Actinic keratosis (AK) is a photodependent skin impairment with local intraepidermal atypia of keratinocytes, which is manifested by erythematous, erythematous­squamous, papulo­squamous elements with localization mainly in open (for insolation) areas of the body. Objective — to analyze the comorbidity and factors affecting the course of АК in different age groups of the population, taking into account the growing incidence of AK in recent years, especially in the southern regions of Ukraine. Materials and methods. During 2020—2024 under our supervision were 78 patients with AK aged 40 to 83 years, of which 40 were men and 38 were women. Trigger factors and somatic diseases were analyzed, which, according to patients, could affect the course of dermatosis. Results and discussion. The average age of men under our supervision was (54.3 ± 0.3) years, women — (58.4 ± 0.5) years. 54 (69.2 %) patients had a complicated family history of AK, including 3 (3.8 %) people having first­line relatives suffering from malignant skin diseases. 56 (71.8 %) of the respondents identified their past sun exposure as excessive and accompanied by skin burns followed by epidermal detachment. 5 (6.4 %) patients had long­term contact with harmful substances (petroleum products, household chemicals). In the observation group, 45 (57.7 %) patients with nicotine dependence were found. Against the background of AK concomitant pathology was revealed: diseases of the cardiovascular system (coronary heart disease — in 23 (29.5 %) people, hypertension — in 14 (17.9 %)); diabetes mellitus — in 5 (6.4 %) people; autoimmune pathology (autoimmune thyroiditis — in 2 (2.6 %) people, Behçet’s disease — in 1 (1.3 %) woman, ulcerative colitis — in 1 (1.3 %) man); oncological processes of different localization — in 11 (14.1 %) patients from the observation group. Conclusions. As a result of the clinical study, it was established that one of the leading factors in the development of AK, in addition to excessive insolation, is genetic predisposition, the study of the mechanisms of which is an important aspect in the development of new methods for the treatment of dermatosis and prevention of neoplastic transformations; extended oncological screening of patients with AK is etiopathogenetically justified; an increase in the number of people with nicotine dependence in the group of patients with actinic keratosis (57.7 %) compared with the total number of the nicotine dependent in Ukraine (40—45 %) requires further study of the combined effect of excessive insolations and smoking on the development of AK.

Atopic dermatitis (AD) is a multifactorial, genetically determined disease with a chronic relapsing course and a predisposition to hyperimmunoglobulinemia E. Abnormal colonization of Staphylococcus aureus, Malassezia furfur, and Herpes Simplex plays a significant role in maintaining inflammation in AD. Objective — to determine the frequency of bacterial, mycotic and viral complications in a group of patients with moderate and severe AD. Materials and methods. From 2018 to 2023, 80 patients with AD (moderate and severe forms) aged from 1 year to 53 years (average age 14.6 years) were under our observation. Patients with a SCORAD index ≥ 25 were included in the study. To confirm the nature of the infectious complication, additional examination methods were used: microscopy, bacteriological culture, amplification methods of research, dermatoscopy, immunoenzyme analysis. Results and discussion. An analysis of the total number of relapses of AD during the year was carried out, depending on the age and gender of the patients. The largest number of relapses was observed in the age group from 6 to 10 years — 9.4 ± 0.6. The frequency of AD relapses had a certain correlation with the severity of the course of dermatosis — the SCORAD index increased to 31.2 ± 0.4 in the group of patients with the highest frequency of disease relapses (9.4 ± 0.6) per year and, as a result, increase in the frequency of infectious complications. The conducted analysis showed that each age group of AD patients had its own characteristic spectrum of bacterial, mycotic and viral complications. The most frequent infectious complications of AD observed in the examined patients were streptostaphyloderma (18.8 %), molluscum contagiosum (11.3 %), mycotic lesions (10.0 %), herpes infection (6.3 %), Coxsackie virus (3.8 %), EBV ­infection (2.5 %). Conclusions. As a result of the clinical study, it was established that infectious complications in AD have age, gender, and topographic features that can change the course and prognosis of dermatosis. Against the background of reduced immunoreactivity, the risk of disseminated, life­threatening forms of infections increases in patients with atopic dermatitis.

Acne is among the most common conditions encountered in dermatological practice. In recent decades, there has been an increase in severe, complicated forms of acne. Objective — to analyze the factors that affect the deterioration of the clinical course of acne and stimulate the development of moderate and severe forms of acne. Materials and methods. For 3 years (2020—2023) we monitored 95 patients aged 18 to 35 years (45 men and 50 women), suffering from moderate to severe forms of acne. Before starting treatment, all patients completed a special questionnaire developed by us and taking into account known trigger factors. Results and discussion. Factors stimulating the transformation of mild acne into moderate and severe forms of the disease differ in groups of men and women. Among men, stress worsened the clinical course of dermatosis in 5 (11.1 %) cases, in women — in 9 (18 %). Among the factors that influenced the course of acne in women, we can distinguish the use of contraceptives 2 (4 %) and dysmenorrhea in 4 (8 %) people. 2 (4 %) patients clearly noted an improvement in the course of acne after withdrawal of contraceptives. Alcohol stimulated exacerbation of acne in 3 (6.7 %) men. Not sticking to the diet more often contributed to the exacerbation of acne in women — 9 (18 %), compared to only 6 (13.3 %) in men. A significant role in the stimulation of acne activity was played by irrational antibacterial topical therapy: 2 (4.4 %) men and 4 (8 %) women used topical drugs with clindamycin and erythromycin for a long time. There were cases of prolonged use of topical corticosteroids (for more than 3 months), which significantly worsened the clinical course of acne, in one case led to the development of steroid rosacea. 7 (14 %) women and 3 (6.7 %) men associated exacerbation of the disease with the intervention of a cosmetologist who did mechanical cleaning during the activation of acne. 5 (11.1 %) men and 3 (6 %) women were associated with worsening of the course of acne after SARS-CoV-2 infection. Also, the most common factor in acne exacerbation was self-medication: 7 (15.5 %) men and 6 (12 %) women. Some patients were unable to isolate any of the known trigger factors of acne: 9 (20 %) men, 3 (6 %) women. Conclusions. The study made it possible to identify a number of factors that affect the severity of the clinical course of acne. The most common triggers were psycho-emotional stress (18.0 % of women and 11.1 % of men), diet disorders (18 % of women and 13.3 % of men), self-treatment (15.5 % of men and 12 % of women), the COVID-19 pandemic (11.1 % of men and 6.0% of women), the intervention of cosmetologists with irrational aesthetic procedures (6.7 % of men and 14.0 % of women). Thus, the identified trigger factors of acne have gender, nutritional, behavioral characteristics, which requires further study and development of algorithms for their elimination and correction.

The etiological factors of erythema of the face in rosacea are analyzed in the article. The role of vasoactive peptides, inflammatory mediators and ticks of the genus Demodex in the pathogenesis of the disease has been determined. The main methods of treatment of the disease are considered, including phototherapy with narrowband pulsed radiation and platelet autologous plasma (TAP). Current data indicate the acceleration of natural mechanisms of skin regeneration due to the presence of platelet-derived growth factors and modulation of endothelial reparative function, so the introduction of platelet autologous plasma is a promising method of treating patients with this dermatosis. Key words: rosacea, platelet autologous plasma, facial erythema, platelet growth factors.

Objective — to increase the effectiveness of treatment of various forms of actinic keratosis (AK) with application of topical immunoregulator imiquimod in combination with carbon dioxide (СО2) laser in the form of dermal optical thermolysis (DOT). Materials and methods. 95 patients with various forms of AK were under observation. They were divided into two groups: the main group (50 persons) and the control group (45 persons). Patients of both groups used imiquimod as the main method of treatment for AK. In the main group, before applying imiquimod, additional treatment of AK zone was carried out 1 cm along the peripheral area with a СО2-laser in the form of DOT. Results and discussion. The results of treatment of patients of both groups were evaluated 10, 20 and 60 days after the last application of imiquimod. The following characteristics were analyzed: soreness during and after the procedure, speed of epidermis recovery, presence or absence of dermatoscopic signs of AK, formation of complications (scarring or dyschromic), absence or presence of disease recurrences within 2 months. It was noted that combined treatment with imiquimod and СО2-laser slowed down the epithelialization of the affected areas (up to 20 days in 37 (39.5 %) patients of the main group and only in 19 (20 %) patients of the control group), by increasing the depth and intensity of the intervention, but it slightly increased the effect of post-traumatic hyperpigmentation (after 60 days) in 5 (5.2 %) patients of the main group and in 3 (3.1 %) patients of the control group. This therapy reduced the number of AK recurrences (especially in the hyperkeratotic form) by 3.2 % compared to the imiquimod monotherapy and had a positive effect on the rate of disappearance of dermatoscopic signs of AK (20 days after the end of treatment, they were observed only in 2 (2.1 %) patients of the main group and in 7 (7.5 %) patients of the control group). Conclusions. The combined treatment of AK that includes the application of imiquimod and the use of СО2-laser is promising, etiopathogenetically justified and well tolerated.

When examining 87 patients with moderate and severe forms of atopic dermatitis aged 16 to 49 years, trigger factors in various clinical forms of atopic dermatitis were analysed. It was revealed that diamine oxidase deficiency and trigger factors aggravate the course of atopic dermatitis. Diamine oxidase deficiency in atopic dermatitis was combined with insignificant dynamics in relation to IgE and slow regression of the SCORAD index. It was revealed that the degree of influence of diamine oxidase on the course of atopic dermatitis (especially at SCORAD >= 25) makes it possible to identify a group of patients who need additional regulation of tissue histamine conversion and active blocking of exogenous histamine liberators. A low level of diamine oxidase activity correlated with a slow regression of clinical sympto`ms of dermatosis, including more persistent pruritus, deterioration of the general condition, insomnia, irritability, and psycho-emotional asthenia.

Pyoderma gangrenosum is a rare inflammatory skin disease of unclear etiology, characterized by neutrophilic infiltration of the dermis with tissue destruction. The pathogenesis of pyoderma gangrenosum has not been fully studied and the variety of clinical forms and difficulties in diagnosing this disease are a major problem for clinicians. Currently, the main diagnostic criterion is histological examination. The aim of our work was to analyze the staging of pathomorphological changes development in patients with pyoderma gangrenosum depending on the dynamics of clinical changes. In 21 histological samples of patients, specific histological markers were identified for each stage and clinical form. The most significant were intravascular fibrin deposition with subsequent development of fibrinoid necrosis, characteristic of earlier stages of the disease, formation of granulomas containing giant cells of foreign bodies characteristic of late necrotic stages of pyoderma gangrenosum. Eosinophilic microabscesses were an important histological feature of the vegetative forms of the disease.

We conducted a comprehensive examination of 38 patients with chronic urticaria and determined their level of diaminoxidase (DAO), the main enzyme involved in the degradation of histamine. It was found that the frequency of HIS in patients with CU was 89.5%. A significant number of patients (63.2%) had the background of sensitization. It was established that HIS plays a certain role in the development of CU, acting as a factor aggravating the course of the disease. The value of the DAO level should be taken into account during prescribing the complex therapy for patients with CU. The diagnostic evaluation of the determination of DAO in patients with CU requires further study, especially when the negative markers for the development of allergic reactions are identified. Key words: chronic urticaria, histamine intolerance syndrome, diaminoxidase.

A modern three-stage therapeutic pemphigus treatment algorithm were discussed and analyzed in the article. The main characteristics of each drug and dosage regimens were indicated. The objective. To introduce doctors-dermatovenereologists to the experience of using biological therapy in the treatment of persistent forms of pemphigus. Materials and methods. Two clinical cases of the using of the monoclonal antibodies CD20 rituximab in patients with pemphigus vulgaris and foliaceus are presented. Results. The efficiency of the using of rituximab was analyzed. It was found that monoclonal antibodies CD20 allow not only accelerate the healing of erosions in pemphigus, but also suppress the production of specific antibodies to desmoglein in the early stages of treatment, thus, reduce the corticosteroid load on the patient’s body. Conclusions. The use of modern methods of treatment of pemphigus significantly improves the prognosis of the disease. The most effective of them include the combined using of corticosteroids and monoclonal antibodies CD20.

The modern classification of autoimmune bullous dermatoses is represented by three groups of diseases that have not only clinical, but also histomorphological, histochemical and immunogenetic similarities. Autoimmune bullous dermatoses are a group of heterogeneous diseases accompanied by the formation of blisters and erosions on the skin and/or mucous membranes under the influence of specific autoimmune complexes. The main clinical manifestations and diagnostic markers of autoimmune bullous dermatoses (ABD) belonging to the pemphigus group are considered.Objective — to analyze the prevalence of clinical forms of pemphigus in the southern region of Ukraine for the period from 2010 to 2020.Materials and methods. The observation group consisted of 88 patients aged 21 to 75 years. The features of clinical manifestations of typical and atypical forms of pemphigus have been studied, a diagnostic algorithm and criteria for the effectiveness of treatment in the early stages of the disease have been developed.Results and discussion. Pemphigus vulgaris was found in 61 (69.3 %), pemphigus vegetans — in 7 (7.9 %), pemphigus erythematosus — in 6 (6.8 %), herpetiform pemphigus — in 4 (4.5 %), IgA pemphigus — in 3 (3.4 %), paraneoplastic pemphigus — in 3 (3.4 %) patients.Conclusions. Modern clinical diagnostic features of ABD (pemphigus group) require the inclusion of immunofluorescence microscopy, direct and indirect enzyme immunoassay in laboratory screening. Not only positive clinical dynamics, but also the rate of disappearance of autoantibodies that induce the diseases (desmoglein, desmoplakin, periplakin, etc.) should be considered the criteria of the effectiveness of treatment of patients with ABD. At the same time, knowledge of the clinical features of ABD and the diseases that mimic them remains an important aspect.

Actinic keratosis (AK) is a common disease that is formed as a result of excessive insolation of exposed skin areas. One of the possible options for the development of the disease is the transformation of AK into squamous cell carcinoma. The timely diagnosis of suspicious areas of AK with their subsequent excision and histological examination has great importance in the prevention of neoplastic transformations of the skin.The aim of our study was to identify dermatoscopic patterns of the initial stages of neoplastic transformation of actinic keratosis and a comparative analysis of the diagnostic effectiveness of digital dermatoscopy, two­color spectral dermatoscopy in relation to histological examination in a group of individuals suffering from actinic keratosis.There were 49 patients with AK under our supervision. All suspected cases of keratosis were additionally examined histologically. We analyzed the features of clinical forms and modified existing diagnostic methods. To expand the diagnostic capabilities of standard dermatoscopy, studies were performed in different ranges of light. Spectral dermatoscopy allowed estimating the potential foci of neoplastic transformation in blue and green light field (standard illumination range was suppressed). Particular attention was paid to areas of increased keratinization, areas of excessive vascularization with a predominance of superficial capillary network, micro­ulcers with loose edges that contrast well with the green spectrum, as well as dynamic changes in color in one field of study for 30 days.It was found that the use of spectral dermatoscopy increases the diagnostic capabilities of AK and allows identifying more accurately the early signs of neoplastic transformations associated with both pathological neoangiogenesis («strawberry» pattern, glomerular network) and pathological proliferation (pseudogranulations, pathological keratinization, etc.).

The subject of research is telangiectasia in rosacea. The purpose of this work is to provide demonstration materials that demonstrate the diagnostic value of telangiectasias in rosacea and the mechanisms of their formation. Telangiectasia is an important diagnostic feature of rosacea. Their development is facilitated by the peculiarities of the location of skin vessels in the rosacea zones (face, decollete), changes in hemodynamics in them, disturbances in the neurohumoral regulation of their functions. At the same time, the mechanisms of formation of telangiectasias in rosacea require further research. Key words: telangiectasia, rosacea.

According to the decisions of international scientific forums, the problem of phenomenon of rosacea (acne rosacea), a common dermatosis with numerous unexplained aspects of etiopathogenesis is a promising area of modern medical research. The aim of the study was theoretical substantiation of the essential features of the mechanisms of occurrence, development and clinical manifestations of the first signs of rosacea in women of reproductive age. The use of a systematic analytical methodical approach to assess the data of clinical and laboratory examinations of women with rosacea, conducted in different regions of the world, allowed to establish the originality of such manifestations of dermatosis as the appearance of unexpected rushes to limited areas of the face, accompanied by local redness and local heat areas of the skin differring significantly from similar rushes in other diseases or syndromes (menopause, migraine, etc.). It is established that the peculiarity of the relationship of these clinical characteristics (from English: rush, ruddy, redness, rosacea, reproductive age of women, reaction) allows to indicate the first signs of dermatosis as a phenomenon inherent in this disease Rush-Ruddy-Rosacea-Reproduce-Reaction (abbreviated – «5-R»), the key pathophysiological target of which (as well as the disease as a whole) is a disorder of a set of hierarchically dependent mechanisms of the evolutionarily determined motivational need to ensure reproductive function in women (both at the cellular level and extracellular structures of the ovaries, and at different levels of subcortical formations and centers of the cortex of the cerebral hemispheres). The phenomenon of rosacea rush is closely related to other phenomena of this dermatosis – hypersensitivity of bradykinin receptors, actinic elastosis, development of post erythematous telangiectasia. The prospect of further research on the problem of rosacea is to study the relationship of disorders in the functional systems of molecules of signaling compounds of different classes (hormones, eicosanoids, neuropeptides, kinins, cytokines and others) in the pathogenesis of the disease.

Currently acne and post-acne are serious psychosocial problems. The methods of improving the rehabilitation of patients with acne and post-acne during the use of low doses of retinoids are of great interest. Dermal optical thermolysis (DOT) based on carbon laser has a positive effect on the remodeling of atrophic and hypertrophic skin scars in this pathology.Objective — to evaluate the effectiveness of the use of DOT with a moderate energy load on the tissue (13—15 W/sm2) during the recovery period of acne and post-acne, on the background of low-dose retinoid therapy (Roaccutane 0.15—0.2 mg/kg).Materials and methods. The study included 130 patients with symptoms of acne and postacne, which were divided into two groups: main (n = 80) and control (n = 50). The patients of the main group were given DOT therapy together with low doses of isotretinoin. The patients of the control group received DOT therapy in 3 months after the end of the treatment with retinoids. The results of treatment were evaluated in 30, 90 and 180 days after the end of treatment.Results and discussion. 180 days after the end of therapy, the total number of acne exacerbations in the main group was 3.8 %, in the control group — 6.1 %, excessive sebum secretion was observed in 14.6 % of patients of the main group and 19.3 % of the control group. In patients of both groups, there was a regression of cicatricial changes, however, a more pronounced effect was observed in the main group. The general improvement of dermatological index of quality of life in patients of the main group was 71.1 %, in patients of the control group — 52.6 %.Conclusions. The use of DOT in combination with Roaccutane (in doses of < 0.15—0.2 mg/kg) in the early stages of the formation of atrophic and hypertrophic scars has a positive effect on skin remodeling during post-acne period and improves the dermatological index of quality of life.

Jessner—Kanof lymphocytic infiltration refers to T-cell pseudolymphomas — reactive dermatoses that occur in response to exogenous and endogenous influences and are characterized by histological and clinical similarities with malignant lymphomas, from which they are distinguished by a benign course. It was first described in 1953 by M. Jessner and B. Kanof. The disease is characterized by dense T-lymphocytic muft-like perivascular infiltration of the dermis with a predominance of small mature polyclonal lymphocytes without epidermal involvement and usually appears as erythematous papules or plaques on the face, neck and back. The etiology of Jessner—Kanof lymphocytic infiltration remains poorly understood. The disease proceeds with periods of exacerbations and remissions. The provoking factors (most often) are chronic diseases of the digestive tract (chronic gastritis, colitis, cholecystitis, peptic ulcer of the stomach and duodenum, etc.), less commonly — medication, immunotherapy, insolation. Differential diagnosis of Jessner—Kanof lymphocytic infiltration is carried out with discoid lupus erythematosus, lymphocytoma, malignant lymphoma of the skin, sarcoidosis, toxicoderma. Diagnostic difficulties of this disease are caused by a variety of its clinical manifestations.A case of Jessner—Kanof lymphocytic infiltration in the face region of an eighteen-year-old girl is described. Previously, the disease was diagnosed as perioral dermatitis, acne cystic, lupus erythematosus. Histochemical examination revealed pronounced lymphocytic infiltration with a predominance of CD4 (clone 4B12) and CD8 (clone C8/144B) cells, which is typical of T-cell pseudolymphs. After the treatment (triamcinolone, hydroxychloroquine, calcineurin inhibitors, narrow­band phototherapy), a lasting positive therapeutic effect (for more than eight months) was achieved.

The objective: the analysis of the effectiveness of treatment of resistant forms of urogenital chlamydia in using a combination of antibiotic therapy with an inducer of endogenous interferon Overseen.Materials and methods. 38 men with urogenital chlamydiosis, in combination with chronic prostatitis, were examined. Patients were divided into groups. The main group included 20 patients, in the comparison group – 18 patients, in the control group – 20 practically healthy men. All patients before and after treatment were monitored for clinical, biochemical, immunological parameters of blood. The main group (20 patients) received antibacterial therapy in combination with Overin (250 mg IM once a day, every other day, only 10 injections). Patients in the comparator group received standard doxycycline therapy of 200–400 mg per day for 14 days.Results. After the treatment of urogenital chlamydia, the immune parameters of the blood improved to a greater extent in patients receiving an endogenous interferon inducer. Control of cure of patients who participated in the study was performed 30 and 60 days after the completion of etiotropic therapy. In patients of the main group who additionally received Overin, elimination of the pathogen was achieved in 95% of cases, in the comparison group this indicator was 88.8%. 30 days after the treatment, only 2 (10%) patients in the main group maintained dysuric syndrome, while in the group comparing the increase in urination was noted in 6 (33.3%) patients. Chronic pain in the pelvic organs after treatment was maintained in 1 (5%) of the patients in the primary group and in 3 (16.6%) patients in the comparison group.Conclusion. The use of Overin in combination with antibacterial agents increases the effectiveness of the treatment of resistant forms of urogenital chlamydia and accelerates the regression of dysuric phenomena and pain in pelvic organs associated with chronic prostatitis. Overin is well tolerated by patients and does not have clinically significant side effects.

У статті представлений погляд на питання формування мотивації до навчання та необхідність створення лікарського мислення – як кінцеве завдання вивчення клінічної дисципліни.