No 34 (2014)

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Autoimmune pemphigus is a severe, potentially fatal disease affecting skin and mucous membranes. It is characterized by the presence of IgGautoantibodies against target desmosomal antigens of stratified squamous epithelium. Despite the promising results of the molecular biological research in the area of the pathogenesis of autoimmune pemphigus during past decades, diagnosis/ differential diagnosis of pemphigus remains one of the most important problems of dermatology due to rapid progression and expansion of the skin and mucous membranes lesions and the high risk of disability and death in inadequately treated patients. Correct and timely diagnosis of autoimmune pemphigus contributes to proper treatment and reduces complications risk.

Background: Psoriasis is a disease with growing incidence predominantly affecting young and middle-aged patients. It is characterized by frequent exacerbations, insufficient efficacy of the routine therapy and common adverse effects. Thus, use of alternative therapies is of great importance. Aim: To assess efficacy and safety of homeopathic medicine Loma Lux Psoriasis in patients with different forms of psoriasis. Materials and methods: 45 patients with progressive (n=17) and stable (n=28) psoriasis and mean PASI (Psoriasis Area and Severity Index) value 17.3 (5–30) were treated with homeopathic medicine Loma Lux Psoriasis in combination with topical medicines: salicylic Vaseline 2%, tar and naphthalane preparations, ointments with fluocinolone acetonide and mometasone, betametasone/salicylic acid combinations. Diet was also recommended. Results: After 12 weeks, significant improvement (PASI decrease 75–100%) was demonstrated in 40%  of the patients including completely absent skin desquamation, resorption of psoriatic papules and patches with residual hyper- or depigmentation. 57.8% of the patient had moderate improvement (PASI decrease 25–75%). In one patient with only slight improvement (PASI decrease less than 25%) treatment was prolonged for 4  weeks and significant improvement was achieved. Therapy was well tolerated in all patients. No side effects or treatment-related complications were reported. Clinical recover was associated with marked tendency to improvement of blood biochemistry and immunology: elevation of immunoregulatory index up to 1.6 and T-helpers content up to 44.3%. Conclusion: Homeopathic medicine Loma Lux Psoriasis is characterized by good efficacy and safety profile and may be recommended as addon to comprehensive treatment of stable and progressing psoriasis.

The article reviews current data on the mechanisms of effects of laser radiation on the body, technical aspects of using different intensities of laser radiation and the effects of the laser on biological tissue. The results of studies of laser radiation as a part of comprehensive treatment of skin diseases including skin tumors are presented. Data on the efficacy and safety of laser therapy are discussed. Benefits of laser therapy in dermatology include shortening of treatment duration and only limited contraindications. Considering effectiveness, usability and safety of the method, it is regarded as a promising direction in dermatology.

The article presents a case of a very rare disorder – generalized eruptive keratoacanthoma of Grzybowski in a woman aged 82 years old. The disease is characterized by sudden emergence of hundreds or thousands of neoplasms (2–5 cm in diameters) rapidly spreading throughout the body skin. It is frequently associated with internistic cancer. In this case, generalized eruptive keratoacanthoma of Grzybowski was diagnosed 4 years after the disease onset. The authors emphasize the role of proper diagnosis and treatment of this pathology. Aromatic retinoids were highly effective in the therapy of generalized eruptive keratoacanthoma of Grzybowski.

Aim: To study an association between acrochordon and human papilloma virus (HPV) using quantitative analysis of viral desoxyribonucleic acid (DNA); to detect different phenotypes of beta-HPV. Materials and methods: We examined 52  patients (22 immuno-suppressed patients and 30 immunocompetent subjects) in the Dermatovenereology and Dermato-Oncology Department and Chronic Dialysis and Kidney Transplantation Department of the Moscow Regional Research and Clinical Institute (MONIKI). Control group included 49 healthy donors. Burr biopsy samples (micro-samples) of acrochordon and intact skin (apper arm) were collected in sterile conditions. After sample procession and DNA isolation using DNK-sorb-C kit (Central Research Institute for Epidemiology – CRIE), polymerase chain reaction for HPV was performed with real-time fluorescent hybridization detection. For DNA amplification and detection we used RotorGene 3000 analyzer (Corbett Research, Australia). In the beta-HPV assay, recombinant plasmids were used as positive controls and control human beta-globin gene fragments (CRIE). 4 oligo-nucleotide systems (group-specific primers and probes) were used for the detection of beta-HPV DNA. Results: Preliminary data indicated that acrochordons of open and covered skin regions were common in renal transplant recipients. Beta-HPV DNA was more frequent in acrochordons and intact skin (64% and 54%) of renal transplant recipients compared to healthy donors (47%). 57% of renal transplant recipients demonstrated mixed infection in acrochordons. Conclusion: HPV DNA was frequently detected in acrochordons and intact skin of renal transplant recipients. In immunocompetent patients prevalence of HPV DNA in acrochordons was significantly higher compared to intact skin.

Background: Photodynamic therapy is frequently applied for non-invasive destruction of basal cell carcinomas (BCC) of the skin; though, there is lack of evidence for efficacy of the method. Aim: To assess objective response of BCCs to photodynamic therapy with intralesional administration of photosensitizer Radachlorin in patients with different clinical forms, stages, flow patterns and localization of BCC. Materials and methods: 45  stage I–II BCCs patients with primary and recurrent solitary (ulcerative, superficial, scleroderma-like and nodular forms) and multiple lesions (predominantly Т₁– Т₂N₀M₀), with difficult to treat localization and high risk of recurrence were included during the period from March 2004 to March 2007. All patients received one cycle of photodynamic therapy with intralesional Radachlorin (0.5–1  ml/1  cm² tumor surface) and irradiation dose 300  J/cm² (wavelength 662 nm). A primary outcome measure was grade of clinical and cytological lesion regression after three months. Secondary outcome measure was stable clinical and cytological reaction at the lesion site. In the long-term, lesion recurrence was assessed yearly during 5 years. Results: Complete regression of BCCs was found in 43  (95.5%) patients and 47  (95.9%) lesions. In 2 (4.5%) patients with partial regression of 2 (4.1%) lesions repeated cycles of photodynamic therapy resulted in complete response. In BCCs Т₁N₀M₀, early outcome was independent from the clinical form of the diseases; by contrast, in BCCs Т₂N₀M₀, treatment of scleroderma-like BCCs was non-significantly less effective (66.7%) compared to nodular, surface (100% for both) and ulcerative (92.8%) forms. In the long-term, 1  tumor recurrence was observed after 29 months at the site of completely regressed ulcerative lesion. Conclusion: Photodynamic therapy with intralesional administration of photosensitizer Radachlorin is an effective treatment method for different clinical forms of BCC.

Background: Basal cell carcinoma of the skin (BCC, basalioma) is one of the most common malignant skin tumors. Dermoscopy is the most available today method of non-invasive diagnosis of skin tumors. Though, its usability is limited due to absence of prognostic dermoscopic criteria associated with different morphological variants of basalioma. Aim: To define dermoscopic features of different histological types of BCC. Materials and methods: 35 biopsy specimens from BCC lesions were evaluated. After clinical examination, superficial basalioma was diagnosed in 18 patients and nodular form in 17 patients. Results: Vascular structures were detected in 100% of cases. In patients with superficial multicentric type of basalioma, presence of all vascular types was a significant prognostic factor; predictive values of point- and spike-shaped vessels were 100 and 71.4%, respectively. Absence of point-shaped vessels and presence of other vascular types were associated with the prognosis of nodular basalioma. In patients with infiltrative type of basalioma, dendriform, tortuous and linear vessels in combination with short tiny teleangiectases and absence of spike-, comma-, point- or glome-like vessels had positive prognostic value. In patients with superficial multicentric and nodular types of basalioma, homogenous white and rose zones were most prevalent: in 53.8 and 57.1% of cases, respectively. In infiltrative type, this feature was typically absent (р<0,04). Conclusion: Different morphological types of basaliomas are characterized by different dermoscopic features. Vascular structures are most strongly associated with the prognosis of the disease.

Aim: To assess clinical efficacy of nicotinamide in 2 the treatment of patients with early stages of malignant T-cell skin lymphomas and large-plaque parapsoriasis. Materials and methods: 12 patients with erythematous stage of mycosis fungoides and 14 patients with large-plaque parapsoriasis were treated by nicotinamide 15 mg twice daily during 2 weeks. Treatment cycles were repeated 4–5 times per year; topical therapy was also administrated. Results: Nicotinamide demonstrated high therapeutic effect and good tolerability in patients with early stage of mycosis fungoides and large-plaque parapsoriasis. Stable remission was achieved in 1  woman with malignant T-cell lymphoma and 12  patients with large-plaque parapsoriasis; significant clinical improvement was shown in 8 and 12 patients, respectively. Conclusion: Thus, nicotinamide is recommended for comprehensive treatment of large-plaque parapsoriasis and early stages of mycosis fungoides.

The article reviews literature data on the efficacy of liposomal cosmetics Aicida in the treatment of chronic dermatoses. This product line is Antiseptic Dorogov’s Stimulator (ASD)-based which has been applied in dermatology during 60 years. Modern liposomal technologies have been used in the development of new cosmetic bases to ensure conformance to current standards. Gelcream for sensitive face and body skin, hand gelcream and dry scalp balsam have been successfully used in the treatment of psoriasis. Gel-cream for hands and sensitive face and body skin has demonstrated good efficacy in the treatment of hands eczema and mild and moderate atopic dermatitis. Using cosmetic line Aicida for basic care in patients with remission of chronic dermatoses ensures good skin status and promotes longer remissions.

The article discusses current data on the prevalence and clinical manifestations of papyllomavirus infection. Burning issues of diagnosis and treatment are delineated. Experience-based recommendations on the diagnosis and treatment of papyllomavirus infection are presented.

The article reports successful use of extracorporeal photochemotherapy (photopheresis) in the comprehensive treatment of 9 patients with urogenital reactive arthritis (Reiter’s disease).