Assoc. Dr. Razvigor Durlenski was born in Dobrich in 1980 in a medical family. In 2005, he graduated as a doctor with honors from Medical University - Sofia. He specializes in the Department of Skin and Venereal Diseases in Sofia
In 2010, he acquired a speci alty in dermatology and venereology (skin and venereal diseases). In the same year, he defended his doctoral dissertation on the topic "Clinical-experimental studies on the role of the epidermal barrier in contact hypersensitivity and skin irritation" and obtained the educational and scientific degree "Doctor of Medicine".
Assoc. Durlensky has specialized in the University Clinic of Dermatology at LMU - Munich, Germany (2010), the University Clinic of Dermatology and Allergology - Charite, Berlin, Germany (2007/2008), the University Clinic of Dermatology and Allergology Schwabing - Munich, Germany (2004).
In 2011, he won the "Eureka" award of the Higher Attestation Commission and the "Eureka" Foundation for achievements in science. He is the winner of a number of prestigious international awards: Michael Hornsetin Memorial Scholarship of the European Academy of Dermatology and Venereology, Werner von Siemens Excellence Award, Inaugural Edward L. Keyes Award of the International Academy of Cosmetic Dermatology, etc.
Prof. Durlenski, how does our body react to the cold? Which reaction is considered normal and which - for the presence of a problem?
- Normally cold is a factor that affects both the skin and the whole body. In the physiological, normal reaction, a contraction of the blood vessels of the skin is observed, in which blood circulation from the periphery of the body is directed to the interior of the body, to the internal organs - heart, lungs, liver, which leads to a decrease in heat loss from the body.
Very often when we talk about the potentially harmful effects of cold on the skin, there are many misconceptions, such as what cold allergy is, how common it is, and whether all cases of cold side effects on the skin are related to allergy.
And in this regard, please clarify, is allergy, hypersensitivity and intolerance to cold what we commonly call "cold allergy"?
- The main condition that represents cold allergy is called cold urticaria or urticaria afrigore. This is a reaction to short or longer exposure to cold.
And accordingly, minutes after exposure to cold, either locally on the skin or on the whole organism, there is a reactive redness, raised rashes that are very reminiscent of a nettle sting. They itch, quickly change their places. When body temperature normalizes, they disappear.
This type of cold urticaria is an extremely rare condition - it affects between 0.01 and 0.05% of people. Considering what a true cold allergy is, all other conditions are unrelated to allergic mechanisms.
Most often these are skin diseases that are associated with chronic exposure to cold, such as the so-called pernions, the form of lupus erythematosus, which is called "lupus frost-like". And the most common condition that we actually see in our practice, when people come to us and say: I have a cold allergy, it's eczema or dermatitis, in other words, on the hands.
In most cases, it affects the palms, the space between the fingers, as well as the soft part of the fingers themselves. It is presented with redness, peeling. This, in itself, does not constitute an allergic disease.
It is due to the breakdown of the skin barrier, the water-lipid mantle on the surface of the skin from the contact with dry and cold weather that we as people who live in continental Europe have in winter. Other factors that contribute to the appearance of this condition is frequent contact with water.
You know, one of the problems of the 21st century is frequent and uncontrollable hand washing, which does not always lead to better hygiene results. This is sometimes associated with the development of eczema or dermatitis on the hands. So we must make a clear distinction between true allergy to cold, which is an extremely rare disease, and eczema, most often on the hands or eyelids and face.
These are the areas most often exposed to the cold in winter. This group of conditions is not due to an allergy to the cold, but rather to its action and the dry weather in winter.
Why do you consider frequent hand washing as a factor that can worsen the condition of the skin?
- Excessive contact with water, especially if it has a high temperature, above 38-40 degrees, as well as contact with various detergents, soaps and washing substances, leads to the destruction of the barrier of the skin of the hands.
Accordingly, this is associated with a loss of fat from the surface of the skin and excessive drying, which, if deepened over time, can lead to the development of clinical eczema. It is characterized by the appearance of red, dry lichens in the areas already mentioned.
Are many people suffering from winter skin dryness? Are they looking for professional help?
- Indeed, cold is a factor that seriously affects the whole organism. And people who suffer from the so-called winter skin dryness, as well as hand eczema that worsens in winter, reaches between 10 and 20% of the general population, which is an extremely severe and common problem.
From this point of view, I think that actual allergy to cold is not a socially significant disease, unlike those things that we see in our daily practice, such as hand eczema from the cold, xerosis or dry skin of thighs, pernions.
They are nodules that most often develop on the fingers, on other parts of the body, which are usually located above the joint surface of the hands and feet.
Assoc. Dr. Razvigor Durlenski
Do you have an explanation why some people are so sensitive to the cold?
- A matter of individual sensitivity. In view of this, there are also some familial conditions where this hypersensitivity to cold can be passed from the parents to the child. And accordingly, here we are talking about some conditions that are autoinflammatory syndromes in which proteins or proteins circulate in the blood.
Under the action of the cold, they can be activated and attack their own structures and, accordingly, lead to damage to various organs. These are the so-called cryoglobulins. And usually in people who have some kind of cold intolerance, this is a mandatory test that we do.
The easiest is the diagnosis of cold urticaria, because there the diagnostic test is very simple. We receive the patient in the office, we have special waterproof containers that are filled with ice.
During the examination itself, we place a frozen plastic cube on the patient's forearm for 5 to 10 minutes. After we remove it, the appearance of urticaria is observed - a raised, itchy and red rash, which, accordingly, may pass when the ice cube is removed. This is a provocation test for cold urticaria.
What is the therapy for conditions in which a person shows hypersensitivity to cold?
- The treatment of conditions which are associated with hypersensitivity to cold must be etiological in the first place. That is, to remove the provoking factor.
But this is not always easy to do, because in some patients, for example, the consumption of a cold drink or a drink with ice can lead to swelling and the appearance of this type of inflammation in the swallow or throat area, which is a life-threatening condition.
So in terms of therapy, first of all we need to talk about avoiding the provoking factor, in this case - the cold. And believe me, patients who suffer from this problem learn over the years to protect themselves very adequately and avoid contact with the cold during the winter months and with cold objects.
And the other drug option we have is antihistamine drugs. These are new medications that actually prevent the release of the allergenic substance histamine under the influence of cold. When the medicine is taken, the attacks, despite the person's contact with the cold, are much milder or may even be absent altogether.
If avoiding the provoking factors is impossible, we also give the so-called symptomatic treatment. That is, drugs that suppress the symptoms, but do not treat the cause of the disease. With them, we achieve relief of the condition and increase the patient's quality of life.
What recommendations would you give to people who are hypersensitive to the cold? How to take care of your skin in winter?
- A few tips I can give. First, anyone who has any suspicions of a cold allergy or any other cold-induced illness should consult a doctor.
These are fellow dermatologists who can give competent advice and opinion, perform diagnostic tests and prescribe adequate treatment. As for the most common problem - eczema from overdrying of the skin of the hands, in these cases, as a prophylaxis and prevention of the condition, we recommend the various types of moisturizing and barrier creams for the hands, which are applied after each washing of the hands.
The idea is that the formed thin film of lipids and water simulates the normal skin barrier. In this way, the skin of the hands is protected from the harmful effects of the dryness of the cold, in contact with water and detergents.
But I emphasize again, the main thing is prevention, not so much the treatment of symptoms. Because these are conditions that can be completely prevented.
What are the other dermatological diseases that worsen during the cold months? You mentioned about some of them.
- We observe seasonality in the course of some skin diseases. I can give an example of the worsening of two classic skin diseases, such as atopic dermatitis and psoriasis.
During the winter period, due to the fact that the air is cold and dry, and due to the lack of constant and intense solar radiation, they worsen during this season of the year. Therefore, one of the therapeutic methods we have for these diseases are the so-called phototherapy booths.
These are specialized devices that irradiate the body with selected ultraviolet light. In this way, during the winter period, we can naturally simulate the action of the sun and its anti-inflammatory effect on the skin.
And who "loves" the cold?
- If we have to talk about diseases that, on the contrary, worsen in the summer, most often these are conditions related to some kind of skin infection. What are the so-called erysipelas and an autoimmune skin disease we call pemphigus.
They tend to get worse when the weather is very hot and humid. So really, we as dermatologists always consider the seasonal dynamics of the disease itself when choosing an appropriate plan for the overall impact and prevention of the respective disease.
Dermatological diseases are many, but still, could you indicate what you consider to be a success, a breakthrough in treatment in recent years?
- Very intensive work is done in two areas in dermatology. One is aimed at various chronic inflammatory diseases, such as psoriasis, atopic dermatitis, urticaria. And there, the modern hit, blockbuster in treatment are the so-called biological drugs.
These are molecules that are much larger in size than classical drugs. They are most often done by injection and selectively suppress a certain mechanism from the whole chain of mechanisms in the development of the disease.
And this is usually associated with fewer side effects and better effectiveness compared to classic drugs. The problem with this class of medications is that they are extremely expensive
And we as dermatologists, in particular, and I as the secretary of the Bulgarian Dermatology Society, are making great efforts so that these treatments can be reimbursed by the National He alth Insurance Fund for Bulgarian patients with severe forms of inflammatory diseases.
Undoubtedly, the other wave of progress is the same class of drugs, however, used to treat skin tumors such as melanoma. You know very well that this is the most malignant tumor in the human body.
And the news of the last three or four years is that new and new drugs are constantly coming out, which in patients with metastatic melanoma (the one that has already spread), taking these drugs can prolong their lives and with five to ten years, which significantly changes the prognosis in the fight against this insidious disease.
You mentioned about biological drugs and that you are negotiating to have them covered by the he alth insurance fund. How far have these negotiations come and can we expect this to happen soon?
- We work very successfully with patient organizations, with the ministry, with the Medical Association, with professional organizations of other speci alties that are committed to the treatment of these diseases. It's constant letters, meetings…
In view of the fact that our Fund has an extremely limited budget, compared to a German or French he alth insurance system, the matter is very delicate. We hope that in 2020 we can boast and congratulate the entry of new and reimbursement of modern treatment for patients with severe inflammatory skin diseases.