Correlation between angiotensin-converting-enzyme 2 gene polymorphisms and systemic sclerosis.

OBJECTIVES: Systemic sclerosis (SSc) is a disease with cardiovascular impairment and polymorphisms of the gene coding of angiotensin-converting-enzyme 2 (ACE2) may account for its development. Three single nucleotide polymorphisms of ACE2 (C>G rs879922, G>A rs2285666 and A>G rs1978124) were found to increase the risk for development of arterial hypertension (AH) and cardiovascular (CVS) diseases in different ethnicities. We investigated associations of polymorphisms rs879922, rs2285666 and rs1978124 with the development of SSc. METHODS: Genomic DNA was isolated from whole blood. Restriction-fragment-length polymorphism was used for genotyping of rs1978124, while detection of rs879922 and rs2285666 was based on TaqMan SNP Genotyping Assay. Serum level of ACE2 was assayed with commercially available ELISA test. RESULTS: 81 SSc patients (60 women, 21 men) were enrolled. Allele C of rs879922 polymorphism was associated with significantly greater risk for development of AH (OR=2.5, p=0.018), but less frequent joint involvement. A strong tendency to earlier onset of Raynaud's phenomenon and SSc was seen in carriers of allele A of rs2285666 polymorphism. They had lower risk for development of any CVS disease (RR=0.4, p=0.051) and tendency to less frequent gastrointestinal involvement. Women with genotype AG of rs1978124 polymorphism had significantly more frequent digital tip ulcers and lower serum level of ACE2. CONCLUSIONS: Polymorphisms of ACE2 may account for the development of AH and CVS disorders in SSc patients. Strong tendencies to more frequent occurrence of disease specific characteristics distinct to macrovascular involvement will require further studies evaluating significance of ACE2 polymorphisms in SSc.

Role of short courses on nailfold capillaroscopy in obtaining abilities for the identification of microvasculopathy in patients with Raynaud's phenomenon.

INTRODUCTION: An early distinction between "normal" and "abnormal" capillaroscopic pattern during the first visit to a dermatologist has a crucial significance for a diagnostic management of Raynaud's phenomenon (RP). There exists a question about the level of expertise sufficient to evaluate the microcirculation. AIM: To evaluate the utility of short courses on NFC among dermatologists and medical students in obtaining sufficient abilities for the identification of microvasculopathy in patients with RP using videocapillaroscope and handheld dermoscope. METHODS: Both groups participated in 1-h course on NFC. Before the course, participants were asked to classify 20 videocapillaroscopic and 10 dermoscopic capillaroscopic pictures into "normal" or "abnormal" pattern. Each picture was displayed on a separate slide MS PowerPoint for 10 s. The evaluation was repeated soon after the course. RESULTS: A total of 36 dermatologists and 49 medical students were enrolled. The rate of properly classified dermoscopic and videodermoscopic pictures increased after the course in both groups, but students improved the accuracy of classification on dermoscopic pictures to the greater extent than dermatologists. The rate of correctly recognized pictures with "abnormal" pattern was significantly greater than ones with "normal" pattern at the baseline and after the course, independently of imagining tool. CONCLUSIONS: Short courses on NFC may improve the classification of capillaroscopic images, even in medical staff with no previous experience in NFC. The recognition of capillaroscopic abnormalities seems to be easier than obtaining the confidence that evaluated picture has "normal pattern."

Vascular pattern in dermoscopy of basal cell carcinoma in the H- and non-H-zone.

Introduction: Basal cell carcinoma (BCC) located on the face in the H-zone (nose, ears, eyes), the region corresponding to places of fusion of embryonic masses (EFP) has been associated with a higher risk of deeper invasion and more frequent recurrence. Aim: To characterize the dermoscopic image of the vessels of BCC in the H-zone and non-H-zone. Material and methods: A retrospective analysis of vessels in dermoscopic images of 120 BCC cases in the H-zone and non-H-zone (the rest of the face) was conducted. The H-zone consists of the nose, ears, eyes and the non-H-zone of the forehead, cheek, chin and the rest of the face and neck. Results: Of the 120 lesions analysed, there were 41 (34.2%) in the H-zone and 79 (65.8%) in the non-H-zone. Arborizing vessels, as well as the short-fine-telangiectasias were the most predominant types of vessels present, and their frequency in the H- and non-H-zone was comparable. Significant differences were observed for the occurrence of glomerular and comma vessels, both of which occurred less frequently in the H-zone than in the non-H-zone. Conclusions: The dermoscopic morphology of the vessels in BCC tumours in the H- and non-H-zones is generally similar, with differences in the presence of glomerular and comma vessels, which occur more frequently in the non-H-zone.

Vitiligo and insulin resistance as a component of metabolic syndrome: an analysis.

There have been many studies on the association between vitiligo and metabolic syndrome, while only few scientific papers on vitiligo and insulin resistance. In recent years, there have been significant developments in research to trace and understand the aetiology of both conditions. In this article we have analysed pathophysiological mechanisms and the association of insulin resistance (as a component of metabolic syndrome) and vitiligo.

Hidradenitis suppurativa and squamous cell carcinoma: a systematic review of the literature.

Hidradenitis suppurativa (HS) is a chronic disease which is often recurrent and occurs as abscesses of the apocrine gland. The most common locations of HS are gluteal/perianal, axillary or inguinal. It is reasonable to assume that squamous cell carcinoma may arise from HS. As researchers in the field of dermatology, HS surgery and conventional surgical oncology, we studied whether there is any correlation between HS and neoplasms. Evidence shows a correlation between HS and squamous cell carcinoma. The aim of the study was to find literature about HS and SCC and analyse potential risk factors. This is a systemic review concerning squamous cell carcinoma and hidradenitis suppurativa.

Laser speckle contrast analysis (LASCA): a new device in the diagnosis and monitoring of surgical treatment of hidradenitis suppurativa.

Introduction: Laser speckle contrast analysis (LASCA) is a quite new and unique device which can find applications in multiple diagnostic approaches in dermatology and dermatosurgery. LASCA can be used in multiple approaches. We would like to make the world's first presentation of LASCA usefulness in hidradenitis suppurativa (HS) surgery based on a case series. Aim: To evaluate the usefulness of LASCA in the surgical treatment of HS. Material and methods: In HS surgical treatment at the Centre for Burns Treatment in Siemianowice Slaskie, Poland in 2019-2022, we performed standard preoperative, intraoperative and postoperative speckle laser examinations to assess the vascular perfusion of the surgical sites. The device used was Laser Speckle Contrast Analysis (Perimed AG). This study included 18 patients treated surgically at the Centre for Burns Treatment in Siemianowice Slaskie with specific LASCA findings. Results: As a result of the LASCA examination, we found 1) ischemia of the flap, and 2) local foci of HS, and we could also assess the healing process. Conclusions: LASCA is a great device with which we can evaluate wound healing after surgical procedures (STSG and skin local flaps). LASCA allows for early detection of post-operative complications like ischemia of the local skin flap.

Reconstructive surgical treatment of hidradenitis suppurativa with a 6-month follow-up.

Introduction: Hidradenitis suppurativa (HS) is a chronic skin disease that significantly reduces the quality of life of patients, especially affecting the intimate areas. Surgical treatment is one of the tools available for treating HS, which can significantly improve patients' quality of life. Aim: To evaluate the surgical treatment of 31 patients treated surgically at the Centre for Burns Treatment in Sie-mianowice Slaskie, with a follow-up of 6 months. Material and methods: Thirty-one HS patients were operated on with classical reconstructive methods. The patients were followed up for 6 months in the outpatient clinic. We gathered clinical data of 31 post-operative patients and statistical analysis was performed. Results: 83.87% of the patients were completely healed. The study showed that HS recurrence in the surgical site occurred in 1 (3.23%) patient only after 6 months of follow-up. We found a statistically significant (p < 0.050) positive correlation between patients' age and body mass index (BMI), disease duration and time of diagnosis. BMI value additionally correlated with disease duration and time of diagnosis, while disease duration correlated with time of diagnosis. Conclusions: Surgical treatment is an effective method in HS. The relatively low recurrence rate after 6 months and, in most patients, full healing, support the good therapeutic effect of surgical treatment.

Eye-tracked computer games as a method for pain perception alleviation in chronic wound management.

Introduction: Chronic pain frequently accompanies the daily lives of many chronic wound patients. The degree of pain experienced significantly increases when performing medical procedures related to wound management. The use of eye-tracked games in order to distract the patient's attention from the painful activities performed can be an effective procedure. Aim: Assesment of eye-trackers as a distractors during wound management. Material and methods: Forty patients suffering from chronic wounds were qualified for the study. Patients performed eye tracking games during dressing changes and wound cleaning. Pain sensations were surveyed. The survey concerned the pain experienced on a daily basis, when changing the dressing without use and with the use of eye trackers. Results: It was found that eye trackers significantly reduced the pain experienced during dressing changes compared to the pain caused by these procedures, but without the use of eye trackers. Conclusions: On the basis of the obtained results, it was proposed to introduce eye trackers into routine clinical practice during chronic wound management.

Utility of phototherapy in patients with systemic sclerosis: Systematic review.

Phototherapy is a recommended treatment regimen for different scleroderma spectrum disorders, but so far it has been included neither by European nor by worldwide experts committee in recommendations for the treatment of systemic sclerosis (SSc). The aim of the study was to revisit the utility of dermatological phototherapy in patients with SSc. PubMed using medical subject headings was searched to identify studies evaluating response to dermatological phototherapy in SSc patients. Both UVA1 (340-400 nm) and PUVA (psoralen plus UVA) treatments were found to reduce skin thickening and increase skin elasticity, therefore allowing for the improvement of joint tension mobility, especially in hands. At least several papers showed efficacy of phototherapy in patients who remained non-responsive to previous immunosuppressive therapies. The most probable mechanisms of action of phototherapy in SSc include inhibition of T-cells and prevention from dermal fibrosis. Although most data on the efficacy of phototherapy come from small experimental studies and case reports, phototherapy based on UVA of wavelength manifests relatively mild spectrum of side effects and this should be considered as a treatment option for SSc with dominant cutaneous involvement.

The impact of face masks on acne-prone skin in Polish young adults during COVID-19 pandemic.

COVID-19 pandemic raised many problems for patients with acne-prone skin: a limited access to health care services, the necessity of developing telemedical consultations also in dermatology, and the usage of face masks. The aim of the study was to investigate the influence of respiratory protective measures (type of masks, wearing time during the day) on declared skin condition in patients already diagnosed with acne or reporting acne for the first time. The study was conducted in Poland among 1420 responders using the original authors' questionnaire, of which 1274 responders were included in the final sample. Acne exacerbations were reported as being more frequent and more severe in women than in men. Changing cosmetic products, facial skin decontamination before or after applying masks, the number of days per week that a mask was worn were related to acne exacerbation. The type of mask had no significant impact on the occurrence of acne lesions. Respondents noted that masks contribute significantly to skin condition worsening by exacerbating existing and causing new acne lesions. This phenomenon was particularly observable in women, in whom, according to the research results, new lesions appeared much more frequently. Therefore, there is a need to develop new ways of limiting acne exacerbation during COVID-19 pandemic.

"Fine feathers make fine birds" - non-medical students' opinions on the dermatologists' image in Poland: a cross-sectional study.

Introduction: Medical professions are full of patterns and personal exemplars which determine norms of behaviour. Research works focused on the doctor's image include not only perception of reality, but also patients' subconscious expectations. Aim: To get to know the students' opinion on the image of dermatologists, to assess the public image of that profession and what factors have the biggest impact on that issue. Material and methods: The study was conducted in a group of 1000 Polish, non-medical students (F = 817, M = 183) between 18 and 25 years old. The data were collected through an anonymous, author-designed, online questionnaire. The questionnaire was sent via Internet social media to students from 12 various non-medical fields of study. Results: 51.6% of interviewees considered this profession as moderately prestigious. Only 18.9% of the respondents saw the image of the dermatologist created by the media as adequately presented. There is a statistically significant difference (p = 0.0006) between the different age groups and the frequency of visits to the dermatologist. The median sum the respondents were able to pay for a specialist visit was 100 zloty (IQR: 70-150). The field of study (p = 0.002) and place of residence (p < 0.001) significantly influenced the amount they were able to spend. Conclusions: In students' opinion, factors such as medical experience and communication with the patient have the strongest influence on the image of this profession. The second strongest factor affecting the choice of a dermatologist is information acquired by word of mouth from other patients and family members, without any prior verification.

Sulfotransferase SULT1A1 activity in hair follicle, a prognostic marker of response to the minoxidil treatment in patients with androgenetic alopecia: a review.

Androgenetic alopecia (AGA) is a very common type of alopecia in men and women. It may have a negative effect on the quality of life. The most widely used pharmaceutical treatment for AGA is topical minoxidil and it is also the only external treatment of pattern hair loss. There are two forms of this treatment - 5% and 2% minoxidil. The correlation between SULT1A1 expression in the scalp and minoxidil response has been previously reported. Due to the prolonged treatment time required to elicit a therapeutic response (approximately 6 months) combined with the variable efficacy of minoxidil in the general population, expression of SULT1A1 as a biomarker for predicting treatment response would have a significant clinical utility.

Surgical management of hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic disease, which causes painful discomfort. The main regions involved in this disease are axillary, inguinal and perianal. The etiology is unknown at present. It is suggested that genetics, smoking and diabetes are involved in HS. General treatment consists of antibiotics and anti-inflammatory biological drugs. HS is a multidisciplinary disease, which involves surgical treatment as well. We would like to present surgical treatment in HS. Deroofing and drainage/incisions are the most frequent techniques in general surgery departments. The article describes additional techniques such as skin grafts and flaps. We conclude that local flaps are the best choice in surgical treatment.

Hidradenitis suppurativa: bacteriological study in surgical treatment.

Introduction: Hidradenitis suppurativa (HS) is an inflammatory chronic disease of the hair follicles that presents with different lesions in the apocrine gland-bearing areas of the human body. There are many possible factors for HS. Acne inversa is not primarily considered to be an infectious disease. A variety of Gram-positive and Gram-negative bacteria have been found from the lesions sporadically. Aim: To assess the bacteriological profile of HS before surgical treatment. Material and methods: We collected specimens for aerobic microbiological testing from 18 patients before surgical treatment in our hospital. The specimens were obtained from abscesses, directly from skin fistulas, on day 1 of hospitalisation. Results: The most common bacteria in HS lesions were Staphylococcus aureus and Proteus mirabilis. In 4 patients we found multi-drug-resistant bacteria (MLSB, MRSA and A. baumannii). Conclusions: Long-term antibiotic treatment can cause multi-drug resistance in strains collected in HS lesions.

Psoriasis and Gut Microbiome-Current State of Art.

Psoriasis is a chronic, immune-mediated inflammatory disease that affects around 125 million people worldwide. Several studies concerning the gut microbiota composition and its role in disease pathogenesis recently demonstrated significant alterations among psoriatic patients. Certain parameters such as Firmicutes/Bacteroidetes ratio or Psoriasis Microbiome Index were developed in order to distinguish between psoriatic and healthy individuals. The "leaky gut syndrome" and bacterial translocation is considered by some authors as a triggering factor for the onset of the disease, as it promotes chronic systemic inflammation. The alterations were also found to resemble those in inflammatory bowel diseases, obesity and certain cardiovascular diseases. Microbiota dysbiosis, depletion in SCFAs production, increased amount of produced TMAO, dysregulation of the pathways affecting the balance between lymphocytes populations seem to be the most significant findings concerning gut physiology in psoriatic patients. The gut microbiota may serve as a potential response-to-treatment biomarker in certain cases of biological treatment. Oral probiotics administration as well as fecal microbial transplantation were most reported in bringing health benefits to psoriatic patients. However, the issue of psoriatic bacterial gut composition, its role and healing potential needs further investigation. Here we reviewed the literature on the current state of the relationship between psoriasis and gut microbiome.

Dermatologic aspects of bed bug epidemic: an atlas of differential diagnosis.

Bed bug infestation rate has gone through an unforeseen increase in the past decades worldwide. Their resurgence is a consequence of numerous factors, including growing population density, increased international travel and the spread of insecticide resistance. Bed bug infestation is often revealed by skin symptoms appearing after their bite in sensitive patients. Medical professionals encountering patients with bed bug bites have responsibility for recognizing the condition and for instructing patients about the necessary measures for eradication. Setting the correct diagnosis, however, is not unequivocal as several skin diseases with autoimmune, immune-mediated aetiology or other arthropod stings and bites may present with similar symptoms. In this review we provide a differential diagnostic guide and an atlas of clinical pictures assigned to the diagnoses. We highlight those dermatological findings where the possibility of bed bug bite arises and identify key elements that help in the differentiation so as to avoid unnecessary diagnostic tests and force early start of extermination.

MORPHEA AND LICHEN SCLEROSUS IN A PATIENT WITH HYPORTHYROIDISM.

Thyroid gland is one of the key organs regulating the metabolism of carbohydrates, proteins and fats. Its primary function is connected with increase of the metabolic conversion of the body. Skin lesions are often one of the first symptoms of hypothyroidism. In a 71-year-old patient, skin lesions in the form of thickened areas with severe hyperkeratosis first appeared 12 years before. Eight years before, the patient was diagnosed with hypothyroidism of unknown cause. Upon admission, lesions were observed in the trunk area, left arm and vulva. These lesions had the appearance of brownish spots with hyperkeratosis. Initially, they were localized on the trunk, then involving upper limbs and neck area with time. Significant progression was present in the back area. In the anogenital area, porcelain-white discolorations were observed. Laboratory examinations were normal. During hospital stay, iv. ceftriaxone at a dose of 2.0 g/day for 10 days and intramuscular injection of vitamin B6 were administered, along with 10% urea ointment for hyperkeratosis lesions as topical therapy. The patient had lesions in the form of skin induration and discoloration, with visible, very severe hyperkeratosis, which is not characteristic of changes of the scleroderma and lichen sclerosus type. These lesions caused diagnostic problems due to the atypical clinical appearance.

Teledermatology: idea, benefits and risks of modern age - a systematic review based on melanoma.

Telemedicine may be described as a modern technology supporting health care at a distance. Dermatology, as a visually-dependent specialty, is particularly suited for this kind of the health care model. This has been proven in a number of recent studies, which emphasized feasibility and reliability of teledermatology. Many patients in the world still do not have access to appropriate dermatological care, while skin cancers morbidity is on an upward trend. Technological development has enabled clinicians to care for diverse patient populations in need of skin expertise without increasing their overhead costs. Teledermatology has been used for various purposes: health care workers can use this technology to provide clinical services to patients, to monitor patient health, to consult with other health care providers and to provide patients with access to educational resources. It seems that teledermatology might be the answer to numerous issues concerning diagnosing, screening and managing cancers as well as pigmented skin lesions.

Evaluation of PSEN1 subunit of the γ-secretase gene in patients with psoriasis vulgaris: a pilot study.

INTRODUCTION: Psoriasis is a chronic autoimmune inflammatory disease, the prevalence of which is 1-3% in the Polish population. Genome testing using single nucleotide polymorphisms revealed more than 50 regions associated with the risk of psoriasis, and most of these genes are associated with the immune system. AIM: To assess the presence of PSEN1 subunits of the γ-secretase gene polymorphisms in patients with psoriasis and comparison of results with a healthy control group. MATERIAL AND METHODS: We used polymerase chain reaction - restriction fragment length polymorphism (PCR RFLP) method to assess polymorphisms. The starting material for analysis was peripheral blood obtained from the patient. RESULTS: PSEN1a-positivity was found in 2/52 (2.78%) of patients with psoriasis and 1/36 (3.85%) of healthy controls. PSEN1b positivity was seen in 3/52 (5.77%) of patients with psoriasis and 1/36 (3.85%) of control individuals. Only 3 patients with psoriasis but none of healthy volunteers had a presence of PSEN1c. Four patients were excluded from further statistical analysis. CONCLUSIONS: We have not shown a relationship between PSEN1 polymorphism and the clinical occurrence of psoriasis but now we start the assessment of other subunits of the γ-secretase gene - PSENEN and NCSTN.

The safety of isotretinoin treatment in patients with bone fractures.

Isotretinoin is widely applicable in dermatology, although it may develop severe side effects in the skeletal system. An intention of this review was to establish the safety of oral isotretinoin in patients with bone fractures. Both MEDLINE/Pubmed and SCOPUS databases were searched to investigate the influence of isotretinoin on the skeletal system. The drug shows a strong osteoporotic activity in rats whereas this effect is milder in humans. Biochemical markers of bone turnover remain unchanged except for serum calcium in patients receiving a high dose of isotretinoin. An excessive intake of vitamin A may impair functioning of vitamin D especially in people with a vitamin D deficiency, therefore a similar side effect may also occur in patients on isotretinoin treatment. We suggest reducing the use of isotretinoin after bone injury or continuing the treatment at low dosing with a concomitant correction of vitamin D and calcium status.