morphological and immunohistochemical features of tissue homeostasis in patients with alopecia areata in the chronic stage associated with metabolic syndrome and the non-burdened course of the disease.

OBJECTIVE: Introduction: Alopecia areata (AA) is a tissue-specific disease of the hair follicles, manifested by foci of baldness on the head and other areas of the skin. The aim of the study was to identify the tissue homeostasis state on the basis of pathomorphological and immunohistochemical changes taking into account the features of Ki67, bcl-2, caspase-3, and CD31 expression in patients with AA in the chronic stage associated with metabolic syndrome and the non-burdened course of the disease. PATIENTS AND METHODS: Materials and methods: Pathomorphological and immunohistochemical studies of Ki67, bcl-2, caspase-3, and CD31 expression in biopsies specimens from skin lesions in the chronic stage of the disease were performed in 11 patients with AA associated with metabolic syndrome and the non-burdened course of the disease. RESULTS: Results: The results of complex morphological study showed that in skin biopsies of patients with AA with metabolic disorders pathomorphological changes were more affected both in the epidermis and skin appendages - degenerative changes in the epithelium, in the dermis, manifestations of appendage atrophy and stromal fibrosis. In patients with AA without metabolic disorders the proliferative potential of epithelial cells (Ki67 proliferation index) was 20-25%, in cases of AA with metabolic syndrome - 5-10%, indicating a decrease in regenerative capacity of the tissue. The state of the microcirculatory bed (CD31) in cases of AA without metabolic disorders is more favorable for the trophic tissue function and decreases in the group of AA with metabolic disorders. It was found that activation of pathological cell apoptosis was observed in cases of AA with metabolic disorders and lower level of bcl-2 expression. In our observations, the level of expression of caspase-3 was at a relatively high level, indicating the activation of pathological apoptosis in the tissues of the affected areas. CONCLUSION: Conclusions: Our pathomorphological, immunohistochemical data allows us to assert that it is advisable to carry out a biopsy of the affected areas with the establishment of levels of proliferative activity of epithelial and stroma cells, the state of the microcirculatory vessels, the possibilities of repair of the affected areas, assessment of the level of apoptosis in order to predict the course of the disease and usage of the personified approach to treatment.

[Genetic-morphological peculiarities of response to standard therapy in patients with dyshidrotic eczema of palms and soles].

OBJECTIVE: Introduction: Dyshidrotic eczema of palms and soles (DEPS) is an inflammatory skin disorder that has a multifactorial nature and is characterized by the development of vesical elements with the histological picture of spongiosis and development of intraepidermal vesicles. The aim: Establishment of the features of pathomorphological changes of the epidermis and dermis in patients with manifestations of dyshidrotic lesions of palms and soles with different genotypic variants of the C646G of the NR3C1 gene before treatment based on the study of skin biopsies taking into account the response to standard therapy. PATIENTS AND METHODS: Materials and methods: In 57 patients with dyshidrotic lesions, a pathomorphological and immunohistochemical examination of biopsy specimens from a lesion focus of the skin were carried out and a genetic examination was carried out to determine the polymorphic variant C646G of the NR3C1 gene. RESULTS: Results: The results of this study in patients with DEPS showed that in patients with genotype 646 CC, which are torpid to treatment, there is a complex of immune defense with the activation of complement system with activation of C3 and C4d. The activity of expression of CD4 + cells indicating the intensity of the inflammatory response compared with patients with the 646 CC genotype, which were sensitive to treatment. In cases of 646 CG genotypes which were sensitive to topical treatment with steroid, there was a slight decrease in C3 and a decrease in C4d. There was no change in the activation of CD4 + lymphocytes compared with insensitive patients with genotype 646 CG. Moreover, in determining the prognosis and choosing treatment tactics, of great practical value is the presence of immunological parameters that were revealed by the immunohistochemical examinations and were determined by the genotypic peculiarities in patients with DEPS. CONCLUSION: Conclusions: Integral evaluation of the pathomorphological study of biopsy dyshidrotic lesions of sensitive and insensitive patients with different genotypic variants of the C646G of the NR3C1 gene before treatment allows obtaining objective information on the direct effect of glucocorticosteroid therapy. According to the results of our study, the association between NR3C1 gene variants, the pathomorphological features and degree of healing of dyshidrotic lesions of palms and soles was established: the polymorphic version of 646 CC in insensitive patients was associated with additional complement activation of the complement of fractions of C3 and C4d in comparison with sensitive patients of this genotype; рolymorphic variants of 646 CG in sensitive patients - with a slight decrease in the deposition of complement fractions of C3 and C4d іn comparison with insensitive patients of the corresponding genotype.