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Issue. Articles

3(62) // 2016



1. Scientific researches


Analysis of special aspects of cytokines, immunologic and immunomorphologic changes in patients with psoriasis

I.Y. Voznyak, O.O. Syzon

Danylo Halytsky Lviv National Medical University

Objective — to clarify the relationship between immunological shifts and consecutive changes of neoangiogenesis, inflammatory infiltration and maturation failure of keratinocytes in psoriasis.
Materials and methods. We comprehensively examined 85 patients with vulgar psoriasis in progressive stage, of light and medium severity, men and women aged 24—58 years, with experience of the disease of over one year.
Results and discussion. We found the prevalence of psoriasis incidence among men (59 %), increase in the frequency of undifferentiated type of psoriasis (50 %) with frequently relapsing course (57 %) and greater prevalence of the disease among mature (61 %) and medium (33 %) age persons.
Based on immunohistochemical, pathomorphological studies in patients with psoriasis of moderate severity, increased expression has been detected of markers of VEGF and MMP-9 neoangiogenesis, which provided high — in 49 and 67 % and excessive reaction in 18 and 25 % cases, respectively. Moderate correlation has been established between the increase in the intensity of expression of these markers and increased severity of psoriasis. The number of vessels with a medium severity is twice as big as in mild psoriasis (p < 0.001), and by 5 times exceeds that in the control group (p < 0.001). The dependence of expression of the marker and epidermal keratinocyte proliferation index on the severity of dermatosis was proved. Dependence of index expression of R63 marker on the severity of psoriasis has not been revealed. Statistically significant difference of CD3+ T-lymphocytes (p < 0.05) infiltration of epidermis and dermis, infiltration of CD68+ macrophages of the dermis, increased expression of MMP-9 (p < 0.05) were established in psoriasis of medium severity compared to mild psoriasis and healthy skin.
Serum of patients had a significant decrease (p < 0,01) of the number of immune competent cells of phenotype CD3+, CD22+ or B-lymphocytes, moderate decrease of CD4+, CD8+ and increased content of CD16+; increased levels of cytokines IL-1β, IL-8, IL-17, IL-22, TNF-α, IgG and IgM, CIC immunoglobulins, indicating the intensity of stress mechanisms, even at the stage of clinical stabilization of skin process. Significant increase in the concentration of these cytokines in serum (by more than 3 times) and skin (by more than 3—5 times p < 0.05) of patients during the first months since the onset of psoriatic skin disease syndrome may serve as an additional diagnostic criterion for predicting the persistence of subsequent pathological process.
Conclusions. To identify special aspects of psoriasis course (risk of severe course, evaluation of the probability of persistent pathological process) and to choose the treatment strategy, immunological and immunohistochemical studies should be used besides the standard morphological ones.

Keywords: psoriasis, CD34, VEGF, MMP-9, CD3, CD68, S100, p63, Ki-67, immunological, immunohistochemical indicators, cytokine level.

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Original language: Ukrainian

2. Scientific researches


Clinical and morphological parallels in psoriasis patients with concomitant arterial hypertension

G.I. Makurina

Zaporizhzhia State Medical University

Objective — is the comparison of features of clinical manifestations of dermatosis and structure damage of skin in patients with psoriasis and arterial hypertension as compared to patient without comorbid states.
Materials and methods. Clinical and morphological status of the skin was studied in 17 patients with psoriasis and concomitant essential hypertension of II stage. The control group included 19 patients with psoriasis and normal levels of arterial pressure.
Diagnosis, form, stage and type of psoriasis were determined based on history and clinical examination. PASI index counting methodology was used to assess the severity of the disease. For histological examination of skin structure we examined biopsy materials of 2 × 3 mm, taken from the areas affected by elements of psoriatic rash, as well as from the contralateral visually intact skin areas. Serial tissue sections were prepared using routine histological standards.
Results and discussion. Medium severity forms of psoriasis without hypertension dominated among psoriasis patients with concomitant hypertension (the majority of them had psoriasis vulgaris). The feature of the clinical picture of patients with comorbidity was a brighter, exudative rash. Papules were stable, often have stagnant shade, covered with an accumulation of a large number of scales and crusts. Men of the main group more frequently had exudative forms. In women, the process soon becomes systematic, with the defeat of the joints. These data are consistent with the PASI index in both groups: in the study group the average is (33.9 ± 4.2), in the control group — (26.7 ± 5.3).
Histologically, patients with comorbidity had cell hyperproliferation as a part of microvascular wall, violation of arteriole angioarchitectonics and intrapapillary hemocapillars on a background of diffuse papillae fibrosis which are significantly superior to pathological changes of the microvasculature in psoriasis patients without hypertension. Typical violations of the tissue structure of the skin on the background of comorbid diseases were also systemic fibrosis of the papillary layer and reticular dermis fibroelastosis. The consequences of pathomorphogenesis of damage to dermis during the development of psoriatic process on a background of hypertension were significant interstitial edema of papillary layer, perifocal leukocyte infiltration, exudation, extravasation, plasmorrhages as part of the dermal papilla; lymphostasis and local expansion of lymphatic drainage level of microcirculation, erythrocyte aggregation, erythrodiapedesis, hemorrhage, enhancement of endothelial dysfunction with activation of platelet hemostasis.
Conclusions. Specific clinical picture of dermatosis in patients with psoriasis and concomitant hypertension is a manifestation of pathomorphological processes that occur both in the centers of the affected skin and in the skin with no visible changes.

Keywords: psoriasis, hypertension, pathomorphism.

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Original language: Ukrainian

3. Scientific researches


A study of skin microflora of psoriasis patients and evaluation of possible value of bacterial component in pathogenesis of dermatosis

R.L. Stepanenko

O.O. Bogomolets National Medical University, Kyiv

Objective — to conduct morphological studies of biopsy samples from the areas of skin psoriasis rash and areas of intact skin in patients with psoriasis before and after a course of systemic immunosuppressive therapy with «Etanercept» to identify structural changes and colonies of microorganisms in the skin, as well as immunohistochemical studies of relevant biopsies to determine the species composition of microbial colonies in the skin based on identification of antigenic properties and assessment of the impact of this additional bacterial factor on the severity of the clinical course and prognosis of duration of dermatosis remission.
Materials and methods. We observed 74 patients with psoriasis vulgaris (progressive stage, moderate or severe degree of dermatosis flow). The patients’ age ranged from 18 to 73 years. Women made up 31 (41.9 %), men — 43 (58.1 %). Before the prescription of treatment all patients underwent complex clinical, laboratory and special examinations. We also performed the morphological and immunohistochemical studies of biopsies from areas of psoriatic skin rashes and intact skin before and after systemic immunosuppressive drug therapy with «Etanercept» for 3 months for the detection of structural changes, the presence of colonies of micro-organisms, their species composition.
Results and discussion. The complex morphological and immunohistochemical studies revealed the presence of bacterial components, particularly, numerous colonies of Staphyloccocus aureus under the horny layer of the epidermis of psoriatic lesions in areas of rash in the majority of surveyed psoriasis patients with advanced­stage of dermatosis. Some patients also had a colony of micro-organisms under the horny layer of the epidermis in biopsies from areas of intact skin. The presence of colonies of Staphyloccocus aureus under the horny layer of the epidermis in the areas of regression of psoriatic rash and in areas of intact skin after a three months’ course of immunosupresive systemic therapy was revealed, as also the clinical remission was achieved in some patients.
Conclusions. The presence of Staphyloccocus aureus colonies under the horny layer of the epidermis in the areas of psoriatic rash and intact skin after achieving clinical remission may be additional negative prognostic criterion of the term of occurrence of acute cutaneous psoriatic process.

Keywords: psoriasis, automicroflora of skin, systemic immunosupresive therapy.

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Original language: Ukrainian

4. Scientific researches


Cytokine profile of peripheral blood of patients at different stages of mycosis fungoides

L.M. Hamadeh

.. Bogomolets National Medical University, Kyiv

Objective — to determine the serum concentration of cytokines of Th2-profile (interleukin (IL)-10, IL-4, IL-5) and Th1-pro­file (interferon-γ, IL-2, tumor necrosis factor-α) in patients with erythematous and plaque form of mycosis fungoides.
Materials and methods. We have observed 12 patients with clinical manifestations of mycosis fungoides that were divided into two groups: the first (n = 6) – with histologically confirmed erythematous stage and second (n = 6) – with plaque stage of the disease. The control group consisted of 30 healthy donors. The level of serum cytokines was determined by ELISA using commercial kits of test systems (Immunotech and Diaclone companies (France)).
Results and discussion. Patients with plaque form of mycosis fungoides have had a significant increase of IL-10 concentration in the blood and statistically significant decrease of IL-2 and interferon-γ concentration compared to the control group and the group with erythematous form of the disease. This may be a differential criterion for the diagnosis of mycosis fungoides and increased concentration of IL-4 and IL-5.
Conclusions. The progression of mycosis fungoides is associated with switching of type 1 immune response to type 2.

Keywords: mycosis fungoides, inflammation, cytokines.

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Original language: Russian

5. Reviews


Air pollution and the skin

C. Diehl

Universitá Degli Studi Guglielmo Marconi, Rome, Italy

It is well known that air pollution is for a long time a major concern for public health. Being designated by WHO as the «world’s largest single environmental health risk», its consequences in term of mortality and morbidities are serious and well-documented. On the contrary, the effects of air pollution on the human skin have not been deeply studied, and day after day we discover that it can affect the health and aesthetic appearance of the skin more than previously reported. This review is summarizing the various air pollutants and reporting their influence at cell level and their incidence on the occurrence and worsening of different dermatological diseases.

Keywords: Skin, air pollution, pollutants, particulate matter, ozone, polycyclic aromatic hydrocarbons, nitrogen oxides, cigarette smoking, skin cancer, atopic dermatitis, skin aging.

Additional: Dr. Christian Diehl, Department of Dermatology, Universitá Degli Studi Guglielmo Marconi
Via Plinio, 44, 00193, Rome, Italy
-mail: chdiehl@hotmail.com

Original language: English

6. Reviews


Approach to development of unified protocol for diagnosis and treatment of atopic dermatitis

L.D. Kaliuzhna, L.V. Grechanska

P.L. Shupyk National Medical Academy of Postgraduate Education, Ministry of Healthcare of Ukraine, Kyiv

A retrospective analysis has been conducted of the experience of creating a Ukrainian protocol for diagnosis and treatment of atopic dermatitis. The purpose of the study is the need to analyze the European and the World protocols.

Keywords: protocols, atopic dermatitis, diagnosis, treatment.

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Original language: Ukrainian



Modern approaches to complex treatment of rosacea and demodecosis in light of ethiopathogenetic factors. Literature review and promising new domestic topical treatment and preventive agents

L.V. Hunchenko1, V.I. Stepanenko2

1 TMA «Dermatovenereology», Kyiv
2 O.O. Bogomolets National Medical University, Kyiv

Objective — to estimate the efficacy of treatment of patients with rosacea and demodecosis with the use of new domestic topical medical and preventive agents «Demoskin» (balsam) and «Demoskin» (gel for eyelashes), produced by «Botanika» ltd (Ukraine).
Materials and methods. A special literature review and efficacy analysis of the current agents and methods for the treatment of rosacea and demodecosis was performed. In­house clinical and laboratory tests included examination of 16 patients with rosacea and 9 patients with demodecosis, including 14 females and 11 males. Age of the examined patients ranged from 24 to 65 years. The presence of demodecid mites (Demodex folliculorum, Demodex brevis) was diagnosed using microscopy of the content of oil glands and flakes from the affected facial skin in all 16 examined patients with rosacea and 9 patients with demodecosis. The number of demodecid mites found during these examinations of the patients ranged from 3 to 23 per 1 cm2 of the facial skin area. Furthermore, demodecid mites were also found using microscopy of eyelashes from eyelids in 7 out of 9 examined patients.
In view of the clinical course of rosacea and demodicosis, in particular erythematous, papulous and pustular forms, all 25 examined patients were divided into different follow­up groups. In 12 out of 16 examined patients with rosacea and in 6 out of 9 patients with demodecosis, various concomitant conditions of the gastrointestinal tract as well as endocrine conditions were diagnosed.
Patients with rosacea and demodecosis of erythematous form of lesions (6 patients), and patients with papular form (11 patients) were administered topical therapy with new domestic drug «Demoskin» (balsam). 7 demodecosis patients with demodecid mites found on their eyelashes were additionally administered «Demoskin» (gel for eyelashes) topically on the eyelids. Appropriate topical therapy with «Demoskin» (balsam) and «Demoskin» (eye gel) was carried out in combination with the systemic antibiotic therapy, which was recommended to all 8 patients with pustular lesion form.
The effectiveness of treatment of patients with rosacea and demodecosis was evaluated after a month of therapy according to the following criteria: clinical recovery, significant clinical improvement, clinical improvement, no response. Additionally, all patients underwent a microscopic control study for demodecid mites.
Results and discussion. According to the results of the microscopic examination of the content of oil glands and flakes of the epidermis of the facial skin and eyelashes for the presence of demodecid mites in the examined patients with rosacea and demodecosis, performed after one month of topical application of the new agents «Demoskin» (balsam) and «Demoskin» (gel for eyelashes), they were absent in all 25 (100 %) patients. Also, all 7 (100 %) patients with demodecosis, who had the mites in eyelashes before treatment, did not reveal any of them after the topical application of «Demoskin» (gel for eyelashes) for one month. The results of the study of clinical efficacy of «Demoskin» (balsam) after local treatment for a month also require review and discussion. 2 (50 %) of 4 rosacea patients with erythematous form of lesions as also 1 (14 %) of 7 patients with papular form of this dermatosis, and 2 (100 %) patients with demodecosis of erythematous form of lesions manifested complete clinical recovery characterized by a complete regression of erythema, papular rash on the face, burning and itching in the areas of destruction. Significant clinical improvement was observed in 1 (25 %) out of 4 patients with erythematous form of rosacea, 4 (57 %) out of 7 patients with a papulous form, and 1 (20 %) out of 5 patients with pustular form of rosacea, as well as in 2 (50 %) out of 4 patients with a papulous form of demodecosis and 1 (33 %) out of 3 patients with a pustular form of this dermatoses.
Clinical improvement was reported in 1 (25 %) out of 4 patients with an erythematous form of rosacea, 2 (28  %) out of 7 patients with a papulous form and 3 (60 %) out of 5 patients with a pustular form of rosacea, as well as in 2 (50 %) of patients with a papulous form and 2 (66 %) of patients with a pustular form of demodecosis.
Conclusions. Application of the new domestic medical and preventive agents «Demoskin» (balsam) and «Demoskin» (gel for eyelashes) for the topical treatment of rosacea and demodecosis is sufficiently effective in case of erythematous, papulous and pustular clinical forms of these dermatoses. The proved anti­inflammatory and anti­demodectic effects of «Demoskin» (balsam) and «Demoskin» (gel for eyelashes) show that these agents can be alternatively applied in the complex topical therapy of rosacea and demodecosis.

Keywords: rosacea, demodecosis, topical treatment, Demoskin (balsam) and Demoskin (gel for eyelashes).

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Original language: Ukrainian



Optimization of external therapy of patients with chronic lupus erythematosus

Y.F. Kutasevych, I.O. Oliinyk, I.O. Mashtakova

SI «Institute of Dermatology and Venereology of NAMS of Ukraine», Kharkiv

The paper presents the possibilities and methods of use of topical steroids for the treatment of chronic lupus erythematosus, which is characterized by a torpid course and resistance to therapy. It is recommended to use drugs containing glucocorticosteroids of different force of action depending on varying degrees of disease severity.

Keywords: chronic lupus erythematosus, external treatment, topical corticosteroids.

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Original language: Russian



Clinical route of patients with precancerous lesions of skin

.. shyvalova

SI «Scientific and Practical Centre of Preventive and Clinical Medicine» the State Administration, Kyiv
P.L. Shupyk National Medical Academy of Postgraduate Education, Ministry of Healthcare of Ukraine, Kyiv

Objective — to develop and implement local protocols of medical care for patients with precancerous lesions of the skin in profile medical facility.
Materials and methods. We used the personalized database of State Scientific Institution «Scientific and Practical Center of Preventive and Clinical Medicine» of State Administration for 2014—2016 years.
Results and discussion. Local health care protocol for patients with precancerous lesions of the skin is designed for doctors of out-patient clinics, general practitioners, dermatologists, oncologists, surgeons, histopathologists, etc. These protocols and clinical routes were implemented to the work of diversified medical institution for 9 months.
Conclusions. Implementation of the protocol allowed to increase the effectiveness of early diagnosis of precancerous pathology of the skin and reduce the incidence of squamous cell skin cancer.

Keywords: precancerous skin pathology, actinic keratosis, Bowens disease, squamous cell skin cancer, local protocol, patients clinical route.

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Original language: Ukrainian



Elixir of youth within us

E.G. Tatuzyan, A.M. Bilovol, S.G. Tkachenko

Kharkiv National Medical University

Beautiful well-groomed appearance often ensures great success and big opportunities, so a successful woman understands how important it is not only to pay attention to the intellectual development, but also to save external beauty and attractiveness, youthfulness and health. In recent years a very effective method has emerged to combat all signs of aging of the skin which produces the result almost immediately after the first use and does not require a period of rehabilitation. This procedure is called plasmolifting. It can solve many problems of not only aesthetics but also skin health.

Keywords: plasmolifting, fibroblasts, youthfulness, vitality, aging, platelets.

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Original language: Russian



Agent for topical treatment of eczema

V.I. Stepanenko1, L.M. Shkaraputa2, L.V. Sologub1, L.O. Naumova1, L.O. Tyshchenko2, L.. Shevchenko2, Ya.V. Tsekhmister1, V.P. Kukhar2

1 O.O. Bogomolets National Medical University, Kyiv
2 Institute of Bioorganic Chemistry and Petrochemistry of NAS of Ukraine, Kyiv

Use of teobon­dithiomycocide (N-­(1,1-dioksotiolan-3-yl)potassium dithiocarbamate) for the topical treatment of eczema al­lows in case of good tolerability and absence of side effects, to shorten the moisture term up to 2—3 days, to accelerate erosions epithelization (on 4th —5th days), to eliminate the inflammatory signs and subjective symptoms of eczema without risk of side effects that usually accompany the treatment with topical corticosteroid agents.

Keywords: Teobon-dithiomycocide, topical drug, eczema, efficiency, moisture, epithelialization.

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Original language: Ukrainian



New approaches to treatment of herpes virus affections and postherpetic neuralgia

M.E. Zapolskiy1, M.M. Lebediuk2, N.B. Prokofyeva2, I.V. Ashanina2, K.A. Borisova1

1 Odesa Regional Dermatovenerologic Dispensary
2 Odesa National Medical University

Objective — to reduce the incidence of postherpetic neuralgia in patients with herpes zoster by use of abnormal nucleotides in combination with anticonvulsants.
Materials and methods. The study included 65 patients aged from 18 to 65 years with various forms of herpes zoster. Depending on the therapy, the patients were conditionally divided into main (n = 37) and comparative group (n = 28). They were also divided into three groups depending on the terms of beginning of therapy: (I group — on 2—3 day of the disease, II group – on 4—6 day, III group — on 7—10 day). For treatment of patients of the main group we used valacyclovir containing drugs («Valtrovir») in combination with anticonvulsants («Gatonin»); for treatment of patients of the comparative group — standard schemes with valacyclovir.
Results and discussion. In the main group receiving the combination therapy, post-herpetic neuralgia developed in 35.1 % of cases, in the comparison group — in 53.5 %. Early epithelization elements were noted on days 7—8. Disappearance of rash after the 14th day of treatment was observed in 32.4 % of patients of the main group and in 39.3 % of patients of the comparison group.
Conclusions. Concurrent use of anomalous nucleotides and anticonvulsants helped to reduce the frequency of postherpetic neuralgia on an average by 18.4%. The rate of epithelialization of herpetic sores and regression of postherpetic neuralgia are directly proportional to the terms of the beginning of the specific therapy.

Keywords: herpes zoster, postherpetic neuralgia, anticonvulsants, Valtrovir, Gatonin.

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Original language: Russian



Case of Schwenninger  Buzzi macular skin atrophy: clinical features and differential diagnosis of other types of skin atrophy

V.E. Tkach1, L.D. Kalyuzhna2, O.D. Aleksandruk1, M.S. Voloshynovych1

1 Ivano-Frankivsk National Medical University
2 P.L. Shupyk National Medical Academy of Postgraduate Education, Ministry of Healthcare of Ukraine, Kyiv

A case of Schwenninger­-Buzzi macular skin atrophy, differential diagnosis, possible diagnostic mistakes were described.


Keywords: skin atrophy, clinical varieties, rare clinical form.

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Original language: Ukrainian



Dermatitis herpetiformis: etiology, pathogenesis, clinical picture, diagnostic methods, treatment

I.A. Ivanischeva

O.O. Bogomolets National Medical University, Kyiv

In article we reviewed modern concepts of etiology, pathogenesis, clinical manifestation, diagnosis and treatment of dermatitis herpetiformis. We paid practitioner’s attention to the possibility of atypical clinical manifestation of dermatitis herpetiformis, which is important in terms of preventing diagnostic errors.

Keywords: dermatitis herpetiformis, etiology, pathogenesis, clinical picture, diagnosis, treatment.

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Original language: Ukrainian



Symptoms of some dermatoses of outer ear

V.G. Kravchenko

Medical Consulting Center «Medipol», Poltava

A number of dermatoses on the skin of the outer ear were considered, in particular: nodular hondrodermatitis, eczema, light pox. Much attention is paid to otomycosis in dermatological practice. The results were presented of the survey and the successful treatment of 19 patients with otomycosis (aspergillosis and candidosis) using the author’s specially developed technique with antiseptic preparation «Cidipol».

Keywords: eczema, light pox, otomycosis, antiseptic preparation Cidipol.

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Original language: Ukrainian

16. History of dermatovenereology


The story of two photos

S.S. Korkhov, M.. Lebedyuk

Odesa National Medical University

The personalization of two photographic documents representing an obvious historical interest was held. Brief biological information about students of Microbiological courses at Pasteur Institute depicted in the photo is presented. The facts of their involvement in the events reflected in the photos are revealed. The answer to the question why Dr. Trapeznikov is present on both phtoes was given.

Keywords: biography, history of national and world science, dermatology, syphilidology, Microbiological courses, Pasteur Institute, World Congress, Paris, Odesa.

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Original language: Russian