Generalized eruptive keratoacanthomas of Grzybowski (case report)

В статье представлен краткий обзор литературы о клинических проявлениях, современных методах диагностики и лечения чрезвычайно редкого заболевания – множественной эруптивной кератоакантомы типа Гржебовски. Заболевание характеризуется возникновением сотен или тысяч генерализованных зудящих узелков на коже лица, туловища, конечностей, половых органов, слизистой полости рта и гортани в течение короткого времени. Заболевание развивается в возрасте старше 40 лет, имеет рецидивирующее течение, возможна спонтанная инволюция отдельных элементов с формированием участков депигментации или атрофических рубцов. Авторы приводят случай собственного клинического наблюдения множественной эруптивной кератоакантомы типа Гржебовски у пациента 50 лет, который обратился на консультацию к дерматовенерологу в клинику Уральского НИИ дерматовенерологии и иммунопатологии. Длительность болезни на момент обращения составляла 2,5 года, ее возникновению предшествовало неоднократное посещение больным стран с избыточной инсоляцией, что может рассматриваться в качестве этиологического фактора развития заболевания. Диагноз впервые был заподозрен на консилиуме дерматовенерологов на основании клинической картины заболевания и в дальнейшем верифицирован данными патоморфологического исследования биоптата пораженной кожи. Показана эффективность применения ароматических ретиноидов в лечении множественной эруптивной кератоакантомы типа Гржебовски и приведены побочные эффекты, которые развились у больного при самостоятельном увеличении дозы ацитретина до 70 мг/сутки. В статье констатируется чрезвычайно редкая встречаемость данного заболевания, о чем свидетельствует приведенный клинический случай, диагностируемый впервые более чем за 90-летнюю историю существования института. Подчеркивается важность консолидации клинического опыта нескольких ведущих дерматовенерологов для диагностики множественной эруптивной кератоакантомы типа Гржебовски. The article presents a brief review of the literature about clinical manifestations, modern methods of diagnosticsand treatment of an extremely rare disease – generalized eruptive keratoacanthomas of Grzybowski. The disease is characterized by the appearance of hundreds or thousands of generalized itchy nodules on the skin of the face, trunk, limbs, genitals, oral mucosa and larynx within a short time. The disease develops at the age of over 40, has a recurrent course, spontaneous involution of individual elements with the formation of areas of depigmentation or atrophic scars is possible. The authors describe a case of their own clinical care of generalized eruptive keratoacanthomas of Grzybowski in a 50-year-old patient who consulted a dermatovenerologist at the clinic of the Ural Research Institute of Dermatovenerology and Immunopathology.The duration of the disease at the time of visit to a doctor was 2,5 years, its occurrence was preceded by repeated visits to countries with excessive insolation, which can be considered as an etiological factor in the development of the disease. The diagnosis was first suspected at a boarddermatovenerologists based on the clinical picture of the disease and subsequently verified by the data of a pathomorphological examination of the biopsy of the affected skin.The effectiveness of the use of aromatic retinoids in the treatment of generalized eruptive keratoacanthomas of Grzybowski is shown and the side effects that developed in the patient with an independent increase in the dose of acitretin to 70 mg/day are given. The article states the extremely rare occurrence of this disease, as evidenced by the above clinical case, diagnosed for the first time in more than 90 years of the institute's existence. The importance of consolidating the clinical experience of several leading dermatovenerologists for the diagnostics of generalized eruptive keratoacanthomas of Grzybowski is emphasized.

Linear perioral spontaneous atrophic scars (atrophia maculosa varioliformis cutis) giving purse string appearance in a 36 year female

Spontaneous atrophic scarring of face is characterized by an idiopathic, non-inflammatory macular atrophy that typically occurs on the face. It usually occurs spontaneously over the face of children or young adults. The shallow atrophic scars have sharp margins and may be linear, rectangular or varioliform. Inheritance is usually autosomal dominant. The condition seems common, however less reported in literature. We are reporting a case of superficial linear, bilateral atrophoderma over face (perioral region) in a 36 years female, giving a purse string appearance.

Efficacy of autologous plasma microneedling with cells in patients with post-acne atrophic scars

Objective: to studythe effectiveness of autologous plasma-cell microneedling in patients with different phenotypes of post-acne atrophic scars. Group 1A (n = 32) included patients with post – acne atrophic scars: ice pick – 12 patients; boxcar – 11; rolling – 9 patients. Group 1B consisted of 34 patients with scars ice pick – 12; boxcar – 12; rolling – 10 patients. In group 1A, patients underwent a microneedling procedure. In group 1B, microneedling was performed with autologous plasma with cells. To evaluate the effectiveness of the therapy methods, we used the IGA (Investigators Global Assessment) scale modified for post-acne scars, adapted for post-acne scars by the Assessment of the Psychological and Social Effects of Acne (APSEA). Special methods included ultrasound examination using an ultrasound scanner IU 22. The end result for different post-acne scar phenotypes showed the advantages of the developed complex for boxcar and rolling AR and slightly lower for ice pick. The recommended course of therapy is three procedures performed once in 4 weeks.

Laser technologies in the correction of post-traumatic atrophic scars

The multifactorial genesis of collagen synthesis disorders in atrophic scars suggests the need to develop combined methods of scar tissue remodeling. Objective: to determine the therapeutic effects of various combinations of high-intensity laser therapy (HILT) in patients with traumatic atrophic scars. Methods: 34 patients were studied in two groups with developing (N = 15) and mature (N = 19) skin scars. Homogeneous photothermolysis (λ = 1,064 microns) followed by fractional photothermolysis by laser radiation (λ = 10,6 microns) was used in patients with developing scars, and homogeneous photothermolysis (λ = 1,064 microns) and planar ablative laser photodestruction (λ = 10.6 microns) of scars were applied in patients with mature scars. Dermatoscopic methods were used to assess the functional properties of the skin, morphometric analysis of scars, assessment of the quality of life and integral effectiveness of HILT in patients. Results: An improvement in the functional properties of atrophic scars was found mainly due to smoothing the borders with the surrounding skin, restoring the thickness of the epidermis by reducing the thickness of all layers, especially the spiny layer with an increase in the volume of keratinocytes of the granular layer. As a result of the course of treatment, an improvement in the quality of life indicators on the DQLI scale was revealed. The effectiveness of HILT in patients with developing scars was 81 %, with mature — 75 %. Conclusion: A comparative analysis of the dynamics of the state of developing and mature scars under the influence of various protocols of high-intensity laser therapy will allow individualizing their use in the schemes of atrophic scars correction.

Apparatus methods in complex treatment of patients with atrophic scars

Atrophic scars are a common pathology that can have a negative impact on the patient’s quality of life. Methods for correcting atrophic scars include chemical peels, dermabrasion, ablative or non-ablative laser resurfacing, filler insertion, and surgical techniques. Depending on the type and severity of the scar, an individual approach is required to obtain satisfactory results. Material and methods. The study included 32 patients with atrophic scars. Depending on the therapy, the patients were divided into two groups in which they received microneedle radiofrequency therapy or fractional photothermolysis. The effectiveness of the methods of therapy was assessed using laser doppler fluometry and ultrasound scanning. Research results. The RF microneedle method and fractional photothermolysis have a positive effect on the epidermal-dermal structure of the skin, which is expressed in the approximation of the acoustic density and thickness of the epidermis and dermis to normal values, and also improve microcirculation. When analyzing the results of correction of atrophic scars, more pronounced positive dynamics was observed after the application of RF microneedles.