Physiological functions of keratinocyte epidermal growth factor receptors and their role in the development of skin toxicity during targeted cancer therapy

The binding of epidermal growth factor (EGFR) receptors is a good target for the treatment of lung, colon, pancreatic, head and neck cancers. The adverse events that develop as a result of therapy, in the form of lesions of the skin and mucous membranes, is a serious problem for the doctor to choose a long-term treatment strategy. The developing symptoms of skin toxicity, as skin problems in patients are often called, are worrisome and often affect the quality of life and compliance with the treatment regimen. Thus, it is important for doctors to know the prerequisites and ways to manage skin toxicity associated with the use of tyrosine kinase receptor inhibitors of epidermal growth factor. The mechanism and consequences of EGF receptor activation are described to explain the development of undesirable skin toxicity associated with inhibition of the epidermal growth factor receptor.

What do we know about osteoma cutis? Literature review. Clinical cases

This article summarises the data of epidemiology, etipathogenesis, a clinical picture, diagnosis and the treatment of osteoma cutis. The classification, a histological picture, the place of osteoma cutis from the point of view of the phenotype in relation to the information of the world literature are presented. Osteoma cutis is a rare benign disease characterised by the formation of the bone tissue in the dermis or subcutaneous fat. Two theories of the origin of osteoma cutis are of particular interest: the result of fibroblast metaplasia into osteoblasts or the differentiation of primitive mesenchymal cells into osteoblasts and their migration to an ectopic site. Diagnosis and differential diagnosis are based on the clinical examination, measurement of calcium, parathyroid hormone, x-ray and skin biopsy. The differential diagnosis involves many dermatoses, including ossified hair follicle, osteosarcoma, epidermoid cysts, fibromas, neurofibromas, basal cell carcinoma, etc. The approach to the treatment is to use non-invasive or invasive methods: tretinoin cream, dermabrasion and punch biopsy, YAG laser, scalpel excision, curettage and CO2 laser. We consider skin osteoma to be an underestimated dermatosis, since we have not found descriptions of such cases in reviews in the available Russian literature.

Systemic therapy of onychomycosis of the feet with terbinafine: dynamics of nail rehabilitation and quality of life

BACKGROUND: Systemic therapy with terbinafine (Exifin) forms the basis of any treatment programs for onychomycosis of the feet of dermatomycete etiology. At the same time, the available literature presents relatively little data on the efficacy and safety of systemic terbinafine drugs for individual age groups; and there are practically no such studies based on a large statistical sample with a simultaneous assessment of the dynamics of the quality of life indicator. AIMS: To study the use of the drug Exifin tablets in certain age groups of patients with mycosis and onychomycosis in clinical practice. MATERIALS AND METHODS: The study was a multicenter observational (non-interventional) study involving 1602 patients with varying degrees of severity of onychomycosis of the feet/hands. The patients were divided into 4 age groups, each of which was divided into subgroups according to the severity of onychomycosis, from very mild to extremely severe. The positive dynamics of regression of symptoms, improvement of the quality of life according to the survey scale, the presence or absence of significant adverse reactions were evaluated. RESULTS: In all 1602 patients, positive dynamics from the skin process was obtained in the form of regression of onychomycosis symptoms. The best results on the speed of nail sanitization were obtained in more young age groups with a mild degree of onychomycosis. The lowest rate of regrowth of a healthy nail plate was observed in the age groups 4560 years and over 60 years. In the same age groups, the greatest number of persistent onychodystrophy remained after the eradication of the fungus. In all age groups, there was a positive trend in the quality of life: at the end of treatment, 67% of patients rated the quality of life as excellent and good, and another 24.1% ― satisfactory. No adverse events were recorded in any clinical case. CONCLUSION: Systemic therapy with terbinafine in onychomycosis of the feet/hands is a highly effective component in the combination treatment, allowing to achieve eradication of the fungus in 8590% of cases.

Evaluation of the effectiveness and safety of photodynamic skin therapy

BACKGROUND: Photodynamic therapy is an innovative technique for non-invasive skin rejuvenation by stimulating neocollagenogenesis. AIMS: The aim of our study was to assess the safety and efficacy of photodynamic therapy on the skin using a wavelength of 660 nm, as a photosensitizer (PS) Spherometallochlorin. MATERIALS AND METHODS: The study was divided into 2 stages. The first stage of the study involved 5 female laboratory rats. The first stage was divided into 2 substages: 1A the oral mucosa of 5 rats were irradiated for 30 minutes with 5 wavelengths of 660 nm (energy 100 J/cm2, power 100 mW/cm2). 1B FS Spherometallochlorin was applied to the skin of the back of rats after preliminary shaving in the form of 0.4% gel. Before applying the topical agent, after 15 minutes of exposure, after 30 minutes of exposure, after 45 minutes of exposure, in order to assess the penetration of the PS, a punch biopsy was taken in the area of application of the gel. The second stage of the study involved 15 female volunteers aged 21 to 65 years. At stage 2A, the skin behind the ear of 5 women was irradiated for 30 minutes at a wavelength of 660 nm (energy 100 J/cm2, power 100 mW/cm2) using a PS 0.4% gel containing Spherometallochlorin. Stage 2B evaluated the effectiveness of the effect of PDT procedures on the skin of 15 women. Skin condition was assessed using cutometry, corneometry, measurement of transepidermal water loss, and punch biopsy samples of the parotid skin (before and after the course of procedures), photographing and assessment of unwanted effects were also carried out. RESULTS: The histological picture before and after the study was similar. The preparation usually contained small fragments of the oral mucosa. The superficial squamous non-keratinizing epithelium was of normal morphology. On the surface of some fragments, hemorrhages (artifact of material sampling) were present. No inflammation, edema or hyperemia was observed in the underlying mucosa. Thus, no signs of inflammation or burns were found. CONCLUSION: The used radiation with a wavelength of 660 nm is completely safe, does not cause pathological changes in the skin. The course of PDT procedures is a safe, effective method causing remodeling of the dermis. PDT using 660 nm radiation and Spherometallochlorin as a PS can be recommended for use in practical health care.

Pustular psoriasis and arthropathy in a patient with HIV infection. Clinical case

The article presents a clinical case of pustular psoriasis and arthropathy in a patient with HIV infection. The diagnosis of psoriasis was confirmed by morphological examination. Signs of arthropathy were confirmed by X-Ray: presence of oligoarthritis of the distal interphalangeal joints of the fingers and feet was seen. Dactylitis severity ― 23 points, the Ritchie index ― 2, DLQI ― 28. The clinical course of psoriasis and its treatment in HIV-infected patients was considered after taking into account the data from literature and the patients current condition and observation. The above observation of a combination of several clinical forms of psoriasis (vulgar, pustular and arthropathy) in patients with HIV infection is an illustration of the features of the course and comorbidity of chronic dermatosis and AIDS, due to the influence of the infectious process, immunosuppression and ART. The development of pustular form and arthropathy creates the additional challenge of prescribing basic systemic treatment for severe and complicated psoriasis in an HIV-infected patient due to the presence of contraindications due to comorbidity. The glucocorticosteriod selected by the committee was effective on the skin and joint pathological processes, without having any negative impact on the course and treatment of the HIV infection. Such cases require further study and development of methods for the treatment of patients with comorbidity and their inclusion in an additional section in the clinical recommendations for the diagnosis and treatment of psoriasis.

Pharmacogenetic approach to methotrexate-related toxicity prediction in psoriasis

Methotrexate is a highly effective for psoriasis, but the use of methotrexate may be limited by its adverse effects. Approximately 1030% of patients treated with methotrexate experience adverse drug reactions, leading to the therapy discontinuation. Patient genetics can play a significant role in the interindividual variability of drug response. There is a growing body of literature on allelic variants of various genes that are assosiated with methotrexate toxicity. Pharmacogenetic studies may establish how patients genotype affect the safety of methotrexate. Treatment Data shows that to predict the risk of methotrexate-induced toxicity it is necessary to take into account the interindividual variability in methotrexate pharmacokinetics, which may be determined by the presence of single-nucleotide polymorphisms of genes encoding methotrexate carrier proteins and enzymes of its biotransformation. The activity of transporter proteins affects the drugs in the blood plasma and peripheral tissues, thereby determining its toxicity. The review was aimed is to summarize the current knowledge on pharmacogenetic polymorphisms that may affect the variability of methotrexate-related toxicity. Evaluation of such promising candidates for predictors of methotrexate-related toxicity risk could be used in psoriasis treatment personalization.

Subacute disseminated microbial eczema in an adolescent

Microbial eczema among the various clinical forms of eczema in the structure of incidence ranks is on the second position after the true one. Adults get sick more often than children. The pathogenesis of microbial eczema is based on misfunctions in the immune status and microbial sensitization of the body Due to bacterial background, as well as dysbiosis in the microbiome. The clinical picture of the disease is characterized by asymmetric localization of rashes on the limbs in the form of single plaques. The affected skin is reddish, squamous, slightly infiltrated. Outside the main foci, papulovesicular and pustular lesions, crusts are observed. Rash is not not always accompanied by itching. Microbial eczema was of a limited nature, manifested by coin-shaped foci, dot weeping, crusts. We observed a patient of 15 years before admission to the hospital was ill for 8 months. At the same time, during the last three months, the pathological process on her skin existed acutely without any dynamics. The occurrence of a rash is not associated with anything. Multiple efflorescence were located throughout the skin, on the scalp, ears, in the ear region, on the face, neck, torso, upper and lower limbs, buttocks, accompanied by severe itching. The inflammatory pathological process was represented by excoriations, wet spots, erosions, crusts and erythematous-squamous foci of various shapes and sizes. Dermographism pink. Repeated outpatient treatment brought temporary improvement. Due to the lack of therapeutic effect in the last 3 months, the patient was hospitalized in the branch Kolomensky. A comprehensive clinical and laboratory examination diagnosed disseminated subacute microbial eczema. Against the background of adequate therapy, the anti-inflammatory pathological process was completely resolved. Recommendations are given to maintain the achieved therapeutic effect.

Photogallery. Sarcoidosis (part 1)

Sarcoidosis (synonym: BenierBeckSchaumann disease, benign granulomatosis, chronic epithelioid cell reticuldoendotheliosis) ― is a multisystem disease from the group of granulomatosis, of unknown etiology, the morphological feature of which is the development of epithelioid cell granulomas without caseous necrosis fibrosis in the tissues of various organs. Taking into account the variety of clinical lesions, there are three main forms: extrathoracic, intrathoracic, mixed (generalized).

Methods of camouflage vitiligo (literature review)

Vitiligo significantly affects the quality of life of patients, their social and psychological adaptation in society. It has been noted that patients with vitiligo are more likely to develop anxiety and depressive disorders, suicidal thoughts. Standard therapy regimens today often take a long time, are not enough effective and do not always meet the expectations of the patient and the dermatologist, reduces compliance to treatment. In this regard, comprehensive therapy for vitiligo remains a pressing issue to this day. Medical camouflage is a promising adjunctive or alternative therapy for vitiligo, as it allows to control the clinical manifestations of the disease. The purpose of this review is to consider the main types of medical camouflage in the Russian and foreign markets, their availability and principles of action. The PubMed database and the Internet were used to identify the most effective, affordable, and easy-to-use products available in the Russian and foreign markets. The research identified the most significant products that are most convenient to apply to the skin and are easily available for purchase by vitiligo patients in Russia. Parameters such as shape, texture, composition and effect duration were evaluated. Each group of preparations was described in detail, as well as the technique for their correct application. Thus, this review will be useful to all practicing dermatologists in controlling the clinical course of vitiligo as well as its skin manifestations.

Clinical experience of observation and tactics of management of a patient with ectodermal angydrotic dysplasia

The concept of ectodermal dysplasias covers a group of rare hereditary developmental anomalies that have a variety of phenotypic variants, but are characterized by common signs of underdevelopment or abnormal formation of organs and tissues derived from the ectodermal layer (skin and its derivatives - nails, hair, teeth, nervous system and sensory organs) ... Approximately 25% of ectodermal dysplasias known to date are inherited in an autosomal dominant or autosomal recessive manner; in other cases, the mode of inheritance is unclear. The syndrome is characterized by a wide range of clinical manifestations and may include additional symptoms of damage to other ectodermal, mesodermal, and endodermal structures. Ectodermal anomalies are a manifestation of disturbances in spatial-temporal coordination during the development of the epidermis. They involve genes such as EGF (epidermal growth factor), ED1 (ectodisplasin), EDAR (anhydrotic receptor ectodysplasin 1) and others that regulate the activity of genes involved in epidermal morphogenesis by activating or suppressing transcription factors (in particular, pb3; Koster). So far, only about 20% of genes have been identified that are responsible for about 200 ectodermal dysplasias of various symptoms and severity. This article describes the clinical observation of a patient with a rare disease - ectodermal anhydrotic dysplasia. The literature data on the clinical features of the course of this dermatosis, as well as the features of the course in this patient are presented.