Current challenges in diagnosing and treating infectious skin diseases - a case series. / Choroby zakazne skóry jako wciaz aktualny problem diagnostyczny i terapeutyczny ­ przeglad nietypowych przypadków klinicznych.

Infectious skin diseases constitute a significant public health problem. Despite the systematic development of many modern diagnostic and therapeutic tools, they still pose a serious challenge for clinicians. Due to their prevalence and mild course in most cases, they are often marginalized, which can delay their diagnosis and treatment initiation. Such an approach in more clinically advanced cases can have serious consequences, sometimes leading to tragic outcomes. This work presents a series of four cases of common infectious skin diseases with an unusually atypical clinical picture: the history of a 49-year-old female patient with recurrent erysipelas of the right lower leg co-occurring with a SARS-CoV-2 infection, a 75-year-old male patient with a generalized form of herpes zoster, a 38-year-old female patient with a complicated severe course of head lice, and a 34-year-old male patient with a severe form of post-steroid mycosis. In each of these cases, difficulties in making the correct diagnosis were highlighted, even though they represent some of the most common bacterial, viral, parasitic, and fungal dermatoses. The paper discusses the risk factors for these diseases, the pathophysiology of their atypical course, the effects and challenges in the therapeutic approach conducted. Infectious skin dermatoses require aggressive treatment and should never be underestimated.

Scalp vascularization as a marker of topical minoxidil treatment efficacy in patients with androgenetic alopecia.

Introduction: Androgenetic alopecia is the most common type of non-cicatricial hair loss both in male and female patients. The pathomechanism of the disease involves chronic and progressive miniaturization of hair follicles, which leads to the conversion of terminal hair to vellus hair. Minoxidil is a first-line drug in the treatment of female pattern hair loss (FPHL). Aim: The study is aimed at verifying whether the degree of scalp vascularization has an impact on the efficacy of topical 5% minoxidil treatment. Material and methods: The study involved a group of 76 patients diagnosed with FPHL, who underwent a scalp biopsy for a histological examination of their scalp vascularization. The patients were divided into two groups, with rich and poor scalp vasculature. In all patients, topical treatment with 5% minoxidil was applied for a minimum of 6 months, followed by video-trichoscopic assessment. Results: A significant increase in the total count was observed 6 months into the treatment as compared with baseline, and a decrease in the number of single hair per follicle. It was observed that the number of single hair units had gone down in 50.67% of patients. The study also demonstrated an increase in the total hair count in 57.33% of patients as well as no drops in the total count in 68% of patients, following 6 months of treatment. Conclusions: Patients responded equally well to the applied topical minoxidil treatment, irrespectively of the number of blood vessels in the scalp.

The role of CYP19A1 and ESR2 gene polymorphisms in female androgenetic alopecia in the Polish population.

Introduction: Androgenetic alopecia is the most common type of non-cicatricial alopecia both in male and female patients. The mechanism that leads to hair loss is similar in both sexes, but the underlying cause, and especially the role of genes and sex hormones in the pathogenesis of the disease in women has not fully been explained as of yet. So far, a few attempts have been made to assess selected SNPs for CYP19A1 and ESR2 genes, but their results are not unequivocal and fully reproducible. Aim: To investigate the association of 13 CYP19A1 and 11 ESR2 gene SNPs with female androgenetic alopecia (FAGA) in a population of Polish patients, including some already genotyped SNPs of possible importance for FAGA pathophysiology in other populations. Material and methods: Twenty-four genetic polymorphisms were analysed for the ESR2 and CYP19A1 genes in 117 patients with FAGA and 128 healthy subjects treated at the Department of Dermatology in Krakow. Results: In the studied Polish population, none of the selected SNPs, frequently detected in the Caucasian population and linked with the transformation pathway of sex hormones, showed a significant association with FAGA. Conclusions: Further studies into the genetic background of androgenetic alopecia are needed. Ethnic differences as well as the size of the studied population may be of great significance for the obtained results.

Dendritic cells may help differentiate discoid lupus erythematosus alopecia from lichen planopilaris.

Introduction: Primary cicatricial alopecia (PCA) encompasses a heterogeneous group of inflammatory diseases characterized by the replacement of hair follicle structures by fibrous tissue. Discoid lupus erythematosus (DLE) and lichen planopilaris (LPP) are the most common causes of scarring alopecia. The distinction between both entities is often challenging because of significant clinical and histopathological overlap. Aim: We hypothesized that dendritic cells which are implicated in PCA pathogenesis can provide a reliable histopathological clue to distinguish between these two entities. Material and methods: In a retrospective cohort study including 51 patients diagnosed with LPP and DLE we mapped and quantified the distribution of dendritic cells. Cell count in lesional skin was performed on immunohistochemistry by using characteristic monoclonal antibodies to specific subpopulations of dendritic cells. Results: We demonstrated that almost all subpopulations of dendritic cells were highly expressed in lesional skin of discoid lupus erythematosus patients in comparison with lichen planopilaris ones. Conclusions: In the light of this observation, dendritic cells might be used as an additional clue in differential diagnosis of PCA.

The role of family history and its influence on the onset time in female pattern hair loss.

INTRODUCTION: Female pattern hair loss (FPHL) is one of the most common causes of hair loss in women. Genetics plays an important role in the development of the disease, but the etiopathogenesis and the inheritance pattern in women remain unexplained. AIM: To determine the extent to which FPHL is of genetic origin in women from the Polish population and whether a positive family history is a risk factor for its earlier onset. MATERIAL AND METHODS: Family histories of 111 unrelated female patients with FPHL and 129 female patients without hair thinning were analysed. FPHL was diagnosed based on a detailed medical history, the clinical picture and trichoscopic features. RESULTS: A positive family history was noted in 69 (62.2%) patients with FPHL. In 32 (28.8%) patients from that group, more than one person in the family suffered from hair loss, whereas in the healthy group, the same was true of only 4 patients (3.1%) (p < 0.0001). A positive family history on the mother's side proved statistically significant for FPHL patients. In the case of 20 (18%), hair loss had been identified in their grandparents, while the healthy group had a negative history in that respect. A positive family history of hair loss in grandparents was three times more frequent in the group of patients with the disease onset before 40. CONCLUSIONS: A positive history on the mother's side may be of great significance for FPHL development. Hair loss in more than one family member and in one's grandparents may also indicate a higher risk of disease development.

The level of stress and the assessment of selected clinical parameters in patients with androgenetic alopecia.

Androgenetic alopecia is the most common type of hair loss both in male as well as female patients. It is a type of non-cicatricial hair loss. Pathophysiology of the disease remains largely unknown. It is believed that the occurrence of FPHL (female pattern hair loss) is linked with cellular insensitivity to androgens. Human hair does not only represent beauty, health and youth, but it also has a significant impact on one's self-esteem. For many patients, hair loss is a stigmatizing experience, many of them complain about a lower quality of life, anxiety or even depression. AIM: Aim of the study was to evaluate the levels of selected clinical parameters, including exposure to stress and disease progression based on the Ludwig scale, and of the applied therapies in a group of female patients with androgenetic alopecia. MATERIALS AND METHODS: A group of 106 patients with androgenetic alopecia was analyzed with respect to their age, duration of disease, disease progression based on the Ludwig scale, family history of AGA, exposure to stress (with the level of stress subjectively assessed by the patients using a score of 1 to 10), and treatment modality. Comparison of the results will be carried out with the help of the Statistica software, using the Student's t-test or its non-parametric equivalent. RESULTS: Patients reported very high levels of stress exposure: 7 and 8 on a scale of 1 to 10. The type of treatment applied (local vs. systemic) was of no significance with respect to the alleviation of stress. Disease progression was not found to correlate with the level of stress. When analyzing disease progression, using the Ludwig classification scale, most of the patients met the criteria of type I-2 (24.74%). As regards the comparison of treatment modalities in the study group, a great majority of patients was treated with topical agents in the form of scalp massage liquids (80.00%), while 17.14% of the study population underwent systemic treatment. A small percentage of patients also resorted to esthetic medicine procedures (3.81%), and 22.86% of them used dietary supplements or OTC topical agents. CONCLUSIONS: High levels of stress exposure reported by patients most probably stemmed from the symptoms of the disease itself, as the study population was quite diverse in terms of their levels of professional activity and the type of profession performed.

Is hormone testing worthwhile in patients with female pattern hair loss?

Androgenetic alopecia (AGA) is the most common type of hair loss both in male and female patients. As regards its etiopathology, it is postulated that hair follicles grow sensitive to androgens in persons who are genetically predisposed to it. In the pathomechanism of the disease, hair follicles undergo miniaturization. AIM: The aim of the study was to evaluate the levels of selected hormones (sex hormones, adrenal and thyroid hormones), and the results of laboratory tests (iron metabolism) performed in a group of female patients with AGA in order to specify which of those tests should be taken during the diagnostic process in such patients. MATERIALS AND METHODS: Test results and types of therapies have been analyzed for a group of 106 adult female patients (of different age) with female pattern hair loss (FPHL) of different duration. Selected hormone parameters have been analyzed as well as iron metabolism, BMI ( body mass index), and signs of androgenization in the patients' histories (presence of menstrual disorders, hirsutism and acne). Additionally, their insulin levels were measured. RESULTS: The most common hormonal disorders in the study population involved increased concentrations of sex hormone binding globulin (SHBG) in 38.8%, decreased concentration of total testosterone in 25.4%, increased antibody titers against thyroid peroxidase (ATPO) in 17.3%, decreased concentrations of dihydroepiandrostendione (DHEAS) in 15.6%, and increased concentrations of insulin in 12.6%. Increased concentrations of free testosterone were only observed in 6.8 % of the study participants, and increased concentrations of cortisol were revealed in 6.7% of them. 40% of the patients complained about symptoms related to menstrual disorders, hirsutism and acne. Sex hormone concentrations did not correlate with the reported symptoms, and test results in that sub-group were not found to significantly differ from the rest of the patients who did not report signs of hyperandrogenism. CONCLUSIONS: In spite of the fact that nearly half of the patients reported symptoms which may be suggestive of hormonal disorders, no significant abnormalities were revealed in hormone tests.

The influence of methotrexate on hair loss while using immunomodulatory doses.

Hair loss is a significant and constantly growing social problem among both women and men. Many drugs through their toxic effects on the cells of the hair follicle matrix have an influence on mitotic divisions and the hair growth cycle, leading to anagen or telogen effluvium. Currently, there are more and more publications and clinical studies evaluating the possibility of using methotrexate in the treatment of various types of non-scarring and scarring alopecia, but there is no study of the effect relating to the hair loss with low doses of the drug in other therapeutic indications. AIM: The aim of the study was to evaluate if methotrexate used in immunomodulatory doses could cause increased hair loss. MATERIALS AND METHODS: Data from a survey was analyzed in 68 patients treated with methotrexate at the Department of Dermatology of the Jagiellonian University in Cracow in the years 2015-2018. RESULTS: Increased hair loss after the beginning of methotrexate administration occurred in 29,4% of the subjects, the majority (60%) were women. More frequent occurrence of general symptoms was perceived among the patients who reported alopecia. CONCLUSIONS: Studied group of patients was relatively small, however, it seems that drug hair loss during methotrexate treatment occurs relatively often.

Methods of treatment patients with androgenetic alopecia based on reference of Department of Dermatology in Cracow.

Androgenetic alopecia (AGA in men/female pattern hair loss FPHL in women) has been associated with the most frequent culprit of hair loss concerning both men and women. It may be viewed as chronic, progressive, non scarring type of hair loss. The main factor in its pathophysiological mechanism plays genetic susceptibility to androgens of certain individuals. Increased level of androgens shown to be the cause in men, whereas in women this level may be elevated or normal. For the management of the condition topical treatment with minoxidil has been approved, as well as orally administered finasteryd, spironolakton or dutasteride. AIM: The main objective of this research project was to study the patients with AGA in terms of gender, age, prescribed treatment and hormone dysfunctions. MATERIALS AND METHODS: The analyzed population consisted of 104 patients treated in dermatology department in Cracow in three years period (2015-2018) for AGA. Initially, demographic characteristics and treatment were tested. The next step of the analysis was the comparison of groups according to gender and, what is more among women according to age (up to 45 and >45 years of age). Statistical analysis was performed with U Mann-Whitney and Chi square Pearsons tests. RESULTS: The majority of patients participating in the study were women (87,5%). The average age of the study population was 45,5±15,5 years of age. The most frequently ordered medicine was minoxidil 5% solution (82,2% of patients), besides polytherapy of two medicines were applied in 45,8% of patients. In the study group hypothyroidism was observed in 10.6% of patients. The examined group of women were older than men (48.3 vs. 25.8 years; p<0.0001). Male patients were more often ordered systemic treatment (52.9 vs.15,4%; p=0.0012), whereas topical treatment was more often applied to women (94.5 vs. 69.2; p=0.0024). Women usually were ordered more than one medicine in contrast to men (44.0 vs. 15.4%; p=0.0495). Therefore no significant difference between women up to 45 and >45 years of age was observed. CONCLUSIONS: Statistically significant occurrence of hypothyroidism was observed. Therefore this connection requires further studies. Other endocrinological dysfunctions like acne, hirsutism or menstrual disorder were relatively rare.