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.

Cutaneous Toll-like Receptor 9 Pre-Defines Hydroxychloroquine Dosage in Patients with Both Discoid and Subacute Lupus Erythematosus.

Background and Objectives: Cutaneous lupus erythematosus (CLE) presents clinically heterogeneous manifestations, partially explained by the different expression of Toll-like receptors (TLRs) type 8 and 9, located to endosomal compartments where they are poised to recognize microbial nucleic acids. This disease is empirically treated with hydroxychloroquine (HCQ), which is hallmarked with a safe and effective profile, but induces a slow and sometimes clinically insufficient therapeutic response. Currently, no biomarkers predictive of response are validated or even proposed in the scientific literature. We aimed to evaluate endosomal TLR type 7, 8 and 9 as predictive biomarkers of HCQ efficacy. Materials and Methods: We conducted a case-control study comparing CLE patients retrospectively assigned to three subgroups based on 3-6-month Cutaneous LE Disease Area and Severity Index (CLASI) reduction upon treatment with HCQ (I = <40% vs. II = 40-80% vs. III = >80%). Before HCQ, lesional skin specimens were collected in untreated CLE and through immunohistochemistry; TLR-7, -8 and -9 expression was evaluated in the epidermis and the lymphocytic infiltrate was evaluated in the dermis. Results: Sixty-six lesional skin biopsies were compared with healthy controls. CLE patients displayed lower epidermal expression of total TLR 8 and 9 as well as infiltrating TLR-8, TLR9 + lymphocytes compared to controls. High HCQ responders differed from low responders for TLR-9 positivity (high vs. low) and for the lymphocytic dermal infiltrate (high vs. low). Conclusions: TLR9 could be envisaged as a possible biomarker to predict HCQ response level and dosage in CLE patients.

Clinical aspects of the treatment of atopic dermatitis with topical glucocorticoids and calcineurin inhibitors - a pilot questionnaire study.

Atopic dermatitis (AD) is the most common inflammatory skin disease. However, recent reports concerning the simple clinical aspects of treatment with topical glucocorticosteroids (TCS) and calcineurin inhibitors (TCI) are lacking. The objective of this study is providing an update on these characteristics of AD management. A group of 150 adults suffering from AD treated with TCS during last year was asked to fill an anonymous questionnaire. The course of topical treatment was analyzed in the context of the severity of symptoms and the knowledge of the patients about therapy. During the last year, the majority of patients (66%) were treated with class IV TCS; however, in the last two weeks, class I TCS was used the most frequently (35%). Only 11% were familiar with the concept of intermittent therapy and 4% used the fingertip unit (FTU). In total, 77% of them used TCI. Most of the patients used the same class of TCS permanently. Unfortunately, patients are unaware of simple approaches (like intermittent therapy or FTU) that increase both the effectiveness and safety of the treatment. Practicians should be aware of these problems to identify and eliminate them, primarily through the education of patients.

Clinical characteristics of elderly patients with atopic dermatitis - a retrospective observational study.

Atopic dermatitis (AD) is a chronic, recurrent inflammatory dermatosis. The most characteristic symptoms of the disease include itch, eczematous eruptions and excessive dryness of the skin. Elderly patients with AD represent a poorly characterized population because the physiological ageing, possible comorbidity and polypharmacy modify the clinical presentation typically observed in the younger age groups. The aim of the study is to comprehensively assess the clinical characteristics of elderly patients (>60 years old) with AD. Data were collected from 26 AD patients treated in the Department of Dermatology of the University Hospital in Krakow. Late-onset AD with generalized/prurigo lesions was the most predominant phenotype. Skin biopsy was required in 15 (58%) patients in the differential diagnosis process. Allergic rhinitis, a positive family history of atopy and xerosis were associated with a higher number of hospitalizations during the year prior to the last admission (p = 0.034, p = 0.046 and p = 0.036, respectively). Xerosis was more prevalent among subjects with polypharmacy (p = 0.046) and higher serum total IgE concentration (p = 0.048). AD in elderly patients is a new phenotype of the disease that requires careful differential diagnosis. Aged patients with an individual or family history of atopy, due to the increased incidence of severe exacerbations of AD, may benefit from the introduction of proactive therapy.

Pruritus Characteristics in Severe Atopic Dermatitis in Adult Patients.

Atopic dermatitis (AD) is classified as a most common inflammatory skin disease. The condition is characterized by recurrent eczematous lesions and intense pruritus or itch, a hallmark of AD. The aim of this study was to identify the provoking factors of itch in severe AD adult patients. There were 34 adult patients suffering from AD of the median age of 40 years enrolled into the study and a control group that consisted of 20 healthy subjects. The severity of AD was assessed with the SCORing Atopic Dermatitis (SCORAD) index, pruritus intensity was assessed on a visual analog scale (VAS), and itch aggravating factors were assessed with a questionnaire. Specific IgE (sIgE) antibodies and interleukin IL-33 were measured in venous blood. We found that all the patients with severe AD had intensive itch (VAS: 9-10 points) during the whole day and 30 (88.2%) patients had it during nighttime. The most significant factors aggravating itch were the following: dry skin (27 patients; 79.4%), exposure to dust mite (22 patients; 64.7%,), and emotional distress (17 patients; 50%). Moreover, there was a positive correlation between the intensity of itch and the level of sIgE antibodies to dust mite (p < 0.001). The content of IL-33 was significantly higher in AD patients with severe skin lesions. This exploratory study shows that skin dryness, dust exposure, and distress play an essential role in the exacerbation of AD in the adult population.

Pathophysiology and clinical management of pellagra - a review.

Pellagra is a rare disease caused by niacin deficiency or a disruption of its metabolism. Its manifestations are dermatitis with pronounced photosensitivity, gastrointestinal symptoms, and neuropsychiatric ailments. Currently pellagra is developed in people who chronically abuse alcohol or are treated with medications from specific pharmacological groups (immunosuppressive and anti-tuberculosis drugs). Although the root cause of the disease was established in the mid-twentieth century, a detailed explanation of the processes leading to the development of symptoms has not yet been proposed. They include complex abnormalities at the molecular, metabolic, and immunological levels. Diagnostics is based primarily on the clinical presentation of the disease, while auxiliary tests play secondary role. The low prevalence of the disease, meaning that physicians are unfamiliar with its recognition, often leads to delays in diagnosis and appropriate treatment. The therapy is causal and based on administering niacinamide. Failure to implement treatment in the early stages of the disease leads to the patient's death. The aim of this literature review is to summarize the current state of knowledge on the pathomechanisms of pellagra, highlighting the clinical implications, and key elements of diagnostic and therapeutic management that are important in the treatment of pellagra patients.

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.

Melatonin and sleep disorders in patients with severe atopic dermatitis.

INTRODUCTION: Many atopic dermatitis (AD) patients suffer from insomnia. Out of numerous factors associated with sleep disorders, melatonin seems to play a significant role. AIM: To assess the relation between melatonin concentration and sleep disorders in adult patients with severe and very severe AD. MATERIAL AND METHODS: The study included 36 adult patients with severe and very severe AD and 20 healthy Caucasian volunteers. The severity of skin lesions was assessed by the EASI scale. Skin itch was evaluated by a visual-analogue scale (VAS), and sleep disorders were assessed by the Polish version of the Athens Insomnia Scale (AIS). Serum melatonin concentration of patients and controls was determined by ELISA. RESULTS: Melatonin concentration in patients with very severe AD was significantly (p < 0.001) lower than in patients with severe AD, however, melatonin concentration in the group of AD patients did not differ significantly (p = 0.33) from that observed in the control group. There was a significant negative correlation between the concentration of melatonin in the study group and the severity of itching (R = -0.54, p < 0.001). The intensity of sleep disorders was significantly higher (p < 0.001) in patients with a very severe form of AD compared to patients with severe AD. Moreover, there was a significant negative correlation between melatonin concentration and sleep disorders (R = -0.67, p < 0.001). CONCLUSIONS: Our results clearly showed that sleep disturbances are more expressed in very severe AD patients compared to subjects suffering from severe disease. We also suggest that melatonin serum concentration could play a role in the pathogenesis of sleep disturbances in AD patients.

Cat Allergy as a Source Intensification of Atopic Dermatitis in Adult Patients.

Atopic dermatitis (AD) is characterized by exacerbations and remissions of eczematous skin, underlain by impaired skin barrier and aberrant Th2-type and Th-22 cytokine production. A number of allergens, in particular contact with fur animals, may aggravate the disease. This study seeks to define the influence of having a regular contact with a pet cat at home on the severity of symptoms and signs of AD. We addressed the issue using the SCORing Atopic Dermatitis (SCORAD) and visual analog (VAS) scores to assess the intensity of pruritus and by measuring the blood content of specific IgE and IL-4, IL-13, and IL-22 cytokines. The study group consisted of 47 adult patients suffering from AD since childhood, 18 of whom declared having regular contact with a cat and the remaining 29 who denied it. There also was a control group consisted of 16 healthy volunteers with no AD signs. The SCORAD and VAS scores were significantly higher in patients in contact with a cat than in those without it (median SCORAD 61.0 vs. 50.4 and VAS 9.0 vs. 4.0 points, respectively). The sIgE of a majority of patients (94.4%) in contact with a cat was in Class V-VI, compared with just a few patients (3.4%) with no such contact, having sIgE in the same classes (p < 0.001). Significant correlations were revealed between SCORAD and VAS scores and the class level of serum sIgE value. In addition, IL-22 was a single elevated cytokine, only in the patients in contact with a cat, and it correlated with pruritus severity. The results of the study underline the need to beware of the cat fur allergen, and they stress forethought and caution in acquiring and keeping a pet cat by patients suffering from AD.

Depression and Serum Content of Serotonin in Adult Patients with Atopic Dermatitis.

Atopic dermatitis (AD) is a chronic skin disease with the etiology not yet conclusively established. Recent reports demonstrate the role of serotonin (5-hydroxytryptamine; 5-HT) in the pathogenesis of AD. The aim of this study was to investigate the relationship between the serum content of serotonin and depression in adult patients suffering from severe AD. There were 31 patients of the median age of 41 years enrolled into the study, who suffered from AD since childhood, and a control group that consisted of 14 healthy subjects. AD was diagnosed on the basis of Hanifin and Rajka criteria. The severity of skin lesions was assessed with the SCORing Atopic Dermatitis (SCORAD) index and that of depression with the Montgomery-Åsberg Depression Rating Scale (MADRS) questionnaire. We found that all of the patients with severe AD characterized by SCORAD >50 had depression. Depression was classified as mild and moderate according to the MADRS score. Serotonin content was significantly lower in the patients with severe AD (MADRS >12), and there was an adverse relation between the serotonin content and the score of depression, the features not noticed in the control group. We conclude that severe AD, as expressed by the intensification of skin lesions, associates with depression and with the lowering of serum serotonin content. The findings point attention to the cognitive and affective problems in AD patients which could worsen the course of the skin disease.

Is the presence of a fur animal an exacerbating factor of atopic dermatitis in adults?

Atopic dermatitis is one of the most common inflammatory dermatoses in children and adults. To date, no clear relationship between the severity of AD and the exposure to dog and guinea pig-derived allergens has been established. AIM: The aim of the study was to assess the association between the specific serum immunoglobulin E levels (against dog and guinea pig) and the grade of skin symptoms measured with the SCORAD and VAS scales in the population of adult patients suffering from atopic dermatitis. MATERIALS AND METHODS: The study was performed in the group of 47 patients suffering from atopic dermatitis since infancy (30 women and 17 men). Concentration of IgE was measured by the fluoroenzymatic immunoassay. The Mann-Whitney's test was used to compare the distribution of specific IgE concentration and the distribution of atopic dermatitis grade. RESULTS: The statistically significant correlation between SCORAD and VAS scales, and the measured specific IgE concentrations for investigated fur animals was found. CONCLUSIONS: The study demonstrated that in the patients with atopic dermatitis the concentration of specific IgE was correlated with severity of the disease symptoms, including itch. This enables forecasting the course of the disease and selecting a group of patients who should immediately reduce their contact with allergen.

Can the blood tryptase be an indicator of the severity of atopic dermatitis?

Atopic dermatitis (AD - atopic eczema) is a chronic inflammatory dermatosis resulting from complex genetic, epigenetic and environmental interactions with an overlapping defect in the epidermal barrier.AD is one of the most common inflammatory dermatoses in children and adults. AIM: The aim of the study was to assess the relationship between serum basal tryptase (sBT) and total IgE (tIgE) level in blood serum and the severity of lesions (SCORAD; SCORing atopic dermatitis). MATERIALS AND METHODS: The study was performed in the group of adult patients (57 people, F/M: 30/27; average age: 37.5 years) and in the control group (10 people, K/M: 6/4; average age: 44 years). Diagnosis of atopic dermatitis was established by a dermatologist-allergist specialist based on the criteria of Hanifin and Rajka. The severity of lesions was determined on the SCORAD scale (SCORing atopic dermatitis). RESULTS: The distribution of tryptase concentration did not differ statistically significantly between patients with various disease severity and the control group also the severity of skin lesions was significantly higher (p<0.001) in patients whose tIgE level exceeded 3500 IU / ml. Conclusion. sBT did not prove to be a useful biomarker in assessing. CONCLUSIONS: sBT did not prove to be a useful biomarker in assessing severity of AD. The present study demonstrated that in the patients with atopic dermatitis the concentration of total IgE was correlated with severity of the disease symptoms.

Is vitamin D concentration an indicator of the severity of atopic dermatitis and chronic spontaneous urticaria in adults?

Atopic dermatitis (AD) and chronic spontaneous urticaria (CSU) are common chronic and recurrent dermatoses. The role of vitamin D in the immunological processes, including the development of inflammation, has been the subject of numerous studies. The feasible measurement of vitamin D serum concentration and possibly supplementation necessitates the assessment of its impact on the clinical severity of mentioned diseases. AIM: The aim of the study was to determine the relationship between blood serum vitamin D concentration and the severity of clinical symptoms in the group of adults suffering from AD or CSU. MATERIALS AND METHODS: The study was conducted in 2018 on groups of patients suffering from AD or CSU. Serum vitamin D concentration was determined by electrochemiluminescence assay. Student's t-test was adopted to compare vitamin D levels between groups. Spearman's rank correlation coefficient was used to assess the correlation between vitamin D concentration and the severity of AD (according to the SCORAD scale) and CSU (according to the UAS 7 scale). RESULTS: There was not found any statistically significant relationship between the severity of skin lesions scores in the course of AD and CSU and serum vitamin D concentration.

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.

Chemerin alleviates acute pancreatitis in the rat thorough modulation of NF-κB signal.

OBJECTIVE: Chemerin, an adipokine, works as the chemoattractant for the immune cells. The role of chemerin in the inflammatory reaction is controversial. Chemerin has been shown to aggravate the inflammatory response, but other studies demonstrated its anti-inflammatory influence. This study assessed the effects of chemerin on acute pancreatitis (AP) in vivo and in vitro. METHODS: For in vivo experiments male Wistar rats were used. For in vitro study rat pancreatic AR42J cells were employed. Chemerin (1, 5 or 10 µg/kg) was given to the rats prior to the induction of AP by subcutaneous caerulein infusion (25 µg/kg). For in vitro studies cells were subjected to caerulein (10 nM) with or without chemerin (100 nM). Serum amylase activity was measured by enzymatic method, serum TNFα concentration - by ELISA kit. Western-blot was used to examine cellular proteins. RESULTS: AP was confirmed by histological examination. Chemerin given to AP rats decreased histological manifestations of AP, reduced serum amylase activity and TNFα concentration. In AR42J cells subjected to caerulein with addition of chemerin signal for TNFα was reduced comparing to the cultures treated with caerulein alone. Analysis of the dynamics of nuclear translocation for p50, p65 and Bcl-3 points out to NF-κB attenuation as a mechanism of observed anti-inflammatory action of chemerin. CONCLUSION: Chemerin significantly alleviated severity of AP in the rat, this is possibly due to the inhibition of pro-inflammatory signaling in the pancreatic cells.

The knowledge of issues associated with topical corticosteroids using in patients with atopic dermatitis.

Atopic dermatitis (AD) is the most common inflammatory dermatitis, always accompanied by the pruritus. First line treatment comprise of topical steroids, however, there is a particular concern among patients with atopic dermatitis - "steroid phobia", which results in lack of efficacy of the therapy. Steroid phobia arises usually from insufficient knowledge of these drugs. AIM: The aim of the study was to evaluate the knowledge of topical corticosteroids (TCS) and familiarity with so called safe therapy methods among atopic dermatitis patients. MATERIALS AND METHODS: In the study participated 143 adult patients with AD diagnosis made by a specialist dermatologist-venereologist and allergist in accordance with Hanifin and Rajka's diagnostic criteria. Patients filled anonymously authorial survey which included questions concerning disease duration, severity of pruritus, frequency of skin lubrication, understanding of topical steroid therapy and practical aspects of safe TCS application. RESULTS: Correct answers responding incidence to questions related to TCS diminished with the patients age, while on the other hand, it increased statistically significantly with the level of education. What responders were afraid of most frequently were the skin atrophy (56,6%), cataract (52,4%) and teleangiectasias (44,8%), in opposite to neoplasms (16,8%) and obesity (22,4%). Concerns were dependent to the treating physician- patients under the care of dermatologists more often were worried about the skin atrophy, teleangiectasias and cataract. Among participating patients just 3,5% of them (5 patients) knew the finger tip unit term, whereas the majority (56%) had been informed about safe TCS therapy methods. Amidst respondents who answered questions about TCS correctly statistically significantly lower pruritus intensity was observed. CONCLUSIONS: Results of our study indicate on necessity of taking action to improve cooperation between patients and doctors insofar as topical therapy of atopic dermatitis.

The level of total immunoglobulin E as an indicator of disease grade in adults with severe atopic dermatitis.

Atopic dermatitis is one of the most common inflammatory dermatoses in children and adults. The disorder is associated with significant worsening of quality of life. Due to the frequently suggested pathogenetic relationship with atopic dermatitis, immunoglobulin E seems to be an adequate indicator of the disease. AIM: The aim of the study was to assess the association between the total serum immunoglobulin E levels and the grade of skin lesions measured with the SCORAD and oSCORAD scales in the population of adult patients suffering from severe atopic dermatitis. MATERIALS AND METHODS: The study was performed in the group of 31 patients suffering from atopic dermatitis since early childhood (17 women and 14 men) in 2017. Total IgE was measured by the fluoroenzymatic immunoassay. The Spearman's rank correlation coefficient was used to determine the power of the relationship between the concentration of total IgE and atopic dermatitis severity. The Kruskal-Wallis and Mann- Whitney's tests were used to compare the distribution of IgE concentration and the distribution of atopic dermatitis grade. RESULTS: The statistically significant correlation between SCORAD/ oSCORAD and the measured IgE levels was found in the patients with the IgE level above 3500 IU/ml (19 subjects). CONCLUSIONS: The present study demonstrated that in the patients with severe extrinsic atopic dermatitis, the concentration of total IgE was correlated with the severity of the disease. This suggests an opportunity of employing IgE as an atopic dermatitis biomarker.

Primary cutaneous lymphomas: the analysis of cases treated in the Department of Dermatology University Hospital in Krakow.

Introduction: Primary cutaneous lymphomas are lymphoproliferative skin infiltrates of T-, B- or NK-cells, classified according to the World Health Organization - European Organization of the Research and Treatment of Cancer (WHO-EORTC) criteria. They are the second most common group of extranodal non-Hodgkin lymphomas, that present in the skin with no evidence of systemic involvement at the time of diagnosis. Aims: The aim of the study was the analysis of clinical profile of cutaneous lymphomas in the tertiary referral center in Poland. Material and Methods: We analyzed case records of 63 patients (26 women, 37 men aged 19 - 86) referred to the Department of Dermatology, University Hospital in Cracow for the diagnosis and treatment of cutaneous lymphoma. Results: After analysis of clinical and histological data, the final diagnoses were: mycosis fungoides (42 patients), primary cutaneous CD30+ lymphoproliferative disorder (7), Sezary syndrome (3), parapsoriasis (3), primary cutaneous B-cell lymphoma (1), acute myeloid leukemia (1), Hodgkin lymphoma coexistent with mycosis fungoides (1), generalized allergic contact dermatitis (2) and erythema elevatum diutinum (1). We excluded 2 patients due to incomplete data. The most common location of skin lesions was the lower limb (52.46%) and most common clinical presentation was raised erythematous lesion (26.23%). Pruritus was present in 45.9% of the patients and 39.3% had extracutaneous symptoms, with lymphadenopathy as the most common symptom. 37.7% of patients presented with mild eosinophilia and another 37.7% with mild monocytosis. Prior to referral to our center, general practitioners misdiagnosed the lymphomas commonly as: atopic and contact dermatitis, borreliosis, drug-induced exanthema. Conclusions: The diagnosis of cutaneous lymphoma is often delayed due to their indolent, often recurring course, non-specific symptoms and uncommon appearance. The cooperation of a clinician and pathologist is essential in the diagnostic process.

Pachydermodactyly - a report of two cases.

Pachydermodactyly (PDD) is a rare and benign form of digital soft tissues fibromatosis, which affects the skin of the fingers. The disorder is characterized by asymptomatic, symmetric, progressive soft tissue swelling of the proximal interphalangeal (PIP) joints of the fingers. The etiology of disease remains unknown. It is usually acquired, even though there are some publications that document family cases. It affects mainly adolescent men. We report two boys with the bilateral swelling of the of the PIP joints of the fingers and skin and subcutaneous tissue thickening. Based on clinical manifestations, radiological study and histopathological examination, pachydermodactyly was diagnosed. PDD is a rare and benign disorder, although it is important to consider other diseases, especially rheumatic conditions, in the differential diagnosis in order to avoid unnecessary additional tests and treatments.