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A 43-year-old female zoologist has an occupational dermatomycosis of the face, neck and upper part of chest caused by T. mentagrophytes. It was mistakenly diagnosed and treated as "Rosacea, papulopustular subtype, ocular rosacea" for 1.5 years. Symmetrical, atypical clinical manifestations with recurrent blepharoconjunctivitis developed as a result of self-treatment using a topical steroid. The detection of cicatrizing folliculitis in the eyebrow area and an arcual peripheral edge in fresh foci on the chest helped to suspect dermatomycosis. The definitive diagnosis was made after the detection of abundant coarse septate mycelium during microscopic investigation of skin scales from foci on the face and chest with 30% KOH and an abundant growth of Trichophyton mentagrophytes during a cultural research study of skin scales, eyebrow hair and eyelashes from lesions. The use of terbinafine for 4 weeks led to the recovery of the patient.

Currently there are a large number of psoriasis classifications, slightly different from each other, used worldwide. Some of these classifications contain the disease forms allocated descriptively, without the pathogenesis characteristics in their basis. Among the dermatologists, there is lack of common understanding of various psoriasis forms peculiarities. And that affects both the diagnostic process and the approaches to therapy. The authors propose a revised unified clinical classification of psoriasis, including psoriatic arthritis. This method reflects the up-to-date view on the classification of psoriasis in Russia and globally.

Tumor necrosis factor alpha (TNF-α) is one of the key inflammatory cytokines in the pathogenesis of psoriasis and psoriatic arthritis, and its inhibition with genetically engineered biological drugs ensures control of the main symptoms of these diseases. Certolizumab pegol is a PEGylated (linked to polyethylene glycol) Fab’ fragment of a monoclonal antibody that inhibits human TNF-α. It is approved for treatment of moderate to severe plaque psoriasis and psoriatic arthritis. This review summarizes the results of randomized clinical trials of efficacy and safety of certolizumab pegol in plaque psoriasis (CIMPASI 1, CIMPASI 2, and CIMPACT) and psoriatic arthritis (Rapid-PsA). The represented data demonstrate high efficacy of certolizumab pegol is bio-naïve patients and in patients previously exposed to other TNF inhibitors or IL17 inhibitors. The absence of the Fc-fragment in certolizumab pegol ensures minimal to no placental transfer of the drug and enables its usage during the entire pregnancy.Conflict of interest: the authors state that there is no potential conflict of interest requiring disclosure in this article.

We describe three patients with a rare form rosacea-like chronic lupus erythematosus which at the beginning is diagnosed as rosacea due to similarity clinical picture. Literature data of clinical features, epidemiology, сlassification and treatment are presented.Conflict of interest: the authors state that there is no potential conflict of interest requiring disclosure in this article.

Netakimab, the original monoclonal antibody against IL-17A, is an innovative drug for the treatment of moderate-to-severe plaque psoriasis in patients who have indications for systemic therapy or phototherapy. Netakimab was approved in Russian Federation, registration certificate number ЛП-005439 from 04.04.2019. This article outlines the first 12-week results of a phase III clinical trial in patients with psoriasis.Materials and methods. The BCD-085-7 study (PLANETA) is a comparative, randomized, double-blind, placebo-controlled phase 3 clinical study of the efficacy and safety of netakimab in patients with moderate-to-severe plaque psoriasis. This review presents the results of the first 12 weeks. The study is ongoing at the moment, the total duration of treatment for each patient is 3 years (154 weeks). Patients were randomized in a ratio of 2:2:1 into one of three arms: group 1 received netakimab subcutaneously at a dose of 120 mg once a week for the first three weeks (induction) and then once every 2 weeks up to week 10, group 2 received netakimab subcutaneously at a dose of 120 mg once a week for the first three weeks (induction) and then once every 4 weeks up to week 10, group 3 received a placebo subcutaneously on day 1 at weeks 0, 1, 2, 4, 6, 8 10. In order to maintain a double-blind design, placebo was administered to patients in group 2 at weeks 4 and 8.Results. Both netakimab groups showed a significant superiority over placebo (p < 0.001) and the absence of statistically significant differences between the two regimens of therapy (p > 0.05) across all endpoints. PASI 75 at week 12 was reached by 77.65 % of patients using netakimab once every 2 weeks and 83.33 % of patients using netakimab once every 4 weeks (ITT population). The rate of clear and almost clear skin (sPGA 0–1) was reached by 81.18 and 79.76 % of patients using netakimab once every 2 weeks and once every 4 weeks, respectively. The safety assessment showed no statistically significant differences between the groups, the incidence rate of adverse events in netakimab arms was not higher than in the placebo arm. There were no cases of early withdrawal due to adverse events and cases of grade 4 toxicity according to CTCAE 4.03. During the 12 weeks of the study, one serious adverse event was registered in group 2 (pneumonia grade 3), which was recovered without any consequences. The immunogenicity assessment showed binding antibodies formation at week 12 in one patient who received BCD-085 every 2 weeks. Neutralizing antibodies were not detected. Conclusion. Netakimab showed high efficacy in the treatment of psoriasis, more than 80 % of patients achieved PASI 75 and sPGA 0–1 (clear and almost clear skin) by the week 12 of treatment. The drug showed a favorable safety profile and low immunogenicity. Based on the study results the regimen once a week during the first 3 weeks (induction), then once every 4 weeks was chosen for medical use in patients with psoriasis.

This article is about the case of actinic reticuloid — the rare dermatosis which clinical presentation is similar to atopic dermatitis, T-cell lymphoma. Good treatment effect was obtained by long cycles (2 cycles for 3 months) of hydroxychloroquine and sun protective therapy included sunscreens SPF 50, nicotinic acid, sun-safe clothes which blocked ultraviolet radiation without any glucocorticosteroid drugs and cytostatic treatment.

An extremely rare case of sinus histiocytosis of the non-Langerhans cell histiocytoses type is described in 55-year-old patient with isolated localization of cutanious lesion on the right cheek without involvement of nodular structures. Main skin lesion was an erythematous-cyanotic node with multiple milia-like lesions on the top of it. Histologically revealed feature was a large number of plasma cells, besides phenomenon of emperipolesis was described, which was first falsely perceived by pathologists as phagocytosis. In immu-nohistochemistry assay the changes were characterized by proliferation of large polygonal histiocytes with accumulation of pentalamellar markers in its cytoplasm (protein S-100, CD68).

A case of belatedly diagnosed late cardiovascular syphilis that had continued progressing despite two courses of ceftriaxone therapy is described. The patient had a combination of all possible complications of syphilitic mesaortitis including aortic regurgitation, coronary insufficiency, as well as fusiform aneurysm of the ascending aorta and the proximal aortic arch. Current issues of diagnosis and therapy of late cardiovascular syphilis are discussed.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that mainly affects the sites of the apocrine glands; HS is characterised by relapsing painful knots and abscesses, leading to the formation of fistulas and scarring. Modern ideas about the pathogenesis of HS allow us to consider it as a kind of inverse acne, since the mechanism of development of HS and inverse acne does not differ. Detailed studies of patients with HS in recent years have provided the basis for several authors to suggest that HS is a systemic, chronic, immune-mediated progressive disease. The key role of the proinflammatory cytokine tumor necrosis factor Į (TNF-Į) in the development of the inflammatory process during HS was determined. Elevated TNF-Į levels are found in the blood and HS lesions, having a positive correlation of the TNF-Į level with the severity of the disease. At the present time, the treatment with a TNF-Į blocker, adalimumab (the only one genetically engineered biological preparation approved for treatment of HS/inverse acne in the world and in Russia), is recommended as a first-line therapy in the absence of an adequate response to standard systemic therapy in the case of active HS of moderate or utmost severity. The presented clinical case confirms the fact that for HS patients it is very important to determine the correct diagnosis as quickly as possible and to prescribe the appropriate treatment according to the developed recommendations. Erroneous diagnoses, inadequate therapy (surgical treatment, short courses of antibiotics, etc.) contribute to the progression of the disease, to the appearance of common symptoms due to the attachment of secondary infection and increase in general intoxication, to limited working capacity, to the emergence of persistent and gross scars, as well as to the deformations of affected skin. Our clinical case of adalimumab (Humira) treatment of a patient with an extremely severe HS form demonstrated that the application of this medication can be effective and well tolerated.

А clinical case of a rare form of pustular psoriasis, known as “acrodermatitis continua suppurativa Hallopeau” is described. The involvement of the distal phalanges of the fingers and toes in combination with localized psoriasis vulgaris is observed. Specific features of this case are the presence of two different forms of the disease and comorbidities, that limits treatment options. The article provides current data on the clinical features and management of acrodermamtitis continua suppurativa Hallopeau. An acceptable personalized treatment with systemic retinoids and topical substances containing betamethasone dipropionate and calcipotriol has been proposed.

The tertiary cutaneous syphilis has become extremely rare as a result of the effective treatment of early syphilis with penicillin and occasional antibiotic therapy for concomitant infections. We report a case of tertiary gummatous syphilis associated with asymptomatic neurosyphilis that was initially misdiagnosed as basal cell carcinoma of the skin. A 67-year-old woman presented with the 18-month history of multiple, firm, bluish-red asymptomatic nodes on the parietal scalp, chin and lateral part of the trunk that had developed without preceding trauma. One node on the trunk had small central ulceration covered with dry yellowish crust. On the left retroauricular area the brownish-purple atrophic scar was observed. Blood tests revealed reactive VDRL, ELISA and TPHA assays. Skin biopsy has showed endarteritis with endothelial swelling and caseating granulomas along with plasmocytic infiltrate in the dermis and subcutaneous tissue. Increased lymphocyte count and the positive VDRL test with cerebrospinal fluid have confirmed the diagnosis of asymptomatic syphilitic meningitis in this patient. The treatment with aqueous penicillin intravenously has lead to resolution of the skin infiltrates and progressive more than 4-fold reduction of follow-up serum VDRL titers. This case is reported as a reminder of the possibility of tertiary syphilis with misleading clinical patterns in patients infected during the epidemics of 1995-2000. We would like to emphasize the necessity to perform timely serological and pathomorphological study to prevent misdiagnosis and mistreatment.

The aim of the study was to determine the level of cytokines in the serum of patients with psoriatic arthritis (PsA) and psoriasis vulgaris (Ps) and to identify key immune markers associated with clinical manifestations of psoriasis. Materials and methods. The study involved 52 patients with psoriatic arthritis (PsA) and 20 patients with psoriasis vulgaris (PS) by multiplex analysis of proteins using Bio-Plex device and commercial test kits 23-Plex and 27-Plex, 8-Plex. Assessment of the severity and prevalence of psoriatic skin lesions in patients was conducted by index PASI (Psoriasis Area and Severity Index). Indicators of acute-phase activity (ESR, CRP), CEC were defined in all patients. the comparison group consisted of patients with a diagnosis of patchy scleroderma (10 patients) and patients with atopic dermatitis (10 patients). 13 healthy individuals were examined as a control group. Main results. Significant elevation of cytokines: IL-2, IL-6, GM-CSF, IFN-y and TNF-a was found in the serum of patients with PS compared with the group of apparently healthy individuals, and GM-CSF, IFN-y compared with patients with atopic dermatitis. It was determined that the detected levels of Il-В in serum has a direct correlation with the prevalence and severity of PS. Inverse correlation between ESR and the level of IL-8, GM-CSF and the CEC, IFN-y and the CEC and the direct correlation between the level of TNF-a and CRP in serum were shown. Conclusion. The obtained data indicate shifts in the system of pro-inflammatory and anti-inflammatory cytokines in psoriasis, which can be considered as a manifestation of endogenous homeostatic mechanisms designed to limit the intensity of the inflammatory process. Immune markers associated with clinical manifestations of psoriasis, in particular, the prevalence and severity of PS (index PASI), indicators of acute-phase activity (ESR, CRP), were identified.

The data are given about the history of the invention and development of antimicrobial therapy in the XX-th and the beginning of the XXI-th centuries. There are presented data on the pharmacological effects of antibacterial agents from different groups that are used for the treatment of patients with pyodermatosis, dose schedules, pharmacokinetics, adverse effects, contraindications, and medicine interactions. The main causes leading to the formation of resistant microorganism strains are pointed. Advances of broad-spectrum antibacterial antibiotics for treatment the pyodermic patients are demonstrated on the example of amoxicillin+clavulinic acid, josamycin and doxycycline monohydrate. The arguments justifying the need to refuse empiric administration of antibacterial therapy are presented. To select a rational causal initial therapy of patients with pyoderma it is necessary to use the results of microbiological study of etiology and pathogenic microflora sensitivity to antimicrobial preparations.

A review article presents theoretical basics of the development of innovative STI prevention programs for high-risk groups Urgent need for integrated multidisciplinary preventive strategies aimed at correcting risky behaviors and adapted for the particular vulnerable populations is justified.

A review article is addressed the issue of the diagnosis and treatment of neurosyphilis that is developing against the background of HIV-infection. HIV-infected patients are at higher risk of neurologic, ocular and auricular manifestation of syphilis as well as treatment failures and relapses. Diagnosis of neurosyphilis in HIV-positive patients is complicated because both infections cause similar changes in the cerebrospinal fluid (CSF). The effectiveness of neurosyphilis treatment in patients with HIV co-infection is difficult to estimate, since the normalization of their CSF goes slower comparing to HIV-negatives. The increase in incidence of syphilis and HIV co-infection is anticipated in the coming years. This necessitates a comprehensive study of the problem and requires the development of new approaches to neurosyphilis diagnosis and treatment in co-infected patients.

This article is about the case of actinic reticuloid - the rare dermatosis which clinical presentation is similar to atopic dermatitis, T-cell lymphoma. Good treatment effect was obtained by long cycles (2 cycles for 3 months) of hydroxychloroquine and sun protective therapy included sunscreens SPF 50, nicotinic acid, sun-safe clothes which blocked ultraviolet radiation without any glucocorticosteroid drugs and cytostatic treatment.

The paper contains review of studies on microbiota and cutaneous microbiome using modern techniques of methagenomic analysis. The existing data on microflora of normal skin and among the patients with acne, seborrhoeic dermatitis, rosacea atopic dermatitis are consequently analyzed. The interaction between microbiome and innate/adaptive immunity is presented The perspectives of knowledge on microbiome both in dermatology and cosmetology are pointed out.

The authors describe a clinical observation of a case with 15 years remission between the first relapse and to the second relapse of pemphigus vulgaris. The review of clinical features and treatment methods, is also present.

The introduction of penicillin has been a breakthrough in the treatment of syphilis. For 70 years, penicillin remains the preferred drug for the treatment of all forms of the disease; its effectiveness has been proven by wide experience gained from clinical observations. However, a very limited number of published meta-analyzes, systematic reviews and data from randomized controlled trials on the comparative assessment of the effectiveness of various antibiotics and treatment regimens are currently available. Some aspects of syphilis treatment are insufficiently developed, particularly, the treatment schedules for neurosyphilis, syphilis in pregnancy, syphilis in HIV-infected individuals and persons allergic to penicillin. There are disagreements in the assessment of the clinical significance of serofast state after a course of antibiotic therapy. There is no uniform approach to the management of patients with treatment failures. This article compares the Russian standards for syphilis treatment set out in the «Federal guidelines for the management of patients with syphilis» with the current European recommendations of the International Union against Sexually Transmitted Infections (IUSTI) and the recommendations of the US Centers for Disease Control and Prevention (CDC). The peculiarities of these guidelines, their strengths and shortcomings, as well as controversial issues of syphilis therapy are discussed. The differences between the domestic and foreign recommendations are more significant in the section concerning the treatment of syphilis than in the section of diagnosis.

A review article highlights the practical issues of design, implementation and effectiveness estimation of STI prevention programs aimed to correct the behavior leading to infection. the importance of epidemiological modeling method for the organization of preventive interventions is discussed. the prospects of the multidisciplinary behavioral approach to STI prevention are demonstrated.

Results of sampling epidemiological investigation of patients with dermatologic diseases, which sought treatment in the specialized Russian outpatient facilities over two-month period, and assessments of approaches to treatment of patients with atopic dermatitis, psoriasis and eczema are presented. Data of 2991 individual registration cards, which were filled out by the dermatovenerologists providing primary specialized care to patients in outpatient facilities of Perm, Samara and St. Petersburg, was analyzed. It was observed that women were prevalent among patients with dermatoses, and most of women and men were of working age (82.2 and 89.2% corresponding). The nosological structure of appealability consists of 25.6% patients with dermatose, psoriasis (14.5%), eczema (13.4%), seborrhea and acne (8.6%), atopic dermatitis (5.8%), and pyodermatitis (3.2%). Using standardized indexes for assessment it was discovered that among applied outpatients 80% persons, presented with atopic dermatitis, and 50% persons, presented with psoriasis, had moderate and severe appearances of dermatoses. In therapy of patients with atopic dermatitis, psoriasis and eczema, specialists used widely standard system treatment - topic glucocorticosteroid agents for external care.

Case study of the patient with a follicular lichen planus long-flowing form was presented. In the process of its evolution there formed a focal atrophy of the smooth skin. This atypical form clinical features data is provided.

Atopic dermatitis (AD) is a common skin condition treated by dermatologists all over the world. Guidelines for management and treatment of AD have appeared in Europe, USA and Russia recently. the paper contains comparison of European, American and Russian guidelines. Definition of AD, epidemiology, pathophysiology of the disease, clinical features, diagnostic criteria, and risk factors are consistently matched. the analysis demonstrated that guidelines do not contain serious contradictions and principal differences thus stressing their supplementation of each other.

Despite the abundance of existing laboratory methods the diagnosis of syphilis still faces many challenges. Though direct detection of T. pallidum plays an important role in early manifest forms of the disease, serological tests remain the mainstay of diagnosis. Traditional syphilis screening algorithm based on nontreponemal tests with subsequent confirmation using treponemal tests is a standard worldwide. Recently, the ability to automate the treponemal tests promotes the increasingly widespread implementation of reverse algorithm when these tests are used for syphilis screening. None of the current serological algorithms are able to reliably differentiate between active and previously treated syphilis, which causes uncertainty in the management of patients. There is no «gold standard» for the diagnosis of neurosyphilis, ocular, auricular and visceral syphilis. The interpretation of serological tests in children born to seropositive mothers is also complicated. Diagnosis of congenital syphilis in newborns and, consequently, the prescription of antibiotic therapy often depends on assessment of the adequacy of maternal treatment during pregnancy, which leads to subjective decisions. This article provides a comparative analysis of the «Federal guidelines for the management of patients with syphilis» and their foreign analogues, discusses significant peculiarities of these guidelines and reviews current concerns and controversies in syphilis diagnosis.

The history of the Department of Dermatovenereology of the First St. Petersburg State Medical University from its foundation in 1901 till 1956 is traced in the article. These years of formation and development of the Department were associated with the activities of the outstanding dermatologists such as T.P. Pavlov, S.Ya. Kulnev, A.A. Sakhnovskaya, O.N. Podvysotskaya.

The authors describe a rare clinical observation of the cutaneous manifistation of Lyme Borreliosis: primary borrelial lymphocytoma and surrounding secondary erythema chronicum migrans. The review of clinical features, histology, is also present.

The authors describe the clinical observation of a case of the aggressive systemic mastocytosis with skin involvement, the type of generalized urticaria pigmentosa. They also present literature data concerning the etiology, pathogenesis, diagnosis and treatment of dermatosis.

The article explores the history of the Department of Dermatovenereology of the First St. Petersburg State Medical University from 1956 till present time. During this period the invaluable contribution to the development of the Department was made by eminent clinicians and scientists A. N. Aravijsky and I. M. Raznatovsky. Over the past 20 years, the department has been successfully developed under the leadership of professor Evgeny Vladislavovich Sokolovskiy.