More than 20% of people worldwide suffer from allergic diseases. The high prevalence and wide range of provocative factors, which are increasing daily, complicate the diagnostic search. On the one hand, this leads to inadequately extensive dietary and lifestyle restrictions that reduce the quality of life for patients; on the other hand, it results in the failure to identify life-threatening allergens. The discovery of immunoglobulin E over 60 years ago initiated the search for specific biomarkers to etermine the causes of allergic diseases. Traditional methods of allergen diagnostics have several limitations that hinder the search for potential allergic disease triggers. The article discusses modern laboratory approaches to multicomponent molecular allergen diagnostics, describes its differences from traditional diagnostic methods, and analyzes the advantages, prospects, limitations, and shortcomings of this method. It also presents a comparative characterization of the test systems available today. The article presents four clinical cases that demonstrate the capabilities of the multicomponent ALEX 2 test system in diagnostics, choice of therapy tactics, and in forming further personalized recommendations for patients suffering from various allergic diseases.

Langerhans cell histiocytosis (LCH) belongs to histiocytic proliferative diseases, which are rare in clinical practice; however they pose significant challenges both for their diagnosis and choice of therapeutic strategies. Histiocytic proliferative diseases are the scope of oncology; nevertheless, at the diagnostic stage the patients are referred to pediatricians or dermatologists. That is why the interdisciplinary interaction of various specialties and common approaches to their classification, diagnosis and treatment are important for the management of patients with histiocytic proliferative disorders. Accumulation of the studies on the LCH pathophysiology has promoted the development of new diagnostic algorithms and treatment methods. After the fact of MAPK signal pathway activation had been established, the potential target for therapy was identified. Neoplastic nature of LCH has been hypothesized. If confirmed, we can expect actual diagnostic algorithms being elaborated, in particular, the potential to predict the disease depending on the tumor clone mutation type. The unique characteristics of LCH including proliferate clonality (presumable of neoplastic nature), the disease course with spontaneous regression and frequent relapses and tropism to certain tissues (target organs) make up the grounds for further in-depth studies of the disease.

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.

The progressively increased incidence of atopic dermatitis among children and increased persistence in adulthood, combined with an inevitably decreased quality of life of patients, determine the relevance of studying the development mechanisms of this disease not only for dermatology but also for the entire health care system. Thus, the prerequisites for the emergence of new pathogenetic concepts and the search for the most effective therapeutic modalities arise. Currently, atopic dermatitis is considered as the interaction of endogenous (impaired immune response and insufficient epidermal barrier function) and exogenous (exposure to allergens, chemical or physical irritants, and microorganisms) factors. Environmental factors, such as temperature and humidity, genetic makeup, antibiotic use, and good hygiene, play a critical role in skin microbiome maintenance and stability. Normally, the skin microbiota is mainly formed by bacteria of the genus Staphylococcus, Propionibacterium, Corynebacterium, and Streptococcus. In 70% of patients with atopic dermatitis, colonization of Staphylococcus aureus is observed on the affected skin, whereas on the unaffected skin in 39%, which secondarily contributes to the development of immune imbalance and increased skin xerosis. This fact determines the importance of basic therapy, which, on one hand, helps to strengthen the epidermal barrier, and on the other, normalizes the microbiome of the skin, thereby reducing the colonization of Staphylococcus aureus. The normal skin microbiome suppresses the activity of immune-inflammatory responses and regulates pH, lipid synthesis, and transepidermal water loss. Thus, skin microbiome normalization is the key to successful therapy and long-term remission of atopic dermatitis.

Epidermis plays an important role in protecting the body from negative environmental influences. The horny layer plays a special role in carrying out these functions. Skin defense mechanisms are multistage and include 5 protective barriers responsible for maintaining the integrity and performing the main functions of the skin. The first one is a microbial barrier – determined by commensal flora which prevents contamination of pathogenic microorganisms; the second one is a physical barrier preventing mechanical skin damage, penetration of allergens and microorganisms; the third one is a chemical barrier achieved by forming pH and components of natural moisturizing factor as well as epidermal lipids; the fourth one – immune barrier – Langerhans cells, tissue basophils, lymphocytes etc.;the fifth is the neurosensory barrier – numerous nerve endings transmitting signals of skin integrity damage and controlling metabolic processes and homeostasis maintenance. Epidermal barrier of newborns and infants is imperfect and differs in its structure and functional activity from that of adults. Children’s skin is prone to excessive dryness, irritation, allergic reactions and inflammation. For young children, it is very important to minimize the risk of these manifestations. Individual selection and use of emollients in the basic care of infants promotes the functional stability of five protective «frontiers» of the epidermal barrier: prevents skin damage when exposed to unfavorable environmental factors, reduces TEWL, supports the normal microbiome, has antipruritic and anti-inflammatory action. Modern emollients restore the hydrolipidic layer of the epidermis and prevent the development of dermatitis and skin infection in children. An important role when choosing an emollient is played by its texture, which can be represented by a lotion, cream, balm, ointment. Chemically, creams, lotions and balms are emulsions, i.e. they consist of two immiscible components – fat (oil) and water. In this case, one of the components is in the other in the form of tiny droplets. Most skin diseases faced by young children are related to the integrity of the epidermis, which is why daily care should be primarily focused on protecting the skin barrier

The problem of using artificial intelligence technologies in the diagnosis of skin neoplasms is considered. Dermatoscopic images for 8 nosologies were considered as the object of research. The melanoma was one of them. Melanoma is responsible for the most deaths of all skin cancers. The aim of the study was to evaluate the effectiveness of the use of pre-trained convolutional neural networks for the classification of skin neoplasms. A classification algorithm for an ensemble of convolutional networks was proposed. Pre-trained neural networks have been studied to form the ensemble. Neural network samples were selected from a set of neural networks that have proven themselves in the ImageNet Large Scale Visual Recognition Challenge. According to the results of the experiment the best three of the eight convolutional neural networks were selected for inclusion in the ensemble – MobileNet_v2, ResNet_152, ResNeXt_101_32x8d. The experiment was conducted on a sample of 10015 images representing 8 nosologies. The average classification accuracy for all nosologies was 79%. The paper highlights the features of ensuring information security when using telemedicine diagnostic technologies using the proposed approach in the recognition of images of skin neoplasms. The results of the work can be used in the design of medical decision support systems for the diagnosis of malignant skin neoplasms (including melanoma).

Enteropathic acrodermatitis is a rare form of genodermatoses, a group of hereditary disorders with prevailing skin lesions. The disease manifestation in children is associated with withdrawal of breastfeeding and switch to the cow milk-based products, which makes it difficult to differentiate enteropathic acrodermatitis from allergic dermatoses. We describe a familial case of enteropathic acrodermatitis in a 4-month old girl with advanced skin lesions and diarrhea. The familial history positive for enteropathic dermatitis made it possible to immediately suspect this diagnosis in the patient and to administer a zinc sulfate-containing agent before the genetic test results have become available. The response to therapy was obtained within a few days. Genetic testing of the patient identified a new mutation in exon 10 of the SLC39A4 gene. Proper collection of the past history and physician's vigilance to zinc-deficient conditions in acral dermatitis combined with alopecia and diarrhea in infants would allow for a timely and proper diagnosis and choice of a subsequent management strategy.

General information on atopic dermatitis (AD), its history and epidemiological significance are presented. Multiple etiopathogenetic factors affecting disease manifestation are identified. The absence of specific tests, laboratory and histological studies, that can help in correct AT diagnosis, is mentioned. Most of AT diagnostic schemes clarify main (major) and additional (minor) signs of disease. Clinical manifestations of AD minor signs crucial for revealing of subacute and chronic course, as well as onset of incomplete remission of disease are described. Topical AD management regimens are presented. Pathogenetic verifications for emollients and regenerating agents use are presented.

Mastocytosis is a heterogeneous group of neoplasms characterized by increased mast cells proliferation and accumulation in various organs and tissues. The paper introduces the newest mastocytosis classification and diagnosis principles. Each type of cutaneous mastocytosis is discussed separately, with the recommendations for the affected patients’ management. The paper reports the typical mastocytosis manifestations in a 1(1/2)-year-old infant.