Pharmateca

Scar development is the most common complication and one of the main criteria for success or failure in skin tumor removal. The location, size, and appearance of scars depend on oncological, anatomical, and surgical limitations, as well as internal factors influencing the complex healing process. Timely preventive measures for postoperative wounds and immature scars optimize the healing process in the early stages, improving the cosmetic appearance of the scar and reducing the risk of developing pathological defects. This literature review presents the main methods for the early prevention of scar development, including surgical, medicinal, and physical therapy methods, and evaluates their effectiveness as mono- or combination therapy, based on current research data.

Systemic isotretinoin remains a highly effective standard treatment for severe acne, targeting key pathogenetic pathways. However, its use is associated with a wide range of adverse events, creating a safety paradox. This scientific review analyzes currently available data on the potential side effects of systemic isotretinoin therapy.

The study of aging mechanisms has remained an important area of scientific research for many years. Currently, particular attention is being paid to epigenetic mechanisms of aging. Current knowledge of the epigenetic aspects of age-related skin changes opens up extensive opportunities for the development of therapeutic tools that target the cellular and molecular patterns of skin aging. Epicellin, a flavonoid from Ampelopsis grossedentata, exhibits antioxidant, anti-inflammatory, antibacterial, and antitumor activity. It reactivates youth genes and significantly eliminates signs of skin aging caused by epigenetic changes by inhibiting DNA methyltransferase 1, an enzyme that plays a key role in age-associated pathological DNA methylation.

This article examines the problem of secondary infection in atopic dermatitis (AD), caused by impaired skin barrier function and dysbiosis, with a predominance of Staphylococcus aureus. The role of bacterial, fungal, and viral infections in aggravating the disease is emphasized. Three clinical cases demonstrate the effectiveness of a gel containing polyhexanide and betaine. Application of the gel ensured gentle cleansing of crusts and biofilm, exerted an antimicrobial effect, and created optimal conditions for regeneration, significantly increasing the effectiveness of subsequent anti-inflammatory therapy and achieving rapid relief of infection symptoms.

Aesthetic medicine is seeing a growing demand for minimally invasive procedures that provide effective results with minimal recovery time and a low risk of complications. One such modern technique is endolift – a minimally invasive laser method based on a 1470 nm diode laser. Literature data demonstrate the high efficacy and safety of the endolift technique for a wide range of aesthetic and therapeutic indications, including skin rejuvenation, lipolysis, periorbital correction, rhinoplasty, as well as the treatment of acne, scars, keloids, and hidradenitis suppurativa.

Background: The widespread use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for weight loss has led to the development of the aesthetic phenomenon of Ozempic face, characterized by rapid loss of midface volume, tissue ptosis, and impaired skin quality. This is associated with a reduction in subcutaneous fat and decreased synthesis of extracellular matrix components.

Objective: Evaluation of the efficacy and safety of subdermal laser therapy (EndoliftX^®, 1470 nm) for the correction of facial involutional changes in patients receiving GLP-1 RA therapy.

Materials and methods: The study included 10 patients (8 women, 2 men) aged 35–60 years with a BMI of 25–32 kg/m² receiving semaglutide or tirzepatide. All patients underwent a single EndoliftX^® laser rejuvenation procedure. Results were assessed clinically and using 3D scanning (Liveviz) over a period of 3 to 12 months.

Results: With drug therapy, average body weight loss was 10–15% (8–17 kg). The EndoliftX^® laser technique improved facial contours and increased skin firmness and elasticity in all patients. No complications were reported.

Conclusion: Subdermal laser therapy (EndoliftX^®, 1470 nm) is an effective and safe minimally invasive method of aesthetic correction in patients with rapid weight loss while taking GLP-1 receptor agonists and can be recommended as a component of comprehensive treatment programs for these patients.

Objective: Determination of the clinical significance and validity of the most common dermatological indices for assessing acne severity.

Materials and methods: The results of a clinical examination of 230 acne patients (129 men and 101 women) were analyzed, resulting in the recording of data according to the GAGS, IGA/PGA, DIA, and ECCA.

Results: Interpretation and statistical processing of the obtained data revealed no agreement among the indicators of any of the scales, and the reliability of these indices revealed extremely low validity thresholds.

Conclusion: These data indicate the need to develop a fundamentally new and easy-to-use acne severity assessment system.

Background: Premature aging of the periorbital region, characterized by bone resorption, changes in fat pads, thinning skin, and the formation of «malar bags,» presents a complex aesthetic problem. Surgical methods, due to their high invasiveness and lengthy rehabilitation, often have limited popularity among patients.

Objective: Development and evaluation of the effectiveness of a three-stage non-invasive protocol for periorbital rejuvenation aimed at reducing the rehabilitation period and achieving a pronounced aesthetic result.

Materials and methods: The study included 32 female patients aged 28–35 years. The single-stage protocol included: 1) high-intensity focused ultrasound (HIFU) treatment of the infraorbital fat pad for compaction; 2) deep microbolus injection of a hyaluronic acid-based filler (24 mg/ml) along the ligaments for volumization; 3) microneedle radiofrequency (RF) lifting for skin remodeling. Efficacy was assessed by photographic documentation and patient questionnaires after 30 days using a numerical rating scale (NRS, 0-5 points).

Results: One month after the procedure, a visible reduction in the appearance of «malar bags» and an improvement in skin condition were noted. The average patient satisfaction rating on the NRS was 4.2 points («the result exceeds expectations»). None of the participants rated the result as unsatisfactory (1–2 points). Side effects were minimal, and the recovery period was short. Conclusion: The proposed combined protocol, targeting various layers and structures (subcutaneous fat, deep volumes, skin), is a highly effective, safe, and well-tolerated alternative to surgery for the correction of age-related changes in the periorbital region, including malar bags.

Background: Devergie’s disease (DD) is a rare inflammatory papulosquamous skin disorder of unknown etiology, often characterized by the development of erythroderma. Due to the lack of data on the etiology and pathogenesis of DD, treatment remains challenging. Systemic retinoids are the first-line therapy for DD, but they are not always effective. However, existing data on the similarity between the pathogenetic mechanisms of DD and psoriasis suggest that genetically engineered biological agents (GEBAs) may be considered as an adjunctive treatment for DD. Objective: Analysis of the data from patients with the erythrodermic form of DD and evaluation of the effectiveness of systemic therapy and phototherapy in treating this disease.

Materials and methods: The study was conducted at the V.A. Rakhmanov Clinic of Skin and Venereal Diseases, Sechenov University Clinical Hospital No. 2, between May 2014 and May 2024. Fifteen patients over 18 years of age with the erythrodermic form of DD were included in the study. Patients were selected based on archival records according to the following criteria: age 18–80 years, presence of the erythrodermic form of DD (erythroderma index (EI) ≥36). The Dermatological Quality of Life Index (DQLI) was assessed before treatment, as well as 2, 3, and 4 months after treatment. Of the 15 patients with DD, 46.7% (n=7) received acitretin, 20% (n=3) – isotretinoin, 33.3% (n=5) – methotrexate, 20% (n=3) – prednisolone, 6.7% (n=1) – dexamethasone, 13.3% (n=2) – netakimab, 6.7% (n=1) – ustekinumab, and 6.7% (n=1) – phototherapy (PUVA, UVB-311nm). Before treatment, the mean EI was 89±3.5 points, and the DIQI was 21±2.1 points.

Results: On acitretin therapy, patients demonstrated significant regression of the rash, followed by a decrease in the EI and DLQI to a mean of 26±3.2 and 3.7±1.9 points, respectively, demonstrating a positive effect of this drug on the dynamics of DD. For example, one patient (6.67%) underwent phototherapy (PUVA and UVB-311 nm) without achieving a clinical effect. However, our study identified cases of stabilization of the skin process and improvement in disease dynamics with a combination of phototherapy and other treatment methods. Thus, we presented cases of acitretin and phototherapy in combination (Re-PUVA) with a mean EI of 39.6±3.2 points and a DLQI of 5±1, which increases the effectiveness of phototherapy for the disease.

Isotretinoin therapy demonstrated a decrease in the EI and DLQI, demonstrating positive disease dynamics, but without complete regression of the rash. The efficacy of methotrexate and phototherapy as monotherapy for Devergie’s disease remains controversial. In cases of relapses after previous therapy, insufficient response, or resistance to treatment, biological agents were the drug of choice, with efficacy comparable to acitretin. Remission in patients after successful treatment of Devergie’s disease with netakimab and ustekinumab was observed for 18 months. It is worth noting that patient follow-up to assess the long-term results of biological therapy for Devergie’s disease is ongoing.

Conclusion: The obtained data support the use of systemic retinoids as first-line therapy for Devergie’s disease, particularly acitretin, which demonstrated superior efficacy compared to isotretinoin in our patients. Biological therapy may be considered an effective adjunctive treatment for severe and resistant forms of Devergie’s disease, as well as promoting long-term remission and improving quality of life in patients with this disease.

Background: Itching significantly impacts patients’ quality of life, causing stress, anxiety, or depression. Psychological stress and subsequent modulation of the immune and nervous systems significantly influence itching. Stress can worsen itching and vice versa, leading to a vicious cycle that can significantly impair a patient’s quality of life.

Objective: Evaluation of the relationship between itching and stress in patients with itchy and non- itchy dermatoses, skin toxic reactions, and melanocytic skin neoplasms.

Materials and methods: In a multicenter, cross-sectional, observational, continuous, non-randomized, controlled study, patients with common itchy and non-itchy dermatoses, melanocytic skin lesions, and skin toxic reactions (n=597) were examined compared with a control group (n=216). A clinical dermatological examination, assessment of the intensity of itching using a numeric rating scale (0 to 10 points), a survey about the presence of stressful events over the past year, and a psychometric examination using the PSS-10 scale for the assessment of the level of perceived stress were conducted.

Results: The groups differed statistically significantly (<0.001) in the frequency of stressful events over the past year. Patients with skin toxic reactions reported stressful events most frequently (65.6%), followed by patients with psoriasis and acne (48.5% and 48.1%, respectively). The groups differed significantly in the level of perceived stress, with the highest rates observed in patients with skin toxic reactions, lower rates in those with acne and atopic dermatitis, and the psoriasis group ranking third. When assessing the association between itching and stress in different patient groups (Table 3), the strongest correlation was found in patients with melanocytic nevi, but it was not statistically significant. A moderately significant correlation was found for psoriasis and atopic dermatitis.

Conclusion: Thus, this study demonstrates a significant association between itching and stress, which significantly contributes to the disease burden in patients with cutaneous toxic reactions. Comprehensive therapy for patients with itching should be aimed not only at correcting this subjective symptom but also at improving stress management.

Background: This article examines the dynamics of facial skin functional parameters using the Multiskin diagnostic system.

Objective: Comparison of the effectiveness of phototherapy (PT) as a single-method physiotherapy treatment and the combined use of laser radiation and local ozone therapy in patients with rosacea.

Materials and methods: A primary prospective, non-randomized study was conducted. Forty-four women were included in the study. PT group consisted of 34 patients, while 10 patients received combined PT and topical ozone therapy (O3 group).

Results: The results of the study confirm the efficacy of both PT using the Candela Nordlys system and its combination with topical ozone therapy (O3) in patients with rosacea. Although both methods provided clinical improvement (regression of erythema, reduction in the number of papules and telangiectasias, and improvement in skin texture), each demonstrated advantages in specific areas of correction of functional skin parameters.

Conclusion: PT is more effective for patients with rosacea who have a predominantly vascular component and pronounced erythema, while PT combined with O3 is more appropriate for patients with dry skin, decreased elasticity, and a tendency toward post-inflammatory pigmentation. This differentiated approach allows not only to achieve clinical improvement but also to individualize therapy depending on the underlying pathogenetic mechanisms and the patient’s cosmetic expectations.

Background: Psoriasis in children, especially with nail plate involvement and juvenile psoriatic arthritis, is a complex clinical problem for which there is a lack of data on the safety and efficacy of newer systemic therapies. Therefore, it is necessary to present clinical observations using modern medications.

Description of the clinical cases: Two clinical observations of children aged 12 and 11 years with progressive vulgar psoriasis complicated by nail involvement are presented. One patient was diagnosed with juvenile psoriatic arthritis. In both cases, traditional treatment approaches (topical agents, phototherapy, methotrexate) were insufficiently effective or were associated with adverse effects. Use of secukinumab according to approved treatment regimens resulted in significant clinical remission of skin and nail lesions by weeks 16–24, with a reduction in PASI scores to 0 and NAPSI to 0, as well as an improvement in quality of life and the absence of serious adverse effects. Pre-therapy assessments included serological and radiographic tests, as well as consultations with specialized specialists to confirm the absence of contraindications.

Conclusion: These clinical cases demonstrate the high efficacy and safety of secukinumab in children with severe psoriasis and nail lesions. This confirms the feasibility of using this biologic agent in pediatric patients who have failed traditional treatments and who need to improve their quality of life.

Background: This article analyzes current knowledge about fibromas arising in the mucous membranes. The paper examines the clinical features, describes the factors most often triggering their development, and provides detailed information regarding differential diagnosis.

Description of the clinical case: The authors present their own clinical observation of a fibroma in the tip of the tongue in a 71-year-old female patient, which developed after trauma. The article describes the clinical presentation in detail and provides histological data. Of particular interest is the description of the dermatoscopic appearance of the lesion, as it is characterized by a variety of features. To date, only two descriptions of dermatoscopy of traumatic fibromas have been found in the world literature.

Conclusion: Based on the currently available data, it can be concluded that the main dermatoscopic features of traumatic fibromas include evenly distributed punctate vessels, a pale pink homogeneous background, and hairpin-shaped vessels at the periphery of the lesion. The location and presence of homogeneous whitish areas is likely a variable feature and depends on the location of the greatest pressure applied by the dermatoscope.