Prospective 3-month study on the efficacy of UV-free blue light in mild psoriasis vulgaris treatment.

INTRODUCTION: Psoriasis is one of the most common chronic skin diseases affecting up to 2% of the general population. In recent years, an important direction for the development of treatment for psoriasis has been the use of blue light emitted by LED lamps. AIM: To evaluate the efficacy of blue-light emitting device in psoriasis vulgaris treatment. MATERIAL AND METHODS: The study involved 30 adults with a mild form of psoriasis vulgaris not previously receiving biological treatment and other forms of phototherapy. Participants of the study used a device emitting blue LED light for 3 months. Each participant received a device for use at home, with which he/she exposed 2 psoriatic lesions located on the limbs. Before and after the study, the severity of the disease was evaluated using PASI, DLQI and LPSI. RESULTS: During 3 months of the therapy, a statistically significant decrease in the mean LPSI (in both treated locations) and DLQI was noted (LPSI decrease from 5.25 ±1.82 to 1.98 ±1.74, p < 0.0001; DLQI from 7.36 ±5.59 before the study to 5.23 ±4.62 after the study. CONCLUSIONS: Our results confirm that phototherapy using blue LED light is both a safe and highly effective way to treat psoriasis.

Double-blind, randomized controlled trial comparing the use of microneedling alone versus chemical peeling alone versus a combination of microneedling and chemical peeling in the treatment of atrophic post-acne scars. An assessment of clinical effectiveness and patients' quality-of-life.

INTRODUCTION: Acne vulgaris is a common, chronic disease. One of the most commonly encountered complications of acne is permanent atrophic scarring. Treatment of atrophic scars includes fillers, dermabrasion, laser resurfacing, microneedling and peelings and it is often difficult to treat. In our double-blind randomized controlled trial (RCT), we investigated the synergistic effect of microneedling with the application of trichloroacetic acid, kojic acid and hydrogen peroxide in the treatment of atrophic acne scars. AIM: To assess the clinical effectiveness and patients' quality-of-life (HRQoL) after three types of atrophic post-acne scar treatment, namely microneedling alone (MN) vs chemical peeling alone (CP) vs. a combination of microneedling and chemical peeling (MN + CP). MATERIAL AND METHODS: A total of 120 patients were enrolled into the study following strict inclusion/exclusion criteria and randomized into the three treatment groups - MN, CP (a combination of trichloroacetic acid, kojic acid and hydrogen peroxide), and MN + CP. According to a preapproved protocol, each patient underwent four treatment sessions, each spread 20 days apart. Both pre- and post-treatment clinical status (using the Goodman-Baron scale; two expert raters blinded to the treatment used) and patients' HRQoL (using the Dermatology Life Quality Index) were assessed. RESULTS: During the 5-month recruitment period, a total of 120 patients were approached and agreed to take part in the study (94 females - 78.3% and 26 males) (mean age of 30.14 ±3.64 years; range: 18-45 years). Only in the MN + CP group there was a statistically significant improvement according to the G-B scale post-treatment (2.87 ±0.83 vs. 2.03 ±1.16 respectively; p = 0.0005). Patients in all three treatment groups experienced a statistically significant improvement in their HRQoL post-treatment (all p's < 0.05). CONCLUSIONS: A combination of microneedling and chemical peeling produces the best, objectively measured effects in the treatment of atrophic post-acne scars. All examined treatments, even if not producing a clinically significant treatment outcome, improve patients' HRQoL.

Serum concentration of matrix metalloproteinases and angiogenic factors in patients with venous leg ulcers.

INTRODUCTION: Leg ulcers are a frequently observed medical problem affecting 3-5% of the general population over 65 years of age. The most common factor responsible for the development of leg ulcers is chronic venous insufficiency (CVI). It is believed that during the formation of an ulcer there are two processes occurring simultaneously, extracellular matrix (ECM) degradation and angiogenesis in which several proteins including matrix metalloproteinases, angiogenic and regulatory factors are engaged. AIM: To determine the serum concentration of matrix metalloproteinase-1 (MMP-1), -9 (MMP-9), tissue inhibitors of metalloproteinases-1 (TIMP-1), angiogenin and vascular endothelial growth factor (VEGF) in patients suffering from venous leg ulcers and in the healthy control group. MATERIAL AND METHODS: The study group consisted of 71 Caucasians (39 patients, 32 controls). To evaluate the serum concentration of MMP-1, MMP-9, TIMP-1, VEGF and angiogenin, the ELISA technique was used. RESULTS: Mean MMP-1 and MMP-9 concentrations in the study group were 14.16 ±2.98 and 12.45 ±3.85 ng/ml, respectively, and in controls 6.08 ±2.51 ng/ml and 6.77 ±2.41 ng/ml, respectively and both differences were statistically significant (p < 0.001). There was no significant difference between the study and the control group in TIMP-1 concentration. Mean VEGF and ANG concentrations in the study group were 589.3 ±346.2 pg/ml and 1802.0 ±415.7 pg/ml, respectively, and in controls 220.3 ±110.4 pg/ml and 1229.0 ±337.7 pg/ml, respectively and both differences were statistically significant (p < 0.001). CONCLUSIONS: Lack of significant differences in the concentration of TIMP-1 between the control and the study group confirms that proteolysis is a hallmark of CVI, but increased concentration of VEGF and angiogenin in the study group compared to the control group shows that angiogenesis occurs simultaneously with ECM remodelling.

Overexpression of cathepsin K and vascular endothelial growth factor in chronic venous ulcerations.

INTRODUCTION: Chronic venous disease (CVD) is a disabling condition affecting about 1% to 3% of the general population. Besides varicose veins, CVD can result also in the formation of severe skin lesions, especially venous ulcerations (VU). The exact mechanism of VU is still unknown. AIM: To evaluate immunoexpression of vascular endothelial growth factor (VEGF) and cathepsin K in healthy individuals and patients with VU. MATERIAL AND METHODS: The study included 12 patients with venous ulcers and 10 healthy individuals who served as controls; both groups were sex- and age-matched. Biopsy samples were obtained from lower leg areas and submitted to histochemical analysis. RESULTS: There was a significant difference between the study group and the control group in cathepsin K expression (1.007 ±0.3 vs. 0.22 ±0.2, respectively, p < 0.001) and VEGF expression (1.17 ±0.59 vs. 0.27 ±0.19, respectively, p < 0.001). Additionally, the microvessel density (per mm2) differed significantly between the study group and the control group (97.6 ±28.81 vs. 59.32 ±12.71, respectively, p < 0.001). We found no correlation between cathepsin K and microvessel density, and cathepsin K and VEGF in both groups, but there was a significant correlation between microvessel density and VEGF immunoexpression in the study group (r = 0.82, p = 0.002). CONCLUSIONS: Increased immunoexpression of VEGF and cathepsin K suggests that both of these proteins may play a role in VU development.

Ingenol mebutate treatment in actinic keratosis - clinical effectiveness and potential side effects.

INTRODUCTION: Actinic keratosis is a common skin disease that occurs in response to prolonged exposure to ultraviolet radiation. This problem affects up to 60% of the population over 40 years of age. Actinic keratosis is considered to be a precancerous lesion leading to squamous cell carcinoma (SCC). The new therapeutic option for the treatment of actinic keratosis is ingenol mebutate gel (0.015%, 0.05%). AIM: Retrospective evaluation of response and potential side effects of ingenol mebutate treatment in clinical practice. MATERIAL AND METHODS: Eight patients with actinic keratosis lesions on the face or scalp self-applied a 0.015% gel for 3 consecutive days on the 25 cm2 marked area. They were assessed at baseline and on day 4, 7, 14 and 57. RESULTS: All patients on day 57 presented a complete absence of AK lesions in the area of ingenol mebutate application. No adverse events were observed. CONCLUSIONS: Our study shows that ingenol mebutate is highly efficacious field treatment for actinic keratosis.

Omalizumab for urticaria treatment in clinical practice: a case series.

INTRODUCTION: Omalizumab (Xolair) originally intended to reduce symptoms of moderate to severe asthma uncontrollable with steroids is the first monoclonal antibody approved for treatment of chronic spontaneous urticaria in 2014. AIM: To evaluate response and potential side effects to omalizumab treatment in clinical practice. MATERIAL AND METHODS: Eleven patients (6 males and 5 females) were recruited into the study. All participants signed written informed consent before enrollment to the study. At the beginning they were receiving 300 mg of omalizumab in a subcutaneous injection every 4 weeks in an outpatient clinic. Five the clinical response was sufficient, the dose of omalizumab was decreased to 150 mg. We evaluated response to the treatment using the Urticaria Activity Score in the last 7 days and the Urticaria Control Test at certain time points. RESULTS: Nine out of 11 patients achieved complete syndrome resolution. Five patients achieved clinical remission after the first dose of omalizumab. Mean time to remission was 9.3 weeks. During the study, no side effects were observed. CONCLUSIONS: Omalizumab appears to be a safe drug, which in a quick and effective way inducts remission in patients who have not responded to previous treatment.

The effect of an emollient with benfothiamine and Biolin prebiotic on the improvement of epidermal skin function.

INTRODUCTION: Complications of diabetes can damage internal organs and the skin. Diabetic skin, irritated and dry, is susceptible to skin infections. However little is known about influence of emollients on biophysical changes in skin during diabetes. AIM: To evaluate clinical skin changes after application of emollients with benfothiamine and Biolin prebiotic and to assess changes in biophysical parameters of the skin before and 4 weeks after daily application of an emollient. MATERIAL AND METHODS: We recruited 50 patients with diabetes mellitus type 1 (DM1) or type 2 (DM2). All participants applied emollients on their left forearms and left shins for 4 weeks. The biophysical properties: pH, transepidermal water loss (TEWL), hydration of the stratum corneum and sebum content were measured and compared to those before enrollment to the study, after 1 h, 1 week and 4 weeks after application of an emollient. RESULTS: After 4 weeks of treatment, there was an increase in skin hydration (40.61 ±19.03 vs. 48.83 ±15.51), pH (5.11 ±0.56 to 5.27 ±0.48) and sebum content (22.16 ±8.67 to 63.99 ±25.41) and a decrease in TEWL (12.54 ±5.6 vs. 9.85 ±5.69 g/m(2)/h) on forearms (p < 0.05 for all comparisons). On lower legs, significant changes in skin hydration (37.21 ±14.01 vs. 43.95 ±12.67), pH (5.04 ±0.57 to 5.31 ±0.49), sebum content (25.82 ±10.46 to 72.63 ±31.23) and TEWL (8.87 ±4.05 vs. 7.39 ±3.22 g/m(2)/h) were observed (p < 0.05 for all comparisons). CONCLUSIONS: Our study provides an insight into changes in diabetic skin after application of an emollient. To our knowledge, this is the first report on the emollient containing benfothiamine and Biolin prebiotic and its influence on biophysical parameters of epidermis.

NLRP1 and NLRP3 inflammasomes as a new approach to skin carcinogenesis.

Inflammasomes are key innate immune system receptors that detect pathogenic endo- and exogenous stressors like microorganisms or ultraviolet radiation (UVR) which activate the highly proinflammatory cytokines interleukin-1ß and interleukin-18. Inflammasomes are not only involved in inflammation, but also in carcinogenesis and tumor progression. Due to the dynamic increase in non-melanoma skin cancers (NMSC), it has become necessary to determine how UVR, which plays a key role in NMSC development, can regulate the structure and function of inflammasomes. In the present study, the regulatory mechanisms of NOD-Like Receptor Family Pyrin Domain Containing 1 and 3 inflammasome activation as well as an effective inflammasome-mediated immune response after UVR exposition are discussed. The differences and similarities between these molecular complexes that monitor cellular health, inflammation, and skin carcinogenesis are also highlighted. Despite numerous scientific data, more studies are still required to better understand the biology of inflammasomes in skin cancer development and to explore their therapeutic potential.

Proteins involved in cutaneous basal cell carcinoma development.

Basal cell carcinoma (BCC) is the most common skin malignancy type in the Caucasian population, with a continuously increasing incidence rate. The etiology of BCC remains unknown, but it appears to have a multifactorial origin resulting from intrinsic and extrinsic factors, including short-wavelength ultraviolet B radiation. The role of specific proteins in BCC that are known to be responsible for the regulation of cell division and are involved in skin aging, including transforming growth factor (TGF)-ß, Smad2, matrix metalloproteinases (MMPs)-1, -3, -8 and -9, cathepsin-K and progerin, remains unknown. The aim of the present study was to assess the mRNA and protein expression profile of samples with diagnosed nodular BCC (nBCC) compared with that of healthy skin samples collected from matched areas. The study group included 22 patients (10 men and 12 women; mean age, 59 years; range, 44-82 years) with pathologically confirmed nBCC, and 22 healthy volunteers (10 men and 12 women; mean age, 59 years; range, 43-78 years) as a control group. The expression of the studied proteins was assessed in all samples by western blotting and reverse transcription-quantitative polymerase chain reaction analysis. Statistically significant increases in the expression of TGF-ß, Smad2, cathepsin-K, progerin and MMP-1, -3, -8 and -9 were detected in skin biopsies with diagnosed nBCC compared with the control group, confirming the important role of these proteins in skin carcinogenesis.

Impact of Ultraviolet Radiation on Expression of Transforming Growth Factor ß, Smad2, Metalloproteinases-1, -3, -8, -9, Cathepsin K and Progerin.

Ultraviolet radiation (UVR) is one of the most important environmental factors involved in photoaging. Exposure to UVR leads to dysregulation of expression of cell cycle-related proteins which play key role in skin photodegradation that pretends to develop carcinogenesis. This study examines the role of various UVB doses on the expression of transforming growth factor beta (TGF-ß), Smad2, cathepsin K, progerin and matrix metalloproteinases (MMPs)-1,-3,-8,-9. A group consisting of 63 healthy individuals underwent one of the following treatments: (1) whole body exposed to UVB irradiation on each of 10 consecutive days with 0.7 MED, or (2) whole-body irradiation as described followed by a single erythemal UVB dose on a small body area, or (3) irradiated only with a single erythemal UVB dose on small body area, or (4) were not irradiated at all (control group). When we compared all irradiated groups to the control group, there was significantly higher expression of TGF-ß, MMP-1,-3,-9 and cathepsin K proteins evaluated by Western blot method. The results suggest the role of UVB in impairment of proteins expression that is involved in cell cycle's regulation. Changes in the protein expression involved by acute and chronic UVR confirm its essential role in skin photodestruction. Moreover, obtained result indicates the tendency to occurrence of photoadaptation phenomenon.