卷 98, 编号 5 (2022)

The article presents the results of analysis of resources and performance rates of medical organizations providing medical care in the field of dermatovenereology over 2019–2021 in the Russian Federation. The changes in the rates of provision of the population of the Russian Federation with dermatovenereologists are reflected. The rates of provision of the population of the Russian Federation with round-the-clock and daytime dermatovenereological beds are presented. The rates of dermatovenereologic medical care provided to the population of the Russian Federation in 2021 in outpatient, inpatient and day hospital conditions were compared with those before the pandemic. The dynamics of incidence of sexually transmitted infections as well as dynamics of prevalence and incidence of skin and subcutaneous tissue disorders among the population of the Russian Federation, and specifically in different age groups, during the period under review is presented.

The literature review presents the characteristics of the human leukocyte antigen (HLA)-B27 as a factor contributing to the development of psoriatic arthritis. HLA-B27 is a class I surface antigen encoded by the major histocompatibility complex (MHC) B locus located on chromosome 6. The main function is to present antigenic peptides to the CD8+ T-cells. HLA-B27 is the most important genetic biomarker for psoriatic arthritis, as it provides phenotypic differentiation in the patient population. The prevalence of HLA-B*27 in various population groups are presented. The structural features of the HLA-B27 molecule are described. The characteristics of methods for detecting HLA-B*27 status and determining its subtypes are given. The main mechanisms of the HLA-B*27 polymorphism influence on the development of psoriatic arthritis are considered, and hypotheses are analyzed that explain the pathogenic effect of HLA-B*27: the arthritogenic peptide hypothesis, the misfolding hypothesis, the HLA-B27 heavy chain homodimer formation hypothesis. The features of the clinical manifestations and course of HLA-B*27-positive psoriatic arthritis are presented, allowing the use of HLA-B27 to predict the development of psoriatic joint damage.

Red scrotum syndrome is a chronic, difficult-to-recognize dermatosis affecting middle-aged and elderly people. It is manifested by erythema of the scrotum with clear boundaries, without neck. The etiology and pathogenesis of the disease have not been established. Hypotheses about the causes of dermatosis as a consequence of uncontrolled use of topical steroids, neurological inflammation, formation of microbial biofilm are based on anamnestic data and the results of trial treatments. Etiologically and pathogenetically justified therapy has not been proposed. Therapy with the use of doxycycline, gabapentin, pregabalin, indomethacin, tacrolimus was carried out in small groups of patients. The lack of clarity in the etiology and understanding of the mechanism of development of the disease explains the lack of a unified focus of the proposed therapies based on isolated clinical cases. In general, the problem of diagnosis and treatment rests on the absence of major clinical, epidemiological and laboratory studies that allowed to establish the pathophysiology and assess the true prevalence of red scrotum syndrome.

Background. In the last decade, there has been a significant increase in interest in the study of the role of epidermal barrier structural integrity in order to determine the prospects for its pathogenetic correction. It is now known that patients with filaggrin gene mutations have increased risk of developing atopic dermatitis, xerosis, ichthyosis, eczema. Filaggrin participates in the formation of a full-fledged stratum corneum, provides formation of a natural moisturizing factor, stabilizing the water balance of the stratum corneum. In Russia, the innovative filaggrin-containing “Admera” has been registered, which opens up prospects in the management impaired skin barrier function diseases.

Aims. Efficacy and safety of "Admera" emollient in patients with primary and secondary xerosis.

Materials and methods. A single-center prospective interventional study December 2021 — March 2022 at the Department of Skin and Venereal Diseases of the Sechenov University. The study included 32 patients (22 — main group, 10 — control group) aged 18 to 60 years (29 ± 9.78), 14 men and 18 women diagnosed with atopic dermatitis, skin xerosis. Patients applied moisturizers 3 times a day for 21 days. Performance was evaluated using vIGA-AD, POEM, EASI, 5D Elman scale, SKINDEX-29, HADS, on Capricorn AI, ANTERA 3D machines.

Results. A steady regression of clinical symptoms of xerosis was noted during the study by the dynamics of the study scales. The mean EASI score decreased by 67% from 25.25 ± 18.78 — screening to 7.8 ± 4.41 — control visit (p < 0.001). Assessment of POEM index dynamics showed a significant decrease in total score from 18.65 to 6.6 (p < 0.001). There was good tolerability of the product and absence of adverse events.

Conclusions. The filagrinol-containing emollient “Admera” (Dr. Reddy's Laboratories Ltd., India) demonstrated high efficacy and safety in all patients. This emollient can be recommended as a basic care product in the treatment schemes and prevention of primary, secondary xerosis, relapses of atopic dermatitis.

Rosacea is a widespread disease worldwide, affecting 5.5% of the human population and accompanied by a significant deterioration in the patient's quality of life. Currently, there are two classifications of rosacea, the first of which is based on a subtype approach (erythematous-telangiectatic, papulo-pustular, phimatous and ophthalmological subtypes), or on an individual analysis of the presented phenotype of rosacea. New data on the pathophysiology of rosacea have emerged, which show that genetic factors and environmental components can cause the initiation and exacerbation of rosacea due to a violation of the regulation of the innate and adaptive immune system. In addition, trigger factors can directly interact with the cutaneous nervous system and, with the help of neurovascular and neuroimmune active neuropeptides, lead to the manifestation of rosacea foci. The main mechanisms of rosacea pathogenesis are currently: activation of the immune system, disorders of neuro-immune regulation, genetic predisposition. New pathogenetic mechanisms of rosacea make it possible to continue the diagnostic search and therapeutic approaches with the personalization of management tactics for each patient, depending on the prevalence of clinical features of the course of the disease. It is necessary to evaluate the advantages and disadvantages of subtypical and phenotypic approaches to rosacea classification and choose the most optimal one. The article presents arguments on this issue, and also suggests assessing the need to switch to a new classification in order to improve the effectiveness of therapy and improve the quality of life of patients.

The article describes the onset of pemphigus foliaceus against the background of vaccination with the combined vector vaccine "Gam-COVID-Vac" ("Sputnik V"). A feature of this clinical case is the duration of the period from the moment of development of the first symptoms of the disease to clinical and immunohistochemical confirmation of the diagnosis, which, in fact, indicates a low availability of specialized medical care for rare dermatoses. In particular, the waiting period for taking material for histological examination lasted for several months, which, in fact, is not an isolated case. At the same time, against the background of an increase in clinical symptoms, this became an additional factor in the patient's self-referral to a specialized federal state medical institution, where, within two weeks, the diagnosis was confirmed by immunohistochemical analysis methods and inpatient treatment was carried out with a pronounced positive effect. In addition, the analysis of the medical care provided to the patient showed insufficient alertness and the level of training of dermatovenereologists in diagnosing rare dermatoses accompanied by blistering rashes. In particular, the patient initially underwent several courses of antifungal therapy in combination with intravenous infusion of systemic glucocorticosteroids. The article also presents an analysis of the frequency of occurrence of this disease in different countries for more than 100 years.