SOME FEATURES OF THE CLINICAL COURSE OF LICHEN PLANUS IN THE ORAL MUCOSA. A CLINICAL CASE OF GRINSHPAN-POTEKAEV SYNDROME.

The clinical picture and course of lichen planus (LP) on the mucous membrane of the oral cavity have significant differences from its manifestations on the skin. In particular, greater resistance to treatment, which is due to the structural features of the mucous membrane, as well as the specificity of biological and physicochemical processes in the oral cavity. There are 6 clinical forms of LP of the red border of the lips and oral mucosa - typical, hyperkeratotic, exudative-hyperemic, erosive - ulcerative, bullous and atypical. The variety of clinical manifestations and low effectiveness of treatment present certain difficulties and interest not only for dentists, but also for dermatologists in terms of diagnostics and treatment of LP with localization on the oral mucosa. A clinical case of a rare triad of symptoms of erosive lichen planus (LP) of the oral cavity, hypertension and diabetes mellitus - Grinshpan-Potekaev syndrome is presented. In the described clinical case, a 65-year-old female patient took antihypertensive drugs for a long time for arterial hypertension. Type 2 diabetes mellitus was latent and was diagnosed after contacting our clinic. Complex therapy with Delagil, tetracycline, application of corticosteroid preparations and protopic cream (on the oral mucosa) along with effective antihypertensive and antidiabetic treatment led to a rapid regression of the manifestations of LP with complete epithelialization of erosions.

[PATHOGENETIC FEATURES AND METHODS FOR TREATMENT OF VARIOUS FORMS OF ROSACEA].

The aim of the work was to study the features of the pathogenesis of various clinical forms of rosacea (the presence of mite Demodex folliculorum, the determination of VEGF, IL-2 IL-6, IL-8) and, based on the obtained results, to ensure adequate methods of therapy. Mite identification was performed by microscopy. The concentration of cytokines in patients with various clinical forms of rosacea (papulopustular form 15 patients, steroid form - 15, erythematous telangiectic form - 10, Ophthalmo Rosacea - 3, rhinophyma - 3) was determined by enzyme immunoassay using appropriate monoclonal antibodies and expressed in samples. Based on the results we obtained in the local treatment of patients with papulopustular rosacea (with a high population density of demodicosis ticks and an increased concentration of IL-8 in the blood), 1% ivermectin cream was applied externally to the skin of the face 1 time per day every day for the entire course of treatment (3-4 months). In patients with erythematous-teloangiectatic form (with a high cytokine VEGF, IL-8), a combined phased use of 1% pimecrolimus cream 14 days and 0.5% bromonidine tartrate gel was administered once a day - 14 days (with a single course of 1 month). In patients with a steroid form of rosacea with a high concentration of cytokines (IL-2, IL-6, IL-8), 1% pimecrolimus was administered 2 times a day - 1 month, 1% ivermectin 1 time a day - 14 days. During therapy, patients with advanced treatment were divided into 2 groups. Patients of group 1, who received externally 1% ivermectin 1 time per day as the main therapy, in the evening for 16 weeks. Group 2 applied 1% ivermectin and 1% pimercolimus cream for 16 weeks. In group 2 patients showed a significant improvement in a shorter time (4 weeks compared to 8 weeks in 1 group of patients). Taking into account the torpid flow and the difficulty of rosacea therapy, the pathogenetic approach when choosing new external preparations, opens promising directions for further deeper study of the pathophysiological mechanisms underlying the individual clinical forms of dermatosis. At the same time, the efficacy and safety of using ivermectin, pimecrolimus, and brimonidine tartrate in the treatment of various forms of this dermatosis suggests their widespread use in practical dermatology.

[THE RATIONALE FOR THE POSSIBLE ROLE OF DEMODEX FOLLICULORUM IN THE PATHOGENESIS OF ROSACEA].

The purpose of the study was to study the frequency of detection and population density of the mite in rosacea patients depending on the clinical form, the location of the morphological elements on the face and some parameters of the functional state of the skin. We observed 55 patients (38 women and 17 men) aged from 30 to 65 years old with disease duration from 6 months to 10 years. According to clinical forms, 35 had PPR and 20 - ETR (erythematous - telangiectatic rosacea). By location of the rash elements, the following types are distinguished: central, medial, asymmetric, lateral, and total. The mite was identified by a microscopic method. The functions of the skin barrier of the face skin: moisture, oiliness, dryness were determined using a bio-impedance analyzer (BIA). As shown by the results of the study of the above parameters in the observed patients, a high density of the mite population (> 5 per cm2) was noted in cases of total, medial and central type of their location. This indicator was in direct correlation with parameters such as skin fat content and moisture. 75% of patients in this group were diagnosed with PPR. In the group of patients with medium and low population density of mites (<5 per cm2), the lateral, asymmetric and central type of their location were dominated in 65% ​​of patients with ETNR. This group of patients showed low levels of skin fat and moisture, relatively high rates of dryness. Thus, the population density of the mites is dependent on the intensity of the anatomical location of the sebaceous glands of the face skin. An analysis of the results obtained in the study of the role of mite in the pathogenesis of rosacea led us to the conclusion: in rosacea patients, a correlation was found between the increase in the population density of mites, the type of element arrangement and the severity of dermatosis, which proves the role of the mite as one of the most frequent but not obligatory pathogenetic factors in the development of this dermatosis, especially its papulopustular form.

[FEATURES OF ROSACEA PATHOGENESIS IN PERIMENOPAUSAL WOMEN].

In patients with rosacea, the monitoring of blood melatonin in the menopausal period, as one of the criteria for assessing the severity of the disease, seems appropriate and pathogenetically justified. The aim of this study was determination of blood melatonin, VEGF, IL-8 concentration in perimenopausal period of women suffering by rosacea. 43 to 65 years old 15 women with various clinical manifestations of rosacea, and severe climacteric syndrome were under observation. The control group consisted of 15 female patients with rosacea but without climacteric syndrome. Melatonin, VEGF,IL-8 level in serum were determined by ELISA (IBL - international - reagent), the results were expressed in pg/ml).As the results of the study showed, the concentration of vasoactive peptides in patients with rosacea differes significantly from those in the control group. Increase the concentration of cytokinesin in the blood of patients with rosacea indicate that they are playing significant role in the pathogenesis of rosaceaAccording to the results of the study, the concentration of melatonin was reduced in all patients with rosacea (the main group). The degree of reduction was in direct correlation with the severity of climacteric syndrome (11,6÷1,5 pg/ml at a rate of ≥ 20,0 pg/ml). In the control group, the melatonin concentration was approaching to the norm (19.1 pg/ml). Statistical analysis of received data revealed the correlation in between of the severity of dermatosis and changes in lipid metabolism and concentration of melatonin (R = 0,91; p <0,05) in the main group of patients (with rosacea and climacteric period). Thus, on the basis of the obtained results it can be concluded that the inclusion of melatonin-containing preparations in prescription for rosacea patients having climacteric syndrome pathogenetically is justified.

[THE ROLE OF SOME VAZOACTIVE PEPTIDES IN THE PATHOGENESIS OF EARLY FORMES OF ROSACEA AND THE HEMOSTASIS SYSTEM].

Recently, the role of vasoactive peptides has been increasingly discussed in the pathogenesis of rosacea. The most attention is paid to the growth factor of the vascular endothelium (VEGF). VEGF affects angiogenesis and survival of immature blood vessels. Cytokine contributes to an increase in the level of IL-8, which plays a role in the development of inflammation. VEGF is synthesized by activated keratinocytes as a result of various factors. In particular, after exposure to ultraviolet irradiation, the production of cytokines-IL-1 and TNF-α-is provoced, which stimulate keratinocytes to synthesize of VEGF. The latest data on the state of the coagulation system in rosacea patients indicate a shift in the functional activity of the hemostasis system toward hypercoagulability. The aim of the study was to study the relationship between changes in the concentration of certain vasoactive peptides and the parameters of the hemostasis system in patients with rosacea. The state of the hemostasis system was assessed by prothrombin and thrombin time. The content of fibrinogen, fibrinolytic activity of blood, and also prothrombin index were determined as well. The concentration of free VEGF, IL-8 in the serum was determined by the method of enzyme immunoassay In the study, patients with rosacea, according to their age, were divided into 2 groups: -I group - patients aged 35 to 45 years, II group - patients aged 45 to 65 years. As the results of the study showed, the concentration of vasoactive peptides in patients with various clinical forms of rosacea differs significantly from those in the control group. In patients with various clinical forms of rosacea, the tendency of changes in all parameters (thrombin time, prothrombin time, fibrinogen, prothrombinic index) of the state of the coagulating system of blood with the manifestation of hypercoagulability is traced. And if the change in the content of cytokines was observed equally often in all observed patients, the manifestations of hypercoagulability were most pronounced in the second group of patients (aged 45 to 65 years) Thus, the results of the study allow us to conclude that an increase in the concentration of cytokines (which are a potent provoker of changes in permeability, atony and brittleness of the vessel walls), as well as hypercoagulable phenomena, indicative of ongoing microcracking processes, are the leading links in the pathogenesis of early forms of rosacea.

[RISK-FSCTORS OF CARDIOVASCULAR DISEASE IN PATIENTS WITH ROSACEA].

The purpose of the research was to study the lipid profile, some indices of hemostasis and cytokine status of rosacea patients with severe climacteric syndrome. Serum lipid profile was studied by means of the following parameters: total cholesterol, high density lipoproteins (HDL), low density lipoproteins (LDL), triglycerides (the study of lipid profile was performed by the device "INTEGRAM +400" (Company "ROSH¼). Haemostatic system was evaluated in terms of prothrombin, thrombin time. Content of fibrinogen, fibrinolytic activity, and prothrombin index were determined. The concentration of free VEGF (vascular endothelial growth factor) and IL-8 were measured by ELISA. The results of these studies suggest that the phenomenon of hyper coagulation and disorders in lipid profile of blood serum in patients with rosacea with climacteric syndrome can be considered as risk factors of cardiovascular disease. From the other side, as a powerful provocateur of increased permeability, atony and fragility of vessel walls, VEGF, IL-2, IL-8 may be directly related to the mechanism of the development of cardiovascular disease in rosacea patients.

[ELEMENTAL STATUS OF PATIENTS WITH VARIOUS FORMS OF VITILIGO].

Vitiligo is a multifactorial disease in which, in each specific case of its manifestation, different mechanisms of its pathogenesis and different levels of melanin formation in the skin can be involved. Skin is one of the most metabolically active organs. Carrying out a number of vital functions (barrier, protective, respiratory, excretory, metabolic, immune, etc.), it needs microelementss. Of the 92 naturally occurring chemical elements, 81 are found in the human body. Lack of the vital elements, leads to the emergence of diseases, which are based on deficiency, excess or imbalance of micro- and macroelements in the body. To assess the elemental status of patients with various forms of vitiligo, fluorescent x-ray spectroscopy was used. The method has good informativeness, since the hair most fully reflects the level of content of both toxic and vital elements. According to the results obtained, in patients with segmental vitiligo, a slight decrease in the content of manganese and copper was detected in the hair. In the group of patients with non-segmental form of vitiligo, along with a significant decrease in the concentration of basic elements (on average from 20 to 50%) copper, manganese, selenium, zinc, there was an increase in the indices of such toxic elements as lead and cadmium. The data of multi-element hair analysis, as are confirmed by well-known information about the role of certain chemical elements in the pathogenesis of vitiligo, also allow us to make new assumptions about the possible relationship between the violation of the microelement balance of the organism with the emergence and peculiarity of the flow of various forms of vitiligo. The correct approach to understanding the mechanisms of the emergence of vitiligo, will allow to offer new effective schemes for the treatment of vitiligo.

[EFFICACY OF COMBINED USE OF ANTIOXIDATIVE AND PHOTOTHERAPY IN THE TREATMENT OF VITILIGO].

Despite of numerous investigations, carried out practically in all countries of the world for the study of vitiligo and the search for its new effective therapies, pathogenic mechanisms of vitiligo are still poorly understood, and the proposed treatments are not perfect. One of the most accepted theories of the pathogenesis of vitiligo is an oxidative stress theory, according to which a series of biochemical anomalies cause oxidative stress, leading to accumulation of melanocytotoxic substances and inhibition of natural processes of detoxification with subsequent destruction of melanocytes in vitiligo focus. On the other hand, the use of antioxidants in combination with ultraviolet therapy of dermatological diseases, has been theoretically proved by biophysical studies, according to which- the antioxidants inhibit the oxidation of products, formed in the skin after ultraviolet irradiation and greatly reduce erythema sensitivity (1.5-2 times). Due to this effect, the power of radiation exposure can be approximately increased many times. Based on the foregoing, the use of antioxidants during phototherapy of vitiligo pathogenetically is justified. The aim of the study was to evaluate the therapeutic efficacy of Se ACE in treatment of patients with various forms of vitiligo. 35 patients (23 women and 12 men) aged 18 to 40 years with duration of the pathological process from 2 months to 15 years were under observation. 17 of these were diagnosed with a form of non segmental vitiligo (NSV), 18- segmental vitiligo. In 11 patients onset of the disease was not connected with any other problem, 24 noted the appearance of white spots after stress. Vitiligo patients were divided into 2 groups: the study group and the group of comparison. The study group included 17 patients (9 women and 8 men) aged 18 to 40 years with duration of the disease from 2 months to 5 years. The comparison group consisted of 18 patients (10 women and 8 men). Distribution of patients in both groups was homologous by the sex, age, duration and clinical forms of dermatosis. All patients underwent phototherapy. In the study group Selenium was used as an antioxidant, which was administered at a dose of 1 capsule 2 times a day for a month. Phototherapy was performed by means of MEDlight OCTAderm (3 times per week, the course of treatment - 15 procedures). After a course of phototherapy in combination with Selenium (study group), 1 patient had complete regimentation, in 43.5%of patients with NSV whisk of regimentation was formed, in 60.9% of patients with partial NSV we observeda partial regimentation in the form of pigmented inclusions withinthe foci of depigmentation. In the group of comparison we did not reveal any case of full regimentation, the whisk of hyperpigmentation was observed only in 34.7%, formation of pigmented inclusions within the foci of depigmentationwere revealed in 29.1% of cases. Thus, the phototherapy of vitiligoin combination with Selenium gives a well pronounced therapeutic effect, the clinical picture of which can be described as the following: high frequency, fast enough occurrence (2-3 months), cosmetic favorability-regimentation has uniform character without noticeable hyperkeratosis and peeling, as well as without any redness and hyperpigmentation.

[KINETICS OF PHOTO-INDUCED FREE RADICALS IN THE HUMAN HAIR CHESTNUT COLOR AFTER SHORT PERIODS OF RED, GREEN, BLUE AND WHITE LIGHT EXPOSURE].

The aim of the study was to investigate the kinetics of photo-induced free radicals in the human hair chestnut color with short-term exposure to visible light in different frequency ranges. Studies carried out on human volunteers aged 17-21 years (n=37). Hairs of volunteers of the study were not treated with dyes and other active cosmetic preparations. Hairs bundled in a bun had a length - 1.5 cm, weight - 40 mg. At the beginning background EPR-spectrum of a sample was measured and then hairs were irradiated with visible light (blue, green, red and white) of different wavelength subsequently; exposure duration - 60 minutes; after the exposure the kinetics of photo-induced free radicals was measured within 60 minutes. The radiation source was selected LED array of the four crystals that provides a nearly monochromatic radiation spectrum having no parasitic infrared and ultraviolet radiations. The studies give a reason to assume that the impact on hairs by visible electromagnetic rays a leading factor is their frequency characteristics: on the one hand - the proximity of the blue light to ultraviolet radiation, and on the other - the red light to the infrared range.

[MELATONIN CONCENTRATION IN THE BLOOD OF VITILIGO PATIENTS WITH STRESS IN ANAMNESIS].

In recent years, despite some progress in the study of vitiligo many aspects of pathogenesis and treatment of this dermatosis remain unsolved or are highly controversial. It is believed that progression of disease is associated with a genetic predisposition, autoimmune processes and oxidative stress, but the concrete role of stress on the processes having place in the organism of vitiligo patients so far is not investigated. As we know, epiphysis is the main regulator of adaptation of the individual to the environment. An important product of secretion of the pineal gland is the hormone melatonin - a universal regulator of vital functions and biorhythms of the body. Psychoses, neuroses, depression, immunopathology are aspects of disturbances in circadian, seasonal and annual rhythms of the synthesis of this hormone. Clinical and experimental studies indicate that the hormone melatonin, which is one of the links in a stress defense mechanism of the body, has antioxidant and immunomodulatory properties. The purpose of this study was to determine plasma level of melatonin in the blood of vitiligo patients (with stress in anamnesis), depending on the clinical form and duration of the disease. 41 patients with vitiligo (16 with segmental and 25 with non-segmental form) with stress in anamnesis and duration of disease from several months to 20 years were under observation. The level of melatonin in the blood plasma was determined by ELISA (IBL - international - reagent), the results were expressed in units of pg/ml. According to the results of our study, 8 patients with segmental vitiligo had the normal level of plasma melatonin concentration (in the range of 20.2-31.1 pg/ml), in 2 cases - the level was near the norm (19.2 pg/ml). In the group of patients with non-segmental vitiligo, the level of melatonin was below the norm (12.5 pg/ml) and in 2 cases, the content of melatonin was very low - 4.05 pg / ml. Correlation analysis of melatonin levels with duration of disease have shown direct correlation just in the group of patients with non-segmental vitiligo. For a complete analysis of our results concerning of melatonin levels in the blood of patients with stress in anamnesis and for getting of some principal conclusions that will allow outline the ways to effectively treat patients with this pathology, further research is needed.

ALTERATION OF OXIDATIVE METABOLISM AND IMMUNOLOGICAL PARAMETERS UNDER THE INFLUENCE OF UVA RADIATION IN WOMEN OF DIFFERENT AGES.

Purpose of study was to investigate the alteration of oxidative and immunological metabolism in blood of reproductive and menopausal age women after UVA irradiation. Women of two groups (1 - menopausal, 2 - reproductive age) were exposed to radiation with wave length 320-400 nm for 5-10 minutes per session in the solarium for the period of 3 months (6 days per month).. Parameters of oxidative metabolism - activity of red blood cells (RBC), antioxidant enzymes catalase (CAT) and superoxiddismutase (SOD) were studied by spectrophotometric method; reactive oxygen (O2-) and lipid (LOO/) free radicals content in whole blood were studied by Electron Paramagnetic Resonance (EPR) methods with use of specific spin-traps - 5,5-Dimethyl-1-Pyrroline-N-Oxide (DMPO) and α-phenyl-N-tert-butylnitrone (PBN) (SIGMA). Parameters of immunological metabolism - IFN-α, IL-2, IL-10 cytokines content in blood were studied by immunoenzymatic assay ELISA. The study protocol has been approved by the Ethical Committee of the Tbilisi State Medical University. After the course of UVA irradiation in menopausal women CAT activity increased by 20%, SOD - by 24%, and EPR signal of spin trapped lipoperoxide radicals was detected. No alterations in blood redox-balance were detected in women of reproductive age. Values of blood immunological parameters in menopausal women were not changed under the influence of UV radiation; in women of reproductive age IL-10 content increase by 93% (within a normal value range) was revealed. Research results have shown that UVA rays cause a particularly significant influence on the oxidative metabolism in the women of menopausal age. Increase of IL-10 blood levels in women of reproductive age (considering its imunosupressing activity) represents an additional risk of cancerogenesis. Based on the study results, we recommend avoiding UV (including UVA) radiation procedures to women of both reproductive and menopausal ages.

[VISIBLE LIGHT AND HUMAN SKIN (REVIEW)].

Biological effect of a visible light depends on extend of its property to penetrate into the tissues: the greater is a wavelength the more is an effect of a radiation. An impact of a visible light on the skin is evident by wave and quantum effects. Quanta of a visible radiation carry more energy than infrared radiation, although an influence of such radiation on the skin is produced by the light spectrum on the boarder of the ultraviolet and the infrared rays and is manifested by thermal and chemical effects. It is determined that large doses of a visible light (405-436 nm) can cause skin erythema. At this time, the ratio of generation of free radicals in the skin during an exposure to the ultraviolet and the visible light range from 67-33% respectively. Visible rays of 400-500 nm length of wave cause an increase of the concentration of oxygen's active form and mutation of DNA and proteins in the skin. The urticaria in 4-18% of young people induced by photodermatosis is described. As a result of a direct exposure to sunlight photosensitive eczema is more common in elderly. Special place holds a hereditary disease - porphyria, caused by a visible light. In recent years, dermatologists widely use phototherapy. The method uses polychromatic, non-coherent (wavelength of 515-1200 nm) pulsating beam. During phototherapy/light treatment a patient is being exposed to sunlight or bright artificial light. Sources of visible light are lasers, LEDs and fluorescent lamps which have the full range of a visible light. Phototherapy is used in the treatment of acne vulgaris, seasonal affective disorders, depression, psoriasis, eczema and neurodermities. LED of the red and near infrared range also is characterized by the therapeutic effect. They have an ability to influence cromatophores and enhance ATP synthesis in mitochondria. To speed up the healing of wounds and stimulate hair growth light sources of a weak intensity are used. The light of blue-green spectrum is widely used for the treatment of neonatal hyperbilirubinemy. A photodynamic therapy takes a special place. The third generation of the blue (410 nm), yellow (595 nm) and red photosensitors are used. Photodynamic therapy is used in the treatment of cancer as well.

[Capillary fragility and some hemostatic parameters in patients with rosacea].

The aim of the study was to investigate the association between capillary fragility and some hemostatic parameters, lipid profile in patients with rosacea. 50 patients (30 women and 20 men) aged 35 to 65 years were under observation. Control group consisted of 50 healthy persons, adequate to comparison group by sex and age. To determine the resistance of the capillary, Rumpel-Leede cuff (tourniquet test) was used which consists in determining the formation of petechial hemorrhages on the skin in the area of ​​short-term increase in venous pressure. The hemostatic system was evaluated in terms of prothrombin and thrombin time. Content of fibrinogen and fibrinolytic activity of blood were determined also. The serum lipid profile was studied by means of the following parameters: total cholesterol, triglycerides, HDL (high density lipoprotein), LDL (low density lipoproteins). The survey revealed that in 25 patients the arm cuff test was positive, whereas in the control group, only 2 cases it was weakly positive. Manifestations of hypercoagulation were found in half of patients with a positive cuff test, almost in half of the patients an increased level of fibrinogen and the reduced fibrinolytic activity in blood serum has been revealed. Significant correlation with lipid metabolism have not been identified. Phenomenon of hypercoagulation in rosacea patients on the one hand suggests the existence of processes of microcoagulation, on the other hand the connection with the results of a cuff test can be used to predict the severity of the dermatosis and the possible risk for developing of cardiovascular disease.

Evaluation of blood redox-balance, nitric oxide content and CCR6 rs3093024 in the genetic susceptibility during psoriasis.

The aim of our study was to evaluate whether this polymorphism of CCR6 gene and oxidative stress are associated with psoriasis risk in Caucasian population. The association of the CCR6 polymorphism in the genetic susceptibility of psoriasis was performed at the Department of Dermatology and Venereology, Policlinico Umberto I of Rome (Italy). 516 participants were enrolled including 127 patients affected with psoriasis and 389 healthy controls. Cases and controls were genotyped, using a commercially available assay (Life Technologies, Carlsbad, California, USA) for CCR6 rs3093024 polymorphism. To verify the relations between genotypes and psoriasis risk we evaluated genotype frequencies for each individual DNA polymorphism in both case and control series. There were no differences in the genotype frequencies of the polymorphism between psoriasis cases and healthy controls. When patients with arthropathic psoriasis were excluded from the analysis, logistic regression showed that allele A was likely to reduce the risk of developing psoriasis in a dominant model. Logistic regression showed that male patients harboring the heterozygous genotype GA presented a reduced risk of developing psoriasis, compared with the reference GG genotype. None of the clinical features as age at onset, gender, family history of psoriasis, type of psoriasis, severity, BMI, smoking history or alcohol consumption, were associated with the genotype frequencies of the tested CCR6 polymorphism. In blood samples of patients with psoriasis intensive EPR signals of lipoperoxide (LOO.) free radicals were detected. Activity of blood SOD was significantly decreased in psoriatic patients compared to healthy controls. Activity of catalase was significantly increased in psoriatic patients, reflecting a high concentration of peroxide radicals. In blood samples of psoriatic patients decrease of free spin-trapped NO content were detected, that may be explained by biological transformation of NO into other reactive nitrogen species (proxy nitrite or nitrosylated hemoglobin). Thus, the alterations of redox-balance and NO degradation leads to development of skin perfusion impairments, disorder of proliferation and transcription of cell cycle, initiation of T-cell mediated immune responses, formation of chemokine receptor 6 (CCR6) related with intensification of cellular infiltration in the psoriatic plaques. Furthermore, correction of redox-balance is responsible for inhibiting CCR6 formation resulted in suppressed cellular infiltration with concomitant decrease in oxidative stress. The data reviewed suggest the necessity of evaluation of other blood redox-balance and nitric oxide in psoriasis should with additional investigations to targeting CCR6 rs3093024 in the genetic susceptibility of psoriasis.

[Peculiarities of cytokine status in patients with vitiligo and stress in anamnesis].

The aim of our study was to investigate the content of some proinflammatory cytokines (IL-2, IL-6) in the serum of patients with vitiligo and stress in anamnesis. Cytokine levels in serum were measured in 50 patients with vitiligo (20 men and 30 women aged from 18 to 65 years old.) All the patients were divided according to anamnesis (27 patients with stress in anamnesis and 23 patients, where the onset of the disease was not preceded by stress). Patients of both groups were similar in terms of shape (according to T. Fitzpatrick classification) and in terms of the dermatosis stages. Concomitant autoimmune or inflammatory diseases of the skin in our vitiligo patients were not observed. The cytokines in the blood serum of vitiligo patients were determined by ELISA using the corresponding monoclonal antibodies. Student's t-test was used for evaluation of statistical significance of received results (p < 0.05 was considered as a statistically significant). Content of IL-2 in the serum of patients with vitiligo, in which stress was not preceded dermatosis, was significantly higher than that in healthy individuals (25,5 ± 7,6 vs 10,5 ± 3,6 pg/ml, p < 0,05). But the same parameter in patients with stress in anamnesis was significantly lower than those in healthy individuals (3,5 ± 1,5 vs 10,5 ± 3,6 pg/l, p < 0.05). Changes in the content of IL-6 in the serum of vitiligo patients was a similar to changes in IL-2 content, and the most significant this indicator was in patients with generalized and progressive stage of the disease. Data on increased concentrations of IL-6 agree with the majority of studies conducted earlier. For a complete analysis of our results on the reduction of the cytokines (IL-2, IL-6) content in patients with a stress in anamnesis, that will allow to identify the most effective ways to treat patients with this pathology (including their cytokine status), further research is necessary.

[Role of redox- and hormonal metabolism in the mechanisms of skin aging].

The aim of the study was to investigate the role of redox balance in the pathogenesis of skin aging in menopausal women. 30 menopausal women aged 40 to 55 years and 30 reproductive women aged 25 to 35 years were studied. Qualitative assessment of the skin (moisture, fat, elasticity) was performed; in the venous blood hormonal metabolism indicators: estradiole - E, testosterone - T, follicle stimulating hormone - FSH and redox parameters - oxygen and lipid free radical content (EPR method), antioxidant enzymes (catalase, superoxide dismutase (SOD) and glutationreducrase (GR)) activity (spectroscopic method) were studied. According results of the study, in menopausal women statistically significant loss of skin elasticity and increase the number of pores was revealed in comparison to the reproductive women. These changes occur against the background of statistically significant increase of the blood testosterone and FSH content; estradiol in women menopausal period has tendency to decrease. Redox indicators of blood did not differ statistically significant in women of reproductive and menopausal period, although there was a tendency to increase the activity of catalase and GR in menopausal women period, indicating on the intensification of oxidative processes in this age group. Statistically significant negative correlation between blood estradiole content and SOD's activity (r=-0.413, p=0.0017) and positive correlation between blood estradiole content and GR activity (r=0.565, p=0.002) was revealed. Decrease in the estradiol concentration and disbalance in redox-system in the women's blood correlats with the rate of pigmented spots growth and decrease of the skin moisture. It is concluded that in mechanisms of skin aging of menopausal women estrogen-depending alterations in redox-balance places important role.

The role of nitric oxide in the pathogenesis and severity of psoriasis.

The aim of our study was to investigate the possible role of nitrogen reactive species in pathogenesis of psoriasis. A total of 187 individuals were included in this study, out of these 84 were patients suffering from psoriasis and 103 were healthy subjects, served as a control. Patients with psoriasis were graded according to the Psoriasis Area Severity Index (PASI), presenting at the time of blood collection. After obtaining prior consent, about 2 ml of random blood was collected for estimation blood free nitric oxide (NO) content by Electron Paramagnetic Resonance (EPR) Spectroscopic method. For detection of NO in blood the spin-trap (diethilditiocarbamate (DETC) (Sigma) was used. In blood samples of patients with psoriasis nitrosilated hemoglobin (HbNO) complexes and alterations of free spin-trapped NO EPR signal intensity and were detected. Free NO content in blood decreased with the increasing severity of the psoriasis. It may be concluded that under oxidative stress conditions during psoriasis the decrease level of free nitric oxide in the patient's blood may contribute to a violation of the vasomotor activity of subcutaneous capillaries, impairment of skin blood supply, development of hypoxia, exacerbation of oxidative stress, alteration of immune balance, spreading of skin infection and exacerbation of the severity of psoriasis. Use of NO-containing creams will contribute to a partial recovery of disturbed functions and remission of the disease.

Alterations of redox-status during psoriasis.

The skin is constantly exposed to oxidative stress induced by reactive oxygen species (ROS) that are generated both from endogenous neutrophils and external pro-oxidant stimuli. The present study was planned to investigate the possible involvement of free radical oxidation in psoriatic patients. Study was carried out in the Department of Dermatology and Venereology in Tbilisi State Medical University. A total of 60 individuals were included in this study, out of these 40 were patients suffering from psoriasis and 20 were healthy subjects (a control). Psoriasis patients were further graded according to the Psoriasis Area Severity Index (PASI); in patients' blood redox-status superoxide (O2-) and lipoperoxide (LOO.) free radicals, free Mn2+-ions and (ceruloplasmin/Fe3+-transferrin) system antioxidant activity were estimated by Electron Paramagnetic Resonance (EPR) method and activity of catalase (CAT) and superoxide dismutase (SOD) were determined by spectrophotometry. In the blood of patients with psoriasis, the EPR signal intensities of oxidized form ceruloplasmin (Cp) increased and ferrum-transport protein, Fe3+-transferrin (Fe3+-Tr) decreased in comparison to the same parameters of healthy persons. Activity of blood catalase increased and activity of blood SOD decreased with increasing severity of psoriasis. EPR signals of low-molecular Mn2+-containing complexes and lipoperoxide (LOO.) free radicals were detected. The obtained data indicate the alteration of blood redox-balance during psoriasis; the intensity of impairment of redox balance correlates with severity of psoriasis.

[Angioprotectors in the treatment of rosacea].

Rosacea - a common chronic inflammatory dermatosis (3-10% of all dermatoses) primarily affecting the skin of face. Numerous methods for the treatment of rosacea are defined by the diversity of etiologic and pathogenic factors of dermatosis, its stage and clinical form. But a significant role in its development, most researchers relate to vascular disturbances. It is suggested that vascular changes in this disease are the product of two interrelated pathological processes: the disturbances in integrity and tone of the vascular wall and disorganization of perivascular connective tissue. The results of these processes are formation of a stable dilatation of skin blood vessels clinically manifested by erythema and telangiectasia. Based on foregoing, The aim of this study was evaluation of therapeutic efficacy of Rutin Forte in complex treatment and prevention of rosacea. 30 patients with an erythematous stage of rosacea were under observation (20 women and 10 men) aged 25 to 50 years. The first group (15 patients) was treated by the standard procedure (Antibiotics, systemic metronidazole, antihistamines, traditional external therapy). Patients of the second group (15 people) additionally received a Rutin Forte containing long-acting vitamin C, zinc and selenium. The drug was administered at a dose of 2 capsule per day. Duration of treatment - 2 to 3 months. Observation period after treatment were 12 months. During this period we revealed a significant reduction of erythema, recurrence of disease in the second group of patients was not observed, but in the group of comparison recurrences were detected on 3rd month of follow up and the degree of erythema reduction was significantly less. Thus, the study revealed that Rutin Forte is an effective means for the treatment and prevention of the torpid relapsing forms of rosacea on erythematous stage of dermatosis.

[Improvement of rosacea treatment based on the morphological and functional features of the skin].

Rosacea - a widespread disease sometimes aleak with severe complications, mainly affecting the skin. Irrational and inadequate treatment leads to chronicity of diseases and psychosocial disadaptation of patients. Lately, a clear upward trend in the number of patients in whom in the process of complex treatment manifestations (with the varying degrees of severity) of impaired barrier function of the skin are observed and they need the protection and restoration of the damaged stratum corneum. In patients with rosacea in order to study the function of the facial skin's horny layer we used the skin analyzer BIA (bioimpedance analysis, which in duration of 6 seconds determines the moisture content, oiliness and the softness of the skin) and significant deviations from the norm (decrease in moisture content, fatness and increased roughness) was revealed. These changes were most clearly pronounced in patients with steroid rosacea. To restore the skin barrier the drug "Episofit A" (Laboratory of Evolutionary Dermatology, France) has been used (1-2 times a day for 6 weeks). Evaluation of treatment efficacy was conducted every 2 weeks by means of a scale from 0 to 5 for parameters of dryness, erythema, peeling and expression of subjective feelings. In accordance with received results, using of Episofit A emulsion, especially on the baсkground of long-term treatment with topical steroids, had a pronounced therapeutic effect. Thus, treatment of patients with consideration of morphological and functional features of facial skin, helps to improve the results traditional therapy, and the drug is highly effective means of the new direction in skin care - corneotherapy aimed to reconstruct and protect damaged stratum corneum.