During an interdisciplinary advisory board held in Moscow last year, experts have performed a comprehensive review concerning the problem of diaper dermatitis, the most common condition that somehow worsens the quality of life of individuals using diapers, both in adult patients and infants, including premature newborns. Discussion implicated epidemiologal and etiological issues, as well as approaches to treatment and prevention. Experts have agreed that the basis for both the prevention and treatment of diaper dermatitis is a set of measures called ABCDE, with a special focus on protecting the skin in the area under the diaper using barrier agents (B) containing 5% dexpanthenol as an active ingredient to maintain the epidermal barrier function, moisturize the skin and exert an anti-inflammatory effect. To create a strong semi-exclusive barrier on the skin under the diaper, a dexpanthenol 5% ointment with a 25% lanolin content can be successfully used, as it meets the requirements for an optimal diaper product and is a well-studied effective and safe medication with high preventive and therapeutic potential.

In recent years, the Russian Federation has seen an increase in the incidence of superficial mycoses of the skin, a change in the nature of the disease course and spectrum of its pathogens. At the same time, the imperfection of the nosological classification and nomenclature of pathogens is noted. Besides there is a deficit of modern methods for diagnosing and treating mycoses of the skin and cutaneous appendage. These facts determine the current need to update clinical guidelines and create guidelines for onychomycosis, scalp mycoses and skin mycoses. The main methods of diagnosing superficial mycoses of the skin and its appendages in most countries are the KOH test and culture, with luminescence, histological examination and nail dermatoscopy as auxiliary methods. In some diagnostic laboratories, molecular genetic methods with high sensitivity and specificity have become much more widely used. The greatest difficulty is the diagnosis of onychomycosis. The accumulated experience of clinical practice and research data confirm atypical clinical manifestations of modern mycoses and difficulties in their diagnosis. Currently, one of the most important problems in the treatment of skin mycoses is the development of resistance to antimycotics. In this regard, it is necessary to use drugs that reduce the risk of resistance. Amorolfine, as a morpholine, acts on two different enzymes (sterol Δ14 reductase and sterol Δ7-Δ8 isomerase) and is a possible therapeutic option for overcoming antifungal resistance. It has a favorable safety profile and efficacy similar to other classes of antifungal agents. There is now a significant evidence base for the fungistatic and fungicidal activity of the amorolfine molecule, its efficacy and safety. In this regard, it seems appropriate to include amorolfine in cream form 0,25% in national clinical guidelines for the treatment of superficial cutaneous mycosis.

Sarcoidosis is a disease of unknown etiology characterized by the formation of epithelioid cell granulomas in several organs or tissues without caseous necrosis (fibrinoid necrosis may occur). With sarcoidosis, almost all organs and tissues can be affected, which determines the interdisciplinary nature of the problem. Skin sarcoidosis is one of the most common manifestations of systemic sarcoidosis. At the same time, the role of dermatologists in the diagnosis of sarcoidosis is exceptionally large, since skin lesions are often the key to the discovery of systemic sarcoidosis, which allows internists to purposefully and timely diagnose and treat lesions of internal organs. Skin rashes in patients with sarcoidosis may occur secondarily against the background of specific lesions of the lungs, intrathoracic nodes and other internal organs, however, skin sarcoidosis may also develop primarily. All forms of skin sarcoidosis may be the only manifestation of the disease, and it is impossible to distinguish clinically and histologically between skin changes in systemic sarcoidosis and skin lesions alone. Treatment of skin sarcoidosis often presents great difficulties and includes, depending on the prevalence and activity of the process, local (corticosteroids, tacrolimus) and systemic therapy (immunomodulators, immunosuppressors, TNF inhibitors).

Background. Hidradenitis suppurativa hidradenitis is a chronic recurrent inflammatory skin disease that develops after puberty and is characterized by the appearance of recurrent painful nodes, abscesses, the formation of fistula passages and scars on skin areas rich in apocrine sweat glands. Treatment of purulent hidradenitis is aimed at suppressing inflammation, relieving pain, preventing the formation of fistulas and scars. The objectives of this review. Summarize the information in the published international clinical guidelines for the diagnosis and treatment of purulent hidradenitis, their comprehensive assessment and comparison with each other. Methods. In the period from December 2022 to February 2023, scientific articles were searched in the PubMed database of the National Center for Biotechnological Information. Inclusion criteria: scientific articles in English, without date restrictions; interdisciplinary publications of specialists in which dermatovenereologists participated. Results. The analysis of the existing relevant international clinical recommendations for the diagnosis and treatment of purulent hidradenitis indicates the absence of specific treatment schemes and algorithms, criteria for evaluating the effectiveness of therapy. In the treatment of purulent hidradenitis, the use of external keratolytics, antiseptics and antibiotics is recommended. Among systemic drugs, antibiotics, retinoids, immunosuppressive agents, hormonal drugs are used. The highest therapeutic efficacy in patients with purulent hidradenitis was shown by genetically engineered drugs that inhibit TNF-α and IL-17A. Conclusions. Patients with purulent hidradenitis require various treatment approaches, including a variety of surgical interventions, depending on the stage, severity, prescription of the disease and the general condition of the patient. The basic principle is the individual selection of the treatment method for a particular patient. In this regard, there is a need to develop domestic clinical guidelines for the management of patients with purulent hidradenitis.

The relevance of the disease is due to its prevalence ― for acute urticaria up to 20% with predominance in the paediatric population, for chronic spontaneous urticaria up to 0.5–5% of the population. The course of the disease is characterised by unpredictability of prognosis of duration, effectiveness of standard therapy, serious impact on the quality of life of the patient, his relatives, the burden on health authorities. The lack of accurate understanding of the mechanisms of disease development, a wide range of pathogenetic treatment complicates the possibility of rapid achievement of drug remission. The clinical Recommendations contain up-to-date information on epidemiology, pathogenesis, clinical picture, differential diagnosis, possibilities of examination and stage treatment, including immunobiological therapy. The procedure of medical care, prophylaxis and dispensary observation, criteria for assessing the quality of patient management and supporting material, including questionnaires to assess the severity of the condition and the effectiveness of treatment are outlined. Clinical recommendations on urticaria are intended for practicing physicians of all specialities, students, teachers of medical schools, residents, postgraduates and researchers.

Background: There are insufficient data on the antifungal activity of active zinc pyrithione, which is widely used in practice. Considering the reported role of Malassezia spp. in the pathogenesis of several dermatologic diseases, it is of scientific and practical importance to investigate this issue. Aim: To evaluate the antifungal activity of external forms of activated zinc pyrithione in the treatment of psoriasis, seborrheic dermatitis, and pityriasis versicolor. Method: An open-label prospective study was conducted between March and July 2022. Patients with psoriasis, seborrheic dermatitis, and pityriasis versicolor were treated with external forms of activated zinc pyrithione for 21 days. Skin scales and circular prints from lesion foci, as well as from skin areas without clinical manifestations before and after therapy were studied. A quantitative assessment of skin colonization by micromycetes of Malassezia was performed using microscopic and cultural methods of examination. Clinical efficacy and drug safety of the therapy was assessed using the Dermatological Symptom Scale Index, by recording adverse events at weeks 0, 1, 2, and 3. Results: 64 patients aged 18 to 65 years with diagnoses of psoriasis, seborrheic dermatitis, and pityriasis versicolor were included. 60 patients completed the study, 4 were excluded due to failure to adhere to the schedule. In patients with seborrheic dermatitis and pityriasis versicolor in the lesion foci after therapy, a significant decrease was observed in the colonization level according to the results of microscopic and cultural studies. In psoriasis patients, a significant decrease in the colonization level was obtained only based on the results of microscopic examination. In all groups, significant differences in comparison to the initial level were observed at the 1st week of treatment. There was no adverse events observed. Conclusion: Activated zinc pyrithione in the form of cream and aerosol showed moderate antifungal activity against micromycetes of the genus Malassezia.

The paper presents an analysis of different variants of acne classifications and the assessment of acne severity, carried out by the working group of the RODVK Committee for Classifications in Dermatovenereology. There is a division of acne vulgaris according to age and severity. Assessing the severity of acne is important for choosing the correct prescriptions in daily practice and for the evaluation of treatment outcomes. Most of existing acne grading systems are based either on a global grading of severity or on calculating the number of lesions in a variety of anatomic locations. For clinical practice of dermatovenereologists, as well as for educational and scientific purposes, the working group proposed to supplement the acne classification based on severity grading with counting the number of the lesions, and to take into account localization, rash prevalence and scarring when determining the acne severity.

The article provides modern definitions and classification of urticaria. The general provisions of the treatment of chronic urticaria, the treatment of which is often very difficult, are outlined. The main provisions of the treatment of urticaria were formulated, according to which the patient should be treated until the rash is completely resolved. In chronic urticaria, it is necessary to identify and eliminate the causes of dermatosis; avoid exposure to identified triggers; increase tolerance; pharmacological treatment should be aimed at preventing the release of mast cell mediators and/or the effects of mast cell mediators. The goal of treatment should be to relieve the symptoms of urticaria as completely as possible, taking into account the safety and quality of life of the patient in each individual case. The importance of identifying and addressing underlying causes and avoiding identified triggers is emphasized. The therapy algorithm is considered in detail, including 4 lines according to the European guidelines and domestic clinical guidelines. Particular attention is paid to the treatment of various subtypes of chronic urticaria. A comparative description of the most effective antihistamines is given.

The Union of Pediatricians of Russia together with the Russian Association of Allergologists and Clinical Immunologists and the Russian Society of Dermatovenerologists and Cosmetologists have developed new clinical guidelines for the urticaria in adults and children. Urticaria is a common disease; its various clinical variants are diagnosed in 15–25% of people in the global population, and a quarter of all cases belongs to chronic urticaria. The prevalence of acute urticaria is 20%, and 2.1–6.7% in child population, whereas acute urticaria is more common in children than in adults. The prevalence of chronic urticaria in adults in the general population is 0.7 and 1.4%, and 1.1% in children under 15 years of age, according to the systematic review and meta-analysis, respectively. This article covers features of epidemiology, etiology, and pathogenesis of the disease with particular focus on differential diagnostic search. Guidelines on treatment and step-by-step therapy scheme (both based on principles of evidencebased medicine) for pediatric patients were presented. Clarification on the analysis of the therapy efficacy and the degree of disease activity was given.

Leading experts in the field of dermatovenereology, cosmetology, and allergology took part in the meeting of the expert board. Following the discussion, the working groups of the Expert board assessed the role of filaggrin deficiency in the pathogenesis of atopic dermatitis and other diseases/conditions accompanied by xerosis. In addition, they formed recommendations for the use of emollient Admera, taking into account the role of filaggrin in the development of atopic dermatitis and xerosis. The experts comprehensively analyzed the best basic therapy for atopic dermatitis, xerosis of diverse etiologies secondary preventive options for atopic dermatitis and developed unified recommendations on the principles of managing such patients. In addition, they also established the place of emollients in clinical practice. Additional educational, informational, and organizationalactivities were proposed to help patients and doctors understand the problem of using emollients in atopic dermatitis and xerosis of diverse etiologies. This article was first published in the Kremlin Medicine Journal (Kruglova LS, Lvov AN, Araviyskaya ER, et al. Practical issues on the application of emollients containing filaggrin modulators in the management of patients with atopic dermatitis and xerosis. Resolution of the Council of experts. Kremlin Medicine Journal. 2022;1:8794. doi: 10.26269/m4bj-f167). This article published with permission from authors and copyright holder.

Background. Netakimab, a recombinant humanized monoclonal antibody, specifically binding to IL-17 blocks its activity resulting in plaque psoriasis signs decrease. The results of the first year of BCD-085-7/PLANETA study showed high efficacy and a favorable safety profile in the treatment of patients with moderate-to-severe psoriasis. Aims. Efficacy and safety assessments of netakimab through 2 years of treatment in patients with moderate-to-severe psoriasis. Materials and methods. BCD-085-7/PLANETA study is ongoing Randomized, Double-blind, Placebo-Controlled Phase III clinical study. In the study, 213 patients with moderate-to-severe plaque psoriasis were randomly assigned to one of three study groups. In the first two groups of patients, after weekly drug administration, received netakimab at a dose of 120 mg every two or four weeks. In the third group the patients received placebo. During 12-week double-blind study period the efficacy were evaluated based on the proportion of patients achieved PASI 75. After that all patients were switched to netakimab (once in 4 weeks). Patients who failed to achieve PASI 75 at Week 52 were withdrawn from the study. The open period lasts about 3 years. Herein we focus on the results of 2-year netakimab treatment (120 mg, weekly for 3 weeks, then once in 4 weeks), the recommended per label dose. Taking into account the epidemiological situation (COVID-19) and results limitation due to missing visits, additionally to the efficacy analysis in patients received, at least, one dose of netakimab, analysis in those of them who had relevant data on each visit per Protocol was conducted (ITT and PP populations). Results. At Year 1, PASI 75/90/100 responses were achieved in 88,7/74,5/56,6% patients, respectively (ITT-population) and in 100/85/66% patients, respectively (ITT-population). In 2 year, 69,3/58,0/40,6% sustained their responses in ITT-population and 93,2/78,2/53,1% in PP-population. Through 2 years, the high quality of life sustained among patients. The safety profile remained favorable and immunogenicity was low. Conclusions. Treatment with netakimab at a dose of 120 mg every 4 weeks results in high rates of sustained clinical response and quality life improvement in patients with moderate-to-severe plaque psoriasis with remains of a favorable safety profile.

IntroductionThe objective of this study was to demonstrate that BCD-057 is similar to innovator adalimumab (iADA) in terms of efficacy, safety, and pharmacokinetics in steady state in the target population of patients with moderate to severe plaque psoriasis (NCT02762955).MethodsPatients were randomized in 1:1 ratio to receive 80 mg of BCD-057 or iADA at week 0 and 40 mg thereafter every other week from week 1. At week 24 patients from iADA group were re-randomized (1:1) to continue iADA or to be switched to BCD-057. The primary efficacy endpoint was 75% improvement in Psoriasis Area and Severity Index from baseline (PASI 75), secondary endpoints included PASI percent improvement and relative change in affected Body Surface Area (BSA) from baseline at weeks 16, 24, 33, and 55. Safety was assessed through monitoring of adverse events (AEs) and antidrug antibodies. Pharmacokinetics was evaluated at steady state.ResultsOverall, 346 adult patients were included in the study (174/172 patients in BCD-057/iADA arms, respectively). At week 16 PASI 75 was achieved by 60.34% and 63.37% of patients in BCD-057 and iADA arms, respectively (p = 0.5622). Bounds of the calculated 95% confidence interval (CI) for the difference between PASI 75 responses in arms [-13.26%; 7.2%] fall within the equivalence margin [-15% to 15%] demonstrating equivalent efficacy of BCD-057 and iADA. At week 55 81.61%, 85.56%, and 80.49% of patients in BCD-057, iADA and iADA/BCD-057 arms achieved PASI 75. Comparison of the secondary endpoints did not show significant differences between arms. A comparable pharmacokinetics was shown at steady state. Safety profiles and proportions of patients with antidrug antibodies were similar between arms. The switch from the iADA to BCD-057 did not affect the immunogenicity profile.ConclusionObtained data demonstrate that BCD-057 and iADA are highly similar in clinical efficacy, pharmacokinetics, safety, and immunogenicity in patients with moderate to severe plaque psoriasis.

This article reflects the main issues discussed at the Advisory Board with the participation of leading dermatovenereologists, allergists, and immunologists. The Advisory Board has become a platform for discussing the accumulated clinical and organizational problems in the field of managing patients with chronic urticaria and other allergic dermatoses. The Advisory Board also discussed the possibility of long-term use of cetirizine and levocetirizine and the use of their high doses in clinical practice. The subject of discussion was the question of the algorithm for escalation and subsequent de-escalation of the dose of non-sedating H1 antihistamines. An algorithm for escalation and de-escalation of doses of antihistamines was created based on the discussion, which can be recommended for use in clinical practice. This article was simultaneously published in several journals with permission from authors and publishers. The parallel publication is available here: The use of cetirizine and levocetirizine in patients with chronic urticaria and other allergic dermatoses: Issues of dosage increasing and long-term use from the resolution of the Advisory Board. Effective Pharmacotherapy. 2022;18(25):614. DOI: https://doi.org/10.33978/2307-3586-2022-18-25-6-14. This article published with permission from authors and copyright holder.

Psoriasis is a chronic multi-factorial immune-mediated inflammatory disease of skin and joints. The variety of clinical forms of dermatosis is consistent with various pathogenetic features of the disease progress which have been significantly supplemented and reviewed recently. Knowledge of these mechanisms will improve and personalize the prescribed therapy. This study places the emphasis on modern ideas about the formation of T cell memory, the role of melanocytes and innate lymphoid cells. Development mechanisms of guttate and paradoxical psoriasis with important distinguishing characteristics are described separately. Today, knowledge of the molecular basis of the disease progression has led to the creation and introduction of a number of highly effective targeted drugs into clinical practice. Further developments related to the inhibition of resident memory cells, innate lymphoid cells, as well as the study of guttate psoriasis perpetuation and the occurrence of paradoxical psoriasis will significantly increase the effectiveness of the therapy.

Псориаз является хроническим воспалительным иммуно-опосредованным заболеванием, характеризующимся повышенной скоростью деления кератиноцитов и нарушением их дифференцировки. Несмотря на стремительную разработку и внедрение новых системных лекарственных средств, наружная терапия остается неотъемлемой частью лечения больных псориазом. Основным её недостатком является низкая избирательность и неспецифичность противовоспалительного действия при различных дерматозах, в том числе и псориазе, что может проявляться как развитием нежелательных явлений, так и недостаточной терапевтической эффективностью. В данном обзоре представлена концепция нового направления терапии больных псориазом на основании разработки препарата, блокирующего сериновые протеазы. Приведены сведения о современных механизмах развития псориаза и роли ИЛ-36-опосредованного воспаления. Освещены вопросы о сериновых протеазах кожи, а также их эндогенных и синтезированных низкомолекулярных ингибиторах. Показаны перспективы реализации данного направления, в том числе результаты доклинических исследований. Дальнейшее развитие этого направления позволит усовершенствовать подходы к лечению как ограниченных, так и распространенных форм заболевания, что может принципиально поменять подходы ведения больных псориазом. Psoriasis is a chronic inflammatory immune-mediated disease characterized by increased division rate and impaired differentiation of keratinocytes. Despite the rapid development and introduction of new systemic drugs, external therapy remains an integral part of the treatment of patients with psoriasis. A major disadvantage of this treatment is the low selectivity and the non-specificity of its anti-inflammatory action in various dermatoses, including psoriasis, which may manifest itself as adverse effects and insufficient therapeutic efficacy. This review presents a new direction in the treatment of psoriasis based on development of a drug that would inhibit serine proteases. Current information about mechanisms of psoriasis and the role of IL-36-mediated inflammation is presented. Also, the review addresses serine proteases of the skin, specifically their endogenous and synthetic low-molecular inhibitors. Prospects for implementation of this novel treatment, including results of preclinical studies, are described. Further development of this direction will allow improving the treatment of both limited and widespread forms of psoriasis, which may fundamentally change the approach to managing patients with this disease.

Analysis of various classifications of pemphigus shows that there are no fundamental differences between them. The main distinctions consist in use of diverse terms in naming of some forms of pemphigus and in inclusion or exclusion of certain subtypes from the classifications. Authors propose to use the following classification in the dermatological clinical practice, for educational and scientific purposes and for clinical guidelines: 1) pemphigus vulgaris (1.1. Pemphigu s vegetans); 2) pemphigus foliaceus (2.1. Pemphigus endemic (Fogo selvagem), 2.2. Pemphigus erythematosus (Senear Usher)); 3) herpetiform pemphigus; 4) paraneoplastic pemphigus; 5) IgA pemphigus (5.1. Subcorneal pustular dermatosis, 5.2. Intraepidermal neutrophilic dermatosis).

Abstract Background Psoriasis is a chronic immune‐mediated inflammatory skin disease manifested by an increased rate of keratinocyte division. Currently, it has been established that the cytokines of the IL‐36 family play a significant role in the initiation and regulation of the inflammatory process in psoriasis. The IL‐36 cytokine found in skin is inactive and its activation requires proteolytic processing that may occur via the involvement of neutrophil serine proteases such as human neutrophil elastase (HNE). The localization of these enzymes in the upper layers of the epidermis suggests that topical application of HNE inhibitors could be efficacious in the treatment of psoriasis. Sivelestat is an HNE inhibitor developed for systemic use towards the treatment of acute respiratory failure. Aim The present study focussed on the investigation of the effects of sivelestat formulated for topical use, in the imiquimod‐induced model of psoriasis in mice. Methods The psoriasis‐like state was induced by application of imiquimod (Aldara®) 5% cream to mouse shaven skin. A group of 40 inbred mice of the BALB/c strain randomized into 4 groups of 10 was used in the experiment: Group 1 – no therapy (control), Group 2 – ointment (Vaseline) containing 1% sivelestat, Group 3 – cream (lanoline + olive oil + water in equal proportions) containing 1% sivelestat, Group 4 – 1% betamethasone dipropionate. Dermatological assessment of skin lesions was performed by means of the PASI method (mPASI), as well as histological and immunohistochemical evaluation. Results Based on the evaluation of efficacy manifestations, it was established that the total mPASI index value decreased by 50% during therapy with sivelestat cream and by 36% during therapy with sivelestat ointment. Histological study revealed that the epidermal thickness in groups that underwent therapy was 2.4–3.6 times lower compared to the control group. Immunohistochemical study of the skin indicated that following sivelestat treatment, the quantity of CD3+cells in the skin was 1.8–2.2 times lower, and the level of proliferative activity (Ki‐67+cells) was 2.3–2.9 lower compared to the non‐therapy group. In contrast to topical corticosteroids where the more pronounced anti‐inflammatory effect is typically seen with ointment formulations, with sivelestat we observed an opposite effect. The reasons for that reversal remain unclear. Conclusion Based on the results obtained using the animal model of imiquimod‐induced psoriasis, it was established that the HNE inhibitor sivelestat demonstrated efficacy comparable to that of a strong topical glucocorticoid steroidal drug (betamethasone dipropionate 1%). Significant resolution of skin lesions, reduction of epidermal thickness, diminishing of the skin infiltration with T‐lymphocytes and normalization of the cell division rate in epidermis and dermis were evident. Thus, suppression of IL‐36 mediated inflammation activity in the skin by topical application of a HNE inhibitor represents a promising new direction in the treatment of psoriasis. Certainly, HNE has other targets; thus, molecular studies could be subject of future experiments beyond the scope of the present study.

Topical medications are used to treat not only limited, but also common forms of the disease. Currently prescribed external anti-inflammatory drugs have a low selectivity of action, which does not allow achieving a long-term and pronounced clinical effect without the development of undesirable phenomena. This review presents new options for the use of methotrexate in modern topical forms (AuNPs-3MPS), which make it possible to reduce the incidence of adverse events with a high efficiency of therapy. Shown is an innovative drug that blocks resident memory cells (PAP-1), which will influence the course and relapses of the disease, and possibly even lead to the cure of the patient from psoriasis. A new direction has been described inhibition of serine proteases (ER143, AAN-16) and thus inhibition of IL-36-mediated inflammation, which will allow controlling the inflammatory process in psoriasis in the early stages of its development. In addition, a number of drugs are shown whose action is based on blocking intracellular signaling pathways, which leads to inhibition of the development of the inflammatory response and resolution of psoriatic eruptions: inhibitors of Janus kinases (tofacitinib), transcription factor Stat3 (rS3-PA), secondary messenger of signals (SIS3), phosphodiesterase 7 (ASB16165) and 4 (AN-2728/crisaborol), ROR transcription factor (PF-06763809), phospholipase A2 (AVX001), hydrolases (DZ2002). The results of preclinical and initial stages of clinical trials with an assessment of the safety and tolerability of the studied substances are presented. Based on the review, the advantages and disadvantages of the proposed drugs are characterized. Topical therapy with a selective effect on the key links in the development of psoriasis will increase the effectiveness of treatment and reduce the frequency of unwanted effects.