High-frequency ultrasonography-New non-invasive method in assessment of skin lymphomas.

BACKGROUND: Mycosis fingoides (MF) is the most common subtype of primary cutaneous T-cell lymphomas. Current evaluation of disease extent and severity is based on mSWAT scoring system, which seems to be relatively subjective. The aim of this subject was to present the usefulness of 20 MHz in objective 5-year long monitoring of response to therapy in MF patients. MATERIALS AND METHODS: The 5-years long follow-up based on 19 skin USG images of patients diagnosed as early stages of MF was studied. The assessed USG parameter was the mean diameter of subepidermal low echogenic band (SLEB). RESULTS: In every MF patient during exacerbation within lesional skin we could observe SLEB, which thinning or complete disappearance was detected after finishing the therapy. Lack of complete absence of SLEB was related to the lack of complete remission assessed by mSWAT. CONCLUSION: We present for the first time the possibility of monitoring patients' clinical state on the base of non-invasive USG imaging. We recommend additional use of 20 MHz USG to reduce intra-observer variability and to assess residual disease. USG imaging can complement evaluation of skin lesions in MF and can support clinical judgement.

Long-term efficacy of allergen specific immunotherapy in atopic dermatitis patients in relation to quality of life.

INTRODUCTION: Atopic dermatitis (AD) is an inflammatory, chronically relapsing and highly pruritic skin disorder that considerably effects patients' life. Dermatology Life Quality Index (DLQI) is often applied in clinical research in order to evaluate the impact of AD on daily performance of patients. AIMS: The aim of the study was to evaluate the long-term effect of allergen specific immunotherapy (ASIT) on the quality of life in AD patients. MATERIALS AND METHODS: 15 patients suffering from AD, allergic to house dust mites or grass pollen allergens, who were previously treated with ASIT participated in the study. Our treatment with allergy vaccinations was performed during the time period between 1995 and 2001. DLQI questionnaires have been filled by the patients before the treatment, after termination of ASIT and after 2 - 12 years of the observational period. RESULTS: The statistical tests revealed a significant difference between the DLQI before ASIT was introduced and after termination of ASIT. Every answer except two (describing the influence of skin condition on preventing from working or studying and on sexual life) of these periods also disclosed statistically significant difference. As for the relation between the DLQI after ASIT and the actual one the tests revealed non significant difference, also regarding to every single answer of the questionnaire. CONCLUSIONS: In relation to improvement of quality of life in AD patients, this study confirms the effectiveness of ASIT and it discloses the persistence of its results in long-term aspect.

Oral health status and dental treatment needs of psoriatic patients with different therapy regimes.

The aim of the study was to investigate the dental treatment requirements and oral health status of psoriatic patients with different severities of the disease, managed by different methods, including biological therapies. METHODS: One hundred and twenty-seven patients diagnosed with psoriasis were enrolled in this study. All subjects completed a general medical history and a Dermatology Life Quality Index (DLQI) questionnaire. The severity of the disease was assessed using the Psoriasis Area and Severity Index (PASI) scale and a DLQI questionnaire. In order to evaluate the oral health status, the following techniques were used: Approximal Plaque Index (API), the Community Periodontal Index (CPI) and the Decayed, Missing and Filled Teeth (DMFT) index. RESULTS: Patients treated with biologicals presented a significantly lower mean CPI index and required no surgical interventions. Subjects managed with topical therapy had significantly more decayed teeth and higher treatment needs. Only 11.3% of patients did not require dental intervention. CONCLUSIONS: The study revealed a high need for dental interventions in patients with psoriasis. The type of treatment used may affect the oral health status of patients. However, further investigations are required to explain the significantly lower CPI value in the group treated with biologicals.

Majocchi's granuloma (granuloma trichophyticum) in a guinea pig owner: A case report and literature review.

Majocchi's granuloma is a folliculitis caused by dermatophytes, which is most commonly located on the skin of the lower limbs in women. A favorable factor for the infection is an injury caused by epilation, which, together with an existing fungal infection, can lead to the spread of folliculitis to other parts of the body. The disease is extremely rare (Burgdorf et al., 2010). The aim of this article is to describe the case of a patient who developed severe edematous lesions of the lower extremities from a mycosis infection with Trichophyton mentagrophytes varietas granulosum, the carrier of which was a domestic guinea pig.

Methotrexate in the treatment of mycosis fungoides - a multicenter observational study in 79 patients.

OBJECTIVE: The first report concerning methotrexate (MTX) in the treatment of Mycosis fungoides (MF) was published in 1964 by Wright. The mechanism of MTX action in the treatment of primary cutaneous T-cell lymphoma (CTCL) has been not explained in detail yet (the anti-inflammatory, immunomodulating, immunosuppressive, and cytostatic actions have been under discussion). PATIENTS AND METHODS: This is a retrospective analysis of 79 MF patients in 4 dermatology clinical centers in Poland. Data are presented in terms of the duration, use of MTX, the effectiveness of treatment with MTX in terms of time required to achieve remission, the disease stage, route of administration, age at diagnosis and the dosage. Moreover, the occurrence of side effects depending on the route of administration and duration of therapy with MTX was analyzed. RESULTS: The analysis has revealed that 56 patients (70,9%) had achieved remission on the MTX. The remission began in the 1st month of therapy in 20% of patients, lasted 4 to 6 months in 50% of cases. At least 12 months' remission was confirmed in 25% of patients (2-year-long only in 10% and 3-year-long in 5% of patients). The time to remission was related to the stage of disease at diagnosis as well as to minimal and maximal dose of MTX. The total therapeutic dose of MTX was found important for the course of the disease: higher total dose had prolonged the remission. CONCLUSIONS: Despite the common use of MTX in MF patients, relatively few clinical studies have been published. The response of MF subjects to MTX seems to depend on the stage and, more importantly, the dose of MTX treatment. Methotrexate appears to be an effective treatment at every stage of MF; however, it is not devoided of side effects such as infections and elevated level of aminotransferases, which are most common.

Pruritus in selected dermatoses.

Pruritus is a natural defence mechanism of the body and creates the scratch reflex as a defensive reaction to potentially dangerous environmental factors. Together with pain, pruritus is a type of superficial sensory experience. Pruritus is a symptom often experienced both in healthy subjects and in those who have symptoms of a disease. In dermatology, pruritus is a frequent symptom associated with a number of dermatoses and is sometimes an auxiliary factor in the diagnostic process. Apart from histamine, the most popular pruritus mediators include tryptase, endothelins, substance P, bradykinin, prostaglandins and acetylcholine. The group of atopic diseases is characterized by the presence of very persistent pruritus. It is found in almost all patients with atopic dermatitis or urticaria. Cutaneous T-cell lymphoma is another group of pruritic diseases where the symptom of pruritus develops at an early stage and becomes intensified as the disease progresses. Other dermatoses include psoriasis, parasitic diseases and also systemic diseases in which pruritus is often the first and the only symptom suggesting an internal health problem. Cases of pruritus in healthy subjects, possibly associated with skin dryness or pregnancy in women, have also been reported. This paper presents mechanisms responsible for pruritus and the most important dermatoses in which this symptom is found. Treatment of pruritic dermatoses is difficult and always requires an interdisciplinary approach. Not all dermatoses can be successfully treated with antihistamine drugs, particularly if patients suffer from cutaneous T-cell lymphoma, liver or kidney diseases. For this reason, the problem of pruritus is the focus of attention of many scientists, and the subject of interdisciplinary studies.

Photoprotection: facts and controversies.

Excessive exposure of the skin to sunlight can lead to many negative effects, such as sunburn, photoaging and skin cancer development. Pollution and stratospheric ozone layer depletion are factors that increase exposure to ultraviolet radiation. This work is an accurate summary of the current state of knowledge on broad-spectrum photoprotection. Avoiding the sun, skin protection through the use of protective clothing and protective filters are currently the most effective methods of sunscreen provided that they are suitably used. In addition, discussed are controversial issues such as the toxicity of zinc used in sunscreen preparations and the potential for deficiency of vitamin D3 in relation with the application of strict photoprotection. The study has also addressed issues concerning the most recent lines of research in the exploration of modern methods of photoprotection both local and systemic, such as with the use of photolyase or examination of various enzymes repairing damage after sun exposure, as well as the promising future in photoprotection technology.

[The treatment of extensive onychomycosis in aged patients]. / Leczenie rozleglej grzybicy dermatofitowej paznokci u pacjentów w starszym wieku.

The aim of the study was to present the own observations concerning treatment of patients above 50 years of age suffering the toe nail dermatophyte onychomycosis with intensified subungual keratosis and considerable nail plates destruction. Three different treatment methods were administered: 40 patients were treated only with itraconazole pulse method for 3 month, 35 patients besides itraconazole were given also pentoxifylline. In case of 20 individuals besides 3-month itraconazole pulse method treatment, the amorolfine varnish application onto changed nails once a week for 6 month was administered. In the group of patients treated only with itraconazole, in 22 cases (55,0%) the cure was obtained, while in the group of individuals given the combined therapy with pentoxifylline, the cures made 71,4% (25 individuals). From among patients treated with itraconazole and external amorolfine application the cures made 75,0% (15 individuals).

[The yeast-like fungi infections in medical intensive care patients in years 1996 - 2000]. / Zakazenia wywolane przez grzyby drozdzopodobne u pacjentów intensywnej terapii w latach 1996 - 2000.

The aim of this study was to analyse, taking into consideration the infection risk factors, the incidence of fungal infections occurrence in Medical Intensive Care Units. Yeast-like fungi strains isolated from various clinical materials underwent mycological examination. Mycological diagnosis was performed in compliance with compulsory laboratory methods. The detailed observation concerned patients who were admitted to the intensive care unit by urgent reasons or because of basic disease aggravation, trauma, surgical operations and those with diabetes mellitus. The main etiological fungal infections factor were C. albicans strains. The increased incidence of C. glabrata and C. parapsilosis participation in yeast-like fungi infection pathogenesis was observed. The results presented in this study confirm, that intensive care units patients, for the reason of fungal infections, make the increased risk group.

Topical tacrolimus vs medium-dose ultraviolet A1 phototherapy in the treatment of atopic dermatitis - a preliminary study in relation to parameters of the epidermal barrier function and high-frequency ultrasonography.

INTRODUCTION: Atopic dermatitis (AD) is a chronic, relapsing skin disorder, which is characterized by intense pruritus, skin dryness and concomitant epidermal barrier dysfunction. The basic therapy involves the application of anti-inflammatory topical drugs like; glucocorticosteroids and calcineurin inhibitors. Phototherapy in AD is regarded as an additional form of treatment. The latest invention, ultraviolet A1-UVA1 phototherapy (340-400 nm), was introduced to the treatment of AD by Krutmann et al in 1992. It appears that the main mode of action of UVA1 phototherapy in AD is through activation of apoptosis of T lymphocytes. Additionally, new studies show that UVA1 can also inhibit the activity of calcineurin phosphatase, similarly to calcineurin inhibitors such as cyclosporin A or tacrolimus. The aim of this study is to, for the first time, compare the efficacy of medium dose UVA1 phototherapy and tacrolimus ointment in patients with moderate-severe AD. PATIENTS AND METHODS: This study involved 20 AD patients. Half of the patients were treated with UVA1 phototherapy, while another 10 participants were treated with the application of tacrolimus ointment. The severity of the disease progress was assessed on the basis of EASI score (Eczema Area Severity Index). Moreover, the clinical condition of patients was assessed using non-invasive techniques such as measurement of transepidermal water loss - TEWL and skin capacitance, as well as high-frequency ultrasonography (20 MHz). RESULTS: This study described above confirmed the beneficial influence of both therapies on the course of moderate-severe AD. Tacrolimus induced a greater reduction in TEWL, while phototherapy caused the reduction of subepidermal low echogenic band-SLEB within sites affected with pathological lesions. CONCLUSIONS: Both tacrolimus and phototherapy treatment seemed to significantly reduce EASI.

Common variants of ZNF750, RPTOR and TRAF3IP2 genes and psoriasis risk.

Psoriasis vulgaris is a genetically heterogenous disease with unclear molecular background. We assessed the association of psoriasis and its main clinical phenotypes with common variants of three potential psoriasis susceptibility genes: ZNF750, RPTOR and TRAF31P2. We genotyped 10 common variants in a cohort of 1,034 case-control individuals using Taqman genotyping assays and sequencing. Minor alleles of all four TRAF3IP2 variants were more frequent among cases. The strongest, significant association was observed for rs33980500 (OR = 2.5, p = 0.01790). Minor allele of this SNP was always present in two haplotypes found to be associated with increased psoriasis risk: rs13196377_G + rs13190932_G + rs33980500_T + rs13210247_A (OR = 2.7, p = 0.0054) and rs13196377_A + rs13190932_A + rs33980500_T + rs13210247_G (OR = 1.8, p = 0.0008). Analyses of clinically relevant phenotypes revealed association of rs33980500 with pustular psoriasis (OR = 1.2, p = 0.0109). We observed significant connection of severity of cutaneous disease with variation at rs13190932 and suggestive with three remaining TRAF3IP2 SNPs. Another positive associations were found between age of onset and familial aggregation of disease: smoking and younger age of onset, smoking and occurrence of pustular psoriasis, nail involvement and arthropatic psoriasis, nail involvement and more severe course of psoriasis. We found no statistically significant differences in the prevalence of the examined variants of RPTOR and ZNF750 genes among our cases and controls. We have replicated the association of TRAF3IP2-_rs33980500 variant with the susceptibility to psoriasis. We have found new associations with clinically relevant subphenotypes such as pustular psoriasis or moderate-to-severe cases. We ascertain no connection of RPTOR and ZNF750 variants with psoriasis or its subphenotypes.

Scedosporium prolificans fungaemia in a patient with acute lymphoblastic leukaemia.

Aggressive chemotherapy and immunosuppressive treatment may prolong patients' life, but influence the risk of severe, life-threatening infections. Here, we report the case of a 21-year-old caucasian female who developed a disseminated infection of Scedosporium prolificans after allogenic stem cell transplantation performed for treatment of relapsed acute lymphoblastic leukaemia. The pathogen was isolated from the blood and identified on the basis of its macroscopic and microscopic morphological features. The empirical treatment with amphotericin B provided no improvement. However, introduction of intravenous voriconazole resulted in amelioration of fever. Unfortunately, the patient died due to progression of underlying disease and multiorgan failure. However, this case report indicates a possible relevance of voriconazole-based treatment regimens in invasive S. prolificans infections.