Background. Macrophages are of great importance in the development of obesity and psoriasis. Signaling via PPAR-γ in certain macrophage populations is associated with M2-like features and anti-inflammatory profile. In this research, we evaluated the anti-inflammatory action of pioglitazone by the immunohistochemical study of M1 and M2 macrophages in psoriasis-affected skin in obese patients. Methods. We used immunohistochemistry to characterize CD68+ and CD163+ macrophages and pathomorphological description of skin biopsy, obtained from 6 obese psoriatic patients before and after treatment with 15, 30, and 45 mg pioglitazone, once a day during 6 months. Two patients with conventional therapy and without pioglitazone served as control. Results. Generally, CD163+ cell quantities in psoriasis-affected skin significantly dominated over CD68+ before and after all treatment regiments. Among patients who received pioglitazone, some of them clearly responded to treatment from lowest to highest doses by decreasing CD68+ cells. In the group with 30 mg pioglitazone regiment, we detected a significant reduction of CD68+ cells in dermal infiltrates: CI 95% (16–32) before versus CI 95% (2–7) after treatment. Pioglitazone dose escalation led to certain normalization of skin morphology. Conclusion. The immunohistochemical study allows us to show the anti-inflammatory effect of pioglitazone in psoriatic obese patients, which can be mediated by reducing the number of СD68+ macrophages, but not СD163+ macrophages, in the affected dermis.
Acne (acne vulgaris) is a chronic, widespread, multifactorial disease manifested by open and closed comedones, inflammatory skin lesions in the form of papules, pustules and nodes. Emotional reactions are the most characteristic manifestations of human mental activity, which are accompanied by autonomic and endocrine changes associated with the release of various hormones: primarily stress hormones and androgens. Antibiotics have been effective and widely used for the past four decades. However, worldwide, there is an increase in antibiotic resistance due to their frequent and prolonged use. Retinoids are currently one of the most effective groups of drugs used to treat acne. The aim of our study is to investigate the efficacy of the first generation retinoids (isotretinoin) in the treatment of third and fourth degree acne in order to improve emotional status of patients. Patients received Isotretinoin in a starting dose of 0.5 mg / kg of body weight during meals, dose adjustment was carried out after 1 month at the rate of 0.5-0.75 1.0 mg / kg of body weight, the duration of treatment was assessed by gaining the commutative dose of 120 mg / kg of body weight, and the treatment duration lasted 16-24 weeks. After 3 months, the majority of patients 26 (89.66%) noted the disappearance of the rash completely, and 3 (10.34%) found only single papular-pustular elements. At the end of the therapy course with isotretinoin, complete clinical remission was achieved in all patients and the emotional load completely disappeared, self-esteem increased, disbelief in a positive result faded in 25 (96.15%) of 26 patients in the "Depressive" category.
The problem of antibiotic resistance is currently one of the most urgent challenges for public health at the global level. An assessment by international experts shows that the resistance of microorganisms to antimicrobial agents is the cause of more than 700.000 deaths annually. Hence, only in the countries of the European Union, more than 25 thousand people die every year from infections caused by antibiotic-resistant bacteria. Despite the widespread use of systemic antibiotics in all fields of medicine, topical treatment of pathological processes continues to successfully serve in dermatology, gynecology, pediatrics, surgery, dentistry, and other areas of healthcare. Worldwide, one can observe a significantly increased interest in the development of topical antiseptic (non-antibiotic by origin) agents and their introduction into clinical practice, both for separate use and in combination with specific medications of systemic action (iodine derivatives, chlorhexidine bigluconate, cidipol, cimesol, etc.). We analyzed the current crisis situation in medicine and its causes related to the progressive polyresistance of the microbiome to antibiotics. The paper provides an overview of modern antibacterial, antibiotic and antiseptic agents on the domestic pharmaceutical market. We draw the attention of scientists and the creative medical community to the insufficient number of domestic innovative developments of antibacterial drugs and the importance of a demanding attitude to antibiotic treatment in connection with polyresistance of microbial flora. The study emphasizes that the development of new non-toxic medicinal products and a wider introduction of already known topical antibacterial, antiseptic, and anti-inflammatory agents with proven effectiveness and a scientifically based application scheme are extremely relevant and necessary under conditions of antibiotic resistance of the microbiome.
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