COMPLEX TREATMENT THE PATIENTS WITH PSORIASIS AND CONCOMITANT ACTIVATED HERPES VIRUS INFECTION, TYPES 1, 2.

OBJECTIVE: The aim: Is to increase effectiveness and assess safety of the antiviral therapy in complex treatment of patients with psoriasis with activated chronic herpes virus infection of types 1 and 2. PATIENTS AND METHODS: Matherials and methods: 120 patients and 25 practically healthy persons were examined. RESULTS: Results: It has been studied an effect of antiviral therapy on the background of basic therapy in patients with P+HSV 1,2: the percentage of HSV 1,2 DNA detection after the use of acyclovir and/or inosine pranobex was decreased in saliva from 22.0±3.43 % to 6.7±1.32 % (р<0.01) and in epithelium - from 33.3±4.23 % to 6.7±1.8 % (р<0.01); The use of antiviral therapy has showed a decrease in the expression of miR 155 molecules from 126.3 ±10.5 U/6 to 62.4±5.48 U/6 (р<0.05), an increase in the number of T-regulatory lymphocytes from 6.8±1.25% to 9.1±1.41% (p=0.0503); a decrease of IFN-α level in saliva from10.1±1.84 ng/ml to 8.2±1.27 ng/ml (р1=0.0398); in the serum IL-23 level was significantly decreased from14.9±2.11 pg/ml to 8.8±2.03 pg/ml (р<0.05) and TGF-ß synthesis was increased from 3.9±1.23 pg/ml to 9.3±2.21 pg/ml (р<0.01). CONCLUSION: Conclusions: An improved method of treatment and evaluation of its clinical and immunological effectiveness based on an integral criterion was suggested as a result of conducted antiviral therapy amid basic therapy in patients with psoriasis with activated HSV-1 and HSV-2.

EXAMINING THE ROLE OF THE NITRIC OXID SYSTEM AS THE ESSENTIAL PATHOGENETIC LINK IN STEVENS-JOHNSON SYNDROME.

OBJECTIVE: The aim: To determine a possible role of nitric oxide system as one of the pathogenesis links in Stevens-Johnson syndrome depending on the severity of disease progression. PATIENTS AND METHODS: Material and methods: We examined 11 patients with Stevens-Johnson syndrome. The function of nitric oxide system (NO - NOS) in blood serum was examined. RESULTS: Results: During the study of nitric oxide system (NO-NOS) in patients with SJS, it was observed that NO2¯ level was increased by 1.53 times, NO3¯ level - by 3.33 times, activity of total NOS - by 5.78 times, constitutive (cNOS) - by 1.81 times and inducible (iNOS) - by 13.36 times. CONCLUSION: Conclusions: The intensity of nitric oxide system function was studied in patients with Stevens-Johnson syndrome and dependence of changes of its parameters from the clinical signs of disease was detected. It was found that the determination of nitrite and nitrate anion levels in blood serum can be used for the purpose of predicting the disease course and choosing the therapy methods for the patients with SJS.

Combined differentiated therapy in patients with urticaria.

OBJECTIVE: Introduction: The necessity of the study of urticaria is called for by its high specific gravity in the structure of dermatoses, lack of effective therapies and, consequently, negative impact on the quality of life of patients and members of their families. Among the factors that initiate clinical manifestations of urticaria are autoimmune disorders, diseases of the gastrointestinal tract, nervous system, bacterial and viral infections, helminth infestation. However, the state of the internal secretion glands in such patients is understudied. Although, it is recognised that thyroid gland plays an important role in the development of allergic dermatitis, but its role in the formation of autoimmune processes at urticaria is still unclear. Such diversity of mechanisms of urticaria development considerably complicates the choice of rational ways of effective therapy. In particular, traditional agents (antihistamine and other hyposensitizing ones) often do not have the desired effect. Due to such complicated current condition of treatment of patients with urticaria, non-medicated methods of treatment seem to be getting more and more prospective. The aim:To develop differentiated treatment of urticaria patients, taking into account the functional state of the thyroid gland and its participation in the formation of autoimmune processes. PATIENTS AND METHODS: Materials and methods: We had been supervising 127 patients with chronic idiopathic urticaria (49 men and 78 women) of the age range from 15 to 67 years old with the disease duration from 5 months to 29 years. The control group consisted of 20 healthy individuals. The mild degree of severity of dermatosis was diagnosed in 43 (33.9%) patients, the average degree of the disease severity - in 41 (32.2%), and severe form of the disease was observed in 43 (33.9%) patients. The functional state of thyroid gland was evaluated by determining the level of thyroxine, triiodothyronine, thyroglobulin, and autoantibodies to thyroperoxidase and thyroglobulin in serum. RESULTS: Results: It was discovered that in patients with urticaria, dysfunctional state of thyroid gland is observed, which is manifested by a probable increase in thyroxine content up to 107.52±4.20 nmol/l (in healthy individuals - 78.13±3.65 nmol/l; p<0.05) and thyroglobulin - up to 29.73±2.51 ng/ml (in healthy individuals - 20.16±1.34 ng/ml; p<0.05), which is associated with a decrease in the level of triiodothyronine - up to 1.33±0.06 nmol/l (in healthy individuals - 1.52±0.04 nmol/l; p<0.05). In order to evaluate the effectiveness of this approach, all patients were divided into 4 groups. The first group, with the total amount of 32 patients were prescribed only traditional standard treatment, according to the guidelines. The pations of second group (31 patients) were prescribed specific phototherapy (once a week, 6-8 sessions) after traditional medication and afterward absence of clinical manifestations of pathological process. 31 рatients of the third group were prescribed balneo- and halotherapy after traditional medication and no afterward clinical manifestations of urticaria. The fourth group (33 patients) prescribed combined treatment in the way of combined application of specific therapy, phototherapy, balneotherapy and halotherapy, after the elimination of clinical manifestations of dermatosis by means of 2 month traditional medication. It was established that patients with mild dermatosis were exposed to a probable correction of the functional state of the thyroid gland, improved clinical course and quality of life after medication, balneo- and halomethods of treatment, patients with moderate and severe degree - after combined application of medication, specific photo-, balneoand halotherapy. CONCLUSION: Conclusions: Thus, the therapy of patients with urticaria requires a differentiated approach. Patients with mild dermatosis, after traditional medication, should be prescribed balneo- and halomethods of treatment. Patients with moderate to severe degree of the disease require more intensive medical intervention. They should be prescribed a combined application of specific photo-, balneo- and halotherapy. This approach allows eliminating the pathological process.

Pathogenetic peculiarities of neuroendocrine and metabolic disorders in patients with acne associated with chronic stress.

OBJECTIVE: Introduction: Acne is a chronic relapsing skin condition with multifactorial nature associated with disorders of sebaceous glands activity, psycho-emotional disorders and slow response to treatment. The aim: To study a pathogenic role of chronic stress and certain metabolic and neuroendocrine disorders in the development of acne in women depending on the duration of the disease. PATIENTS AND METHODS: Materials and methods: A total of 119 women with acne were examined. Index insulin resistance (іndex HOMA), serum cortisol and prolactin, level of Reactivity-Personal Anxiety and Dermatology Life Quality Index (DLQI) was determined. RESULTS: Results: Possible changes in serum cortisol level depending on duration of the disease (increased in women with duration of the disease less than 1 year and decreased in women with duration of the disease 1-5 years), increased index of serum prolactin and HOMA, with more significant changes in women with duration of the disease 1-5 years. The DLQI was determined in all examined patients. An increased level of anxiety, characterized by higher levels of personal anxiety, was also observed, especially in a group of women with duration of the disease 1-5 years. CONCLUSION: Conclusion: The changes in certain neuroendocrine and metabolic indices, which are the markers of chronic stress, worsening of life quality and significant levels of reactivity and personal anxiety, were observed in women with acne. A strong and moderate correlational relationship between the nature of changes in the abovementioned indices and duration of the disease was detected.

Superficial candidosis course in patients with carbohydrate metabolism disorder and diabetes mellitus.

OBJECTIVE: Introduction: One of the pressing issues of modern dermatology is the prevalence of diseases of skin and mucous membranes caused by yeast-like fungi. The aim: To study specific features of the course of skin and mucous membranes superficial candidosis against the background of initial carbohydrate metabolism disorders or diabetes mellitus. PATIENTS AND METHODS: Materials and methods: We have examined 93 patients aged 18-75 suffering from superficial candidosis. Candidosis was diagnosed based on anamnesis data, results of clinical tests and laboratory studies. The study of carbohydrate metabolism included determining of the glucose level under fasting conditions to establish possible diabetes mellitus and glucose tolerance test (75 g glucose load), glycosylated hemoglobin (HbA1c) and fructosamine (FR). RESULTS: Results: In patients with mild and moderate candidosis we have detected an increased rates of НbA1с and fructosamine, as compared with the like indicators received in the control group, by 1.54 and 1.21 times respectively. In patients with severe candidosis and relapses the concentrations of НbA1с increased by 2.59 times, FR - by 2.26 times against the indicators received in the control group. Thus, increased levels of blood glycosylated protein indicate the pathogenetic importance of these processes in the development of candidosis. CONCLUSION: Conclusions: Consequently, increased levels of blood glycosylated protein indicates the pathogenetic importance of these processes in the development of candidal lesions. Tests for НbA1с and FR proved to be sensitive and allow reliable detection of individuals with diabetes mellitus and glucose intolerance among candidosis patients.

Specific nature of changes in main immunohistochemical parameters of neoangiogenesis in patients with psoriasis.

OBJECTIVE: Introduction: Psoriasis is a skin disease that is accompanied by systemic inflammation and affects about 1 to 5% of the population worldwide. Taking into consideration the data of scientific investigation, at present psoriasis is explained as genetically determined chronic multi factor polysystemic dermatosis. The aim of our research was to determine morphological peculiarities of skin lesions in patients with common psoriasis, investigation of the levels of expression of immunohistochemical markers of vascularization, depending on psoriasis form and severity of the course of pathological processes. PATIENTS AND METHODS: Materials and methods: 93 patients with psoriasis aged from 24 to 58 were observed. The control group consisted of 34 practically healthy people of the same age. Skin biopsy with histological evaluation of biopsy materials was performed for all patients. RESULTS: Results: Analysis of the condition of vascular bed at different levels of severity of psoriasis course showed that a number of cells at moderate degree of severity (22.65±5.87) was considerably higher than at mild psoriasis (10.09±3.22), and even more numerous than in CG (4.32±2.01). We detected a moderate correlation connection between increased intensity of VEGF expression and amplification of the severity of psoriasis course (r = +0.430) and between increased intensity of MMP-9 marker expression and amplification of the severity of psoriasis course (r = +0.532). CONCLUSION: Conclusions: The results of conducted clinical, morphological and immunohistochemical investigations enable to consider importance of neoangiogenesis processes in pathogenesis of this dermatosis and need in elaboration of therapeutic measures with direct influence on this aspect of pathogenesis.

Values of the systemic immunity in patients suffering from acne with different clinical course.

OBJECTIVE: Introduction: Acne is chronic recurrent dermatosis, one of the essential skin inflammation in the structure of dermatological pathology, especially in young people of working age, often caused by persistent cicatricial changes in the skin, and affecting negatively the psychoemotional state of patients, their quality of life and working capacity. It has been established by today that the pathogenesis acne is complex and multifactorial, and the changes of immune reactivity of the organism play an important role in its clinical course development. The aim of the article is to determine and analyze the values of the systemic immunity in patients suffering from acne with different clinical course. PATIENTS AND METHODS: Materials and methods: 128 patients with acne aged from 18 to 35, among which 74 women (57,8 %) and 54 men (42,2 %) were observed. According to the clinical criteria, 26 patients (20,31%) were diagnosed with comedonal form of acne, 40 patients (31.25%) had papules, 10 people (7.81%) -papular-pustular acne, 29 of the observed (22.65%) had pustules, 9 patients (7.03%) suffered from acne conglobata, and 14 patients (10.94%) were diagnosed with post-acne. The control group consisted of 34 practically healthy people (donors) of the same age. RESULTS: Results: Consequently, most of the patients with acne had varying degrees of changes in rates of systemic immunity - the likely reduction in relative and absolute number of total lymphocytes, T-lymphocytes and their subpopulations against the growing number of B lymphocytes and the level of IgM and IgG, which generally indicates the formation in these patients secondary immunodeficiency state of T-link intensified by activation of humoral immunity in response to the development of skin inflammation. The most significant changes in rates of systemic immunity with the depletion of T-cell immunity were found in patients with papular-pustular and pustular acne, and still more significant - in patients with acne conglobate, which justifies differentiated treatment by immunomotropic drugs for these patients. CONCLUSION: Conclusion: In patients with acne, changes in systemic immunity indexes that indicate the formation of secondary immunodeficiency state T-cell link, amid an adequate humoral immunity have been found. Relationship between the causes of changes of systemic immunity has been established.

Modern specific features and therapy of psoriasis and arthropathic psoriasis courses.

OBJECTIVE: Introduction:Psoriasis affects about 2% of population. In 30-40% of occurrences arthropathic psoriasis (AP) is diagnosed and it leads to 11-19% of disability cases development. Recent studies have shown that psoriasis is often synergistically combined with herpesvirus of the 1st and 2nd type, which, according to many scientists, determines the severity, frequency of recurrences, and the course of this dermatosis. Recently, new biomarkers, i.e. a system of small ribonucleic microRNA acids, have been described. Their role and interconnection in respect of regulation of congenital and acquired immunity activity in patients with herpesvirus infection at psoriasis has been defined. The article analyses features of anamnesis, clinical, instrumental and laboratory tests related to arthropathic psoriasis, considers the relationship of probable mechanisms of disease aggravation and progression with the definition of a treatment method influencing the dynamics of a disease course. The aim of our work was to improve the diagnostics of AP patients taking into account some indicators of the immune-endocrine system and features of the disease course to specify their role in AP pathogenesis and to develop the system of integrated therapy of patients whose locomotor system is affected due to psoriasis. PATIENTS AND METHODS: Materials and methods: A total of 178 AP patients have been systematically examined. We have examined AP patients with varying severity of process development, generalization and the severity of skin and osseous-articular apparatus damage, the presence of associated pathology. Additional instrumental studies, determination of biochemical, serological parameters and an assessment of stress-induced immune-endocrine system have been conducted in AP patients. The content of trigger cytokines (IL-1ß, IL-8, IL-17, IL-22) in blood serum, stress hormones (ACTH, cortisol), cellular and humoral immunity condition (CD3 +, CD4 +, CD8 +, CD16 +, CD22 +, IgM and IgG levels) have been studied. RESULTS: Results: The clinical course and characteristic features of AP instrumental tests are extremely versatile as well as the depth of their present study is insufficient. Regardless of the disease duration period, we have detected in blood serum of AP patients probable changes in concentrations of stress-response mediators (decreased parameters of cellular immunity (CD3+, CD4+, CD8+ of T-lymphocytes, CD22+ fraction of B-lymphocytes and compensatory increased CD16+ of T-cells, cytokines - IL-1ß, IL-8, IL- 17, IL-22, stress hormones - cortisol, immunoglobulins IgM, IgG, and CIC), which indicate tension of their stress-induced mechanisms even despite occasional clinical stabilization of skin and articular process. We have offered and tested regiments to treat AP patients, which involve differential application within the integrated therapy of nonsteroidal anti-inflammatory medications (Arcoxia 30-60 mg 1 time daily / Naklofen Duo 75 mg daily), disease-modifying medications (Sulfasalazine ЕН from 500 mg to 2 g daily / Methotrexate 7.5-10 mg/week), lyophilised dialysate of leukocytes. CONCLUSION: Conclusions: The analysis of specific features of the AP clinical course and data of integrated studies allows identifying the probability of manifestation or persistence of the pathological psoriatic articular process. The improvement of AP patients diagnostics taking into account some indicators of the immune-endocrine system and specifics of the disease course contributed to the improved therapy and mended quality of life of patients.