Olga M. Demina

Data on the analysis of efficacy and safety of combined use of systemic isotretinoin (SI) and hardware cosmetological methods in acne treatment are provided. It is known that SI is the drug of choice for the treatment of nodulocystic forms, resistant moderate and severe forms of acne. Despite the widespread application of SI, there are concerns about its various side effects, including changes in the wound healing process. It is traditionally recommended that any cosmetic procedures, including lasers, radio-frequency technologies, chemical peelings etc., should be postponed for at least 5—6 months after the end of SI intake. However, this conservative strategy has recently been challenged by several consensus expert opinions. Meta-analysis of articles on the combined use of SI and acne treatment by high-energy devices in PubMed, Embase, Web of Science databases has identified 650 publications from which a total of 16 studies were selected. General data indicate that the combination of SI (low doses) and high-energy procedures in acne treatment is safe and well tolerated. Thus, the use of SI in standard daily doses requires postponement of ablative laser procedures for 5—6 months after the end of therapy. SI in low doses combined with hardware cosmetological methods may be proposed as an alternative treatment method.

Objective. To study the clinical features of severe acne and pharmacogenetic mechanism of resistance to systemic therapy. Material and methods. A prospective open-label nonrandomized single-center comparative study was performed at the Department of Skin Diseases and Cosmetology of the Pirogov RNRMU in 2011—2024. The study included 388 subjects divided into 2 groups: study —309 patients with severe acne, comparison group — 79 conditionally healthy persons. Molecular genetic diagnosis was carried out by the method of next-generation sequencing (NGS) with the use of targeted multi-gene panels at the Laboratory of Molecular Biology of the Dmitry Rogachev NRCPHOI. Statistical processing of results was done by means of the Python language (Python 3.11.). Results. It has been established that the clinical features of severe acne are 2 clinical forms, namely severe papulopustulous acne, moderate nodular acne and severe nodular acne, acne conglobata in approximately equal proportion (49.5 and 50.5%, respectively). Thus, the pattern has been revealed: women suffered mainly from the first clinical form, men — from the second. We have demonstrated for the first time that the PTCH1 (rs574688) in intron, ABCA1 (rs2777801) in intron, RET (-(. ) in introns increase the risk of acne development by 2.85, 2.54 and 2.33 times, respectively (p<0.05); severe acne is associated with GA SMPD1 rs1050239 genotype. Strong inverse correlation between the GG SMPD1 rs1050239 genotype and the A SMPD1 rs1050239 allele and moderate inverse correlation between the GC PTCH1 rs574688 and GG SMPD1 rs1050239 genotypes have been found. Conclusion. Detection of the specific loci of genes, regulation of the activation of response on retinoic acid and its derivatives can be pharmacogenetic markers of acne resistance.

Acne (acne vulgaris) is an extremely common dermatosis with specific clinical manifestations on the skin in the form of comedones (open and closed), inflammatory elements (papules, pustules and nodules), scars and post-inflammatory pigmentation, which, according to various data, affects more than 90% of adolescents and causes scarring on average in 20% of them. Genetic predisposition occupies an important place among a number of factors that can influence the disease course, as evidenced by the results of numerous studies. Objective. To determine the SNP of TNF (rs1800629) and TGF-β2 (rs1159268) genes significance in the development of moderate acne. Material and methods. The clinical anamnestic and molecular genetic methods were used. The research involved 204 patients aged between 17 and 46 years. The study group consisted of 102 patients with moderate acne (45 (44.1%) men and 57 (55.9%) women) at the age from 17 to 44 years, the control group included 102 conditionally healthy subjects (41 (40.2%) men, 61 (59.8%) women) aged between 18 and 46 years. The association of polymorphisms of GG TNF (rs1800629) and AA TGF-β2 (rs1159268), which increase the risk of developing disease by 2.5 and 3 times, respectively, with the development of moderate acne has been identified. These data allow to use the named indicators as risk markers for the development of moderate acne.

Autologous plasma enriched with platelet cells (Platelet Rich Plasma, PRP) is a promising treatment agent in regenerative medicine as far as it is a source of cytokines, growth factors and other biologically active substances. This technique is increasingly used in various areas of medicine, including aesthetic medicine. The use of autologous drugs has a number of advantages, including low risk of immunological responses, safety, good tolerance with minimal side effects. Plasma therapy for some inflammatory diseases (acne, rosacea, seborrhea) is recommended in comprehensive therapy of skin pathology. Patient D., 31 years old, complaining of increased skin oiliness, rashes on the facial skin was under our supervision. Acne vulgaris diagnosis was made based on the patient’s complaints, medical history’s data and clinical laboratory results. A comprehensive therapy with systemic isotretinoin, phototherapy and the autologous plasma administration was prescribed. We have convincingly demonstrated that comprehensive acne therapy with systemic isotretinoin, phototherapy and PRP provide synergistic effect, which allows to achieve regression of the disease’s clinical manifestations, reduce its duration and decrease the drug load on the patient’s body in the absence of side effects.

Background — One of the manifestations of connective tissue dysplasia (CTD) is premature skin aging. The latter can have different etiological factors. The objective of our study was to investigate the effect of predictors of premature skin aging, especially CTD, on the severity of involutional changes in the skin, as well as to develop the approach for the management of patients with premature aging. Material and Methods — We included in our study 78 women 35-45 years of age with no substantial anti-aging treatment procedures in their anamneses. We considered genealogical and cosmetological anamneses, and life history (including somatic pathology), physical examination; determined prevailing type of facial skin aging; identified predictors of CTD, assessed psychoemotional state of the patient, and performed sonography of the skin and biochemical examination of patient serum. At a clinical stage, we conducted a randomized comparative study of biorevitalizant efficacy in patients with normal and premature patterns of skin aging. Results — Our study established the role of CTD in assessing the risk of premature skin aging. In addition to the presence of CTD, the importance of identifying isolated phenotypic manifestations of CTD (such as arachnodactyly, hypermobility syndrome, low relative weight of the patient, and skin manifestations of CTD) was shown. Other predictors were also analyzed; their identification can help assessing the risk of premature skin aging. Among them, somatic pathology (varicose veins, herniated discs, visceroptosis, autonomic vascular dystonia) and physical examination data (such as pallor of the facial skin, swelling, skin hyperelasticity) were noted. When assessing the clinical efficacy of biorevitalization, the greatest satisfaction of patients with premature skin aging regarding its results was characteristic for the group of patients after 7% collagen treatment. The clinical efficacy according to sonography and histological examination in patients with premature skin aging was significantly higher after the use of collagen or a complex hyaluronic acid (HA) preparation, compared with native HA. Patients with premature skin aging exhibited high level of anxiety and/or depression, which in turn increased the risk of underestimating the outcome of procedures. Conclusion — The presented study confirmed the role of CTD in assessing the risk of premature skin aging. Predictors were revealed (somatic pathology, type of facial aging, physical examination data of the patient, etc.) that could be used to assess the risk of premature skin aging. In patients with premature aging, preparation with native HA (as a biorevitalizant) had a low clinical efficacy comparable to using placebo. A collagen-based preparation and a complex HA-based preparation exhibited high clinical efficacy. Also, patients with premature aging of the skin had a higher score of anxiety and depression, while patients with high levels of anxiety and depression were more likely to underestimate the satisfaction with the results of their aesthetic treatment.

Acne is one of the most common dermatoses, that characterized by presence of closed and open comedones, inflammatory papular and pustular lesions, nodes, postacne syndrome complex, including postinflammatory pigmentation and scars. Recently, there has been an increase in the number of studies examining the impact of comorbid pathology on acne course. Objective. To evaluate role of comorbid pathology in moderate acne pathogenesis. Material and methods. Clinical-anamnestic and laboratory-instrumental methods were used to deal with goal. The number of patients equal 68 (35 (51.5%) women and 33 (48.5%) men) with moderate acne aged 17–44 years, predominantly young (17–26 years), was observed. In addition, 27 (39.7%) patients have suffered from acne for more than 7 years. Results. There has been revealed a comorbid pathology in 37 (54.4%) patients in the form of diseases of gastrointestinal tract and hepatobiliary system (25, 36.8%), gynecological pathology (12, 17.6%) and blood biochemical abnormalities in 35 (51.5%) patients in the analysis of the data. Conclusion. The obtained data on the nosological structure of comorbid pathology and high incidence in acne suggest its pathogenetic effect on acne course and are factors of the torpid dermatosis course, that can be one of the acne resistance reasons to existing therapy methods.

Акне — одно из самых часто встречающихся заболеваний в практике дерматовенеролога. К основным патогенетическим характеристикам относятся чрезмерный фолликулярный гиперкератоз, процесс воспаления, гиперпродукция себума и избыточный рост патогномоничной Cutibacterium acnes. На данный момент не теряет своей актуальности проблема, связанная с влиянием новой коронавирусной инфекции COVID-19 на течение дерматологических заболеваний. Согласно многим исследованиям, инфекция поражает, помимо бронхолегочной, многие другие органы и системы, включая кожу, а также вносит дисбаланс в патогенез имеющихся у пациентов заболеваний. В некоторых случаях поражения кожи бывают одними из первых проявлений коронавируса. Приведено описание клинического случая тяжелой формы акне у пациента в возрасте 15 лет, у которого перенесенная инфекция COVID-19 стала причиной ухудшения течения заболевания. Клинико-лабораторное наблюдение подтвердило высокую клиническую эффективность терапии системным изотретиноином, что обеспечило регресс высыпаний. Иммуносупрессивный эффект, оказываемый COVID-19, является одной из главных причин осложнения течения хронических заболеваний, их обострений и порой резистентности к стандартным методам лечения. С учетом высокой распространенности COVID-19 необходимо дальнейшее углубленное изучение его влияния на дерматологические заболевания и способы их лечения.

ВВЕДЕНИЕ Акне — распространенное заболевание кожи с преимущественной локализацией на лице и верхней части туловища. Как известно, эти участки кожи характеризуются высокой плотностью расположения сальных желез, являющихся экзокринными железами, в которых себоциты синтезируют и накапливают в цитоплазме липиды, заполняющие практически всю клетку. Установлено, что регуляция дифференцировки себоцитов и липидогенеза в сальной железе осуществляется под влиянием гормонов, факторов роста и транскрипционных факторов. ЦЕЛЬ ИССЛЕДОВАНИЯ Определение и анализ различий частот полиморфизмов (SNPs, single nucleotide polymorphisms) генов ALK, LRP5, LPIN2, TAZ и VPS13B. МАТЕРИАЛ И МЕТОДЫ Под нашим наблюдением находились 50 пациентов (29 мужчин и 21 женщина) с тяжелой формой акне — основная группа и 20 условно здоровых лиц (13 мужчин и 7 женщин) — контрольная группа, которым проведено молекулярно-генетическое исследование методом NGS (next-generation sequencing). Результаты исследований подвергнуты статистической обработке с применением стандартных пакетов программ XLSTAT2019. РЕЗУЛЬТАТЫ Анализ выявленных различий частот SNP-полиморфизмов показал, что наличие тяжелой формы акне достоверно ассоциировано с полиморфным локусом ALK rs4589708, тогда как полиморфные локусы LRP5 rs556442, LRP5 rs74585752, ALK (- (.), VPS13B rs115695514 ассоциированы с протективными механизмами. ЗАКЛЮЧЕНИЕ Выявленные различия частот SNP-полиморфизмов генов ALK, LRP5, LPIN2, TAZ и VPS13B у больных с тяжелым течением акне, вероятно, имеют существенное значение в патогенезе заболевания и оказывают значительное влияние на развитие дисбаланса в синтезе липидов в сальных железах как в результате прямого регуляторного механизма через изменение экспрессии генов липидогенеза, так и опосредованным путем через нарушение экспрессии генов рецепторов инсулина.

Our study aimed to develop a comprehensive approach to the management of patients with involutional skin changes, considering the predictors of premature skin aging. The study included two stages, whereby 78 women with no history of aesthetic procedures that could have affected their perceived age were examined. In the first stage, we examined factors associated with premature skin aging. In the second stage, a blind, comparative placebo-controlled study of the effectiveness of intradermal injections for the treatment of involutional skin changes was conducted. Parameters reflecting skin aging were identified. The sum of these parameters could be used to diagnose premature skin aging in patients with no history of aesthetic treatment. For other patients, we developed indicators that can be applied to determine whether there is a risk of premature skin aging. Patients with premature aging have an increased risk of adverse events, such as impaired regeneration and wound healing, postprocedural hematomas, etc. For the correction of involutional skin changes in patients with premature aging, the collagen product (Collost) had the greatest clinical efficiency and the greatest patient satisfaction. A complex product based on HA (Teosyal Redensity 1) had comparable efficiency, with slightly less patient satisfaction. The product based on native HA (Hyon 1.8%) had low efficiency in the group of patients with premature aging and high efficiency in the group of patients with normal aging.

Acne is a common skin disease and usually begins in early puberty, less often later. The early onset of acne vulgaris is typical, often with the rapid formation of severe torpid forms of the disease. Therefore, it requires a timely pathogenesis-based strategy for treating and preventing recurrence. Special attention is drawn to the issue of childhood acne. The most effective drugs, in particular, systemic isotretinoin (SI), for treating acne are contraindicated in children under 12 years of age, which is a great challenge in managing such patients. We present a clinical case of extremely severe acne with rapid progression in a patient aged 11 years and justify the use of systemic isotretinoin. Clinical and laboratory monitoring confirmed the high clinical effectiveness of the therapy, which resulted in clinical regression of rashes after half the course dose with no significant side effects. Given the increase in severe acne in pediatric patients, further studies are needed on the safety profile of systemic isotretinoin for its introduction into pediatric practice.