Anton Sergeevich Dvornikov

Background. Chronological age does not always reflect the severity of functional and morphometric skin changes. Integrated data on age-associated variability in quantitative facial and neck skin parameters and their associations with blood laboratory parameters and gut microbiota features remain limited. Aim. To assess age-associated functional and 3D morphometric characteristics of facial and neck skin and their associations with blood laboratory parameters and gut microbiota features in adult participants of the Russ-Age study. Methods. This single-center cross-sectional observational study included 183 outpatients aged 18-97 years. Skin hydration, elasticity, sebum, pigmentation, erythema and 3D skin parameters of the face and neck were assessed. The laboratory panel included markers of lipid and glucose metabolism, liver and kidney function, thyroid status, vitamin D status, inflammation, and hematological parameters. Gut microbiota analysis included taxonomic characteristics, alpha-diversity indices, and predicted functional pathways. Kruskal-Wallis test and Spearman correlation analysis were applied. Results. The sample comprised 141 women and 42 men. Age-associated differences were observed for skin elasticity, sebum, and all assessed 3D morphometric parameters. Age-stratified nominal correlations were identified between skin parameters, blood laboratory variables, and gut microbiota characteristics. In younger participants, associations primarily involved inflammatory, immunohematological, and selected biochemical variables, in middle-aged participants, glucose metabolism, vitamin D status, and hematological indices, in older participants, cellular blood characteristics, thyroid status, and liver-function parameters. Conclusion. Quantitative instrumental assessment captures age-associated variability in functional and 3D morphometric skin characteristics. Laboratory and microbiota associations differ across age groups and should be interpreted as exploratory associations.

Patients with limited mobility after stroke are at high risk of developing pressure-related skin damage. Visual examination does not always allow timely detection of early skin barrier changes; therefore, objective biophysical monitoring methods are of clinical interest. The aim of this study was to characterize the changes in biophysical parameters of the skin barrier in pressure-prone areas in patients with limited mobility during the early post-stroke rehabilitation period while receiving preventive skin care. A series of three clinical cases is presented. Daily monitoring of corneometry and sebumetry was performed over 30 days in typical areas at risk for the development of pressure-related skin damage, namely the sacral region, heels, and scapular areas, using the Aramo SG device. All patients received a standardized preventive care regimen that included regular repositioning, control of skin microclimate and moisture, hygiene care, timely linen changes, and once-daily topical application of a dexpanthenol-containing cream to intact skin in at-risk areas. At baseline, all patients were assessed as having a high risk of skin barrier impairment. Despite homogeneity in risk level, the patients differed in age and sex, stroke type, degree of functional dependence, nutritional status, and the spectrum of concomitant risk factors. During preventive care, positive changes in corneometry values were registered in all patients, indicating improved skin hydration. The most pronounced changes were observed in the sacral region and heels in completely immobile patients. In the patient with hemiparesis, the changes in parameters in symmetrical body areas showed an asymmetric pattern. In all cases, sebumetry values remained low and did not change within clinically significant variability. Daily monitoring of corneometry and sebumetry may complement clinical examination and photographic documentation in high-risk post-stroke patients with limited mobility. These observations confirm the heterogeneity of skin barrier impairment risk profiles and demonstrate the clinical feasibility of personalized dynamic skin monitoring in the inpatient setting.

Tuberous sclerosis is an orphan neurocutaneous hereditary disorder characterized by multisystem involvement and age-dependent manifestation of symptoms. The disease results from sporadic or inherited mutations in TSC1 (9q34, hamartin) or TSC2 (16p13.3, tuberin). Under normal conditions, TSC1 and TSC2 regulate cell proliferation and tumor growth by inhibiting the mTORC1 complex (mechanistic target of rapamycin complex 1). Mutations in TSC1 and TSC2 disrupt formation of the hamartin–tuberin complex, leading to persistent activation of mTORC1 and uncontrolled cellular proliferation. A detailed description of cutaneous manifestations of tuberous sclerosis is crucial for early diagnosis. Angiofibromas and periungual fibromas are major diagnostic criteria for tuberous sclerosis. Although not life-threatening, these tumors significantly impair patients’ quality of life due to their size, bleeding upon trauma, and risk of secondary infection. Removal of angiofibromas and periungual fibromas substantially improves patients’ quality of life. Various removal techniques have been described in the scientific data, with laser modalities offering practical advantages over surgical excision. We followed two adult patients with large facial angiofibromas and periungual fibromas. Angiofibromas and periungual fibromas were removed using a CO2 laser under local infiltration anesthesia, followed by wound resurfacing with the same device in pulsed mode. Laser output ranged from 2 to 4 W. Immediately after excision, facial angiofibromas were additionally treated intralesionally with a pulsed dye laser. Excised tissue was submitted for histopathologic examination. Outcomes were assessed at 1 month, and patients were subsequently monitored every 3 months for 2 years by a dermatovenereologist. No tumor recurrences were observed during follow-up, underscoring the practical value of this approach for effective fibroma removal and improved quality of life.

Otitis externa is the most common diagnosis in the practice of an otorhinolaryngologist. Definitions of the term are not precise at the moment, and a universal generally accepted classification has not been developed. In a separate nosological group, otitis externa can be distinguished from the background of dermatological diseases. These patients need an interdisciplinary approach, joint supervision of otorhinolaryngologists and dermatovenerologists to increase the effectiveness of treatment and minimize the risks of chronic otitis. Severe complications of otitis externa are obstructive keratosis, fibrous atresia, and persistent conductive hearing loss. Diagnostic algorithms and therapeutic strategies for otitis externa should include the search and therapy of a background dermatological disease. At the moment, the tactics of managing patients suffering from otitis externa on the background of dermatological diseases continues to be developed.

Alterations in systemic cytokine signatures following dupilumab treatment in atopic dermatitis patients

Early accurate detection of skin cancer is a growing global problem of health’s services throughout the world. Malignant skin formation can be suspected by using an anamnesis, visual inspection of the skin, and diffrent types of investigations in primary care settings. The dermatoscopic examination is necessary for exclusion or confirmation skin cancer, which is performed by a dermatovenerologist. The patient is referred futher to an oncologist in case the cancer cannot be excluded. Well-organized identification of patients with suspected skin cancer is accociated with favorable prognosis. However, in order to reduce the rates of high neglect for malignant skin tumors and optimize the routing of patients after visiting a primary care phisician, it is worth to pay attention to the following points: annual medical check-up examinations, especially among people of age is over than 40 years; a complete physical examination, including thorough history and full body skin examination by general practition as part of a clinical examination in a primary care settings; the use of mandatory dermoscopic examination by a dermatovenerologist for early diagnosis of skin cancer, and, if possible, dynamic skin mapping with artificial intelligence analysis; increasing the professional and communicative skills, especially needed in managing newly diagnosed skin cancer, since psychosocial factors influence the patient’s attitude towards his/her own health; maintaining continuity between general practitioners and dermatovenerologists to improve the quality of medical care; creation of “Healthy Skin” schools in clinics to increase the medical literacy of the population concerning the education regarding the danger of skin cancer, training in skin self-examination skills; using e-health technologies as an additional source of information.

Patient K. turned to a dermatologist with complaints of periodic itching in the scalp skin, face, auricles, external auditory canals with discomfort and discharge from them. Clinical diagnosis: seborrheic dermatitis. At the otolaryngologist consultation, the patient was diagnosed with bilateral external otitis media with the formation of hyperkeratotic casts in both external auditory canals. Seborrheic dermatitis was treated in two stages. At the first stage, itraconazole 200 mg was prescribed orally 1 time per day for the first week of treatment, then 200 mg orally 1 time per day for the first two days of each month for 3 months and externally on the scalp ketoconazole shampoo 2% 2 times a week for 4 weeks, then 1 time in 2 weeks. At the second stage, isotretinoin was administered orally at a dosage of 10 mg per day in an intermittent mode. A positive clinical result was obtained against the background of the therapy. The patient continues to remain under supervision.

The number of autoimmune diseases (AS), currently numbering more than 100 nosological forms, is constantly growing and is a significant problem of clinical medicine. Advances in the definition of diagnostic biomarkers and clinical tests make it possible in most cases to carry out differential diagnosis of autoimmune pathology and prescribe personalized immunocorrection. The modern understanding of the mechanisms of AS is based on the breakdown of tolerance to their own antigens, which occurs in genetically predisposed individuals against the background of impaired immunoregulation. In this review, using the example of multiple sclerosis (MS) as a classic AS of the nervous system, a possible combination of common autoimmune mechanisms of MS and such common skin diseases as psoriasis and atopic dermatitis is considered. Advances in the field of pharmacy have accelerated the path from the creation of new molecules to the introduction of modern pathogenetic drugs into daily clinical practice. To prevent exacerbations and progression of MS, disease-modifying therapy of MS are currently used. This treatment is permanent and long-term, and it is very important to take into account the comorbid pathologies that develop against the background of this therapy. The review shows the effect of DMT on the manifestation of skin diseases. The use of modern bioengineered drugs can contribute both to the activation and emergence of new diseases, and to stabilize the patient’s condition in the presence of autoimmune comorbidity.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is often associated with asthma. This combination aggravates the course of both conditions, including the frequency and severity of asthma and CRSwNP exacerbations. Currently, the main strategy in the treatment of severe asthma is the use of biologicals, which may also impact CRSwNP symptoms, considering the similarity of pathogenic mechanisms of these diseases. The aim of our study was to evaluate the impact of biological therapy on CRSwNP in combination with severe asthma. Methods. 49 patients with CRSwNP and severe asthma were included in a single-center prospective cohort study. Patients were divided into 4 groups: dupilumab (n = 20), benralizumab (n = 15), mepolizumab (n = 7), and omalizumab (n = 7). Patients received the biologicals for at least 12 months (min – 12.0 months; max – 52.2 months). Asthma control (ACT, FEV₁, the number of asthma exacerbations) and CRSwNP control (SNOT-22, the number of nasal and sinus surgeries) were evaluated at baseline and during treatment. The safety of therapy was assessed by the examination results and the reported adverse events. Results. We observed statistically significant improvements in asthma control, respiratory function, and a decrease in the number of asthma exacerbations with the use of biologicals in all groups. However, there were no statistically significant differences between the groups (p > 0.05). As for CRSwNP, we found the statistically significant improvements in symptoms (ΔSNOT-22 – (–67,3) ± 23,7, p < 0,001; (–26,1) ± 24,6, p < 0,001; (–34,0) ± 23,5, p = 0,016; (–35,1) ± 25,1, p = 0,025) and a decrease in the number of surgeries after therapy (Δ number of surgeries – (–5,2) ± 8,6, p < 0,001; (–3,7) ± 3,3, p = 0,002; (–3,6) ± 2,4, p = 0,036; (–1,6) ± 1,4, p = 0,010). in all groups. At the same time, dupilumab showed a greater improvement of CRSwNP control according to the SNOT-22 questionnaire than benralizumab (p = 0.001) and mepolizumab (p = 0.034). Conclusion. Biologicals currently used to treat severe asthma have a beneficial effect on concomitant CRSwNP. However, not all biologicals are characterized by an effect on the processes of polyposis tissue remodeling and formation. Our study confirms the relevance of searching for other potential targets for the development of the new biologicals to address the identified clinical needs.

The incidence of skin melanoma in the world is growing every year. Despite advances in diagnostics, the identification of the primary focus of melanoma in some cases is still difficult. The natural course sometimes manifests only with the appearance of melanoma metastases, which can mimic other diseases. Patient S., 52 years old, was admitted to the FCBRN of FMBA of Russia with complaints on periodic systemic dizziness, headaches of a pressing nature, episodes of speech impairment over the past three months. According to the brain MRI-scan results, a volumetric formation of the left frontal lobe was revealed. Upon examination, two non-pigmented lesions were found on the skin of the scalp and forehead. Due to the presence of focal neurological symptoms, it was decided to remove the brain tumor using neurophysiological monitoring and the scalp skin lesion, with histological verification. Morphological diagnosis of the removed brain tumor was a metastasis of amelanotic epithelioid melanoma. The skin lesion was basal cell carcinoma. Thus, the patient had primarily multiple malignant tumors: metastatic melanoma and basal cell carcinoma. The primary focus of melanoma could not be identified by available noninvasive research methods. The patient was referred to an oncologist to decide on the tactics of further examination and treatment. To date, the patient has been treated according to the scheme sh0876 1 line 1 course of pembrolizumab 400 mg IV, cycle 42 days.