Purpose.Development and validation of the severity index of lichen planus (LP). Materials and methods.At the first stage, by means of theoretical substantiation, the main parameters and signs were identified that affect the severity of the disease and the quality of life of patients, which culminated in the derivation of the final index formula, which was called the lichen area and severity index (LPASI). At the second stage, LPASI was validated during the examination of 45 LP patients who were treated in the clinic of skin and venereal diseases of the Military Medical Academy in 20182019. Determination of LPASI was carried out by five dermatovenerologists independently of each other twice with an interval of one week. The analysis of the results was carried out using STATISTICA 10.0 programs and SPSS Statistics 17.0. The Spearman Brown and Pearson correlation coefficients were used to evaluate the intra-expert and inter-expert reliability of the index, and the Cronbach's alpha coefficient was calculated to assess the internal consistency of the scale. Results.The final formula for calculating LPASI is as follows: 0.2A+2B+5С+D, where A is the area of skin lesions in percentage, B is the severity of clinical manifestations on the skin, C is the severity of clinical manifestations on the oral mucosa and D is the severity of subjective sensations. The index can range from 0 to 82. The LPASI values for the whole group (n=45) were characterized by a normal distribution of the trait (p0.05), the minimum and maximum values varied from 7.2 to 42 points, the median was 22 points, the interquartile span from 14 to 27 points. The values of the Spearman Brown and Pearson coefficients were equal to 0.91 (95% CI 0.890.99) and 0,87 (95% CI 0.860.93), which indicates the reproducibility of the results and the reliability of the index. In this case, a high consistency between the selected features within the scale (Cronbach's alpha criterion 0.93) was established. Conclusion.Objectification of the severity of the disease using LPASI should become an integral part of the clinical examination of patients. The use of LPASI will allow to control the effectiveness of prescribed therapy, as well as to compare the results of scientific research.

AIM: to assess the diagnostic accuracy of the main dermatoscopic signs and algorithms used to diagnose skin melanoma. MATERIALS AND METHODS: To assess the diagnostic effectiveness of the performed dermatoscopy in detecting skin melanoma, the main dermatoscopic signs that occur in this disease were identified: atypical pigment network, atypical globules, asymmetry of pigmentation and structure, asymmetric stripes, asymmetric zones of hyperpigmentation (spots), blue-white (white-blue) veil, graininess, scar-like foci of depigmentation, white shiny stripes, negative pigment network. The study was carried out based on the analysis of 34 archival dermatoscopic images of melanocytic skin lesions with a morphologically verified diagnosis (11 melanomas and 23 melanocytic nevi). In addition, a comparison was made of the indicators of the diagnostic efficiency of two main dermatoscopic algorithms used in the diagnosis of skin melanoma: the algorithm by 3 signs and by 7 signs. For this, 186 archived dermatoscopic images of melanocytic skin lesions were analyzed. All patients included in the study were examined and treated at the clinic for skin and venereal diseases in the period from 2015 to 2019. The study was carried out using a HEINE DELTA 20 Plus dermatoscope in immersion mode and in cross-polarization. RESULTS: The following dermatoscopic features had the highest diagnostic efficiency for the diagnosis of skin melanoma: blue-white veil (86.8%), asymmetry of pigmentation and structure (82.6%), and white shiny stripes (72.8%). The diagnostic efficiency of the 3 signs algorithm was 93.0%, the 7 signs algorithm 90.5%. CONCLUSION: Diagnostic algorithms for confirming melanoma can be successfully used by both general practitioners and medical specialists (dermatologists, oncologists). In this case, it is preferable to use the three signs algorithm at the initial admission of patients as a screening option, and the seven-signs algorithm by experienced specialists in the field of dermatoscopy to confirm the diagnosis (4 figures, 3 tables, bibliography: 11 refs).

Background. Focal infection (FI) are important trigger factors for the development of psoriasis, which means they can aggravate the course of dermatosis, including due to an increase in certain pro-inflammatory cytokines in the blood. Aim. To study the cytokine profile of patients with psoriasis in the progressive period of the disease, as well as to assess the effect radical treatment of focal infection on the course of dermatosis. Material and methods. Prospective comparative non-randomized study included 52 patients with psoriasis vulgaris, aged 18 to 65 years, who signed a informed consent. The first group consisted of patients who underwent radical treatment FI (16 people), the second those who did not treat FI (16 people), and the third group consisted of patients in whom FI was not detected (20 people). Cytokine concentrations were measured in the progressive stage of the disease in 52 patients with psoriasis and 20 individuals in the control group (healthy individuals).The spectrum of detected cytokines included: IL-1, IL-2, IL-4, IL-6, IL-8, IL-10, IL-17A, as well as INF- and INF-. For the detection of all cytokines, except for IL-17A, reagents from Vector-Best, Russia were used. The Human ELISA MAX Deluxe Set (BioLegend, USA) was used to determine the concentration of IL-17A. During the main course of treatment (0, 2 and 4 weeks), as well as the follow-up of patients (12, 24 and 52 weeks), the severity of psoriasis was assessed with the calculation of the PASI index. At the end of the study (week 52), the number of relapses and the total duration of remission were recorded. Results. The level of IL-8 was increased in 90,6% of psoriasis patients with FI. In this case, significant differences were obtained in comparison with the group of patients with psoriasis without diagnosed FI and with the control group, in which an increase in the concentration of IL-8 was noted, respectively, in 65% and 30% of cases. A moderate positive correlation was found between the IL-8 level and the PASI index (rs = 0,48; p = 3,6 104). The levels of INF- and IL-6 in psoriasis patients with FI were increased, respectively, in 15,6% and 21,9% of cases and significantly differed from the group of practically healthy individuals (p 0,05), differences from the group of patients with psoriasis without FI was not identified. The concentration of TNF- did not differ in all three groups. The level of IL-17A was significantly increased in comparison with practically healthy individuals both in the group of psoriasis patients with FI and in the group of patients without FI (Me = 3,3 and 4,3 pg/ml versus 0,2 pg/ml). The concentrations of five interleukin cytokines, namely IL-1, IL-2, IL-4, IL-10 and INF-, did not exceed the upper limit of the reference range in all patients of the experimental (patients with psoriasis) and control groups. Evaluation of the PASI index during the observation of patients in the first and second groups showed significantly lower values of this indicator for weeks 24 and 52 in the first group (0,2 vs. 7,0; p = 0,02 and 0,1 vs. 7,2; p = 0,002). The relative risk of disease recurrence in the absence of radical treatment for FI was 2,6 (CI 1,1 to 5,2). Conclusion. Data were obtained showing the role of IL-8 and focal infection, with the presence of which its increased production is associated, in the worsening of the course of psoriasis with the frequent development of relapses. Important preventive measures leading to a decrease in the number of relapses of psoriasis are timely diagnosis and radical treatment of focal infection.

Background. CLA+T-cell are an important component of skin-associated lymphoid tissue, and thus determine the pathogenesis of many immuno-mediated dermatoses. Aims. Determine the relative number of CLA+T-cell subpopulations in the peripheral blood of patients with psoriasis, lichen planus and atopic dermatitis, as well as assess their impact on the severity of dermatoses. Materials and methods. We examined 82 patients with psoriasis aged 19 to 62 years, 54 patients with lichen planus (LP) aged 18 to 54 years, 44 patients with atopic dermatitis (AD) aged 18 to 44 years, as well as 20 practically healthy individuals aged 18 to 52 years who were admitted to the clinic for the removal of benign skin neoplasms. All patients underwent a standard clinical examination with the determination of indicators that characterize the severity of dermatosis: PASI (Psoriasis Area and Severity Index) for patients with psoriasis, IPSLP (index of prevalence and severity of lichen planus) for patients with lichen planus and SCORAD (Scoring of Atopic Dermatitis) for patients with atopic dermatitis. Defining subpopulations CLA+T-lymphocytes were carried out on a flow cytometer Cytomics FC500 by Beckman Coulter using appropriate combinations of direct monoclonal antibodies and isotopic controls. The groups were compared using the nonparametric Mann Whitney test, and the differences were considered significant at p0,05. To analyze the relationship between the severity of dermatosis and the relative content of subpopulations CLA+T-cells used Spearman's rank correlation coefficient. Results. In patients with psoriasis, a significant increase in the percentage of the total number of T-lymphocytes positive for CLA (CLA+CD3+) and T-helpers positive for CLA (CLA+CD4+) (p=0,002 and 8,5104, respectively), in patients with PL and AD only CLA+CD4+ lymphocytes (p=0,028 and 0,003, respectively). In the progressive period of psoriasis, a direct moderate correlation was found between the circulating subpopulation of cytotoxic T lymphocytes positive for CLA (CLA+CD8+) and the PASI index (rs=0,47; p0,001), in the acute period of AD between the CLA+CD3+ subpopulations and CLA+CD4+ cells and the SCORAD index (rs=0,53; p 0,001 and rs=0,57; p0,001, respectively). In PL, the severity of the course of dermatosis was not accompanied by any significant changes in the CLA-positive T-cell subpopulations. Conclusion. The results of the study confirmed the important role of CLA+T cell subpopulations in the development of chronic dermatoses. In all groups (psoriasis, LP and AD), an increase in the relative number of CLA+CD4+ T-helpers was noted compared with the control group. The relationship between the severity of psoriasis and the relative number of CLA+CD8+ cytotoxic T-lymphocytes, and the severity of AD with CLA+CD3+ and CLA+CD4+ T-helpers is also shown.