TREATMENT TACTICS DETERMINATION OF PATIENTS WITH DYSHIDROTIC ECZEMA OF PALMS AND SOLES CONSIDERING CLINICAL ANDIMMUNOHISTO-CHEMICALINDICATORS OF THE COURSE DIS-EASE SEVERITY

For the present, the issue of treatment of patients with with dyshidrotic lesionsremains relevant. In most cases, the clinical criteria for the severity of the process coincide with the pathomorphological and immunohistochemical (IHC) changes in the skin of patients, which facilitates the development of personalized physical therapy of patients. Objective. Theassessmentoftheseverity and ac-tivity of the pathological process with the subsequent choice of the treatment tactics of patients withdyshidrotic eczemaofpalmsandsoles(DEPS) based on clinical, patho-morphological and immunohistochemical features. Materials and methods. A clinical evaluationof the severity of the disease,pathomorphological study and immunohistochemical examination of biopsy samples from the focus of skin lesion were performed in 29 pa-tients with dyshidrotic lesions. Results and discussion. Clinical and morpho-logical comparisons were carried out in patients with DEPS, taking into account the DASI index. During the pathomorphological study, two groups were identified – with moderate and pronounced morphological changes. Moderate morphological changes were observed in pa-tients in Group І with the DASIindex (0-30), combining mild to moderate degrees. Patients withIHC with mild to moderate severity of the process (clinically) were charac-terizedbythe expression of a large number of CD4, CD138 and S100 positive cells in bullous structures, in the epidermis and in perivascular cell infiltrate; expression of CD20 positive cells was determined mainly in the dermis and perivascularly in moderate amounts. In addition, a large number of positive deposits of C3 and C4d complement fractions were perivascularly noted. Group II included patients with the DASI index (31-60), which corresponded to the severe degree of the disease, with pronounced morphological changes. The expression of single CD4, CD138, CD20 positive cells was determined in the epidermis, dermis and perivascular infiltrates in patients with IHC with pronounced pathology. In some cases, the number of S100 positive cells was insignificant and corresponded to the number, as in the group with moderate morphological manifestations. There were single or no deposits of C3 and C4d complement fractions. All patients in the first group received a positive result for the treatment of potent topical glucocorticosteroid (GCS). 14 patients in Group II were not susceptible to GCS and continued systemic treatment with cyclosporine. Conclusions. The treatment tactics of patients with DEPS is determined by the results of clinical, pathomorphological and immunohistochemical studies. During clinical and morphological comparisons, taking into account IHD data, it was found that the number of CD4 positive cells, CD138 cells, deposits of the comple-ment fraction C3 and C4d decreased with the increase of the severity of the clinical course. The vast majority of DEPS patients with severe disease did not respond to the treatment of a potent topical GCS and had a positive effect on the systemic treatment with cyclosporine. The obtained morphological data in comparison with the clinical criteria of the severity of the process can be the basis for the appointment of systemic therapy, namely cyclosporine in patients with DEPS, which are resistant to topical corticosteroid therapy.