Vol 22, No 3 (2025)

BACKGROUND: Stevens–Johnson syndrome and toxic epidermal necrolysis are severe life-threatening conditions characterized by massive lesions of the skin and mucosa. At present, considering the high mortality rate, one of the most promising areas of research is the study of predictors of the severity of the pathology, since prognosis of the disease can further influence the choice of treatment strategy.

AIM: Determination of epidemiological features, identification of clinical and laboratory predictors of the disease severity, and construction of a prognostic model for patients with Stevens–Johnson syndrome and toxic epidermal necrolysis within the framework of analysis of electronic medical records of Moscow.

MATERIALS AND METHODS: The study was based on a retrospective analysis of medical records of patients with SJS/TEN from 2020 to 2023. Initially, 230 individuals over 18 years of age were included in the analysis. As a result of selection from the primary cohort, 122 patients satisfying the criteria for the diagnosis of Stevens–Johnson syndrome and toxic epidermal necrolysis were included in the final analysis. Patients did not undergo additional follow-up as part of this study.

RESULTS: In the analyzed cohort, a prevalence of female patients (n = 72; 59.01 %) over male patients (n = 50; 40.99 %) was observed. Lethal outcome was recorded in 27 (22.13 %) patients, of which 21 (77.8 %) had a verified diagnosis of toxic epidermal necrolysis, which was associated with a higher incidence of death compared to Stevens–Johnson syndrome (n = 6 (p = 0.001)). It was found that 112 (91.8 %) cases were likely associated with medication use, while 10 (8.2 %) presented a verified infectious agent Mycoplasma pneumoniae. Antiepileptic drugs were the most frequent cause of drug-induced Stevens–Johnson syndrome/toxic epidermal necrolysis (n = 62; 55.4 %). Based on the analysed clinical and laboratory data, a prognostic model was developed to determine the probability of lethal outcome, including decreased serum bicarbonate, increased levels of c-reactive protein, fibrinogen, fever, hypoalbuminemia.

CONCLUSION: Stevens–Johnson syndrome and toxic epidermal necrolysis are rare conditions with a high mortality rate and high risk of disabling complications. Early verification of the diagnosis and stratification of patients by severity group is optimal for the choice of treatment tactics; however, further work is currently required to standardise the assessment of the severity of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis.

BACKGROUND: Concentration of fungal spores in the air often exceeds concentration of pollen 100–1,000 fold, reaching 50,000 fungal spores/m³, which is affected by a plethora of environmental factors including precipitation, temperature and wind. Pigmented spores of Cladosporium and Alternaria are prevalent in habitats of the most regions, since colorless spores do not survive ultraviolet radiation. Aerospores are often considered an underestimated source of respiratory allergies, therefore, information on their seasonal trends is significant for both promoting public awareness and assisting medical specialists in effective diagnostics, prevention and treatment of fungal diseases.

AIM: To analyze the annual spore index, seasonality and threshold concentrations of dominant fungal spores Cladosporium and Alternaria in the air of Karakol.

MATERIALS AND METHODS: Aerobiological monitoring was carried out from April to October 2015–2017 using a standardized volumetric Lanzoni pollen trap in the city of Karakol (1716 m above sea level, mid-mountain). A specially developed identifier and atlas were used for microscopic identification of fungal spores.

RESULTS: The concentration curve of dominant Cladosporium and Alternaria fungal spores in the air of Karakol is unimodal with often overlapping quantitative characteristics. Simultaneously, strong interannual variability of their atmospheric levels was observed, exhibiting dependance on meteorological parameters, especially temperature and precipitation. The maximum peak of Cladosporium aerospores was recorded on June 30, 2017 — 12,386, and Alternaria — 5,376 fungal spores/m³ in an extremely dry year (July 28, 2015). Peak concentrations of Cladosporium and Alternaria fungal spores drastically exceeded clinical threshold values in the air.

CONCLUSION: Cladosporium and Alternaria aerospores are recognized as dominant taxa, due to their phytopathogenic and allergenic properties and their predominance in the atmosphere of Karakol for long periods of time. The curve of their spore concentration is unimodal. Variations in the concentration of aerospores in different years positively correlated with air temperature, especially in the 3^rd ten-day period of July 2015, when the maximum peak of spores consisted of 56 % Cladosporium and 13.5 % Alternaria spores and the highest air temperature was recorded (33.5 °С).

Persistent rashes in the head and neck area in patients with atopic dermatitis, particularly those developing after the initiation of dupilumab therapy, represent a complex clinical challenge due to the poorly understood causes and mechanisms of development, as well as the lack of standardized therapeutic approaches. Given the localization in cosmetically and functionally important areas of the skin (face, periauricular region, neck, upper torso), this form of atopic dermatitis is associated with significant stigmatization and a decrease in the patient’s quality of life. The refractory course of atopic dermatitis involving the face and neck may represent a distinct subgroup of patients with additional pathophysiological determinants and unique features of immune dysregulation that require special consideration. This article presents current insights into the etiopathogenesis of this condition and management strategies, including a review of clinical cases from our own practice. The relevance of the issue is underscored by its high prevalence and the potential risk of discontinuing targeted therapy, emphasizing the need for timely identification and appropriate management to avoid unnecessary treatment interruption. To optimize care and develop a personalized patient management strategy, we have proposed a decision-making algorithm that addresses the key questions clinicians may encounter when managing this specific patient group.

BACKGROUND: Dupilumab, a monoclonal antibody targeting the alpha subunit of the interleukins 4 and 13 receptor, has fundamentally transformed the approach to treating atopic conditions such as atopic dermatitis, bronchial asthma, and chronic rhinosinusitis. However, its increasing use has drawn heightened attention to several adverse ocular events — conjunctivitis, blepharitis, keratitis, corneal ulcers, and cicatricle conjunctivitis — that remain underrecognized and often underestimated in clinical practice. These manifestations frequently occur in patients with atopic dermatitis and vary in severity, posing diagnostic and therapeutic challenges.

AIM: To study the efficacy and safety of anti-IL-4,13 therapy in Andogsky syndrome.

MATERIALS AND METHODS: The study included patients with moderate-to-severe atopic dermatitis and cataracts who had experienced insufficient efficacy from conventional treatment over a period of at least 3 months. The decision to prescribe dupilumab was made by a medical commission based on the assessment of the SCORAD index and the previous volume of therapy. Patients were monitored dynamically for 16 weeks. Follow-up visits were conducted at weeks 4 and 16. During these visits, an assessment of atopic dermatitis symptom control was performed using the SCORAD, DQLI, and POEM scales. Additionally, monitoring of adverse events and their timing was conducted.

RESULTS: The study included 5 patients with Andogsky syndrome. Four of them had a history of surgical treatment for cataracts, and initiation of anti-IL-4,13 therapy for severe atopic dermatitis was performed more than 5 years after cataract surgery. One patient with severe atopic dermatitis and progressive cataracts started therapy prior to surgical intervention. The initiation of systemic therapy allowed for successful cataract treatment and preservation of visual acuity without development of adverse events related to dupilumab. No adverse events, including those related to the visual organs, were recorded in this cohort of patients during the entire observation period (52 weeks).

CONCLUSION: The therapeutic potential of dupilumab in the treatment of Andogsky syndrome is of particular interest, given the complex nature of the disease and the involvement of various body systems. Suppression of T2 inflammation through inhibition of interleukins 4 and 13 leads to a reduction in the severity of skin manifestations, a decrease in the intensity of the inflammatory process, and improvement in ophthalmological parameters. Further study of the efficacy of dupilumab in Andogsky syndrome will allow: to determine the optimal duration of therapy, evaluate the impact on disease progression and develop personalized treatment approaches.

Bronchiolitis obliterans is a rare severe complication of Stevens–Johnson syndrome and toxic epidermal necrolysis.

The article presents an observation of a fatal histologically confirmed bronchiolitis obliterans in a 16-year-old patient developed as a delayed complication of Stevens–Johnson syndrome after the use of lamotrigine and nonsteroidal anti-inflammatory drugs. The diagnosis of bronchiolitis obliterans was established based on the development of severe bronchoobstructive syndrome, confirmed by a study of the external respiratory function, chronic respiratory failure 2 months after Stevens–Johnson syndrome, characteristic computed tomography signs (foci of mosaic perfusion, bronchiectasis). Bronchiolitis obliterans therapy, in addition to commonly used drugs, included the janus kinase inhibitor tofacitinib.

To discuss clinical observation, a systematic review of the world literature over 45 years was conducted. 43 cases of post-Stevens–Johnson syndrome/toxic epidermal necrolysis were selected from 187 publications with an analysis of the etiology, timing of onset, spirometric and radiological signs, features of therapy and course. According to the analysis, the main triggers of Stevens–Johnson syndrome/toxic epidermal necrolysis were antibiotics (50 %) and nonsteroidal anti-inflammatory drugs (40 %), infection caused by Mycoplasma pneumoniae (12 %), and less often anticonvulsants. The average age of children with bronchiolitis obliterans was 7 years, and the average age of adults was 28 years. In 50 % of cases, the manifestation of bronchiolitis obliterans occurred 1–3 months after the start of Stevens–Johnson syndrome/toxic epidermal necrolysis. Most patients (35 %) had severe bronchoobstructive syndrome, and characteristic computed tomography signs included mosaic perfusion (75 %) and bronchiectasis (49 %). Systemic (77 %) and inhaled (35 %) glucocorticosteroids, bronchodilators (63 %), and macrolide antibiotics (26 %) formed the basis of bronchiolitis obliterans therapy. Mortality in the analyzed cases reached 30 %, complete recovery was observed in only 33 %, and 35 % of patients retained persistent bronchoobstructive syndrome.