BACKGROUND:Recently there has been an increase in the number of patients with scleroderma. AIM:This study aimed to investigate the pathogenesis and course and present the immunopathogenesis of localized scleroderma (LS) or morphea. MATERIALS AND METHODS:From 2010 to 2019, a prospective study of 77 patients with LS was conducted on the basis of the Leningrad regional center for specialized types of medical care. Based on histological examination, LS diagnosis was verified in 40 of 77 patients. Patients with LS (n = 40) were included in the first research group and were then divided into two subgroups based on the limitation period for the first symptoms of the disease: in subgroup I (n = 20), the disease manifested no later than 1.7 months before clinic visit; in subgroup II (n = 20), the limitation period was 1.5 years. RESULTS:Patients of both subgroups (n = 40) underwent immunohistochemical (IL-2, IL-4, CD4, CD8, vimentin, Toll-like receptor TLR7) tissue analysis and immunological blood tests to determine autoantibodies. To improve the differential diagnosis of LS, a comparative assessment of clinical manifestations and histological signs was performed in patients with LS (n = 40) and patients with clinically similar dermatoses (n = 37): annular granuloma (n = 12, 7 women and 5 men, average age 44 12 years), small plaque (n = 15, 6 women and 9 men, average age 42 4 years), and large plaque (n = 10, 5 women and 5 men, average age 59 8 years) parapsoriasis. According to the results of the histological examination, inflammatory changes are dominant in patients with LS manifestation period of 1.7 months from the onset of the disease, while fibrotic changes are apparent in patients with a manifestation period of 1.5 years. The expressions of CD4, CD8, IL-2, and TLR7 were more pronounced in subgroup 1, while those of IL-4, CD4, and vimentin were high in subgroup 2. No autoantibodies were detected in the blood of patients with LS. The results allow us to divide the pathogenesis of LS into two phases: inflammatory and fibrotic. Immune dysregulation and fibrosis occur simultaneously, but with phase dependant predominance. CONCLUSIONS:In the future, a detailed understanding of the pathogenesis of LS will help improve diagnostic and therapeutic algorithms and reduce the frequency of relapse and complications.
Целью работы являлась оценка антропометрических показателей молодежи в возрасте 21-26 лет, родившихся в период максимального использования пестицидов и до 17 лет проживавших в Приаралье-регионе экологического бедствия, в зависимости от степени экологического неблагополучия территории проживания. Методы. В ходе поперечного исследования проведено измерение 33 антропометрических признаков у социально однородной группы из 320 добровольцев (175 девушек и 135 юношей) в возрасте от 21 до 26 лет. По степени экологического неблагополучия территории проживания испытуемые были разделены на следующие группы: 1-критическая, 2-относительно благополучная и 3-благополучная. Межгрупповые различия в количественных признаках изучали с помощью критерия Краскела-Уоллиса с апостериорными сравнениями по Манну-Уитни с поправкой Бонферрони. Категориальные признаки сравнивали с помощью критерия хи-квадрат для биномиального распределения. Результаты. У юношей из критической группы габаритные размеры тела, показатели массивности костей были значительно меньше, чем у сверстников из других групп. У девушек из группы относительного благополучия при отсутствии регионарных особенностей длины тела имели место увеличенные по сравнению с их сверстницами из других групп размеры груди, массивность костей. Пропорции тела у них характеризовались сочетанием долихоморфного телосложения с отсутствием регионарных различий ширины плеч, увеличенным обхватом бедер и шириной таза. У юношей из экологически благоприятных регионов толщина кожно-жировой складки оказалась больше, чем у сверстников из других регионов. У девушек из группы относительного благополучия имели место более высокие значения массы тела и объема талии. При этом ни у обследованных девушек, ни у юношей не обнаружено статистически значимых отличий в частоте встречаемости отклонений массы тела, определяемых по индексу массы тела. Выводы. Выявленные особенности строения тела могли быть сформированы под влиянием поллютантов, обладающих эндокринразрушающим действием и загрязняющих окружающую среду региона. Использованный в работе подход может быть применен для мониторинга состояния здоровья жителей Приаралья и других зон экологического неблагополучия.
This article considers the modern approaches to terminology, classification, diagnosis, clinical manifestation and the treatment of the erythroderma. Authors touch upon questions about the meaning of the terminology “erythroderma”, with understanding pathogenesis, methods of making diagnosis and the treatment of the erythroderma.
This article presents a case of clinical observation of a 5-year-old child with herpetiformis dermatitis (Duhrings). This rare dermatosis is characterized by a chronic relapsing course, the presence of itching polymorphic rashes, typical histological and immunomorphological signs. The diagnosis was made on the basis of the clinical picture, histological and immunohistochemical studies of skin biopsy, as well as the results of HLA typing by PCR. Clinical observation of this case is of interest to practicing physicians-dermatologists due to the rare occurrence of Duhrings herpetiformis in children, the complexity of differential diagnostic search, which requires further generalization of experience using histological, immunohistochemical and molecular genetic research methods. The disease is clearly differentiated from other rashes with the formation of subepidermal blisters according to histological, immunological and gastrointestinal criteria. The prevalence of dermatosis in various populations of the Europian race ranges from 10 to 39 cases per 100,000 population. Duhrings dermatitis herpetiformis can develop at any age (cases of the childhood form of Dhrings dermatitis herpetiformis have been reported), but most often the disease occurs at the age of 4050 years. Dermatitis herpetiformis persists indefinitely with variable severity. In patients with Duhrings dermatitis, associated gluten-sensitive enteropathy is often noted, which in most cases is asymptomatic.
Each year in the developed countries of the world 100 million patients acquire scars; and there are 11 million keloid scars among them. Aim of the study. Evaluate the effectiveness of treatment and dynamics of scar condition when using self-adhesive dressings (silicone sheet; silicone patch) with a layer of soft silicone. Patients and methods. A clinical prospective observational study of the dynamics of scarring conditions using selfadhesive dressings with a layer of silicone sheet (soft silicone) was conducted in 27 patients. Results. It was shown that by the third visit (42 days after inclusion in the study); the color changed towards lightening and disappearing red; in the largest group with dark red scars at the beginning of the study 43.7% completed the study with light pink scars; 43.7% with hyperpigmented and 5.26% with normopigmented (р 0.0001). Also significant was the dynamics of changes in the position of the scar relative to the level of normal skin (р 0.0001) with level alignment in case it was initially lower than the level of normal skin. The condition of the scar surface by the third visit normalized; in all patients the surface became even (p = 0.0044). There was a marked increase in the number of easily displaceable scars (from 11.1% to 37.0%; p = 0.0003). Also; by the third visit; itching disappeared in all patients (р 0.0001). Conclusion. Overall; the study showed marked improvement across all parameters studied. Silicone sheet; one of the most widely used forms of silicone-based dressings; to be an effective treatment scar management.
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