analysis of complex relationships between factors and clinical outcomes in the analysis of multifactorial diseases. Based on the results of the analysis, topical acne therapy (adapalene 0.1% + metronidazole 1%, gel) in a group of patients with skin microbiome disorders showed efficacy, safety and good tolerability.

Psoriasis is a chronic inflammatory papulosquamous skin disease, but the pathological spectrum of psoriatic lesions is far from limited to skin elements. Psoriasis is a complex disease caused by the interaction between genetic predisposition, environmental triggers and immune system dysregulation. Chronic psoriatic inflammation involves keratinocytes, as well as various cellular and humoral factors penetrating from the blood. Currently, eosinophils, which take an active part in the pathogenesis of psoriasis, are of great scientific interest. This scientific work is a narrative review of the literature and covers clinical and epidemiological studies, as well as descriptive and systematic reviews of the literature. The information presented in our scientific article is obtained from previously conducted studies. Eosinophils are pleiotropic multifunctional leukocytes involved in immune defense. Eosinophils play an important role in hypersensitivity reactions and in a number of autoimmune diseases, can migrate from the bloodstream to the skin in response to various attractors and produce various cytokines. It has been shown that eosinophils are capable of secreting eosinophilic cationic protein in the skin of patients with psoriasis. The degree of eosinophilia can be a marker of the severity and prognosis of psoriasis. Some researchers believe that peripheral blood eosinophilia is associated with severe forms of psoriasis (generalized pustular and erythrodermic). A number of scientists have identified an important negative role of the cytokine IL-31, which is secreted by eosinophils, as the main factor in skin itching. Numerous scientific papers indicate the important role of eosinophils in the development of psoriatic inflammation. Further research is needed to study eosinophils and their potential impact on the progression of psoriasis, with the aim of improving treatment and improving the quality of life of patients.

Atopic dermatitis (AD) is a chronic inflammatory skin disease that is widespread throughout the world. The disease is more common in women than in men. This difference can be explained by the influence of sex hormones on the functioning of the skin barrier and the immune system. Fluctuations in the concentration of sex hormones correlate with the incidence of AD. During the luteal phase of the menstrual cycle, AD exacerbation or worsening of the disease is more common, which is associated with the production of progesterone and estrogens, and during the follicular phase, AD improves due to the predominant effect of estrogens. During the menstrual cycle, women experience a change in the barrier function of the skin, characterized by dryness, impaired sensitivity, and increased transepidermal water loss, which indicates a pronounced effect of sex hormones on the skin. Sex hormones can stimulate the production of a number of cytokines involved in the formation of skin inflammation and itching. During pregnancy, the immune system is modified to achieve immune tolerance; these changes occur both at the mother-fetus level and in the systemic bloodstream, primarily due to an increase in progesterone concentration during pregnancy. Changes in hormonal levels during pregnancy shift the balance in the immune system, which can be a trigger for the development of AD. Studying hormonal status during AD exacerbation, including during pregnancy, is promising and can contribute to the development of preventive and therapeutic measures.

Recent years have witnessed a steady increase in the incidence of skin and soft tissue infections (SSTIs). Skin infections are notably common in children and the elderly. Skin infections are also common in people with systemic diseases, including diabetes mellitus. A large percentage of wounds in patients with diabetes contain a polymicrobial microflora. Infections are mainly caused by aerobic gram-positive cocci, gram-negative rods, and group B streptococci. In patients with diabetes, ulcerous defects are frequently found on the lower extremities, especially the feet (approximately 15%). At the same time, congestive heart failure, chronic lung diseases and renal failure are more common in patients with other wound localizations in the anamnesis. Diabetes mellitus negatively affects the healing of wound surfaces. Hyperglycemia causes delayed epithelialization, chronic inflammation, dysregulation of angiogenesis and other disturbances in the wound microenvironment. Chronic skin infections are often observed in patients with diabetes mellitus, which may result from excessive growth of bacterial flora. Topical treatments for SSTIs may be low-efficient in patients with systemic diseases. Chronic infections can spread and be caught quite rapidly, which requires the prescription of systemic therapy. Moreover, elderly patients or patients with a number of systemic diseases may experience dysphagia, which can affect patients' ability to take antibiotics in solid oral dosage forms. In cases like that, dispersible forms of antibiotics, such as a combination of amoxicillin and clavulanic acid, are of interest. This combination is effective against a wide range of gram-positive and gram-negative bacteria, including causative agents of skin infections.

Seborrheic eczema is a chronic recurrent immune – mediated skin disease that significantly impairs the quality of life of patients. The pathogenesis of the development and course of SE is not completely clear. A proven fact related to the disease is an increase in the number of yeast-like fungi Malassezia spp. on the skin of patients in “seborrheic zones”. The growth of fungi Malassezia spp. It is associated with the level of secretion and changes in the composition of sebum, as well as with increased sweating in patients. But these changes are not sufficient for the formation of symptoms of seborrheic eczema. It has been established that in addition to the main links in the pathogenesis of SE, concomitant diseases can have a significant impact on it and lead to the fact that the clinical symptoms of SE become more manifest. For this reason, the aggravation of the symptoms of diabetes should lead a specialist to think about the combination of dermatosis with other diseases. The most common concomitant diseases are infectious processes, in particular herpetisvirus infections, which do not always have specific clinical symptoms. At the same time, the role of herpesvirus infections in the clinical manifestations of dermatosis has not been studied. Herpesvirus diseases are among the most common. So in 2020, there were about 570.1 million (13.5%) people infected with the herpes simplex virus type 2 worldwide, among patients aged 15 to 50 years. Herpes type 1 virus in the same age group and for the same period was detected in 395 million (10.5%) people. Of the total number of patients, 50% had exacerbations of concomitant diseases due to the presence of a viral infection. At the same time, it is a proven fact that herpesvirus infections significantly disrupt the functioning of the immune system, in particular, changes that trigger autoimmune processes. Thus, the severity of seborrheic eczema and the frequency of its exacerbations may indicate the presence of latent infections in the patient.

Exosomes are microscopic particles secreted by various plant and animal cells, including human cells. They carry valuable biologically active substances such as proteins, lipids, nucleic acids, and metabolites that exert beneficial effects on various structures and tissues. In aesthetic medicine and dermatology, exosomes have attracted attention due to their ability to enhance collagen synthesis, eliminate inflammation, and improve the skin’s protection against harmful external factors. To date, considerable clinical experience has been gained in the use of exosome products for the treatment of skin diseases such as rosacea, acne, pigmentation disorders, and alopecia, as well as for aesthetic correction and skin rejuvenation. When using exosomes, it is important to have an understanding of the origin of a particular product, including the manufacturer, the production and analysis standards used, due to the lack of international standardization in this area. For the most effective implementation of exosome-based treatments, adherence to official directions for use is critical. With no unified application protocols available, the evaluation of specialists’ practical experience in this area is particularly valuable. This article presents a general overview of exosomes, discusses their production and analysis on an industrial scale, and describes the current state of their application in clinical practice. In addition, the experience of exosomal therapy in dermatology and aesthetic medicine is presented.

Defects in collagen synthesis and metabolism underlie the pathogenesis of various pathological conditions, including hereditary disorders (Ehlers-Danlos syndrome, osteogenesis imperfecta (brittle bone disease), Stickler syndrome) and acquired diseases (systemic scleroderma, rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis, scurvy, liver fibrosis (cirrhosis), pulmonary fibrosis, cardiac fibrosis, renal fibrosis, keloid (hypertrophic) scars, osteoarthritis, osteoporosis, bullous epidermolysis, chronoand photoaging of the skin, cancer, etc.). Maintaining the physiological balance between the collagen synthesis and degradation processes is crucial for ensuring the structural integrity and functional activity of connective tissue. The review presents systematic data on the role of collagen in ensuring the structure and function of human body tissues, in particular, skin, as well as on collagen-associated mechanisms of skin aging in the nome and in hyperglycemic conditions accompanied by collagen glycation. The pharmacological justification of the use of glucagon-like peptide-1 (ArGPP-1) receptor agonists for the prevention of age-related skin changes is given. Understanding the mechanisms of collagen glycation is in the focus of anti-aging medicine and is critically important for developing strategies to slow skin aging. ArGPP-1 remains the object of close attention all over the world. The presented data on the positive effect of ArGPP-1 (Semavik®) on the ability to control hyperglycemia clearly demonstrate the enormous potential of these drugs in the prevention of age-related skin changes. Post-marketing studies of this group of drugs, especially newly appearing in the arsenal of the attending physician, in particular, Semavik®, will expand the range of practical approaches to their differentiated use and active implementation in clinical practice.

Age-related changes in the body are a complex biological process that requires research at the intersection of various scientific disciplines. Modern science has made significant progress in the study of molecular, cellular, genetic and biochemical mechanisms of aging. This has allowed us to formulate concepts that describe the influence of external factors on the genome and open up prospects for creating methods of functional rejuvenation. A special place among them is occupied by studies aimed at studying the system of regulation of gene activity that is not associated with a change in the nucleotide sequence of DNA, but has a significant impact on gene expression. These issues are addressed by an actively developing scientific discipline – epigenetics. Epigenomic processes reflect the interaction of genotype and phenotype, playing a key role in the adaptation of aging processes in response to environmental influences. At the same time, the skin is a unique model for studying these mechanisms due to its complex structure, constant renewal and direct interaction with external factors. The article provides an analysis of the modern concept of skin aging, in which the idea of the leading role of heredity is combined with new scientific data on the importance of epigenetic regulation. Key epigenetic changes, such as DNA methylation disorders, histone modifications and gene dysregulation mediated by microRNA are considered. It is emphasized that the study of the mechanisms of the influence of environmental factors on the epigenome opens up prospects for finding therapeutic approaches that contribute to the correction and prevention of age-related changes. The effect of lifestyle modification, physiotherapy methods and various chemical compounds on the epigenetic processes of aging is described. It is noted that the correction of the molecular mechanisms of skin aging can provide a sustainable clinical effect and is of particular interest in the development of cosmetics for epigenetic skin care. Attention is focused on the fact that the integration of epigenetic research into aesthetic dermatology allows not only to correct the external signs of aging, but also to influence their deep biological mechanisms.

With the increasing popularity of glucagon-like peptide-1 receptor agonists (GLP-1RA), the public and the cosmetic and plastic surgery community have coined new terminology to characterize some of the unintended effects of these drugs. Terms such as “Ozempic® face” and “Ozempic® body” have come into common usage to describe the loss of tissue volume resulting from semaglutide therapy. A Google Trends search was conducted to clarify public perceptions of GLP-1 receptor agonists and their relationship to the morphologic changes observed with drug-induced weight loss. There is some evidence to suggest that GLP-1RA may also accelerate skin aging by targeting cells in the adipose tissue layer and suppressing their proliferation and metabolic activity. GLP-1RA affects dermal white adipose tissue (DWAT) and adipose-derived stem cells (ADSCs), and possibly hormonal regulation and facial muscles. A wide range of hardware and injection methods are used to correct changes associated with the risk of a sharp increase in the skin flap and loss of tissue volume. A special place is occupied by injectable collagen stimulators based on polylactic acid (PLA). After administration, PLA fillers cause differentiation of macrophages into the M2 subtype, which is known to induce collagen production by increasing the expression of TGF-β in fibroblasts and is a biocompatible material that is hydrolyzed to water and carbon dioxide. After administration, PDLLA microspheres remain localized in the tissues, promoting the attraction of myofibroblasts and ADSCs, which is important in patients with drug-induced loss of subcutaneous fat. This review presents the main correction methods and options for combined protocols, and provides clinical cases.

Introduction. One of the frequent comorbid conditions in alopecia areata is atopic dermatitis. Existing epidemiological data on alopecia areata and its association with atopic dermatitis remain contradictory and insufficiently studied, which underscores the relevance of this research.

Aim. To study the epidemiological characteristics of alopecia areata in Moscow and its association with atopic dermatitis based on population and registry data.

Materials and methods. A multicenter retrospective cohort study was conducted by analyzing medical records of patients diagnosed with alopecia areata and atopic dermatitis monitored at the Moscow Center for Dermatovenereology and Cosmetology from 2020 to 2024. Federal statistics (Form No. 12), outpatient records (No. 025/u-04), and a specialized alopecia areata registry were used. Rates per 100 000 population were calculated.

Results. Significant differences in alopecia areata epidemiology were found (p < 0.001): prevalence in children (36.8/100 000) was 2.7 times higher than in adults (13.7/100 000), incidence – 22.2 vs. 7.9/100 000/year. Overall morbidity increased by +83.3%, prevalence by +62.6% (p < 0.001). The association between alopecia areata and atopic dermatitis was significant (p < 0.001): overall frequency 2.66% (95% CI: 2.37–2.95), higher in children (4.09%; OR = 8.3, 95% CI: 7.1–9.7) than adults (1.85%; OR = 14.1, 95% CI: 11.9–16.7). The highest increase occurred in 2021. In the adult alopecia areata registry, atopic dermatitis was present in 15.9% (64/403).

Conclusions. The significant age-dependent association between alopecia areata and atopic dermatitis confirms atopic dermatitis as an established risk factor. Registry data provide more accurate information on comorbidities. The results justify screening for atopy in alopecia areata patients and the need for a multidisciplinary management approach.