The objective: on the basis of a comprehensive examination of women of reproductive age to establish the frequency of phenotypes (clinical variants) of polycystic ovary syndrome (PCOS).Materials and methods. 34 patients (main group) who complained of menstrual disorders and/or dermatopathies by recommendation of a dermatologist were examined. The control group is represented by 30 women without gynecological and somatic pathology. The mean age of women in the main group was 26,4±0,9 years and 29,1±0,9 years in the control group (p>0,05). The age of women in the study groups ranged from 18 to 35 years. Patients underwent a comprehensive examination to assess the severity of hirsutism and the severity of acne, as well as the body mass index was determined. All women underwent ultrasound examination in the dynamics and quantitative assessment of the concentration of hormones in the blood plasma, namely cortisol, thyroid-stimulating hormone, prolactin, free testosterone and its index, androstenedione, dehydroepiandrosterone sulfate, 17-α-OH-progesterone, sex hormone binding globulin. Variation-statistical processing of the results was carried out using the program «STATISTICA 13».Results. The results of the conducted research show that 73,5% had menstrual irregularities, and 52,9% – infertility. Acne and hirsutism in every 3rd woman were combined and were diagnosed in 47,1% and 41,2% of women, respectively. Ultrasound signs of polycystic ovaries were found in 94,1% of patients according to the criteria for the diagnosis of PCOS, and in 88,2% – anovulation. According to the laboratory examination, hyperadrogenism was found in 55,9%, which is confirmed by statistically significant (p<0,05) predominance in the main group compared with the control group of androstenedione, free testosterone and its index. In addition, it should be noted statistically significant (p<0,05) higher levels of 17-α-OH-progesterone and prolactin in the main group, but their indicators were within the reference values of the norm. Analyzing the frequency of phenotypes (clinical variants) of PCOS, it was found that phenotype A (classical) occurred in 32,4%. Phenotype B (incomplete classical) was diagnosed in 14,7%, and phenotype C (ovulatory) – only 8,8%. The most often, namely in 15 (44,1%) women with PCOS, the phenotype D (non-androgenic) was established.Conclusions. The results of the conducted research show that in women with PCOS clinical symptoms are characterized by menstrual dysfunction (73,5%), infertility (52,9%) and dermatopathies, namely acne (47,1%) and hirsutism (41,2%). According to the laboratory exanination, hyperadrogenism was found in 55,9%, which is confirmed by statistically significant (p<0,05) predominance in the main group compared with the control group of androstenedione, free testosterone and its index. Among the clinical variants of PCOS, the non-androgenic phenotype (phenotype D) was the most often diagnosed, the frequency of it was 44,1%. Classical (phenotype A) and incomplete classical (phenotype B) were found in 32,4% and 14,7%, respectively. It should be noted that only 8,8% of women with PCOS are diagnosed with phenotype C (ovulatory).

Мета роботи -проаналізувати можливість розвитку та описати клінічний випадок верукозної лейкоплакії червоної облямівки губ на тлі використання системи нагрівання тютюну IQOS і стіків HEETS; запропонувати персоніфікований клініко-діагностичний і терапевтичний алгоритм ведення пацієнта.Матеріали та методи. Описали власне спостереження клінічного випадку хворої на верукозну лейкоплакію червоної облямівки нижньої губи, що розвинулася на тлі куріння з використанням системи нагрівання тютюну IQOS і стіків HEETS. Клінічне, лабораторне, інструментальне обстеження та лікування виконали на базі кафедри дерматовенерології та косметології з курсом дерматовенерології і естетичної медицини факультету післядипломної освіти Запорізького державного медичного університету.Результати. На підставі клінічного обстеження пацієнта та верифікації діагнозу за допомогою лабораторного дослідження, дерматоскопії встановили діагноз верукозної лейкоплакії червоної облямівки нижньої губи, бляшкового типу. Враховуючи можливу травматизацію, високу ймовірність рецидиву захворювання, відмову пацієнтки від хірургічних методів лікування, призначили топічну терапію вогнища ураження з використанням комбінованого препарату, який містить глюкокортикостероїдний, антибактеріальний та антимікотичний компоненти, протягом 1 місяця з наступною тривалою терапією 1 % кремом пімекролімусу.Висновки. За даними фахової літератури, система нагрівання тютюну IQOS і стіки HEETS можуть спричиняти розвиток таких проявів окисного стресу й ендотеліальної дисфункції, як запалення, інфекція, фіброз, онкологічна патологія, а також стати одним із факторів виникнення лейкоплакії червоної облямівки губ. Застосування топічних глюкокортикостероїдів у поєднанні з топічними інгібіторами кальціневрину може бути альтернативою хірургічним методам терапії лейкоплакії.

The article summarizes the data of the scientific publications about the management of patients with androgen-dependent dermatopathies, namely acne, taking into account the current view on the pathogenesis, clinical manifestations and results of the examinations of this group of women. Androgen-dependent dermatopathies are not only a medical problem but also a socio-economic one, as they lead to impaired socialization and reduced quality of life. Acne is one of the most common dermatoses. Acne is a chronic multifactorial disease of the pilosebation complex, which is clinically manifested by polymorphic rash in the form of open and closed comedones, papules, pustules, nodules. The pathogenesis of the disease is based on four main links: changes in the quantitative and qualitative composition of sebum due to hypersecretion of androgens and/or increased sensitivity of receptors to their action, impaired follicular keratinization, inflammation and changes in skin microbiome. Besides the main pathogenetic aspects, trigger factors are taken into account, such as nutrition, stress, smoking, mechanical agents. The current treatment of acne according to dermatological protocols is presented in the article, which is based on a combination of topical therapy with local retinoids and antibiotics, benzoyl peroxide, azelaic acid, in case of severe or ineffective local therapy systemic antibiotics and systemic retinoids are used. However, despite the presence of many treatment regimens for dermatosis, it is often not possible to achieve a lasting effect of treatment, and the adherence of patients to follow the doctor’s recommendations decreases. Given that the leading role in the pathogenesis of acne is due to hyperandrogenic effects on the skin, as well as the fact that the disease reduces the quality of life and self-esteem in patients, it is necessary to involve a wider range of specialists, such as dermatologists, gynecologists, endocrinologists and psychotherapists for successful treatment and prevention of persistent aesthetic skin defects.

The article presents data from guidelines, consensus and literature sources on the modern point of view regarding to the pathogenesis, diagnosis and principles of treatment of women with polycystic ovary syndrome. It is a systemic pathology that occurs in women of any age, from puberty to menopause, involving almost all systems of the body in the process. The work focuses on the variability of the clinical manifestations of this syndrome, which is characterized by menstrual irregularities, infertility, polycystic changes in the ovaries according to ultrasound, dermatopathies and metabolic disorders. The main purpose of diagnosing the syndrome is to determine the severity of clinical manifestations, the sources and pathogenesis of androgen hyperproduction, the impact on reproductive function, as well as the assessment of metabolic and cardiovascular risks. Given the multifaceted clinical manifestations, the management of women with polycystic ovary syndrome requires a multidisciplinary approach, and pathogenetic therapy should include normalization of the hormonal profile and menstrual function, treatment of dermatopathies, correction of metabolic disorders, treatment of infertility (if pregnancy is relevant), etc.

Тhe diagnosis of polycystic ovary syndrome (PCOS) in adolescence still raises many questions. The problem is that the characteristics of normal puberty often coincide with the symptoms of PCOS. The article presents the criteria of a normal menstrual cycle, clinical and laboratory hyperandrogenism. In the diagnosis of the latter, the most informative indicators are the determination of the index of free testosterone and androstenedione, and the assessment of free and total testosterone are relatively low sensitivity. Clinical hyperandrogenism in adolescents includes only severe acne and hirsutism. The level of antimullerian hormone has no independent significance. Irregular menstrual cycles during the first year after menarche represent a normal period of puberty. At the second and third year after menarche , menstrual cycles of less than 21 days and more than 45 days are considered irregular, and from the fourth year – less than 21 days and more than 35 days. From the second year after menarche, menstrual irregularities are considered to be more than 90 days for any cycle. Primary amenorrhea is indicated by the absence of menarche at 15 years, or 3 years after telarche. Ultrasound is not used as a criterion for PCOS in the first 8 years after menarche due to the high frequency of ovarian multifollicularity in adolescence. Therefore, adolescent girls in the presence of menstrual disorders and hyperandrogenism may be diagnosed with «PCOS. Phenotype B» (ultrasound signs are not taken into account). Adolescents who have signs of PCOS but do not meet the diagnostic criteria are at risk for PCOS. The most important stage of PCOS therapy is lifestyle modification, normalization of body weight and metabolic processes. Combined oral contraceptives in adolescents are more often prescribed not for direct purposes (contraception), but as off-label therapy not only at diagnosis, but also in the «risk group», which involves the treatment of irregular menstrual cycles and / or clinical hyperandrogenism. In the absence of the effect of lifestyle changes, proper nutrition to correct metabolic disorders in addition to combined oral contraceptives may be prescribed metformin, inositol and etc.