Objective — to increase the effectiveness of treatment of various forms of actinic keratosis (AK) with application of topical immunoregulator imiquimod in combination with carbon dioxide (СО2) laser in the form of dermal optical thermolysis (DOT). Materials and methods. 95 patients with various forms of AK were under observation. They were divided into two groups: the main group (50 persons) and the control group (45 persons). Patients of both groups used imiquimod as the main method of treatment for AK. In the main group, before applying imiquimod, additional treatment of AK zone was carried out 1 cm along the peripheral area with a СО2-laser in the form of DOT. Results and discussion. The results of treatment of patients of both groups were evaluated 10, 20 and 60 days after the last application of imiquimod. The following characteristics were analyzed: soreness during and after the procedure, speed of epidermis recovery, presence or absence of dermatoscopic signs of AK, formation of complications (scarring or dyschromic), absence or presence of disease recurrences within 2 months. It was noted that combined treatment with imiquimod and СО2-laser slowed down the epithelialization of the affected areas (up to 20 days in 37 (39.5 %) patients of the main group and only in 19 (20 %) patients of the control group), by increasing the depth and intensity of the intervention, but it slightly increased the effect of post-traumatic hyperpigmentation (after 60 days) in 5 (5.2 %) patients of the main group and in 3 (3.1 %) patients of the control group. This therapy reduced the number of AK recurrences (especially in the hyperkeratotic form) by 3.2 % compared to the imiquimod monotherapy and had a positive effect on the rate of disappearance of dermatoscopic signs of AK (20 days after the end of treatment, they were observed only in 2 (2.1 %) patients of the main group and in 7 (7.5 %) patients of the control group). Conclusions. The combined treatment of AK that includes the application of imiquimod and the use of СО2-laser is promising, etiopathogenetically justified and well tolerated.
The etiological factors of erythema of the face in rosacea are analyzed in the article. The role of vasoactive peptides, inflammatory mediators and ticks of the genus Demodex in the pathogenesis of the disease has been determined. The main methods of treatment of the disease are considered, including phototherapy with narrowband pulsed radiation and platelet autologous plasma (TAP). Current data indicate the acceleration of natural mechanisms of skin regeneration due to the presence of platelet-derived growth factors and modulation of endothelial reparative function, so the introduction of platelet autologous plasma is a promising method of treating patients with this dermatosis. Key words: rosacea, platelet autologous plasma, facial erythema, platelet growth factors.
Objective — to study the molecular mechanisms of the development of actinic keratosis (AK) and compare them with Bowen’s disease. Materials and methods. A literature review, analysis of national and international protocols for the diagnosis of AK are presented, which meet the selection criteria. We reviewed works with at least one recommendation for AK diagnostic scenario published after 2015. The systematic literature review is based on modern studies containing descriptions of molecular diagnostics of certain proto-oncogenes to establish the final diagnosis. Interdisciplinary guidelines were also reviewed to further explore all possible diagnostic criteria. Results and discussion. Until now, the molecular mechanisms of AK development have not been fully studied and grouped into a single review. In most of the sources, only p53 protein was mentioned as the main transcription factor regulating apoptosis. However, recent studies prove a sufficient influence of CD95, which, like p53, induces apoptosis and plays a leading role in the development of AK. All precancerous and malignant neoplasms of the skin arise due to mutations in cells, which cause a violation of apoptosis, but there are still no recommendations and a clear diagnostic algorithm that will allow to quickly establish the final diagnosis and make a choice in favor of this or another method of treatment. Conclusions. AK and Bowen’s disease are different stages in the development of the same malignant process, differing in the proliferative activity of cells and the expression of proto-oncogenes CD95, bcl-2, and p16 which can be used as differential diagnostic markers. Thanks to early diagnosis, it is possible to choose the most suitable treatment option, with consideration for modern protocols.
Actinic keratosis (AK) is a common disease that is formed as a result of excessive insolation of exposed skin areas. One of the possible options for the development of the disease is the transformation of AK into squamous cell carcinoma. The timely diagnosis of suspicious areas of AK with their subsequent excision and histological examination has great importance in the prevention of neoplastic transformations of the skin.The aim of our study was to identify dermatoscopic patterns of the initial stages of neoplastic transformation of actinic keratosis and a comparative analysis of the diagnostic effectiveness of digital dermatoscopy, twocolor spectral dermatoscopy in relation to histological examination in a group of individuals suffering from actinic keratosis.There were 49 patients with AK under our supervision. All suspected cases of keratosis were additionally examined histologically. We analyzed the features of clinical forms and modified existing diagnostic methods. To expand the diagnostic capabilities of standard dermatoscopy, studies were performed in different ranges of light. Spectral dermatoscopy allowed estimating the potential foci of neoplastic transformation in blue and green light field (standard illumination range was suppressed). Particular attention was paid to areas of increased keratinization, areas of excessive vascularization with a predominance of superficial capillary network, microulcers with loose edges that contrast well with the green spectrum, as well as dynamic changes in color in one field of study for 30 days.It was found that the use of spectral dermatoscopy increases the diagnostic capabilities of AK and allows identifying more accurately the early signs of neoplastic transformations associated with both pathological neoangiogenesis («strawberry» pattern, glomerular network) and pathological proliferation (pseudogranulations, pathological keratinization, etc.).
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