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.

Wharton's jelly-derived mesenchymal stem cells in the treatment of four patients with alopecia areata.

BACKGROUND: Alopecia areata (AA) is the second most common cause of non-scarring alopecia. Little is known on the etiopathogenesis of AA. It is considered an autoimmune disease, with T lymphocytes and antibodies directed against hair follicle structures. Topical and systemic therapies are used for the treatment of AA, but none of the therapies used to date have a permanent therapeutic effect. OBJECTIVES: To evaluate the efficacy and safety of AA treatment through a single intradermal injection of a suspension of allogeneic MSCs extracted from Wharton's jelly (WJ-MSCs) into the alopecia foci. MATERIAL AND METHODS: The study involved 4 AA patients who underwent experimental therapy with a suspension of WJ-MSCs. The AA intensity was measured using the SALT score. This measure was performed 3 times during treatment: 1st measure (SALT0) prior to treatment; 2nd measure (SALT12) 12 weeks after the treatment; and 3rd measure (SALT24) 24 weeks after the treatment. Furthermore, during each follow-up visit (6, 12, 18, and 24 weeks after the administration of WJ-MSCs) the patient's general condition (physical examination) and local condition were assessed, their mood was evaluated, and a photo of the scalp was taken. RESULTS: Hair regrowth was observed in all patients by an average of 67% at the sites where the cell suspension was administered. In all cases, we observed greater dynamics of hair regrowth in the first 3 months after the treatment, with an average increase of 52.2%, compared to the following 3 months, with an average of 32%. CONCLUSIONS: The results of the applied intradermal injections of an allogeneic WJ-MSC suspension were positive with hair growth observed in all participants and the therapy was found to be safe, with no side effects.

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.

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.

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.

Epidemiology of dermatomycoses in southwest Poland, years 2011-2016.

INTRODUCTION: Superficial mycosis is one of the most common diseases worldwide, however its epidemiology is changing over time. AIM: To present epidemiological data of the skin fungal infections diagnosed in the years 2011-2016 in Lower Silesia. MATERIAL AND METHODS: A total of 11 004 patients with a clinically suspected superficial mycosis were investigated. Skin scrapings, nail clippings and plucked hair were examined with a direct microscopy, Wood's lamp and culture. Particular species were identified via polymerase chain reaction (PCR) examination. The lesions suspected for pityriasis versicolor were screened for Malassezia with Wood's lamp and direct microscopy. RESULTS: Dermatomycosis was diagnosed in 1653 (15.00%) patients with 1795 fungi identified. 1858 specimens were indicative of fungal infection including dermatophytes, yeasts and moulds. Out of 924 cases of dermatophytic infections (51.48%), Trichophyton rubrum accounted for the majority (71.75%) and was followed by Trichophyton tonsurans (16.77%). Among the yeasts (716; 39.89%), Candida spp. was the most common agent identified (521; 67.66%). The sites affected most often were toenails (956; 51.45%) and fingernails (319; 17.17%). In paediatric population the most common diagnosis was tinea corporis (60, 41.10%). CONCLUSIONS: Our study revealed that toenail onychomycosis remains the most common superficial mycosis and T. rubrum is the most common pathogen. However, in a longer period of observation, a decrease in the number of tinea capitis cases and an increase in infections caused by T. tonsurans were noticed. Observed changes indicate the need for continuing studies to detect the upcoming epidemiological trends.

Efficacy of diphenylcyclopropenone in alopecia areata: a comparison of two treatment regimens.

INTRODUCTION: Alopecia areata (AA) is a skin disease of unclear etiology. In AA, topical immunotherapy with diphenylcyclopropenone (DPCP) is considered the most effective treatment; however, the most common therapies give unsatisfactory results. AIM: To assess the efficacy of a topical application of a solution of DPCP based on the intensity, duration and number of exacerbations of AA and to compare the efficacy of two treatment regimens. MATERIAL AND METHODS: In this prospective study, 39 patients with AA were enrolled. Group A was treated at weekly intervals and group B at 3-week intervals. Hair loss was assessed by independent dermatologists and documented by photography and dermoscopy. RESULTS: After 6 months' therapy, hair regrowth greater than 50% was observed in 21 patients, while worsening, no regrowth, or regrowth of less than 50% was seen in 18 patients. Regrowth exceeding 50% of initial loss was observed in 12 of 17 patients with baseline hair loss < 50%, in 9 of 22 patients with severe alopecia, and in 4 of 9 patients with alopecia totalis. Both groups showed significant improvement with higher efficacy in group B (54%) than group A (46%). CONCLUSIONS: Treatment at longer intervals may be safer and more comfortable for patients; however, further research is required.

Diffuse melanosis cutis related to dermal micrometastases as the first clinical symptom of distant metastatic malignant melanoma: Case report.

RATIONALE: Diffuse melanosis cutis (DMC) is a very rare sign of malignant melanoma progression. The condition usually develops after approximately one year from melanoma diagnosis in a patient with metastatic tumors and after anticancer treatment with cytostatic medications. PATIENT CONCERNS: A 72-year old Caucasian man was admitted to the Department of Dermatology with DMC for 4 months and the history of two melanomas treated surgically 30 years and 9 months before present hospitalization. DIAGNOSIS: Histological and immunohistochemical examinations of DMC biopsy indicated melanoma metastatic cells as well as free deposits of melanin and melanophage presence in the dermis. INTERVENTIONS: The patient refused to the treatment. OUTCOMES: The patient died eight months after DMC appeared. LESSONS: DMC is a rare presentation of advanced MM and is a bad prognostic factor. The pathomechanisms of the discoloration of the skin are not fully explained. The role of micrometastases, as well as melanin precursors, released during lysis of MM metastases, and growth factors may play a role in the development of the symptom.

Increase in resistance to fluconazole and itraconazole in Trichophyton rubrum clinical isolates by sequential passages in vitro under drug pressure.

Trichophyton rubrum, an anthropophilic dermatophyte fungus, is the predominant causative agent of superficial skin infections in human population. There are only scanty reports on drug susceptibility profiling of T. rubrum. Neither mechanisms for drug resistance development nor correlation between in vitro drug susceptibility and in vivo response to treatment is known for that species. In this study, changes in the in vitro susceptibilities to fluconazole (FLZ) and itraconazole (ITZ) among thirty T. rubrum clinical strains subjected to sequential passages in the presence or absence of the azoles were investigated. Each strain was passaged 12 times at 4-week intervals as three parallel cultures, maintained on a drug-free medium (1), and a medium containing FLZ (2) or ITZ (3) at subinhibitory concentrations. Susceptibility to FLZ and ITZ of the original strain and its 3 subcultures was determined by microdilution method. The MIC values of the two azoles remained unaltered for all T. rubrum strains tested, after 12 passages on a drug-free medium. Among the strains grown with FLZ, an increase in the MICs of FLZ and ITZ was noted in 17 (56.7 %) and 19 (63.3 %) strains, respectively. Increased MICs of ITZ and FLZ were demonstrated for 24 (80 %) and 20 (66.7 %) strains that were propagated with ITZ. The results indicate the capacity of T. rubrum to develop resistance toward the azoles after prolonged exposure to these drugs. Resistance of T. rubrum to azoles plays an important role in therapy failures and consequently contributes to persistence and chronicity of the infections.