Yu.A. Sokolovskaya

The range of skin diseases in which it is necessary to moisturize the skin is wide and includes atopic dermatitis, ichthyosis, psoriasis, eczema, xerosis and even acne. In turn, the morbidity with these dermatoses is increasing, and their severity has been worsening in recent years. The search for alternative and additional treatment methods that minimize the need for corticosteroids and other topically applied drug products is one of the main challenges of dermatology. The new strategy for treatment of chronic skin diseases accompanied by dryness is called «emollients plus». Emollients plus — a new class of cognitive moisturizing agents, capable of providing a comprehensive approach to the treatment of frequent dermatosis accompanied by defects of the epidermal barrier precisely by restoring the barrier function of the skin and reducing the intensity of subjective manifestations. Unlike conventional emollients, which simply moisturize the skin, emollients plus contain active ingredients that have anti-inflammatory, anti-pruritic, antibacterial, antioxidant, modelling microbiome and epidermal barrier indicators properties, and this is not an exhaustive list. The article presents historical aspects of the evolution of skin softening products from vaseline and lanolin to modern classification including hydratants, occlusive agents, emollients, enhancers and «emollients plus». The mechanisms of action of topically applied agents of different classes and correct selection of emollient depending on the clinical situation are also considered.

Melasma is a common, difficult-to-treat pigmented skin disease characterized by a recurrent course. The article provides an overview of the etiology, pathogenesis and principles of melasma therapy. The multifactorial nature of the disease was noted, including genetic predisposition, exposure to ultraviolet and visible light, and hormonal factors. It is known that visible light, especially high-energy visible light with a wavelength of 400–500 nm (High Energy Visible Light, HEV rays, blue light), and long-wavelength UVA rays (370–400 nm) exacerbate the course of melasma. The importance of an integrated approach to treatment, including the elimination of trigger factors, pathogenetic therapy and mandatory photoprotection using modern broad-spectrum sunscreens, is emphasized. Special attention is paid to the need to inform patients about the chronic nature of melasma and the importance of prolonged therapy. The article considers a multi-level treatment regimen based on the use of topical drugs and peels as first-line therapy, with careful and balanced use of hardware methods at subsequent stages. The key principles of hyperpigmentation therapy are described, namely, inhibition of melanogenesis, reduction of melanosome transport and acceleration of melanin elimination processes. Given example of modern depigmenting topical treatment containing Thiamidol (Beiersdorf AG patent), which contribute to the improvement of mMASI (Modified Melasma Area and Severity Index) after 2 weeks of usage, and justified treatment with Thiamidol for monoand combination therapy of melasma. The proposed three-stage treatment regimen, adapted to the severity of the disease, makes it possible to optimize therapeutic tactics taking into account the individual characteristics of the patient.

Iatrogeny — undesirable effects of medical interventions, which can be caused by errors in the choice of therapy, insufficient qualification of specialist and incorrect compliance with technic of procedures. The increasing popularity and availability of cosmetological treatments are accompanied by a growth in the number of iatrogenic complications. Iatrogenic complications in cosmetology have a significant impact on patients’ psychological state. Physical discomfort associated with complications is often followed by psychological problems: reduced self-assessment, feelings of self-doubt, depressive disorders, social isolation. Post-inflammatory hyperpigmentation (PIH) is a common form of iatrogenic hypermelanosis that occurs after cosmetological procedures. Treatment of PIH requires a comprehensive approach, including the use of photoprotectors and topical agents. The article lists the pathogenetic aspects of PIH, as well as provides external correction agents such as hydroquinone, azelaic, tranexamic, kojic acids, retinoids and thiamidol. Thiamidol is a highly selective human tyrosinase inhibitor, the application of which reduces the risk of PIH development. The presented clinical cases confirm that the irrational use of hardware technologies and the lack of a comprehensive approach affecting all the parts of melanogenesis contribute to the development of iatrogenic complications. Effective application of safe methods, which contribute to the elimination of iatrogenic post-inflammatory hypermelanosis, is an urgent task of improving the quality of life of patients.

Melasma is an acquired pigmentation disorder associated with excessive melanin deposition in the skin, which is characterized by skin discoloration of varying intensity. The presence of hyperpigmentation in melasma is accompanied by reduced quality of life, development of depressive and anxiety disorders. Melasma is the most common disfiguring skin disease, since exactly the localization of lesions on the face has a pronounced negative impact both in aesthetic and socio-economic aspects. Treatment aimed at hyperpigmentation correction is not always successful. This is due to many causes and factors (ignoring the doctor’s recommendations, reference to specialists of incorrect profile, presence of unsuccessful experience of treatment with the side effects development, use of external remedies with questionable effectiveness and safety). Currently, the cosmetic agents market, including the category of depigmenting drugs, is developing rapidly. It has been found that the most promising group of whitening agents are tyrosinase inhibitors, which is a key enzyme in melanin synthesis, and that isobutylamido thiazolyl resorcinol has the highest specific action regarding tyrosinase. The molecule is characterized by greater effectiveness and higher safety profile compared to other group’s representatives, such as arbutin and hydroquinone, which were once the gold standard of skin hyperpigmentation treatment. The article presents epidemiological, topical, clinical, psychosocial aspects of melasma, as well as modern and historical approaches to treatment.

Post-inflammatory hyperpigmentation (PIH) is one of the most significant problems in patients with acne. The prevalence of PIH among patients with acne varies from 45 to 87%. Post-acne, including PIH, has an extremely negative impact on the quality of life and psychological well-being of patients, as it is often resistant to therapy and can persist for even several years. Successful acne treatment does not guarantee complete elimination of PIH and other post-acne symptoms. In the development of PIH, a key role is played by the mechanism associated with the production and distribution of melanin, which is activated by inflammation and the release of cytokines that promote an increase in the level of immunoreactive tyrosinase, which stimulates melanocytes, activation of melanogenesis and further transfer of melanosomes to surrounding keratinocytes. It is important for clinicians to recognize the psychosocial impact of PIH and manage inflammation, as well as proactively address residual PIH with appropriate treatment. Thus, prevention and correction of PIH should be one of the goals of acne treatment. Topical therapy for PIH in acne is considered the most acceptable and can be prescribed both as monotherapy and as part of combined methods. Tyrosinase is a target for topical anti-pigmentation agents, including hydroquinone, kojic acid, and resorcinyl thiazole derivatives. The latter includes isobutylamidothiazolyl resorcinol – thiamidol. The article provides a brief overview of data on the epidemiology of PIH, its pathogenesis, impact on the quality of life of patients and the perception of their image by people around them. Clinical experience with the use of anti-hyperpigmentation serum with thiamidol, licochalcone A and sodium hyaluronate is presented, which confirms the effectiveness, safety and feasibility of prescribing products with thiamidol for the treatment of PIH caused by acne.

Hyperpigmentation is a very common group of conditions with a pronounced negative impact on patients’ quality of life, that requires the necessity of development and search of effective and safe means to control it. Today, the market of depigmentary cosmetics is extremely various, and its global financial turnover continues to grow, that confirms the relevance of whitening products. The article presents the classification and review of modern preparations for hyperpigmentation treatment. The used drugs are divided into different classes depending on the mechanism of action. Conducted studies have shown that inhibitors of tyrosinase, a key enzyme in melanin synthesis, are the most effective group. Till recently, tyrosinase produced by mushrooms due to its commercial availability has been used for the synthesis and study of tyrosinase inhibitors in factories, so many of the released whitening agents are not clinically effective for control of hyperpigmentation in humans. It has been established that isobutylamido-thiazolyl-resorcinol has the most specific action for human’s tyrosinase. The molecule has a higher efficacy and better safety profile than other substances of the group, such as arbutin and hydroquinone, which were once the golden standard for skin hyperpigmentation treatment.

The background of improving the efficacy of acne treatment is undeniable due to the high prevalence of the disease, as well as the significance of its consequences in the form of appearing facial deformities and related psychological problems. In 90% of patients with acne the evolution of inflammatory elements can result in a postacne symptom complex formation, that includes congestive postinflammatory erythema, hyperpigmentation and scars, leading to psychosocial disability and reduced quality of life. Despite the high prevalence of postacne, relatively little is known about the causes for their formation. According to some authors, the basis of the postacne formation is inflammation, in the opinion of others — autodestruction of the acne elements in different stages of their development. Postinflammatory hyperpigmentation is a frequent complication of acne and occurs at any age with the same incidence in male and female patients. It has been found that patients with postacne pigmentation have a lower indices of quality of life than patients only with acne. We present an analytical review of literature, the author’s position on the possible cause of hyperpigmentation, including in patients with acne, the developed gradation of severity degrees of excoriated acne with the postacne, as well as criteria for diagnosis. In the capacity of observations, different clinical variants of postacne and ways of their rational correction are discussed.