Bacteriophages are a large group of viruses that can selectively affect bacteria. Bacteriophages and their ability to regulate the growth and activity of pathogenic microorganisms were discovered by scientists at the beginning of the 20th century. Further studies of the properties of bacteriophages led to the construction of the modern concept of virus activity and formed the ground of molecular genetics and biology. To date, more than 6 000 phage species are known to be ubiquitous, but a prerequisite for their existence is the presence of a bacterial host cell, proteins and energy resources serve as the basis for further viral replication. The ability of bacteriophages to selectively destroy bacterial host cells is of particular importance for the therapy and prevention of dermatoses with a potential risk of bacterial infection or pathogenetically aggravated by the activity of the bacterial flora. Such dermatoses include atopic dermatitis, acne, eczema, psoriasis, pyoderma. The article highlights the main advantages and features of bacteriophages, presents data from some of the currently available studies on the use of phages in dermatovenereology. To illustrate the possibility of using bacteriophages in dermatology, a clinical case of successful relief of exacerbation of IgE- independent atopic dermatitis with a high risk of secondary infection in an 8-year-old child is presented. In this case, as an additional to the recommended standard external anti-inflammatory therapy, a gel for external use was prescribed based on a complex of more than 70 virulent bacteriophages capable of inhibiting the growth of actual bacterial strains, among them Staphylococcus spp. (including S. aureus), Streptococcus spp. (including S. pyogenes), Cutibacterium acnes, etc. The range of bacteriophages in dermatovenereology can be expanded due to the constant growth of antibiotic resistance. The use of bacteriophages in routine dermatological practice requires further clinical trials.
Relevance. Atopic dermatitis (AD) is an inflammatory disease characterized by a chronic course with periods of remissions and exacerbations. IgE-independent atopic dermatitis is a medical and social problem of our time, since the disease manifests itself most often in childhood and is one of the most frequent forms of dermatoses among the pediatric population. The prevalence of atopic dermatitis among children is up to 20 %, among adults - 2-8 %. Recently, there has been a significant increase in atopic diseases worldwide. The aim: to study specific features of IgE-independent atopic dermatitis in children living in a metropolis. Materials and Methods. A prospective cohort study was conducted, which included 451 children aged 5 to 14 years with a diagnosis of AD who applied for outpatient care at the Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology for the period 2020-2021. All parents (guardians) have given voluntary informed consent to the participation of children in the study and the publication of personal data. Examination of patients included general clinical methods, assessment of the SCORAD index and laboratory allergological examination (total and 73 specific IgE in blood serum with the most common food and aeroallergens). In 103 (22.8 %) children (57 (55.3 %) boys and 46 (44.7 %) girls), the results of the allergological analysis did not confirm concomitant allergic sensitization. Atopic dermatitis in these children was defined as IgE-independent. Results and Discussion. Predictors of the development of IgE-independent AD were hereditary predisposition [odds ratio (OR) 2.42; 95 % confidence interval (CI) 1.12-5.25], artificial feeding [OR 4.04; 95 % CI 1.46-11.20], comorbidities [OR 1.42; 95 % CI 0.57-3.52], late onset [OR 1.67; 95 % CI 0.81-3.41]. According to the SCORAD index, the majority of patients (75.7 %) had a moderate degree of AD and no seasonality. Features of skin rashes corresponded to the age periods of the course of AD: erythematous-squamous forms with lichenification foci prevailed. For the first time, the features of IgE-independent atopic dermatitis in children were shown. The role of risk factors for the development of IgE-independent atopic dermatitis in children has been shown for the first time. Conclusion. IgE-independent type of AD can be diagnosed in every fifth child with AD. The study of risk factors will allow predicting the development of this type of disease.
Introduction. Colonization of the skin with S. aureus and S. epidermidis in children with atopic dermatitis leads to the initiation of inflammation and worsening of the disease. The control of overcolonization with S. aureus is an important issue in pediatric dermatological practice. At the same time, to achieve a controlled level of colonization, it is preferable to prescribe non-steroidal external agents. Activated zinc pyrithione has a wide range of complementary pharmacodynamic effects, including anti-inflammatory, pro-apoptogenic, antimicrobial, and antifungal. The article presents the results of the use of zinc pyrithione in mild IgE-independent atopic dermatitis in children. The results of the main clinical studies confirming the effect of zinc pyrithione on the microbiome in AD and the severity of the disease were analyzed.Aim. To evaluate the therapeutic and microbiological efficacy of activated zinc pyrithione as monotherapy in patients with IgEindependent atopic dermatitis.Materials and methods. 30 patients aged 2 to 8 years with mild atopic dermatitis in the acute stage were divided into 2 groups. Group 1 received activated zinc pyrithione, group 2 received a combined topical steroid.Results. Both groups showed a significant reduction in S. aureus skin colonization. In both groups, in comparison with the initial state, a significant decrease in the severity of clinical manifestations of AD was obtained. The therapeutic efficacy of zinc pyrithione was 93.3%, clinical remission was observed in 73.3% of cases.Conclusion. The totality of currently available data on the clinical efficacy and safety of activated zinc pyrithione allows us to recommend it as one of the effective agents for external therapy of mild IgE-independent atopic dermatitis. The use of activated zinc pyrithione showed a rapid, pronounced positive result of treatment, a decrease in the risk of secondary infection in observed children with IgE-independent atopic dermatitis.
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