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Issue. Articles

2(65) // 2017

 

 

1. Scientific researches

 

State of immune system of the body in patients with psoriasis in the dynamics of treatment

R.L. Stepanenko

O.O. Bogomolets National Medical University, Kyiv

Objective — to analyze the quantitative indicators of the cellular and humoral parts of the immune system of patients with psoriasis before and after the course of therapy.
Materials and methods. Under our complex examination were 207 patients with vulgar psoriasis, including 126 (61 %) men and 81 (39 %) women. The age of the examined patients ranged from 18 to 79 years. The indices of cellular immunity in the body were assessed by the changes in the relative and absolute number of T-­(CD3+) and B-­(CD19+)-lymphocytes, as well as subpopulations of (CD4+, CD8+, CD16+, CD25+CD71+, CD30+, CD95+). To identify the surface structures of lymphocytes, a direct immunofluorescence method was used in which a fluorescent label was attached to anti-­CD mononuclear antibodies of the Leu series of Becton Dikinson company (USA). The calculations were performed on a laser flow cytofluorimeter of Baston company (USA).
Results and discussion. The most positive effect on the cellular part of the body’s immune system was found in patients with psoriasis who received immunotherapy with tanercept in combination with narrow-­band (311 nm) phototherapy. After treatment of patients of this group, due to a significant reduction in production of TNF and its concentration in the blood serum, there was decrease in proinflammatory changes in the cellular part of the immune system, and the number of lymphocytes with an early activation marker which initiated a further cytokine cascade of development and prolongation of the filling. In addition, a significant decrease in the number of CD30+-lymphocytes is found to be an indirect factor which indicates the switching of Tx2 responses (autoimmune manifestations) to Tx1, and therefore achievement of clinical and immunological remission of the psoriatic process. It is also very important for the functioning of the immune system to consider the decrease in the content of activated lymphocytes expressing the Fas­-receptor, because due to increased apoptosis of lymphocytes, namely T-­cytotoxic lymphocytes, autoimmune and proliferative changes occured in the exacerbation of the psoriatic process.
Conclusions. It has been established that all our psoriasis therapy regimens have immunorehabilitation properties, but the degree of their expressiveness was different. The most effective therapy scheme is the combined use of tanercept and UVB which reduced proliferative and inflammatory changes in the skin, antigen load, level of CIC, autosensitivity and autoimmune disorders.

Keywords: psoriasis, systemic immunosuppressive therapy, immunological changes.

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Original language: Ukrainian

2. Scientific researches

 

Dermatological and neurological features of the development of the first and second type recurrent herpes infection

U.V. Fedorova, O.O. Syzon

Danylo Halytsky Lviv National Medical University, Lviv, Ukraine

Objective — to compare gender, age, genetic, dermatological and neurological features in patients with recurrent herpes infection (RHI).
Materials and methods. We examined 120 RHI patients with 1 and 2 types of herpes simplex virus (HSV) including 41 men and 79 women. 62 patients were under age 35, 37 patients were 35—50, 21 patients were over 50.
Results and discussion. Credible gender dependence on the nature of common infection manifestations was not found except for fatigue, which was observed more frequently in women (71.0 ± 13.5 %; < 0.05). Gender differences were observed in the range of dermatological manifestations such as lips swelling (14.9 ± 2.97 %; < 0.05). Other body parts swelling (20.2 ± 4.27 %; < 0.01) was more significantly expressed in women however rashes on genitals (23.9 ± 3.94 %,  < 0.05) were more common in men. Among the neurological manifestations, polyneuropathy (11.0 ± 3.03 %; < 0.05), sciatic neuritis (10.3 ± 3.35 %; < 0.05) and especially headaches (21.4 ± 5.68 %; < 0.05) were evidentially more frequent in women than in men. Fatigue was mostly present in patients (81.8 ± 17.2 %; < 0.05) who had 1 and 2 types of DNA HSV in saliva. (39.4 ± 5.83) % of them were under age 35 ( < 0.05) and (29.6 ± 6.82) % were 35 to 50 years old ( < 0.05). Joint pains were more manifested in patients aged 35—50 years (2.75 ± 1.19) % ( < 0.05). Body rashes prevailed among other dermatological manifestations (24.2 ± 5.43) % in patients under age 35 ( < 0.05). Genital rashes were detected in (18.9 ± 6.4) % of patient aged 35—50 years ( < 0.05). Among DNA virus positive individuals the most common were dermatological manifestations such as swelling of lips (16.8 ± 4.94 %; < 0.01) and other body parts (20.5 ± 3.88 %;  < 0.05), genital rashes (24.5 ± 8.03 %; < 0.05). Neurological manifestations were more common in patients with 1 and 2 types of DNA HSV and expressed as polyneuropathy (12.1 ± 3.15 %; < 0.05), eye redness (9.6 ± 4.89 %; < 0.05) and sciatic neuritis (11.3 ± 1.22 %; < 0.01).
Conclusions. Clinical manifestations of recurrent HSV infection of 1 and 2 types were mostly characterized with chronic fatigue syndrome and oedematic, dermatological and neurological disorders. The most significant clinical variations were observed in patients with active replicative ability of HSV of 1 and 2 types in saliva.

Keywords: recurrent herpes infection, herpes simplex virus of 1 and 2 types, clinical picture.

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Original language: Ukrainian

3. Scientific researches

 

Dynamics of ratios of peripheral blood cells of the immune system in patients with mycosis fungoides during combined therapy

L.M. Hamadeh

.. Bogomolets National Medical University, Kyiv

Objective —to determine the dynamics of changes in the indices of the main immunophenotypes of peripheral blood cells in patients with fungal mycosis at various stages of the development of the disease during chemotherapy.
Materials and methods. Under our supervision, there were 12 patients with mycosis fungoides (MF) who underwent treatment at the clinic of the Department of Dermatology and Venereology of O.O. Bogomolets National Medical University. The diagnosis and stages of the disease were confirmed on the basis of clinical symptoms and peripheral blood analysis. Clinical information was obtained during the analysis of patients’ medical records. Patients were treated by preparations based on prospidium chloride (chloroxiperazine) in the form of powder for injection (100 mg in 1 ampoule) and 30% ointment. Flow cytometry was performed on blood samples taken from 12 patients with MF aged 65 to 85 years in the period from 2013 to 2017. 6 patients had stage IA of MF and 6 – stage IIB. The blood test was performed 2 times before and after chemotherapy for prospidium chloride. Statistical analysis was performed using version 1.0 of SigmaSat software (Jandel Corporation, San Rafael, CA). The proportions were compared with the use of Mann­Whitney U test and the Spearman correlation coefficient. For all statistical tests, statistical significance was confirmed at p less than 0.05.
Results and discussion. In the blood of patients with MF of IA and IB stages, a significant decrease in the number of CD45+CD5+CD19– and CD45+CD3+ lymphocytes was detected with flow cytometry after treatment with prospidium chloride. A more pronounced decrease in the amount of CD45+CD3+CD4+CD8– T-­lymphocytes of helpers was revealed in the group of patients at stage IA.
Conclusions. The study of the dynamics of changes in the quantitative composition of the helper subpopulation during therapy with the use of the prospidium chloride preparation indicated a decrease in CD45+CD4+CD45RA+CD45RO– naive T­helpers and CD45+CD4+ CD45RA–CD45RO+ -cells of memory in all groups of patients. The most pronounced decrease in CD45+CD4+ CD45RA+CD45RO– naive T­helpers and CD45+CD4+CD45RA–CD45RO+ T­cells of memory was observed in patients with MF at stage IA. In patients with MF at stage IIB, in contrast to patients at stage IA, there was a significant decrease in populations of CD45+C19+CD5+CD27+ B­memory cells and CD45+CD3–CD16+CD56+ natural killer cells.

Keywords: mycosis fungoides, combined therapy, changes in immunophenotypes of peripheral blood cells.

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Original language: Russian

4. Scientific researches

 

Rheological properties of blood serum at limited and diffuse forms of systemic sclerosis

O.V. Syniachenko1, V.Ya. Mkuksts1, M.V. Yermolaeva1, Ye.D. Iegudna2

1 Donetsk National Medical University, Lyman
2 SI «Dnipropetrovsk Medical Academy of Health Ministry of Ukraine», Dnipro

Objective — to evaluate changes in serum level of rheological properties of blood (RPB) in clinico-morphological variants of limited and diffuse forms of systemic sclerosis (SS).
Materials and methods. The study included 63 patients with SS aged from 16 to 67 years (mean 42 years), among them 11 % men and 89 % women. 43 % of patients had a limited form of the disease, 57 % — a diffuse form. The duration of the disease was 11 years. The I level of activity of the pathological process was registered at 41 % of patients, II — at 38 %, III — at 21 %, anti­topoisomerase 1 antibodies were detected in serum at 78 % of cases, antibodies to native deoxyribonucleic acid — at 64 %, to cardiolipin — at 18 %. RPB was assessed by interfacial tensiometry with the determination of surface parameters. For control the parameters were studied in 52 healthy people and 42 patients with limited scleroderma. Skin microincisional biopsy was performed in 37 patients.
Results and discussion. SS is accompanied by violations of RPB, which are manifested by increased viscoelasticity module parameters in 8 % of patients and the surface tension in – in 66 % against the background of reducing surface elasticity level in 37 %. The last two parameters of interfacial tensiometry differ not only from those in healthy people, but also in patients with limited scleroderma. Changes in the viscoelastic properties of blood are more prevalent in diffuse form of the disease than in the limited form when there is dispersive correlation between RPB and the severity of skin lesions and extradermal manifestations of SS (heart, lung, kidney disease). The elastic and relaxation serum characteristics have predictive value in case of limited and diffuse forms of the disease.
Conclusions. SS occurs with disorders of serum level of RPB which are more characteristic to the diffuse form of the disease and are closely related to the severity of skin and internal organs lesions, the indicators of which can be used to improve the assessment of the clinical course severity and prognosis of the individual signs of the disease.

Keywords: systemic scleroderma, clinical course, blood, serum, rheology.

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Original language: Russian

5. Scientific researches

 

Algorithm of acne treatment with consideration of pathogenetic components

A.V. Petrenko

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

Objective — to explore the relationship between variations of genetic polymorphisms and response to pathogenic treatment.
Meterials and methods. Results of the study are based on data of molecular genetic examination and treatment of 78 patients with acne of medium and severe degrees. Patients were divided into two groups according to treatment prescribed to them. Each group was also divided into two subgroups depending on the severity of the disease.
Results and discussion. In acne patients receiving systemic therapy with nicotinamide riboside there were significantly better outcomes compared to those receiving only local therapy. The best therapeutic effect of nicotinamide riboside was observed in patients with mutations in one or more genes.
Conclusions. Therapy with nicotinamide riboside had positive effect on course of disease in patients with gene mutations.

Keywords: acne, nicotinamide riboside, TLR4, IL 1β, IL 8.

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Original language: Ukrainian

6. TO HELP PRACTICING PHYSICIANS

 

Prospects for inclusion of natural herbal remedies in the diet of patients with acne to improve skin condition

B.G. Kogan, .S. Svyryd-Dzyadykevych

.. Bogomolets National Medical University, Kyiv

The article discusses etiological factors of acne occurrence in different age groups and provides general principles of treatment depending on the stage of the disease. The article reveals the experience of use of «Finer» preparation as a dietary supplement in the diet of patients of childbearing age with a diagnosis of acne. Positive effect of the herbal preparation «Finer» on the skin of patients was proved. «Finer» inhibits the activity of Propionibacterium acnes, shows a pronounced anti­inflammatory effect — that is harmoniously compliments an integrated approach to the management of acne by dermatologist.

Keywords: acne, etiology, treatment, Propionibacterium acnes, antiinflammatory effect.

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Original language: Ukrainian

7. TO HELP PRACTICING PHYSICIANS

 

Complex differentiated approach to treatment of psoriasis with consideration of concomitant pathology of digestive system

T.O. Lytynska, V.I. Stepanenko

.. Bogomolets National Medical University, Kyiv

Objective — to increase the effectiveness of treatment of patients with psoriasis and concomitant pathology of the digestive system by means of differentiated therapeutic correction of disorders.
Materials and methods. 272 patients with psoriasis aged 18 to 72 years were under observation. With consideration of the concomitant gastroenterological pathology diagnosed in patients with psoriasis and in order to evaluate the effectiveness of therapy, patients were divided into equivalent clinical groups. Patients received complex differentiated therapy taking into account the concomitant pathology of the digestive organs, namely: eradication of Helicobacter pylori infection (H. pylori infection), correction of functional disorders of the hepatic system and intestinal microbiota. Patients of the comparison group were prescribed basic therapy.
Results and discussion. Eradication of H. pylori infection and normalization of the functional state of the liver and intestine can improve the effectiveness of basic therapy, increase the duration of remission and reduce the frequency of recurrence of dermatosis in patients with psoriasis and concomitant pathology of the digestive system.
Conclusions. Complex individualized therapy, with consideration of the concomitant pathology of the digestive organs, including eradication of H. pylori infection, correction of functional disorders of the hepatic system and intestinal microbiota, allows increasing the effectiveness of the basic treatment and duration of remission as also reducing the frequency of relapses of dermatosis.

Keywords: psoriasis, Helicobacter pylori infection, hepatic system, intestinal microbiota, dysbiosis.

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Original language: Ukrainian

8. TO HELP PRACTICING PHYSICIANS

 

The use of composition of Teobon-dithiomycocide with gentamicin for topical treatment of dermatoses complicated by fungal or bacterial microflora

V.I. Stepanenko1, L.M. Shkaraputa2, L.O. Naumova1, L.O. Tyshchenko2, L.A. Shevchenko2, Ya.V. Tsekhmister1, V.P. Kukhar2, V.A. Golikov3

1 O.O. Bogomolets National Medical University, Kyiv
2 Institute of Bioorganic Chemistry and Petrochemistry of NAS of Ukraine, Kyiv
3 SE «Experimental Plant of Medical Preparations of Institute of Bioorganic Chemistry and Petrochemistry of NAS of Ukraine», Kyiv

Objective — to improve topical treatment of dermatoses complicated with bacterial or fungal infections by applying a new topical treatment, particularly, the composition of «Teobon-dithiomycocide» with gentamycin.
Materials and methods. We observed 43 patients with dermatoses complicated by fungal or bacterial infection, aged 18 to 55 years. 13 patients were diagnosed with infectious eczema, 23 — with dermatomycosis of the feet (intertrigo or dyshidrotic form), 7 – with rosacea (papulopustular form).
Results and discussion. The composition of «Teobon-dithiomycocide» with gentamicin is effective for topical treatment of certain dermatoses complicated with bacterial infection, particularly, infectious eczema, dermatomycosis of the feet (dyshidrotic form), rosacea. Therapeutic efficacy, absence of side effects and good tolerability of this drug were proved, which indicates the expediency of its use as an alternative for topical treatment of dermatoses complicated with bacterial or fungal infection.
Conclusions. The composition of «Teobon-dithiomycocide» with gentamicin is an effective alternative for topical treatment of dermatoses complicated with bacterial or fungal infections.

Keywords: Teobon-dithiomycocide, gentamicin, topical drug, complicated dermatoses.

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Original language: Ukrainian

9. PHARMACOTHERAPY IN DERMATOLOGY AND VENEREOLOGY

 

Experience of therapy of patients with resistant and heavy forms of acne and rosacea with the use of the systemic LIDOSE isotretinoin

L.Ya. Fedorych

Ukrainian Military Medical Academy, Kyiv

Objective — to highlight the experience of therapy of patients with resistant and severe forms of acne and rosacea using individual doses of systemic LIDOSE isotretinoin.
Materials and methods. In the period of 2015—2017 we observed 35 patients with resistant and severe clinical forms of acne and rosacea treated with LIDOSE isotretinoin.
Results and discussion. Positive effect of LIDOSE isotretinoin therapy was registered in all 35 patients. To treat patients with severe clinical forms of acne and rosacea, a special treatment regimen using increased doses of LIDOSE isotretinoin has been proposed and applied, according to which the drug is prescribed for a short period of time at a dose of 1 mg per kg of body weight per day, with a gradual decrease in the daily dose to a minimum value. At the same time, it is mandatory to achieve the maximum LIDOSE isotretinoin dose of 120 mg per kg of body weight for the entire period of treatment, which usually takes 5—­6 months.
Conclusions. Based on our own experience, systemic LIDOSE isotretinoin technology is a highly effective treatment for severe clinical forms of rosacea, acne of medium, severe and very severe degrees as also treatment­resistant forms of the disease. For treatment of these patients we suggested and applied a special treatment regimen using high doses of LIDOSE isotretinoin.

Keywords: acne, rosacea, treatment, LIDOSE isotretinoin.

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Original language: Ukrainian

10. PHARMACOTHERAPY IN DERMATOLOGY AND VENEREOLOGY

 

Experience of treatment of mycotic infections of the scalp

Zh.V. Korolova, V.M. Borovykov

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

According to WHO, dermatomycoses affect up to 20% of the world population. Microsporia belongs to the most common dermatomycoses, ranking second only to fungal infections of the feet and hands. The defeat of the scalp is indication for the systemic treatment of mycoses. It is not easy for the doctor to choose a highly effective and safe antifungal agent. Griseofulvin is succeed by new fungicidal agents. From this perspective, preference should be given to terbinafine which has high fungicidal activity against dermatophytes and high safety. The aim of the work is to improve treatment of fungal infections of the scalp. The main attention is paid to the use of tableted «Mikofin» in the treatment scheme. «Mikofin» showed high efficiency in treatment of fungal infections of the scalp owing to fungicidal activity against the pathogen agent and dermatotropic property as also high compliance due to easy administration (once daily) and efficiency regardless of the food content. High clinical effectiveness was shown thus «Mikofin» can be recommended for use in treatment of mycotic infections of the scalp.

Keywords: mycotic infections of the scalp, adolescents, systemic treatment, terbinafine.

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Original language: Ukrainian

11. PHARMACOTHERAPY IN DERMATOLOGY AND VENEREOLOGY

 

Plazmotherapy (P-PRP-therapy): modern approach to treatment of atrophic scars postacne

Ya.O. Sulik, .S. Svyryd-Dzyadykevych

O.O. Bogomolets National Medical University, Kyiv

Objective — to improve treatment of atrophic scars by applying the method postacne plazmotherapy (P-­PRP-­therapy).
Materials and methods. The review and analysis of domestic and foreign publications on the method of P-­PRP-­therapy for scars postacne. Our study included 11 patients (aged from 18 to 34 years) with atrophic scars postacne (8 women and 3 men). The course of P-­PRP-­therapy was carried out on an empty stomach with a diet for 3 days once every 2 weeks for 2 months. 9—10 ml of plasma enriched with platelets were injected subcutaneously.
Results and discussion. Using P-PRP-­therapy in the treatment of atrophic scars postacne of third and fourth degree allowed achieving significant aesthetic effect manifested as the decrease of relief of the skin in the areas of lesion on the face and softening of the scars. The color and texture of the skin markedly improved at the end of the first month of treatment. After the treatment, cosmetic defects on the skin of the face were easily masked with the help of cosmetics.
Conclusions. Sufficiently high therapeutic and cosmetic efficacy and good tolerability of plasma therapy (P-­PRP-­therapy) in the treatment of atrophic scars postacne were established.

Keywords: plazmotherapy (P-PRP-therapy), acne, atrophic scars, postacne.

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Original language: Ukrainian

12. Reviews

 

Chemical peeling in dermatology. Part II. Practical application, complications and their management

C. Diehl

Universitá Degli Studi Guglielmo Marconi, Rome, Italy

In spite of a growing number of peelings offered to the dermatologists, the latter often fear of using them in their daily practice, because of an incomplete knowledge of how exactly to apply them, and a fear of complications for their patients. In this article, we are detailing the practical applications of the various categories of peelings and reviewing the possible complications and the best way for managing them in case of occurrence.

Keywords: Chemical peeling, glycolic acid, trichloracetic acid, salicylic acid, phenol peeling, pre-peeling, post-peeling, side effects, complications.

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

13. Reviews

 

Skin manifestation of diabetes

L.. Naumova, L.. Prystupiuk, V.M. Konakh

O.O. Bogomolets National Medical University, Kyiv

Objective — to study the spread of skin lesions in patients with diabetes as marker of the disease compensation state.
Materials and methods. Retrospective analysis was conducted of avaliable literature on the problem of skin lesions in patients with diabetes.
Results and discussion. Diabetes is a chronic metabolic disease. According to the International Diabetes Federation, about 285 mln. adults worldwide suffer from diabetes. It can lead to disruption of homeostasis in the skin, which is manifested by the development of various dermatoses. At least one­third of all patients with diabetes mellitus have abnormal skin changes.
Conclusions. In the vast majority of patients with diabetes, pathological changes occur on the skin. In some cases, skin manifestations may precede the diagnosis of diabetes, and in some cases they are a marker of the state of compensation for diabetes. ooperation of dermatologists and endocrinologists is mportant for preventing the development of severe skin lesions in diabetic patients.

Keywords: diabetes, skin lesions.

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Original language: Ukrainian

14. Reviews

 

Estimation of endogenous nitric oxide metabolites in development of pathological conditions of organism. Study of nitric oxide metabolites level in blood and skin microcirculation of patients with true eczema

V.V. Hiliuk

O.O. Bogomolets National Medical University, Kyiv, Ukraine

Objective — to perform a study of the level of endogenous nitric oxide metabolites (nitrates, nitrites) in the peripheral blood and microcirculation of the skin of patients with true eczema based on the analysis of literature data on the role of nitric oxide in the pathogenesis of certain chronic dermatoses, and to determine the effect of relevant indices on the nature of the clinical course of this disease.
Materials and methods. 48 patients (25 males and 23 females) with true eczema aged 18 to 67 were under study. In order to determine the nitric oxide metabolites level in blood plasma we used a spectrophotometric method, based on the reaction of nitrite with Griess reagent. The state of skin microcirculation was assessed using laser Doppler flowmetry.
Results and discussion. We observed the increased content of the final stable metabolites of nitric oxide in the peripheral blood of patients with true eczema. The most significantly reliable growth of indicators in comparison with healthy people was found in patients with dyshidrotic eczema that persisted for more than 10 years. We registered reduction of skin microcirculation level in patients with acute and subacute stages of eczema, and growth of this parameter in patients with chronic eczema, when compared to healthy people. The most significantly reliable skin circulation disorder was observed in patients with eczema that persisted for more than 10 years. There is a proved correlation between the level of the nitric oxide metabolites levels and the skin microcirculation disorder in affected patients.
Conclusions. The impact of the level of endogenous nitric oxide production in the blood of patients with true eczema and microcirculation disorders in the skin on the nature and severity of the clinical course of this dermatosis has been established, which must be taken into account when developing complex therapy.

Keywords: metabolites of endogenous nitric oxide, blood, skin microcirculation, true eczema.

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Original language: Ukrainian

15. Reviews

 

Review of current theories of etiology and pathogenesis of facial skin hypermelanoses treatment methods

Ye.I. Shelemba 1, 2, V.O. Tsepkolenko1, 3

1 P. L. Shupyk National Medical Academy of Postgraduate Education, Ministry of Health of Ukraine, Kyiv
2 Canadian Medical Center, Abu Dhabi, UAE
3 «Virtus» Institute of Plastic Surgery, Odesa

Understanding etiology and pathogenesis of facial skin pigmentation disorders is essential for correct management of patients with these diseases. The main causes of facial skin hyperpigmentation are considered to be the genetic predisposition, chronic exposure to UV light and action of female sex hormones. Treatment modalities for different hypermelanoses are very similar. However, each individual triggering factor induces a separate kind of hypermelanosis. Recently, there have been ongoing updates on melasma and other hypermelanoses of facial skin with regard to their triggering factors. The presence of certain factors working independently of UV exposure as also the role of dermal factors and microRNAs are considered to be novel discoveries in pathogenesis of hypermelanoses. In this review, the pathogenesis of hypermelanoses is addressed with consideration for modern updated findings and in the aspect of their treatment.

Keywords: hypermelanoses, melasma, pathogenesis, the effect of ultraviolet radiation, dermal factors microNA.

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