Saratov JOURNAL of Medical and Scientific Research

Kruglova L.S.

Central State Medical Academy of the ADP of the Russian Federation, Head of the Department of Dermatology and Venereology and Ccosmetology, Professor, Doctor of Medical Sciences

Assessment of the efficiency of cyclosporine use in psoriasis

Year: 2017, volume 13 Issue: №3 Pages: 673-678
Heading: Dermatovenerology Article type: Review
Authors: Kruglova L.S., Ponich E.S., Osina A.V., Gryazeva N.V.
Organization: Central State Medical Academy of the ADP of the Russian Federation
Summary:

The article presents a review of randomized studies involving patients with severe psoriasis, which showed that after 10-12 weeks of monotherapy with cyclosporine there was a decline of the Index of prevalence and severity of psoriasis (PASI). After achieving clinical remission must be decided on a gradual reduction of the dose of cyclosporine to the lowest effective dose, or the complete abolition of the medication. Simultaneous use of cyclosporine and UVB at the moment is not widely studied. Combined use of methotrexate and cyclosporine has been used successfully in the treatment of rheumatoid and psoriatic arthritis. The combined intake of cyclosporine and systemic biological agents should be used in exceptional cases of severe forms of psoriasis, not amenable to other treatments, and only for a limited period of time.

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Analysis of the various schemes efficiency of methotrexate use in psoriasis treatment

Summary:

Currently, there has been a steady increase in the incidence of psoriasis, including severe forms. It is extremely important for psoriasis to administrate medicines in time. Methotrexate inhibits the increased proliferation of keratinocytes, inhibits the production of such inflammatory mediators as leukotrienes, TNF-a, collagenase, IL-1, IL-6, but at the same time it increases production of anti-inflammatory IL-10. Objective: to analyze the efficacy of methotrexate in various forms of psoriasis. Material and Methods. Under observation in the period from 2011 to 2016 were 516 patients, including those treated with methotrexate. Methotrexate was assigned according to the scheme: 1st injection 10mg/week, with no adverse effects 20-25 mg/week. All patients received folic acid at a dose of 20-40 mg/day for 5 days starting 3 days after the injection of methotrexate. Evaluation of efficiency was carried out using indices of dermatological status and quality of life. Results. Achievement of clinical remission was observed in 257 (49.7%) in patients; achieving a significant improvement was noted in 32 (6.2%) patients; achieving improvements in 126 (24.4%) patients; no effect 33 (6.4%) patients, and deterioration (further progression of skin lesions) were observed in 68 (13.2%) patients. Conclusion. Methotrexate has a high efficacy in such clinical forms of psoriasis as vulgar (64.9%), inverse (63.9%), exudative (44.7%), and pustular palmar-plantar psoriasis 12.9%.

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Immunopathogenetic mechanisms of skin toxic response of antitumor therapy with mul-tikinase of angiogenesis inhibitors

Year: 2017, volume 13 Issue: №3 Pages: 605-611
Heading: Dermatovenerology Article type: Review
Authors: Shatokhina Е.А., Kruglova L.S.
Organization: Central State Medical Academy of the ADP of the Russian Federation
Summary:

The violation of the angiogenesis is associated with pathogenesis of many diseases, but especially pronounced pathological angiogenesis underlies the growth of tumors and metastasis. The physiological control of the angiogenesis is carried out by many growth factors, one main factor — the vascular endothelial growth factor (VEGF), realizing their effects by receptors — proteinkinases. The target therapy of various neoplastic diseases, based on the suppression of angiogenesis, aimed at blockade of receptors for VEGF and other pro-angiogenic growth factors. However, the medicine blockade of receptors for growth factors and suppression of tumor angiogenesis leads to inappropriate exposure are the main cells of the dermis — fibroblasts. As a result of changing the regulatory mechanisms of inhibition of the physiological renewal of epidermis, suppression of angiogenesis and repair when damaged skin there are various skin toxic reactions that are dependent on receptor targets of angiogenesis inhibitors. The study of the mechanisms of adverse events of targeted therapy is an important way of oncoimmunology and dermatology, which will further help to determine the optimal scheme of correction of dermal toxicity and maximize the effectiveness of the antitumor therapy.

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Analysis of the genes polymorphisms distribution of the MMP1, XRCC1, HFE (2), GSTT in patients with non-neoplastic melanin hyperpigmentation

Year: 2017, volume 13 Issue: №3 Pages: 590-594
Heading: Dermatovenerology Article type: Original article
Authors: Ikonnikova EV, Kruglova LS, Shatokhina EA, Talybova AM.
Organization: Central State Medical Academy of the ADP of the Russian Federation
Summary:

Objective: to study the factors of increased risk of hyperpigmentation, with the polymorphism of MMP1, XRCC1, HFE (2), GSTT genes and analysis of their association in patients with various clinical forms of non-neoplastic melanin hyperpigmentation. Material and methods. The study included 38 patients with hyperpigmentation (melasma / chlo-asma, post-traumatic/ post-inflammatory hyperpigmentation, solar lentigo). All patients were underwent buccal swabs with sterile cotton buds to take the material for the study. All patients were underwent genetic analysis of polymorphism of HFE (2), XRCC1, MMP1, and GSTT genes by genotyping single-nucleotide substitutions. Results. In patients with melasma / chloasma, the high value of the alleles cipher of MMP1, XRCC1, and GSTT genes was noted, while the cipher of HFE (rs1799945) and HFE (rs1800562) allele index showed average values. In patients with post-traumatic / post-inflammatory pigmentation, the high value ofthe alleles cipher of MMP1, HFE (rs1799945) and HFE (rs1800562), GSTT genes was noted, while XRCC1 allele cipher showed average values. In patients with solar lentigo, the high value ofthe alleles cipher of MMP1, XRCC1, and GSTT genes was noted, while the cipher of HFE (rs1799945) and HFE (rs1800562) allele index showed average values. Conclusion. Was revealed the similarity ofthe results of genetic research in patients with melasma / chloasma and in patients with solar lentigo.

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The combined application of biological therapy and methotrexate in case of escape phenomenon progressing

Year: 2015, volume 11 Issue: №3 Pages: 405-409
Heading: Dermatovenerology Article type: Short message
Authors: Ponich E.S., Kruglova L.S., Babushkin A.M.
Organization: BU Khanty-Mansi Autonomous District— Yugra «Khanty-Mansi clinical skin and venereologic dispensary»
Summary:

Aim: the study of the efficacy of methotrexate in patients with the "escape effect" during the ustekinumab therapy. Materials and Methods. The results of methotrexate at a dose of 15-20mg/week in treatment of 4 patients receiving biologic and developed "escape effect". Ustekinumab is used as a hypodermic injection at a dose of 45 mg for a body weight of a patient no more than 100 kg, and 90 mg of body weight over 100 kg, at the zero week, the 4th week and then every 12 weeks. Patients control meets the standard management of patients in biological therapy. Results. The study shows that in the case of the resistance progressing when applying preparations of biological therapy, methotrexate is useful at a dose of 15-20mg/week for up to 6 months. The combined use of biologic therapy and methotrexate in the treatment of patients with psoriasis vulgaris, "escape effect" contributes to the marked regression of clinical symptoms and allows to control the process long enough, which is confirmed by the dynamics of the index PASI, BRS and DLQI. The combined method is highly safe, as evidenced by the lack of inhibition of hematopoiesis, the normal level of hepatic transaminases and serum creatinine, which greatly improves patient compliance in this type of therapy. Conclusion. The article presents the data of the combined application of biological medication therapy (ustekinumab) and methotrexate for the treatment of patients with the common form of psoriasis vulgaris. In the case of the development of resistance of biological therapy recommended the appointment of methotrexate. The combined use of methotrexate and biologic therapy in the treatment of patients with psoriasis vulgaris contributes to marked regression of clinical symptoms and allows to control the process for a long time.

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The combined using of ustekinumab and narrow-band phototherapy in treatment of severe psoriasis

Summary:

Aim: research the effectiveness of UVB 311 nm phototherapy in patients with the "escape effect" that developed in the 44th — 56th weeks of the ustekinumab use. Materials and Methods. The examination and treatment of 9 patients with extensive psoriasis vulgaris receiving ustekinumab by hypodermic injection at a dose of 45 mg if body weight of the patient not more than 100 kg, and 90 mg of body weight over than 100 kg, on the zero week, the 4th week and then every 12 weeks. Among them 6 (66,7%) men and 3 (33,3%) women aged from 28 to 65 years. All patients in the 44th — 56th weeks of ustekinumab observed effect of "escape" in connection with which he has been appointed narrowband phototherapy. Results. The combined use of ustekinumab and UVB 311 nm phototherapy in patients with "escape effect" contributes to the marked regression of clinical symptoms and allows you to control the process for long, which is confirmed by the dynamics of the index PASI, BSA and DLQI. Conclusion. In the case of the effect of "escape" in the application of biological therapy drugs (ustekinumab) possible appointment of a narrow-band medium wave phototherapy course 25-30 procedures.

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