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Current Issue. Articles

3(66) // 2017

 

 

1. Scientific researches

 

New phased approaches in the therapy of acantholytic pemphigus

V.P. Fedotov, V.A. Lytvinov

Zaporizhzhya State Medical University

Objective — to increase the effectiveness of acantholytic pemphigus treatment taking into account the data of modern diagnostic methods, the use of cortisone therapy and prevention of complications after long­term use of glucocorticosteroid medications.
Materials and methods. 30 patients with acantholytic pemphigus aged from 51 till 72 years were under the observation; the duration of the disease was from 3 weeks to 3 months. Methods of investigation: general clinical, daily monitoring of arterial pressure, cardiointervalmetry with the device Cardiolab, oxidative modification of proteins, metabolism of nitric oxide. Four­time study was conducted: before the treatment, after 2—3 weeks of taking high doses of glucocorticosteroids (stage I), after 1.5—2 months of the therapy, when hormone doses were reduced (stage II) and 3—4 months after discharge from the hospital, when the patient received therapy with maintenance doses of hormones (Stage III). At the first stage of therapy, in addition to glucocorticosteroids, the use of two antihypertensive drugs, intravenous drip of rehambyrin, platelet aggregation inhibitors, probiotics, hepatoprotectors (Essentiale-H), ATP and cocarboxylase as intramuscular injection, sodium chloride solution iv, antibiotics, potassium preparations, calcium, antacids. At the second stage, patients received the same drugs, but in slightly reduced doses, one antihypertensive drug, hepabene was prescribed from hepatoprotectors. At the third stage, it is necessary to use antihypertensives (mlodipine), diuretics (Triphas), hepatoprotectors, anticoagulants, vitamins, potassium preparations. At this stage, we recommend taking statins (Roxera).
Results and discussion. Patients with acantholytic pemphigus had a statistically significant increase of glucose values, AlAt, AsAt, cholesterol, especially LNSH, triglycerides, a decrease in total protein. In the future, at all stages of treatment, the tendency to normalization was noted, but only triglycerides, LDL cholesterol, glucose, total protein demonstrated full correction at the third stage. When studying the variability of the heart rate, we revealed pathological changes in the vegetative balance towards sympathotonia, which were multidirectional at different stages of treatment. During the 24-hour monitoring of arterial pressure, an increase of patients with an insufficient nightly fall of non dippers pressure over CAT was found, and an increase in patients with non dippers and night peakers before treatment. The study of oxidative modification of proteins has established a high level of endogenous intoxication in patients with AP, even at the third stage of treatment. While studying the metabolism of NO in patients with AP before the treatment, a high level of NO synthase was established, which caused pathological effects of NO, and during the treatment with hormones its level droped sharply, especially at the third stage.
Conclusions. Therapy of patients with AP should be performed in 3 stages depending on the doses of glucocorticosteroids using both traditional drugs and some new ones, based on the study of liver function, biochemical parameters, heart rate variability, monitoring of blood pressure, metabolism of NO, oxidative modification of proteins. The administration of anabolic and sedatives is not recommended.

Keywords: pemphigus, biochemistry, protein, NO-synthase, treatment, preparations, glucocorticosteroids, stages.

Original language: Ukrainian

2. Scientific researches

 

Analysis of factors influencing the development of acne severe forms

M.E. Zapolskiy1, M.. Lebeduk1, N.B. Prokofyeva1, D.V. Ivanov3,
A.V. Dobrovolska3, L.P. Kvitko2

1 Odesa National Medical University
2 Regional Dermatovenerologic Dispensary, Odessa
3 Clinic «Renaisance-Medical», Odesa

Objective — to study of factors contributing to the transformation of mild and moderate forms of acne in severe forms of the disease, to determine the level of sex hormones in patients with different degrees of severity of acne.
Materials and methods. The study included 74 patients with acne of different severity. All patients completed special questionnaires that allowed to determine the factors that provoked the disease. Serum cortisol, dehydroepiandrosterone sulfate, free testosterone, sex hormone binding globulin were determined as well.
Results and discussions. The main clinical manifestations of severe forms of acne are nodular­cystic abscessed forms, nodular­cystic acne with necrosis, nodular­cystic acne with asymmetric lesion, acne with a tendency to keloid formation, fulminant acne. The main trigger factors of severe forms of the disease are psychoemotional stress, irrational cosmetic manipulation, and the prolonged use of topical antibiotics. The most significant endocrine fluctuations were revealed in the analysis of the level of dehydroepiandrosterone sulfate in patients with severe forms of acne. Important prognostic criteria for assessing the severity of acne in men are the rates of dehydroepiandrosterone sulfate and sex hormone binding globulin, in women — the levels of cortisol and free testosterone.
Conclusions. Interpretation of the majority of diagnostic markers of severe forms of acne should be carried out taking into account individual characteristics of the organism, concomitant endocrine and somatic pathology.

Keywords: acne, severe forms, trigger factors, dihydroepiandrosterone sulfate, cortisol, free testosterone, sex hormone binding globulin.

Original language: Russian

3. Scientific researches

 

Features of disbiosis correction of oral cavity in patients with diabetes mellitus 2 type

O.P. Stupak1, A.P. Levitsky2, M.Y. Niedzielsk1, M.O. Dudchenko1

1 HSEI «Ukrainian Medical Stomatological Academy» Poltava
2 SI «The Institute of Stomatology of the NAMS of Ukraine», Odesa

Objective — to study therapeutic effect of Kvertulin (kvercetin + inulin + calcium citrate) in the complex treatment of patients with diabetes mellitus 2 type.
Materials and methods. Under our supervision were 59 patients fasting blood sugar diabetes mellitus 2 type at the age of 45—65 years (men — 24, women — 35). All the patients had diabetes mellitus middle degree, in stage of sybcompensation, fasting blood sugar 8—12 mmol/l. The patients were taken divided 2 groups: compare group, which received basic treatment in accordance with protocol (Actovegin on 1 tablets 3 time in day, AEvit on 1 tablets 1 time in day; injection — Milgama on 2,0 ml/day, Etamzilat on 2,0 ml/day, Nicotinic Acid on 1,0 ml/day; Mildronat on 5,0 ml/day), and the main group, which received the drug of Kvertulin (on 1 tea spoon 4 time in day after eating). Therapeutic effect of Kvertulin evaluated the content of glucose in the blood, plasma levels of biochemical markers of inflammation: concentration of malone dyaldegyde and activity of elastase. On the degree of microbial contamination was tried on activity of urease, nonspecific immunity status was assessed by activity of lysozyme. In terms of relative of urease and lysozyme expected of degree of disbiosis on the method of prof. A.P. Levitsky. Antioxidant activity was assayed by activity of catalase and the antioxidant-prooksi­dantny index.
Results and discussion. In patients with diabetes mellitus 2 type in the plasma of blood elevated levels of biochemical markers of inflammation (malone dyaldegyde, elastase) and microbial contamination (urease) while reducing the activity of lysozyme and catalase. In patients with diabetes increases disbiosis degree 7—9 times, under the influence of the basic treatment is reduced by 29 %, and when combined with Kvertulin — on 87 %. Kvertulin increases the activity of catalase and the antioxidant-prooksidantny index in 3.0–3.5 times.
onclusions. Use in complex treatment of the patients of the drug Kvertulin significantly improves biochemical parameters, reduces disbiosis and increases the level of protection.

Keywords: Diabetes mellitus, disbiosis, inflammation, enzymes, Kvertulin.

Original language: English

4. Scientific researches

 

Clinical and pathogenetical comparison of atopic dermatitis and true eczemacourse

O.D. Aleksandruk

Ivano-Frankivsk National Medical University

Objective — to conduct comparison of clinical course and pathogenesis features of adult atopic dermatitis and chronic true eczema.
Materials and methods. 129 adults with atopic dermatitis and chronic true eczema were examined. Clinical diagnostically important features were compared as well as clinical effectiveness of the treatment, secretion of serumIgE, IFN-g, and IL4 in course.
Results and discussion. It was determined that diagnostics criteria of atopic dermatitis were often presented in patients with true eczema but significant difference of minor criteria presence was of great difference in differential diagnosis. Two different, from pathogenesis point of view, variants of atopic dermatitis and true eczema were determined based on serum IgE level: one with hightotal serum IgE and relation between IL 4 and the disease severity, the other with normal IgE level and dependence on the disease severity on IFN-g secretion. Due to cross­over increase of IFN-g synthesis in patients with IgE­dependent course of disease the common duration of in — patient treatment phase is longer. Out-­patient follow-­up of such patients requires continuation of systemic antihistamine treatment.
Conclusions. Our data shows that both atopic dermatitis and true eczema in adults have common clinical and pathogenesis features and two slightly different variants of course. IgE-­dependent variant for both diseases is connected with longer duration of in­patient management and necessity to continue systemic antihistamine treatment during early follow-­up.

Keywords: atopic dermatitis, true eczema, interleukin, treatment.

Original language: Ukrainian

5. Scientific researches

 

Arthropathic psoriasis: concepts of pathogenesis and clinical course

O.O. Syzon

Danylo Halytsky Lviv National Medical University

Objective — to determine the pathognomonic markers of arthropathic psoriasis (AP), taking into account clinical and instrumental examinations results, to perform differentiated choice of pathogenetic treatment scheme.
Materials and methods. In total 178 patients with AP against the background of psoriasis and 12 patients without complains of osseous-articular impairment underwent clinical laboratory and additional examinations (DXR, USE, MRI) in 2014—2017. The impact of AP and treatment course on the life quality was assessed with questionnaires DLQI, PDI, PASE, CPDAI, Zung and S index. The total protein content and transaminase activity  was determined with SIMKO Ltd reagents set,  amylase, cholesterol, urea, thymol test, bilirubin levels  were assessed with application of BIO­-Lachema- Test (BRNO, AMS, CHOL-150, G, Urea-­450, TTT-­150, Bil st), serological indexes (level RF, C-reactive protein, ASL-O) were identified with qualitative and quantitative methods. The condition of articulation joints and soft tissues was assessed with MRI with the apparatus logiq 3, Aloka SSD-3500 SX ProSound.
Results and discussion. In most cases, at AP joint damage occurs simultaneously with psoriasis. The following pathognomonic AP signs are determined: simultaneous psoriatic skin and nails damage; asymmetric mono or oligoarthritis predominantly of peripheral joints especially associated with the hands DIJs damage; osteolysis; negative reaction to rheumatoid factor. The primary localization of a pathological joint process in AP patients in areas of increased traumatism of tendon-ligamentous apparatus and its relationship with psoriatic nails damage is substantiated pathogenetically. The characteristic presence of periarthritis (enteritis, tendovaginitis confirmed by MRI, USD diagnostics), especially at the initial disease stages, has been determined. In most cases, AP is combined with the presence of nails pathology being a warning of the development of joint articular psoriasis disease. A number of radiological AP features are noted, which include: asymmetry of damages, radial type of hand joints arthritis, weak manifestation of subchondral osteoporosis and combination of osteolysis with osteosclerosis, ultimate narrowing of distal pharyngeal epiphyses of fingers, ossification of diaphysis periost, distal and proximal joints ankylosis of the same finger, zygapophysial joints of cervical vertebra, mosaic inflammation of joints and ossification of ligaments, unilateral sacroiliitis, and the presence of rough syndesmophyte.
Concllusions. Ap is a problem for theoretical and practical medicine solution of which requires multidisciplinary approach to administer differentiated pathogenetic treatment.

Keywords: arthropathic psoriasis, clinical and instrumental examinations fatures.

Original language: Ukrainian

6. TO HELP PRACTICING PHYSICIANS

 

Modern concept on the problem of onychomycosis. Market analysis of the topical antifungal agents

B.G. Kogan1, E.A. Verba2

A modern concept on the onychomycosis problem, methods and approaches to the treatment of have been reviewed in the paper. The comparison data of the main molecules, used for mentioned pathology, is presented. The effectiveness and convenience of using nail lacquer dosage form is shown. A new product on the Ukrainian market — Amoderm Neo (active substance amorolfine), nail lacquer has been presented.

Keywords: onychomycosis, methods of treatment and prevention, new formulations, amorolfine, nail lacquer, Amoderm Neo.

List of references: 1 .. Bogomolets National Medical University, Kyiv
2 Dr. Bogomolets Institute f Dermatology nd Cosmetology, Kyiv

Original language: Russian

7. PHARMACOTHERAPY IN DERMATOLOGY AND VENEREOLOGY

 

Acne vulgaris: modern concepts on etiology, pathogenesis and treatment

N.Yu. Reznichenko

CI «Zaporizhzhya Regional Skin and Venereal Clinical Hospital» of Zaporizhzhya Regional Council

The study of effectiveness and safety of solution Zerkalin® for treatment of papular­pustular form of acne vulgaris has been performed. 63 patients who suffer from acne vulgaris and 28 healthy people aged from 14 to 25 years have been examined. The assessment of clinical manifestations of the disease on special scales was performed, the levels of DLQI index was determined during the study. Patients underwent microbiological examination of skin. It was proved that solution Zerkalin® provided rapid clinical effect in treatment of papular­pustular form of acne vulgaris, and due to that fact it improved their quality of life. In addition, the study showed perfect antibacterial properties of solution Zerkalin®. Solution Zerkalin® was recommended for treatment of papular­pustular form of acne vulgaris.

Keywords: acne vulgaris, papularpustular form, treatment, Zerkalin.

Original language: Ukrainian

8. PHARMACOTHERAPY IN DERMATOLOGY AND VENEREOLOGY

 

Innovative combined treatment of onycho and dermatomycosis in patients of different age groups. New experience of medication clinical application in practice of dermatologist

B.G. Kogan1, E.A. Verba2

1 .. Bogomolets National Medical University, Kyiv
2 Dr. Bogomolets Institute f Dermatology nd Cosmetology, Kyiv

The causes and factors of onychomycosis and mycosis of smooth skin are considered. The characteristics of terbinafine is summarized and the medication variable forms features are defined. The therapeutic efficacy of combined treatment of onychomycosis and mycosis with Terbinorm (active substance terbinafine hydrochloride) in tablets’ and spray forms of issue is substantiated  in patients of different age groups (83.78 %).

Keywords: mycoses, dermatomycoses, onychomycoses, antifungal agents, combined therapy, terbinafine, Terbinorm, spray, tablets.

Original language: Russian

9. PHARMACOTHERAPY IN DERMATOLOGY AND VENEREOLOGY

 

A differentiated approach to topical therapy for steroidsensitive dermatoses

L.A. Bolotna

Kharkiv Medical Academy of Postgraduate Education

In the article the characteristic of the most popular in modern clinical practice medication for treatment of the majority of inflammatory dermatoses — topical glucocorticosteroids is presented. The pharmacological features and therapeutic efficacy of Momederm®, Betaderm® and Cloveit®, the emollient Klobaz are analyzed. A differentiated stepwise approach to external therapy of steroid­sensitive dermatoses (atopic dermatitis, eczema, psoriasis, etc.) is substantiated, taking into account the steroid’s strength, clinical features (stage, form, complications, the state of the epidermal barrier). The possibility of using topical glucocorticosteroids in terms of the strength of the drug action (class),  the dosage form, the «step­down» ­terapy of the administration is shown. The medication application makes it possible to achieve clinical remission quickly and to avoid side effects.

Keywords: hronic inflammatory dermatoses, external therapy, glucocorticosteroids, mechanism of action, basic therapy, emollients.

Original language: Russian

10. PHARMACOTHERAPY IN DERMATOLOGY AND VENEREOLOGY

 

Psoriasis combined pathology. verview of advanced treatment methods for dermatosis

M.E. Zapolskiy1, M.M. Lebediuk2, S.V. Nerubaschenko1, A.V. Dobrovolska3, D.. Zapolska3

1 Regional Dermatovenerologic Dispensary, Odesa
2 Odesa National Medical University
3 Clinic «Renaissance-Medical», Odesa

The article presents the analysis and clinical cases observation results of psoriasis combined pathologies. In such combined cases, treatment for psoriasis should be altered and patients require individual management. Authors outline modern psoriasis treatment approaches depending on disease  severity and pathologies. Despite of high efficiency, there is a risk of unfavorable reactions: immune suppression, asthenization, anabolic disorders.

Keywords: psoriasis, asthenization, hepatotoxicity, immune suppression, detoxicant, Hepargin.

Original language: Ukrainian

11. CLINICAL CASE STUDIES

 

Peculiarities of modern epidemiology, clinical course and therapy of molluscum contagiosum

V.G. Kravchenko

Medical Consulting Center «Medipol», Poltava

Epidemiological analysis indicates an increase in the incidence of MC. The article describes details of the epidemiological circumstances of a rare disease Molluscum Contagiosum (M) of a 2-­month­old baby infected by a mother with clinically and laboratorially diagnose of  typical molluscum (solitary form). A child from 1.5 months had artificial feeding. At 9 months old, ascariasis helminthic invasion was detected. The role of reduced immunological reactivity in the onset and course of the disease is emphasized. Attention is drawn to mandatory clinical examination of parents of young children, especially those who do not attend childcare facilities. Author considers that the infection therapy should be managed in two ways: searching for optimal immuno­modulators and developing effective local means of virus elimination, which is the most acceptable and preferable for the patient. We recommend Cidipol in combination with zinc oxide (in a ratio 1 : 0.8—1 : 1) after the destruction of pathological elements, based on the evidenced  antiviral, antibacterial and anti­inflammatory properties of the preperation in order to eliminate focal­perifocal artificial inflammation.

Keywords: molluscum contagiosum, epidemic analysis, atypical course, destructive treatment methods.

Original language: Ukrainian

12. CLINICAL CASE STUDIES

 

StevensJohnson syndrome in the patient of with severe recurrent course of subcorneal pustular dermatosis SneddonWilkinson

L.D. Kaliuzhna1, N.V. Turyk2

1 P.L. Shupyk National Medical Academy of Postgraduate Education, Ministry of Healthcare of Ukraine, Kyiv
2 Kyiv City Clinical Skin and Venereal Diseases Hospital

A rare disease — subcorneal pustular dermatosis (Sneddon—Wilkinson disease) is described. Typical clinical signs are demonstrated. A case of patient with subcorneal pustular dermatosis and Stevens—Johnson syndrome is presented.

Keywords: subcorneal pustular dermatosis (SneddonWilkinson disease), StevensJohnson syndrome, recurrent course.

Original language: Ukrainian

13. CLINICAL CASE STUDIES

 

Clinical case of congenital erythema telangiectaticum Blooms syndrome

D.S. Polishchuk1, 2, S.I. Polishchuk2, V.S. Komarnytska2

1 National Pirogov Memorial Medical University, Vinnytsya
2 Private Enterprise «Dermatovenereological center of doctor Polishchuk S.I.», Khmelnitsky

linical­morphological peculiarities of the rare photosensitive dermatosis — erythema congenital telangiectaticum (Bloom’s syndrome) have been characterized. The case from personal experience of the disease of a child with the use of treatment that slows the development of complications has been offered.

Keywords: Blooms syndrome, congenital erythema telangiectaticum.

Original language: Ukrainian

14. CLINICAL CASE STUDIES

 

ase of sclerosing lymphangitis of the penis

V.E. Tkach, M.S. Voloshynovych

SHEI «Ivano-Frankivsk National Medical University», Ivano-Frankivsk

The article presents with a rare pathology— sclerosing lymphangitis of the penis.

Keywords: sclerosing lymphangitis, differential diagnosis.

Original language: Ukrainian

15. Reviews

 

The 5 most Frequently Asked Questions (FAQ) from our patients about acne

C. Diehl

Universitá Degli Studi Guglielmo Marconi, Rome, Italy

Acne is a common skin disease. It represents a frequent cause of consultation in dermatology. The patients’ concern is usually high, and this motivates lots of questions to the practitioner. They concern mainly the diet, personal hygiene, possibility of using makeup/camouflage, but also the scars which can eventually persist once acne is treated. Besides the diagnostic and the proposal of treatment, correct responses to these questions is fundamental for the success of the therapy.

Keywords: Acne, diet, hygiene, makeup, camouflage, acne scars, frequently asked questions.

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


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