Erythroderma: A Retrospective Study of 212 Patients Hospitalized in a Tertiary Center in Lower Silesia, Poland.

Erythroderma is a condition characterized by erythema affecting at least 90% of the skin surface area. It can be caused by various underlying conditions. Due to nonspecific clinical and laboratory findings, determining the cause may pose a challenge. In the retrospective study, we identified 212 patients hospitalized for erythroderma in the Department of Dermatology, Venereology, and Allergology at Wroclaw Medical University between January 2012 and March 2022. Clinical, laboratory, and histopathological features, as well as the management of patients, were studied. The median age of adults was 61 years (IQR = 47-68). The most common causes of erythroderma were psoriasis (n = 49, 24.01%), followed by atopic dermatitis (AD) (n = 27, 13.23%), and cutaneous T-cell lymphomas (CTCL) (n = 27, 13.23%). Despite laboratory tests and histopathological examination, the etiology of erythroderma remained undetermined in 39 cases (19.12%). In 70.59% of patients, it was the first episode of erythroderma, while 29.41% experienced a recurrent episode. Regardless of the etiology of erythroderma, patients were most frequently treated with systemic antihistamines (146 cases, 71.57%) and systemic steroids (132 cases, 64.71%). Patients with idiopathic erythroderma constitute the greatest diagnostic and therapeutic challenge, requiring particularly thorough evaluation.

The Pathophysiology and Treatment of Pyoderma Gangrenosum-Current Options and New Perspectives.

Pyoderma gangrenosum (PG) is an uncommon inflammatory dermatological disorder characterized by painful ulcers that quickly spread peripherally. The pathophysiology of PG is not fully understood; however, it is most commonly considered a disease in the spectrum of neutrophilic dermatoses. The treatment of PG remains challenging due to the lack of generally accepted therapeutic guidelines. Existing therapeutic methods focus on limiting inflammation through the use of immunosuppressive and immunomodulatory therapies. Recently, several reports have indicated the successful use of biologic drugs and small molecules administered for coexisting diseases, resulting in ulcer healing. In this review, we summarize the discoveries regarding the pathophysiology of PG and present treatment options to raise awareness and improve the management of this rare entity.

Skin Cancer Risk, Sun-Protection Knowledge and Behavior in Athletes-A Narrative Review.

Outdoor sports are associated with increased exposure to ultraviolet radiation, which may result in sunburn, solar damage, and skin cancers. Water and winter sports create additional adverse conditions, such as washing away sunscreen by water and reflection of UV rays by the water and snow. Sweating-increased skin photosensitivity and activity-induced immunosuppression are associated with a greater risk of developing skin cancers. In this review, we focus on a group of athletes and sports participants and analyze 62 articles concerning sun exposure during outdoor sports, the risk of developing skin cancer, and knowledge and behavior regarding photoprotection methods. Various practices have been linked to an increased risk of developing basal cell carcinoma (BCC), squamous cell carcinoma (SCC), malignant melanoma (MM), or UV-induced skin damage. Water sports and mountaineering increase the risk of BCC. Surfing and swimming are risk factors for SCC. Melanoma is more common in swimmers, surfers, and marathon runners. Photoprotection behaviors can reduce potential skin damage and skin cancers. Athletes' knowledge about the risk of malignant lesions was satisfactory, but despite the risks, outdoor sports participants seem not to protect themselves from the sun adequately.

The Skin Microbiome in Cutaneous T-Cell Lymphomas (CTCL)-A Narrative Review.

In recent years, numerous studies have shown a significant role of the skin microbiome in the development and exacerbation of skin diseases. Cutaneous T-cell lymphomas (CTCL) are a group of malignancies primary involving skin, with unclear pathogenesis and etiology. As external triggers appear to contribute to chronic skin inflammation and the malignant transformation of T-cells, some microorganisms or dysbiosis may be involved in these processes. Recently, studies analyzing the skin microbiome composition and diversity have been willingly conducted in CTCL patients. In this review, we summarize currently available data on the skin microbiome in CTLC. We refer to a healthy skin microbiome and the contribution of microorganisms in the pathogenesis and progression of other skin diseases, focusing on atopic dermatitis and its similarities to CTCL. Moreover, we present information about the possible role of identified microorganisms in CTCL development and progression. Additionally, we summarize information about the involvement of Staphylococcus aureus in CTCL pathogenesis. This article also presents therapeutic options used in CTCL and discusses how they may influence the microbiome.

Facial acne causes stigmatization among adolescents: A cross-sectional study.

BACKGROUND: Stigmatization is defined as a discrediting mark which sets the person from others and hindering interpersonal relationships. Literature data on stigma in acne subjects are scarce. AIMS: This study was undertaken to assess feelings of stigmatization in adolescents with facial acne. MATERIAL/METHODS: The study was performed on 730 high-school students aged 15 to 19 years with the mean age of 17.05 ± 1.18 years. Self-reported acne was found in 74.9% of subjects. The severity of acne was self-assessed with the standardized color images based on Investigators Global Assessment (IGA). Stigmatization was studied with 6-Item Stigmatization Scale (6-ISS) and Perceived Stigmatization Questionnaire (PSQ). Additionally, quality of life (QoL) was evaluated with Dermatology Life Quality Index (DLQI). RESULTS: 58% of adolescents with acne presented with feelings of stigmatization. Within the acne population, stigmatization was significantly more common in females than in males (p < 0.001). The mean level of stigmatization according to 6-ISS was significantly higher in acne sufferers than in those free from acne (1.68 ± 2.42 points and 0.55 ± 1.50 points, respectively; p < 0.001). Feelings of stigmatization were significantly more pronounced by females than males (p < 0.001). Staring at the skin and the fact that others are not attracted to person due to skin lesions were main problems raised by the study participants with acne. 6-ISS scores correlated with acne severity (r = 0.278; p < 0.001) and both 6-ISS and PSQ scores with QoL impairment (r = 0.530; p < 0.001 and r = 0.341; p < 0.001, respectively). CONCLUSIONS: Facial acne is a highly stigmatized skin disease and requires a holistic therapeutic approach.

Photoprotection among young children: assessment of mothers' awareness and health behaviours.

Introduction: Due to the increasing incidence of skin cancer in the last decades a wide promotion of proper sun protection is needed. Mothers and their children commonly spending time outdoors are particularly vulnerable to the harmful effects of sunlight. Aim: To assess health awareness and behaviours connected to sun protection in the group of mothers of children under 6 years of age. Material and methods: An online survey containing 23 questions (19 closed and 4 open) was carried out between July and August 2019. One hundred and seven women (mean age: 30.7 ±4.3years) participated in the study. The mean age of children was 1.9 ±1.6years (range: 0-6 years). Results: One hundred and five (98.1%) mothers declared using sunscreen. Of them, 36 women used sunscreen only in summer, while 14 women applied sunscreen all year. Mothers of younger children used sunscreen all year round significantly more often (p = 0.041) compared to mothers of older children. Mothers of children under the age of 1 used sunscreen when staying in the shade more often (p = 0.025) than mothers of older children. Only 14 (13.3%) women declared applying sunscreen on their children during cloudy weather. Conclusions: A good photoprotection awareness of mothers, especially with respect to the youngest children was observed. However, a need for further education regarding certain photoprotection aspects (proper application and damaging effect of UVA) is necessary.

Alexithymia in Adolescents with Acne: Association with Quality of Life Impairment and Stigmatization.

Alexithymia seems to be more common among patients with skin diseases. However, studies on acne patients are very limited. We conducted this study to evaluate alexithymia in adolescents with acne. In our cross-sectional study, 730 high school students (mean age: 17.05 ± 1.18 years) were recruited. The Toronto Alexithymia Scale (TAS-20) was used to measure alexithymia, the Dermatology Life Quality Index (DLQI) was employed to study quality of life (QoL), and the 6-item Stigmatization Scale (6ISS) was used to evaluate the level of stigmatization in acne subjects. Alexithymia was found in 31% of adolescents, with similar prevalence among those with and without acne (31.3% and 30.1%, respectively). The mean scoring on the TAS-20 in patients with acne (53.1 ± 12.8 points) was not significantly different from that of the non-acne group (53.5 ± 11.9 points). However, significant correlations between TAS-20 scores and QoL assessments (r = 0.332, p < 0.001) as well as stigmatization level (r = 0.284, p < 0.001) were found. These correlations were also significant for the domains of alexithymia described as difficulty in identifying feelings (DIF) and difficulty in describing feelings (DDF), but not for externally oriented thinking (EOT). The findings clearly showed that acne does not predispose to alexithymia; however, alexithymia in acne subjects is related to impaired QoL and stigmatization.

Chitinase-3-like Protein 1 (YKL-40): A New Biomarker of Inflammation in Pyoderma Gangrenosum.

Pyoderma gangrenosum (PG) is a rare, neutrophilic dermatosis with unclear aetiopathology, considered as an autoinflammatory disease, associated with other immune-mediated disorders. Chitinase-3-like protein 1 (YKL-40) is an inflammatory biomarker secreted by a wide variety of cells, including neutrophils. To evaluate YKL-40 serum level in relation to clinicopathological data, 48 patients with PG and 40 healthy controls were enrolled in the study. Skin lesions were measured to calculate the affected area. Inflammatory parameters (C-reactive protein, white blood cell count with neutrophils) were determined from blood samples. YKL-40 and IL-6 levels were measured in serum by enzyme-linked immunosorbent assay. YKL-40 serum level was significantly higher in patients with PG than in controls (58.4 vs 36.4 ng/ml, respectively; p < 0.00001). The positive correlation between YKL-40 level and IL-6 level was observed (r=0.48, p = 0.0006) along with a trend towards significance of relationship between YKL-40 level and C-reactive protein (r=0.28, p = 0.052). YKL-40 can be considered a valuable biomarker of inflammation in PG.

Prevalence and quality of life of facial acne: a cross-sectional study in high school students in Poland.

Introduction: Acne is a frequent chronic inflammatory disease, which affects most commonly adolescents. It might have a negative effect on patients' well-being. Aim: To appraise the prevalence of facial acne among adolescents and to assess how acne of different clinical severity influences quality of life in this age group. Material and method: This cross-sectional study was conducted on a representative sample of individuals aged 15-19 years in high schools in Poland. A total of 730 students were included in the final analysis. Standardized photographs according to the Investigator's Global Assessment (IGA) were used for self-assessment of both the presence and severity of facial acne. The Dermatology Life Quality Index (DLQI) was employed to evaluate subjects' quality of life (QoL) impairment. Results: Facial acne was found in 547 (74.9%) respondents with no significant difference in acne prevalence among females (75.1%) and males (74.6%). The vast majority of acne individuals (90.9%) suffered from minimal and mild acne, moderate acne was reported by 7.3% and severe one by 1.8% of acne students. Acne had a small effect on QoL (DLQI mean score of 2.8 ±3.6 points); females had significantly more decreased QoL than males (3.17 ±3.74 and 1.76 ±2.69 points, respectively). QoL impairment positively correlated with the clinical severity of facial acne. Conclusions: Facial acne is a common health problem in adolescents. Although it is not very severe in the majority of subjects it significantly decreases their QoL. Therefore, acne should be treated as a serious skin condition requiring a holistic approach to the patients.

Emerging biomarker in carcinogenesis. Focus on Nestin.

Nestin is a protein belonging to class VI intermediate filaments, which is involved in organogenesis, cellular metabolism and cytoskeletal organisation. Originally found to be expressed in neuroepithelial stem cells, nestin is also expressed in other tissues. It plays an important role in the carcinogenesis and angiogenesis. Its increased expression in melanoma is associated with an aggressive course of the disease and poor prognosis. Research findings for non-melanocytic skin neoplasms are inconclusive. The aim of this paper was to systematize knowledge on the role of nestin in cancerogenesis. The authors focused in particular on the expression of nestin in skin malignancies, as well as on the potential role of nestin in the pathogenesis, prognosis and treatment of cutaneous neoplasms.

Epidemiology of dermatophytoses in paediatric population in Southwestern Poland, 2011-2016.

INTRODUCTION: Dermatophytoses are the most common superficial fungal infections in paediatric population. Its pathogen pattern has changed over years. AIM: To analyse the spectrum of dermatophytoses in children living in Southwestern Poland, in the years 2011-2016. MATERIAL AND METHODS: A total of 1705 patients were diagnosed with fungal skin infection in the Mycological Laboratory, Dermatology Department of the Wroclaw Medical University. Of them, 163 were under 18 years of age. RESULTS: In 105 cases, dermatophytoses were detected. The collected specimens were examined using direct microscopy examination, staining, culture on specific media and PCR technique. The most common dermatophytes were Trichophyton rubrum and Trichophyton tonsurans (31.4% each), followed in the descending order by Trichophyton mentagrophytes (21.9%), Microsporum canis (13.3%) and Epidermophyton floccosum (1.9%). The most commonly affected body sites were glabrous skin of the trunk and extremities (41.7%), followed by face (22.2%), scalp (15.7%) and toe nails (14.8%). CONCLUSIONS: This study revealed the most common types of dermatophytoses and their pathogens in children in Southwestern Poland. In comparison to earlier data obtained from this region, new epidemiological trends have been revealed. We observed the shift towards anthropophilic dermatophyte infections and an increasing number of onychomycosis in children. Because of climatic variations, migration, and changing lifestyle practices, further studies on dermatophytoses are necessary to improve our knowledge on the epidemiology of fungal infections.

What factors affect the length of hospitalization in patients with erysipelas? A 10-year retrospective study of patients hospitalized in Lower Silesia, Poland.

BACKGROUND: Erysipelas is an acute skin infection caused by group A and G streptococci. This infection is associated with many comorbidities and often requires hospitalization. OBJECTIVES: The aim of this study was to identify the factors related to the length of hospitalization in patients with erysipelas. MATERIAL AND METHODS: This retrospective study included 153 admissions of 135 patients (63 women and 72 men) hospitalized due to erysipelas from January 2010 to December 2019. Clinical symptoms, test results, comorbidities, and antibiotic treatments were taken into consideration as factors affecting the length of hospital stay. RESULTS: The median length of hospitalization was 10 days (interquartile range (IQR) = 7-14). Women spent less time in the ward, but the difference was not significant. Features such as tinea pedis (15.5 days, IQR = 13.5-20; p = 0.002), anemia (11 days, IQR = 9-15; p = 0.02), chills (12 days, IQR = 9-15; p = 0.03), elevated serum C-reactive protein (CRP) level over 100 mg/L (11 days, IQR = 8-17; p = 0.02), and leukocytosis (11 days, IQR = 8-15, p = 0.005) were identified as prolonged hospitalization factors. Moreover, patients with erysipelas localized to the legs (p = 0.01) and with a gangrenous variant of erysipelas (p = 0.03) were hospitalized longer. The first-choice antibiotic was not significant in terms of prolonged hospitalization. Patients treated with clindamycin during hospitalization, regardless of whether it was a first-line or subsequent antibiotic, stayed in the ward significantly longer (p = 0.005). CONCLUSION: Patients suffering from erysipelas with the features identified above, have a higher risk of a prolonged stay in the hospital. Significantly increased inflammatory factors, anemia and tinea pedis contributed to prolonged hospitalization.

Cutaneous Rosai-Dorfman Disease: A Treatment Challenge.

Rosai-Dorfman disease (RDD) is a benign histiocytosis that rarely manifests as a purely cutaneous form. Its differential diagnosis and treatment can pose a challenge to both clinicians and pathomorphologists. We present the case of a 69-year-old woman with cutaneous RDD presenting as multiple nodules on the right thigh who was treated with low-dose methotrexate weekly for > 1 year with a partial response.

Pack-year cigarette smoking affects the course of palmoplantar pustulosis.

BACKGROUND: Palmoplantar pustulosis (PPP) is a chronic inflammatory disease with poorly understood pathogenesis. The disease has a chronic course with improvements and exacerbations. Due to palmoplantar location, PPP has a severely negative impact on patients' quality of life. OBJECTIVES: To identify demographic and environmental factors, concomitant diseases, medications, and bacterial factors which may affect the course of PPP. MATERIAL AND METHODS: A total of 51 patients suffering from PPP took part in the study. They were classified according to the Palmoplantar Pustulosis Psoriasis Area and Severity Index (ppPASI) into 3 groups due to the severity of the disease. Pack-year of smoking score was established as a quotient of packets smoked every 24 h and the years of being addicted. Diagnosis of metabolic syndrome was based on the IDF criteria from 2009. Chlamydia trachomatis was detected using enzyme-linked immunosorbent assay (ELISA) technique, Staphylococcus aureus by the culture swabs. Contact hypersensitivity was examined with the T.R.U.E. test. RESULTS: Significantly high severity of PPP was observed in patients addicted to smoking with a high pack-year score (p = 0.03). Significantly lower intensity of PPP lesions was observed in patients treated with ibuprofen (p < 0.01). There was no correlation between severity of PPP skin lesions and comorbidities. CONCLUSIONS: Addiction to cigarette smoking and a high pack-year score aggravates the course of PPP. Treatment with ibuprofen can improve the course of the disease.

Sun protection among university students in Poland: a survey of awareness and attitudes.

AIM: The aim of the study was to evaluate students' awareness and attitudes related to skin protection against UVR and to check the hypothesis whether medical students differ from other faculty students in terms of health-promoting behaviour in photoprotection. MATERIAL AND METHODS: Internet-based survey containing 24 questions about students' knowledge and attitudes associated with sun exposure and photoprotection was carried out between March and May 2019. Two hundred and forty-three questionnaires were subject to statistical analysis. RESULTS: Out of 243, 149 (60.9%) respondents studied medicine and 95 (39.1%) were students of other faculties. 235 (96.7%) declared using sunscreen. 46 (18.9%) students applied it all year round and 116 (47.7%) only in the summer. Medical students chose more willingly products with SPF > 30 (p = 0.002). A hundred and fifty-nine (65.4%) students used sunscreen once when outdoors and 76 (31.3%) applied products more than once. Additional sun protective methods included wearing sunglasses (82.7%), hats or caps (62.1%) and avoiding sunlight around noon (46.5%). Students of the medical faculty avoided sun exposure statistically more frequently (p = 0.042) than students of other faculties. 28.4% had dermoscopy performed in the past. Medical students underwent dermoscopy examination statistically more frequently (p = 0.001) than students of other faculties. CONCLUSIONS: Medical students, probably due to their education, show increased pro-health attitudes associated with photoprotection. This indicates that they may be involved in creation and promotion of education activities to general public.

Comparison of serum concentrations of interleukins 10, 12, 17 and 35 between patients with alopecia areata and controls.

INTRODUCTION: Alopecia areata (AA) is one of the most common causes of non-scarring hair loss in adults and children with unknown etiopathogenesis, however immunological factors play an important role. AIM: To evaluate the concentration of interleukin (IL) 10 (IL-10), IL-12, IL-17 and IL-35 in the blood serum of patients with AA. MATERIAL AND METHODS: AA study group consisted of 118 patients. The control group consisted of 54 healthy individuals. The severity of the disease was assessed by SALT score. In the study group, the percentage of hair loss averaged 49.6% ±36.3%. The concentration of IL-10, IL-12, IL-17 and IL-35 in the serum was assessed by the enzyme-linked immunosorbent assays (ELISA). RESULTS: In patients with AA, the level of IL-12 and IL-17 was significantly higher than in the control group (p > 0.05). The level of IL-10 in patients was slightly higher, whereas the level of IL-35 was slightly lower, compared to the control group, but those differences were not statistically significant. Furthermore, in patients with more severe disease the IL-12 level was significantly higher as compared to patients with the less severe AA (p < 0.05). CONCLUSIONS: The etiopathogenesis of AA is complex, however Th1 and Th17 lymphocytes and their increased activity are undoubtedly significant contributors in this process. Disorders of immunological processes in AA require further research in order to understand the underlying pathomechanisms of the disease and to provide potential therapeutic strategies.

Impact of Childhood Psoriasis on Caregivers' Quality of Life, Measured with Family Dermatology Life Quality Index.

Psoriasis is a chronic skin disease, that often develops below the age of 18. In an integrated approach to childhood psoriasis, the impact of psoriasis on family members merits consideration. In this study, the impact of childhood psoriasis on caregivers (61 mothers and 4 fathers) of 65 children (age range 5-17.5 years) was measured using Family Dermatology Life Quality Index (FDLQI). Childhood psoriasis exerted a substantial impact on the QoL of caregivers (mean FDLQI 13.62±6.15 points). Caregivers rated routine household expenditure, time spent caring for the skin of the child, and emotional distress as the areas most impacted by psoriasis. The areas least affected were parent-child relationships, and caregivers' social lives. The impact of other people's reactions to the child's disease was rated as more severe by caregivers of girls compared with those of boys (p=0.004).

Paradoxical Skin Reaction to Certolizumab, an Overlap of Pyoderma Gangrenosum and Psoriasis in a Young Woman Treated for Ankylosing Spondylitis: Case Report with Literature Review.

INTRODUCTION: Biologic agents form an indispensable part of modern therapeutic regimens for the treatment of severe inflammatory diseases, especially in the fields of rheumatology, dermatology and gastroenterology. They are favoured by both physicians and patients due to their high effectiveness, good patient tolerance and safety. However, interference in the regulation and dynamics of inflammatory cytokines can on occasion lead to an onset of a dermatological condition also known as paradoxical skin reaction. Here, we present a case of paradoxical skin reaction induced by certolizumab. CASE REPORT: A young woman with ankylosing spondylitis developed a severe and complex cutaneous reaction after 6 months of otherwise successful treatment with certolizumab. The diagnosis of a rare paradoxical cutaneous reaction post anti-tumour necrosis factor alpha treatment was based on overlapping features of pyoderma gangrenosum and palmoplantar pustular psoriasis. Alopecia developed and there was also nail involvement. Treatment proved to be challenging as the disease did not remit after the patient ceased treatment with certolizumab. The patient was started on a combination of secukinumab and methotrexate to control the symptoms, with a promising outcome. CONCLUSION: Paradoxical skin reactions are an emerging clinical entity that require further research in order to establish risk factors and best personalized treatment.

Palmoplantar pustulosis: Factors causing and influencing the course of the disease.

Palmoplantar pustulosis (PPP) is a chronic inflammatory disease, most often occurring in middle-aged women. In the course of the condition, painful skin lesions appear on the hands and feet, i.e., areas that are extremely important in everyday life. Therefore, the disease significantly reduces quality of life. The pathogenesis of this disease is poorly understood, although it is known that genetic, immunological and environmental factors play a role in its development. Clinical observations confirm the role of nicotine and contact allergens in the development of the lesions. The skin lesions can also occur as a side effect of certain medications. In some cases, PPP coexists with other diseases, i.e., seronegative arthropathies, as well as celiac and thyroid diseases. There is also a connection between the disease and infectious bacterial foci. Exacerbation of the skin lesions is triggered by stress. Therefore, patients require multidirectional tests, since finding the cause of the disease is essential to administering effective treatment.