Background: Pemphigus vulgaris is an autoimmune bullous dermatosis for which high-dose glucocorticoid (GC) therapy is the first-line treatment. However, the use of supraphysiological GC doses may lead to the development of hypercortisolism symptoms. Aim: To investigate the somatic and metabolic disorders induced by supraphysiological doses of systemic GCs (prednisolone) in patients with pemphigus vulgaris in order to optimize their management. Methods: A single-center, observational, two-sample, retrospective, comparative, non-interventional study was performed. The main group consisted of patients with pemphigus vulgaris who received supraphysiological doses of prednisolone for 6 months (initial dose 60–120 mg/day; at 6 months, 20–25 mg/day; cumulative prednisolone dose ranged from 6300 to 13200 mg, median 9900 mg). The comparison group included patients with Cushing’s disease or corticosteroma. Anthropometric parameters, clinical manifestations (18 major symptoms of hypercortisolism), and laboratory/instrumental findings were assessed. Results: A total of 25 patients (median age 51 [43; 60] years) with pemphigus vulgaris, 49 patients (median age 39 [32; 45] years) with Cushing’s disease, and 41 patients (median age 43 [34; 51] years) with corticosteroma were examined. The main symptoms observed in pemphigus vulgaris patients after 6 months of high-dose prednisolone therapy were weight gain (20/25, 80%), muscle weakness (17/25, 68%), matronism (12/25, 48%), and central redistribution of subcutaneous fat (11/25, 44%). In pemphigus vulgaris patients, the frequency of such clinical manifestations as weight gain, striae, muscle weakness, increased appetite, irritability / tearfulness, insomnia, and memory impairment did not differ significantly from that in endogenous hypercortisolism, whereas the frequency of abdominal fat redistribution, hair loss, back pain, and decreased libido was similar only to the corticosteroma group. In pemphigus vulgaris patients after 6 months of prednisolone, the frequency of arterial hypertension increased from 3 (12%) to 9 (36%) cases (p = 0.031 compared with baseline); glucose metabolism disorders were newly diagnosed in 8 (32%) patients (p = 0.008), and hypokalemia also in 8 (32%) patients (p = 0.008). Waist and hip circumferences, total cholesterol, triglycerides, and potassium levels did not differ between pemphigus vulgaris patients and those with endogenous hypercortisolism. The cumulative prednisolone dose in pemphigus vulgaris patients correlated positively and significantly with the frequency of muscle weakness (r = 0.460, p = 0.020) and hypertriglyceridemia (r = 0.587, p = 0.003). Conclusion: The clinical and biochemical changes that developed in pemphigus vulgaris patients on GC therapy were more similar to the abnormalities observed in corticosteroma than to those in Cushing’s disease. In pemphigus vulgaris patients before starting prednisolone, it is advisable to assess body mass index and blood pressure, measure waist and hip circumferences, and perform measurements of total cholesterol, triglycerides, potassium, and glucose during an oral glucose tolerance test. During GC therapy, consideration may be given to the following: additional potassium supplementation at 1 g/day and the elimination of simple carbohydrates from the diet; regular monitoring of body mass index, waist and hip circumferences, blood pressure, and self-monitoring of postprandial (2-hour) glycemia; monthly laboratory measurement of serum potassium; and, if postprandial glycemia is elevated, a repeated oral glucose tolerance test.

A combination of vulgar pemphigus and toxic epidermal necrolysis is an extremely rare and clinically complex comorbidity characterized by divergent immune mechanisms of skin damage. We present a case report of a 33-year old patient with rapidly progressive bullous and erosive skin lesions. Immunofluorescence studies showed IgG and the C3 complement component deposits in the intercellular epidermal contacts; the diagnosis of vulgar pemphigus was confirmed. The Pemphigus Disease Area Index (PDAI) at the moment of maximal clinical symptoms was 78. Just before the hospitalization, the patient had been treated with antibiotics. Pathomorphological examination showed virtually total intra-epidermal detachment of the epidermis, in addition to IgG and C3 complement component deposits found by direct immunofluorescence. These findings, combined with clinical manifestations characteristic of toxic epidermal necrolysis, allowed to suspect two diseases. For 9 weeks, the patient was treated with high dose systemic glucocorticosteroids and plasmapheresis, which led to stabilization of the disease. At week 9 from the day of hospitalization, there was a dramatic deterioration in the patient’s condition. At week 10 of the hospitalization, rituximab was added to high dose systemic glucocorticosteroids resulting in clinical improvement at week 13. By week 24 after the treatment initiation, a significant clinical result was achieved, seen as complete epithelialization of the erosions and stable remission of the skin disease. The treatment strategy chosen has led to simultaneous exhaustion of B cell pool responsible for production of pathogenic auto-antibodies in pemphigus and to significant suppression of cell immunity, which plays a key role in toxic epidermal necrolysis. Toxic epidermal necrolysis should be excluded in patients with pemphigus, especially with atypical rapidly progressive course and medication-associated. Immunofluorescence methods play a decisive role in the diagnosis of these comorbid disorders. Combination therapy with rituximab and corticosteroids can be considered as a strategy targeting the pathogenic pathways of both diseases. This case report highlights the need for a thorough diagnostic analysis and the development of clear management algorithms for such complex cases.

Background: The SARS-CoV-2 pandemic can be considered a multifactorial event involving both the direct impact of the virus on the human body and a complex impact (through social, psychological, occupational, and behavioral changes) on the pathomorphosis of many diseases, including skin disorders. The analysis of the incidence, severity, and effectiveness of standard treatments for dermatoses in the new environmental model could be of value for the understanding of the mechanisms of skin disorders, improvement of the approaches to their treatment, development of rehabilitation and preventive tools. Aim: To asses an impact of the new coronavirus infection (SARS-CoV-2) on the severity and progression of non‐communicable inflammatory skin diseases depending on their immune response pattern. Methods: Adult patients with moderate to severe non‐communicable inflammatory skin diseases hospitalized to the Department of Dermatology of a multidisciplinary hospital from March 30, 2020, to March 15, 2023 were included into the study. All patients had SARS-CoV-2 infection in their history confirmed by polymerase chain reaction for SARS-CoV-2 RNA or computed tomography of the lungs. We retrospectively analyzed changes in clinical parameters on the Investigator's Global Assessment (IGA) scale and the number of exacerbations (mean value of each parameter over the year before SARS-CoV-2 infection and after its convalescent period). Also, the changes over time of the Dermatology Life Quality Index (DLQI) before and after SARS-CoV-2 infection were assessed. The patients were divided into the groups based on the dominant immune response pattern: lichenoid (group 1), eczematous (group 2), bullous (group 3), psoriatic (group 4), fibrogenic (group 5), granulomatous (group 6). Results: A total of 845 patients (518 (61,4%) women) aged 19 to 76 years (mean age, 53.8 ± 17.7 years) with the verified diagnosis of non‐communicable inflammatory skin disease and past history of SARS-CoV-2 infection participated in the study. Mean duration of the skin disease was 119.5 ± 103.1 months. Group 1 was represented by 59 patients with lichen ruber planus, discoid lupus erythematoides, and large plaque parapsoriasis; group 2, by 181 patients with atopic dermatitis, chronic eczema, and prurigo; group 3, by 41 patients with pemphigus vulgaris and bullous pemphigoid; group 4, by 366 patients with pustulous psoriasis, psoriasis and small plaque parapsoriasis; group 5, by 177 patients with localized sclerodermia, and group 6, by 21 patients with annular granuloma and rosacea. In all groups, there was a significant increase in the IGA, DLQI and the number of exacerbations of the non‐communicable inflammatory skin disease after SARS-CoV-2 infection. The assessment of the effectiveness of previously used treatment regimens and methods for the non‐communicable inflammatory skin disease showed the necessity to modify the therapeutic protocols in more than 45% of the cases in each group. Conclusion: The SARS-CoV-2 pandemic has contributed to significant worsening of the course of non‐communicable inflammatory skin diseases and deterioration of the patients’ quality of life, regardless of the immunopathogenesis of the dermatoses.

The article substantiates an approach to evaluate the minimal erythema dose (MED) in dermatology without test exposure. Arguments are given in support of using a number of optical noninvasive diagnostic methods for this purpose. A photosensitivity of human skin to ultraviolet radiation in the 305–315 nm waveband is determined by skin optical properties, morphological parameters of the skin and vessels' reactivity in the skin. These quantities can be measured before a treatment, so the evaluation of individual MED is not impossible.

Pemphigus presents a group of chronic autoimmune bullous skin disorders with well-known clinical signs, which pathophysiology is mediated by antibodies to various epidermal self-antigens. For a long time, the only therapeutic option for this disease was the lifelong use of non-selective immunosuppressive agents limited by high rate of severe adverse reactions. The article presents two clinical cases of rituximab use (a targeted agent leading to B-cell depletion) in patients with pemphigus (vulgaris and foliaceous) who were previously resistant to high-dose steroid therapy. Treatment with rituximab lead to response and allowed to decrease the prednisone dose in both cases. These results confirm that rituximab can be successfully used in pemphigus as adjuvant therapy if conventional agents for this dermatosis are ineffective.

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.

According to modern ideas, a reasonable choice of an effective method of treating plaque scleroderma is based on the diagnosis of the pathological process prevailing in the tissues (inflammation-sclerosis). Therefore, an urgent problem of a personalized approach to dermatosis therapy is the possibility of an objective assessment of the prevailing process using non-invasive diagnostic methods. The article presents a clinical case of widespread plaque scleroderma in a 66-year-old patient, demonstrating the possibility of using laser fluorescence spectroscopy and laser Doppler flowmetry to determine the degree of activity of the focus and determine the leading pathological process. We selected three pathological skin foci localized in the abdomen and characterizing three clinical stages of the disease (inflammation, induration, sclerosis). The analysis of fluorescence and laser Doppler flowmetry data showed that in areas clinically defined as inflammation, there is an increase in the average values of the indices of tissue content of porphyrins, lipofuscin and microcirculation index compared with intact skin, while the intensity of collagen fluorescence does not differ significantly. In the induration zone, along with an increase in the fluorescence indices of lipofuscin and porphyrins, there is an increase in the average values of collagen fluorescence indices at effective registration waves. The data obtained by us indicate an active inflammatory process in these foci and the process of fibrosis in the induration zone. In the sclerosis zone, there is an increase in the average values of collagen fluorescence indices compared with intact skin, and the fluorescence of optical markers of inflammation (lipofuscin and porphyrins) do not differ significantly in comparison with the control intact skin. When analyzing the fluorescence spectra and laser Doppler flowmetry data after treatment, we found that in the zones of induration and inflammation, the average values of the fluorescence indices of porphyrins, lipofuscin, collagen and microcirculation index are reduced relative to the initial values (before treatment), but remain higher in comparison with intact skin. The data obtained may indicate that active inflammation in these foci persists at the time of the study. In the study of the focus of sclerosis, the obtained autofluorescence and microcirculation data in dynamics do not differ significantly from the initial values. The data for laser Doppler flowmetry and laser fluorescence spectroscopy are consistent with ultrasound examination of the skin. In our study, the potential possibility of using laser fluorescence spectroscopy and laser Doppler flowmetry methods to establish the degree of activity of the focus, determine the leading pathological process, as well as to evaluate the effectiveness of therapy was demonstrated for the first time.

Even in modern dermatology clinics, the determination of the severity of ultraviolet (UV)-induced erythema and assessment of individual photosensitivity based on the calculation of minimal erythema dose (MED) is still performed visually, which is subjective, and associated with high variability of the results and frequent errors when it done be untrained personnel. The application of non-invasive quantitaitve methods such as laser fluorescence spectroscopy (LFS) and optical tissue oximetry (OTO) could be a solution of these problems. In is well known that acute UV skin damage is associated with structural alterations, vasodilatation and inflammatory response. Moreover, porphyrins which have well-known autofluorescent properties play a role in the chemoattraction of immune cells to the area of local inflammation caused by UV. Using LFS in the preclinical part of the study on ICR mice (N = 25) time-dependent dynamic changes in the fluorescence parameters of porphyrins were found. Optical parameters were in a good agreement with histological findings. Statistically significant correlation was found between the severity of inflammatory infiltrate and the tissue content index (η) of porphyrins. During the clinical part of the study on healthy volunteers (n = 14) the analysis of endogenous fluorescence and microcirculation characteristics by LFS and OTO revealed the correlation relationship between the intensity of endogenous fluorescence of porphyrins and oxygen consumption with a dose of UV radiation. The correlation of the porphyrins fluorescence with a dose of UV was also demonstrated. Overall results have fundamental value and should be investigated and applied in clinical practice to objectively assess and predict MED.

Background: Palmar-plantar psoriasis is characterized by a torpid course and resistance to conventional systemic treatments. Phototherapy is usually considered as an adjuvant treatment of a patient with psoriasis. The potential use of phototherapy as a basic treatment strategy in limited psoriasis, including its plantar-palmar localization, could be of interest. Aim: To study the efficacy, safety and tolerability of the narrowband phototherapy (UVB 311 nm) in the treatment of different forms of psoriasis with predominant palmar-plantar involvement. Materials and methods: We retrospectively analyzed the results of treatment of 77 in-patients admitted to the Department of Dermatology for treatment of various types of psoriasis with prevailing palmar and plantar lesions. The main group consisted of 42 patients who were administered combination therapy including topical corticosteroids, hepatic protectors, antihistaminic agents and, in addition, the narrowband phototherapy with a phototherapy device Dermalight 500-1 (Dr. Hnle Medizintechnik GmbH, Germany). The initial radiation doses were set without the determination of the minimal erythema dose, depending on the patient's skin type, in accordance with the guidelines from the manufacturer. At each consecutive session, the dose was increased by 0.060.3 J/cm. The sessions were conducted 5 times a week with a total of 1421 sessions. The mean cumulative dose was 22.8 J/cm. The control group included 35 age-, gender- and psoriasis severity-matched patients who received the same treatments, except the narrowband phototherapy. The treatment efficacy was assessed by changes in the Palmoplantar Pustulosis Area and Severity Index (PPPASI). Clinical results of treatment were evaluated at day 10 after the treatment course had been completed. Results: No serious adverse events were registered during the treatment. In the patients with psoriasis vulgaris and predominant palmoplantar lesions, receiving the narrowband phototherapy, the PPPASI reduction was higher than in the patients who received only conventional treatment (U-test, p = 0.015). A PPPASI decrease of 50% was observed in 83.3% (25/30) and 60% (15/25) of the patients, respectively. Clinical efficacy criteria were achieved in 66.6% (8/12) of the patients with palmoplantar pustular psoriasis receiving the combination treatment with phototherapy and in 40% (4/10) of the conventionally treated patients in the control group; however, the difference in the distribution of remission achievement was non-significant (U-test, p = 0.123). Conclusion: The study has demonstrated the efficacy of UVB 311 nm narrowband phototherapy in the treatment of patients with psoriasis with predominant palmoplantar lesions. The results obtained make it possible to recommend the inclusion of the narrowband phototherapy UVB 311 nm at mean cumulative dose of 22.8 J/cm into the standardized set of treatments of patients with psoriasis vulgaris with predominant palmoplantar lesions, not only as an adjuvant technique, but also as the main therapeutic strategy. The role of the narrowband phototherapy UVB 311 nm in the treatment of palmoplantar pustular psoriasis, as well as the dosing regimens of the radiation and determination of the necessary follow-up duration should be the subject of further studies.

Peutz–Jeghers' syndrome is a rare hereditary disease inherited by an autosomal dominant type, manifested by a characteristic clinical picture of skin lesions and hamartomas of the gastrointestinal tract. Complications of the disease include bleeding from polyps, anemia, intussusception and intestinal necrosis, as well as a high likelihood of developing malignant tumors. For the first time the syndrome was described at the beginning of the last century, and it is of interest to dermatologists, gastroenterologists, oncologists and surgeons due to the clinical heterogeneity of intestinal and skin manifestations.The article describes a clinical case of a 5-year-old girl with the Peutz–Jaegers syndrome. The patient complained of periodic dull abdominal pain that worsened after eating solid food. During the examination of the skin and mucous membranes the doctors discovered rashes on the face: perioral area, on the red border of the lips and on the mucous membrane of the lips, inside the cheeks, hard palate. Esophagogastroduodenoscopy (EGDS) revealed a polyp on a pedicle in the prepyloric part – it was removed during repeated EGDS under endotracheal anesthesia. Fibrocolonoscopy revealed hyperpigmentation of the dome of the cecum. To confirm the diagnosis, the doctors carried out DNA testing which found a mutation of the STK11 gene.Pigmentation of the perioral area is an early symptom of Peutz–Jeghers' syndrome suggesting optimal examination. Early recognition of the syndrome in children is important in the context of reducing the risk of developing intestinal obstruction, bleeding, and cancer complications in the future.

The clinical picture of dermatological diseases in synergy with the pandemic of coronavirus infection demonstrates various, additional, more striking features of the course of dermatoses. The proposed case of observation illustrates the development of diffuse alopecia in a patient with torpid generalized pustular psoriasis, metabolic syndrome, endocrinopathy against the background of a coronavirus infection complicated by polysegmental pneumonia. In the presented clinical observation, the severity of the lesion of the skin and skin appendages correlated with the severity of the course of COVID-19, which was the trigger point of the general pathological process ― immune-mediated T-cell inflammation. In the manifestation of psoriasis and its exacerbation, a significant role was played by viral load and a pronounced comorbid background ― autoimmune thyroid disease and metabolic syndrome. Thus, the severe course of COVID-19 with involvement in the pathological process of the microcirculatory bed, coagulopathy, hypoxia of hair follicles as a result, as well as the reduced estrogenic background of the sixty-one-year-old patient contributed not only to the exacerbation of psoriasis, but also led to diffuse hair loss. The degree of hair loss according to SALT criteria was 82%, which corresponded to a severe degree of lesion. The use of prolonged-acting injectable corticosteroids in the complex treatment of various forms of alopecia was an effective method of therapy in this patient, which is associated with the immunosuppressive effect of corticosteroids in autoimmune damage to hair follicles, a decrease in inflammation of the microvascular bed in various infectious and inflammatory conditions. In the presented case, the high efficiency may also have been associated with the mechanisms of reducing the damaging effect of cytokine inflammatory factors, expressed both with the existing background disease psoriasis and with coronavirus complicated infection. As numerous observations show, COVID-19 is a potential trigger for many dermatological conditions. Examination and treatment of patients with skin pathology infected with COVID-19 requires a systematic integrated approach.

АКТУАЛЬНОСТЬ Клаудин-1 — белок, являющихся составной частью плотных контактов клеток эпидермиса. До конца его роль в процессе канцерогенеза не ясна. В клетках колоректального рака и рака молочной железы отмечены появление патологической экспрессии клаудина-1 или ее полная утрата, что ассоциируется с высоким риском рецидивирования. Появление четкой экспрессии в клетках инвазивного фронта рака шейки матки коррелировало с появлением регионарных метастазов. Снижение экспрессии клаудина-1 наблюдали в плоскоклеточном раке кожи и актиническом кератозе по сравнению с нормальной кожей, полное исчезновение экспрессии наблюдали в плоскоклеточном раке слизистой оболочки полости рта по сравнению с лейкоплакией. Роль клаудина-1 в процессе роста доброкачественных и злокачественных опухолей кожи до конца не ясна. ЦЕЛЬ ИССЛЕДОВАНИЯ Изучение экспрессии клаудина-1 в клетках эпителиальных опухолей кожи. МАТЕРИАЛ И МЕТОДЫ Иммуногистохимическое исследование по стандартному протоколу с антителами к клаудину-1 биопсийного материала 51 эпителиальной опухоли кожи. РЕЗУЛЬТАТЫ Половина клеток плоскоклеточного и базально-клеточного рака кожи аномально экспрессировала клаудин-1: при первом достоверно чаще встречалось отсутствие иммунореактивности, при втором — экспрессия в цитоплазме; в клеточных комплексах наблюдалось хаотичное распределение клеток с различным типом иммунореактивности. В клетках актинического кератоза, себорейного кератоза, интернирующего фолликулярного кератоза статистически значимо преобладала мембранная экспрессия клаудина-1, отмечалась зональность распределения иммунореактивности, аналогичная нормальному эпидермису. ЗАКЛЮЧЕНИЕ В клетках злокачественных эпителиальных опухолей кожи преобладала патологическая экспрессия клаудина-1: экспрессия в цитоплазаме при базально-клеточном и отсутствие иммунореактивности при плоскоклеточном раке. В клетках АК, СК и ИФК отмечалась преимущественно мембранная экспрессия клаудина-1 и четкая зональность распределения клеток, экспрессирующих маркер.

A chimeric recombinant protein PSH was composed of two antioxidant enzymes, human peroxiredoxin 6 (Prx6) and superoxide dismutase (MnSOD) from Escherichia coll. Analysis of physico-chemical properties of PSH protein confirmed its high antioxidant activity. PSH was shown to protect animals from lethal and sub-lethal doses of ionizing radiation. PSH was most effective after intravenous administration short time before ionizing irradiation. Dose reduction factor for PSH comprised 1.33. PSH was effectively alleviating the degree of radiation-induced leucopenia and thrombocytopenia in animals. Beside that, PSH administration decreased DNA damage in red bone marrow cells. The chimeric recombinant PSH can be considered as an effective radioprotector for minimizing the risks of damage of animal's body by ionizing radiation, and it could be a promising therapeutic molecule for prevention/suppression of pathological conditions accompanied or caused by oxidative stress.

Acute ultraviolet (UV) -induced skin damage is associated with structural alterations, vasodilatation and inflammatory response. Leukocyte infiltration is one of the main features of inflammation and could be found in the area of UV injury. It was shown that porphyrins which have well-known autofluorescent properties play a role in the chemoattraction of immune cells to the area of local damage. This study examined the possibility of application of laser fluorescence spectroscopy (LFS) in the assessment of ultraviolet-induced immune response in ICR mice. Animals (N=25) were exposed by UVB light and LFS was conducted on the dorsal skin of each mice 0, 0.5, 3, 6 and 24 hours after UV irradiation. Moreover, in every time point we performed skin biopsy and histology. Using LFS, time-dependent dynamic changes in the fluorescence parameters of porphyrins were found. Mentioned indices were in a good agreement with histological findings. Statistically significant correlation was found between the severity of inflammatory infiltrate and the tissue content index (η) of porphyrins (Pearson correlation coefficient: r = 0.912, p = 0.031). Achieved results not only have fundamental value but could be further investigated and applied in clinical practice: e.g. to objectively predict individual immunologic reaction to UV-light.

INTRODUCTION:Laser fluorescence spectroscopy (LFS) is a potential tool for diagnosing pathological skin processes such as fibrosis, hypoxia, and inflammation. This article describes the results of the non-invasive assessment of skin autofluorescence for animals of different ages.METHODS:The study was performed on outbred white male mice (n = 14). Fluorescence spectra were measured using the multifunctional device LAKK-M (SPE Lazma, Moscow, Russia), which implements LFS in vivo. The method is to record the fluorescence spectrum of a tissue after laser irradiation at a wavelength of λe excites its fluorescence. The wavelength λe is selected corresponding to specific fluorophore properties. To excite the fluorescence, the wavelength λe = 535 nm was used, which made it possible to estimate the fluorescence intensity of the lipofuscin.RESULTS:Increased autofluorescence of lipofuscin in the green waveband was detected in animals in the older age group compared to the younger group using LFS. It is important to note that the autofluorescence spectra of lipofuscin are in superposition with the spectra of other fluorophores and that the autofluorescence spectra of lipofuscin overlap the spectra of other fluorophores such as porphyrins. This may affect the interpretation of LFS data.CONCLUSIONS:Adjustment of animal age is necessary for the optical assessment of pathological processes using LFS.

Background: The COVID-19 pandemic is seriously affecting the society and economy of many countries, including the Russian Federation. Identifying of the major risk factors for an unfavorable outcome could help save lives and reduce the disease burden. Until now, no results of the studies on this issue based on the Russian clinical material have been published. Aim: To evaluate the effects of comorbidities on the outcome (discharge or hospital death rates) in patients hospitalized with a diagnosis of COVID-19. Materials and methods : We analyzed a database of 13,585 patients who were treated in 66 hospitals functioning under the obligatory health insurance system of the Moscow Region, with a final diagnosis of COVID-19, virus identified (ICD 10 code U07.1) from April 1, 2020 to June 23, 2020 (53.7% women, 46.3% men, mean (± SD) age 56.5 ± 14.9 years (median 57 [46; 67])). In all patients, the diagnosis of COVID-19 was confirmed by polymerase chain reaction (PCR) for the SARS-CoV-2 virus in nasopharyngeal or oropharyngeal swabs. 93.8% of the patients showed signs of interstitial viral pneumonia (87.9% confirmed by computed tomography of the lungs, 5.9% by standard chest X-ray). All patients received the standard treatment according to the Temporary Guidelines on prevention, diagnosis and treatment of the new coronavirus infection (COVID-19), version 7 (03.06.2020)” from the Ministry of Health of the Russian Federation. 1518 (11.2%) patients had at least one comorbid condition, the most frequent being arterial hypertension (AH), ischemic heart disease (IHD), and diabetes mellitus (DM). In 71 female patients, COVID-19 occurred during pregnancy. By June 23, 2020, 10761 (79.2%) patients have been discharged from hospitals with recovery, improvement, or stabilization (the latter was considered a conditionally favorable outcome). 1246 patients died, that transfers into the in-hospital death rates of about 9.2% (unfavorable outcome). The rest of 1578 (11.6%) patients continued their treatment, or were transferred to other medical units for the continuation of care. The comparative analysis included patients (total, n = 12,007) with favorable (n = 10,761) and unfavorable (n = 1246) inpatient outcomes. The age-adjusted Charlson index was used to quantify the severity of comorbidity. Results: In the patients without any comorbidity, the in-hospital death rate was 9.4%. At least one comorbidity increased the incidence of unfavorable outcome to 13.9% (p 3 was associated with a more than 2-fold increase in the in-hospital death rates (25.2%, p < 0.001). Conclusion: Comorbidity is one of the drivers in the prognosis of in-hospital death rates in patients with COVID-19. However, it should be considered in the context of the patient age-related characteristics. The Charlson Age-Adjusted Comorbidity Index is a useful tool for assessment of the COVID-19 prognosis. The prognosis should be considered serious at a score of 3 or more.

Currently, in clinical practice, the assessment of ultraviolet (UV) -induced erythema and the determination of the minimal erythema dose (MED) is done visually, which is subjective, inaccurate and associated with high variability of the results. To solve this problem, the application of optical methods seems promising, allowing us to evaluate changes in epidermis and dermis induced by UV exposure. In this study the analysis of endogenous fluorescence and microcirculation characteristics by non-invasive optical methods revealed the relationship between the intensity of endogenous fluorescence of porphyrins and oxygen consumption with a dose of UV radiation. The correlation of the intensity of endogenous fluorescence of the irradiated region normalized to intact tissue with a dose of UV was demonstrated. Therefore, optical diagnostic methods can be a promising tool for non-invasive and quantitative assessment of UV erythema and MED.

Minimal erythema dose (MED) is the amount of ultraviolet (UV) radiation needed to induce a mild skin erythema reaction after 24 hours following exposure. Determination of MED is based on the assessment of UV-erythema and traditionally performed visually by naked eye, which is subjective and connected with errors due to high intrarater and interrater variability. The application of non-invasive and quantitative techniques such as optical methods could improve MED calculation, allowing us to detect and quantify alterations in epidermis and dermis induced by UV irradiation. In the current study the analysis of microcirculation parameters by non-invasive optical methods revealed the relationship between the oxygen consumption and a dose of UV radiation. Results also showed the correlation of oxygen consumption of UV-exposed tissues normalized to intact skin with a dose of UV. Moreover, we described tendencies in dynamics of porphyrin fluorescence intensity at different time points after UV-exposure. Optical methods have some prospects in non-invasive and predictive evaluation of UV erythema and MED and more research should be conducted in this field.

The effects of composite fibroin-gelatin microparticles (100-250 μ) on the rate of wound healing and regeneration under conditions of contraction prevention were studied on the model of splinted full-thickness skin wound in a mouse. Subcutaneous injection of these particles into the defect area accelerated wound healing and promoted re-epithelialization and recovery of normal structure of the epidermis. In addition, the composite microparticles promoted the formation of connective tissue of characteristic structure, replacing the derma over the entire defect, and stimulated regeneration of subcutaneous muscle (panniculus carnosus) and skin appendages (sebaceous glands and hair follicles).