Background: Among pathological hair loss conditions in men the androgenic alopecia (L64 according to ICD-10) has been the most common diagnosed. However, the reasons of the occurrence and development of the disease remain incompletely clarified, that determines the difficulties of personalized therapy. Aims: To analyze both genetic and non-genetic factors involved in the pathogenesis of androgenic alopecia in men, and to create personalized multifactorial model for description of individual causes of the disease. Materials and methods: The genetic predisposition to androgenic alopecia was estimated by the set of SNP rs929626, rs5919324, rs1998076, rs12565727 and rs756853, analyzed by mini-sequencing. The non-genetic factors included: hormones and metabolic markers, trace elements, and vitamins. Two-stage model creation of androgenic alopecia occurrence and development was carried out using a neural network (for genetic factors) followed by step-by-step linear discriminate analysis (for non-genetic factors). Results: The case-control study included 50 men revealing IIV stages of androgenic alopecia (according to Norwood-Hamilton classification) and 25 healthy volunteers relevant in their age and origin. The analysis of each SNP separately did not show significant differences between these groups, while SNP joint consideration in neural network model made it possible to assess the genetic predisposition to androgenic alopecia, as well as to divide the low and high genetic risk subgroups. A large number of significant non-genetic factors, including elevated levels of dihydrotestosterone, 17-OH-progesterone, insulin, and deficiency of Mg, Cu, Zn, Se, vitamins D, E, folic acid was shown in low genetic risk subgroup. In turn, in the high genetic risk subgroup the set of significant non-genetic factors was limited to metabolic and micronutrient disorders only. These data were used for the multifactorial model showing 81.285.1% accuracy being the most effective in early (III) stages of androgenic alopecia. Conclusions: The different influence of non-genetic factors in patients with low and high genetic risk of androgenic alopecia has been revealed. The integral factors consideration in the proposed two-stage multifactorial model identifies individual causes of the disease and gives the chance for the development of personalized therapy of androgenic alopecia in men.
Background: Data on the possible combinations of apremilast with other types of psoriasis therapy is limited. Description of clinical cases: We present the data on the efficacy and safety of combination therapy of the selective phosphodiesterase 4 inhibitor and dihydrofolatereductase inhibitor (methotrexate) for the treatment of psoriasis and psoriatic arthritis in patients with moderate-to-severe plaque psoriasis and active psoriatic arthritis with lack of efficacy of methotrexate in the anamnesis. The selective phosphodiesterase 4 inhibitor (apremilast) was administered according to the prescription. The severity psoriatic arthritis of was estimated by PASI. The effectiveness of therapy was evaluated at week 14. Due to the lack of effect, methotrexate was added subcutaneously at week 14. The effectiveness of combination therapy was assessed at week 26. In both cases, the significant clinical improvement was reached (patients reached PASI 75 and PASI 90), a decrease of the psoriatic arthritis activity according to the DAS28 and DAPSA. Conclusion: These clinical cases demonstrate the efficacy and safety of combined therapy with methotrexate and apremilast inpatients with active psoriatic arthritis and moderate to severe plaque psoriasis.
Congenital epidermolysis bullosa is a clinically and genetically heterogenous group of hereditary skin diseases characterized by the formation of bullae and/or erosions in response to insignificant mechanical effect. The variety and severity of clinical manifestations of the disease determine the early disablement of patients and the decrease in the quality of life, which requires the development of pathogenetic and etiological methods of treatment. Methods of gene therapy are the most promising direction to study, since they can affect the cause of congenital epidermolysis bullosa.
The article substantiates the relevance of registries of patients as illustrated by registries of patients with psoriasis, gives a comparative characteristic and description of the advantages and disadvantages of randomized controlled and observational registry studies, considers the main goals of patient registers. The importance of patient registers as sources of additional knowledge about diseases is described. Review of the existing dermatological patient registers is given. The paper provides the detailed description of the most significant registries of patients with psoriasis: PSOLAR, Badbir, Corrona, BIOBADADERM and others. An overview of publications and main results of the research based on registries of psoriasis patients is presented. A description of the register of patients with psoriasis as part of the Database of patients with chronic diseases of the skin and subcutaneous tissue, maintained by the Russian Society of Dermatovenereologists and Cosmetologists since 2018 is given. The article substantiates the relevance of patient registries as illustrated by registries of patients with psoriasis, gives a comparative characteristic and description of the advantages and disadvantages of randomized controlled studies and observational registry studies, argues in favor of complementarity of data from randomized controlled trials and registry-based studies. Consideration of the main goals of patient registers is given. The importance of patient registers as sources of additional knowledge about diseases and quality of medical care is described. Review of the existing dermatological patient registers is given. The paper provides the detailed description of the most significant registries of patients with psoriasis: PSOLAR, Badbir, Corrona, BIOBADADERM and others. An overview of publications and main results of the research based on registries of patients with psoriasis is presented. A description of the register of patients with psoriasis as part of the Database of patients with chronic diseases of the skin and subcutaneous tissue, maintained by the Russian Society of Dermatovenereologists and Cosmetologists since 2018 is given, as are inclusion criteria. In addition, the main federal registries of patients that are maintained in the Russian Federation are listed, the goals of their maintenance are indicated.
The article presents an analysis of the resources and activities of medical organizations providing medical care in the field of dermatovenereology for the period 20152020. Up-to-date data on the number of medical organizations and units providing specialized medical care in the field of dermatovenereology are provided. A description of the main changes in the provision of the population of the Russian Federation with dermatovenereologists, staffing with dermatovenereologists of medical organizations is given. Changes in the number of outpatient visits in 2020 are given. The dynamics of the bed fund of 24-hour and day hospitals of a dermatovenereological profile, the bed occupancy, the number of patients treated is described. The data on the incidence of sexually transmitted infections, infectious skin diseases are presented. Prevalence and incidence rates of diseases of the skin and subcutaneous tissue, including atopic dermatitis and psoriasis, are given. The impact of measures aimed at preventing the spread of a new coronavirus infection and organizing the provision of medical care to patients with COVID-19 on the performance rates of dermatovenereologic medical organizations has been demonstrated.
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