Psychological Aspects of Cutaneous Pain in Psoriasis.

Introduction: Psoriasis is a chronic inflammatory disease that negatively impacts patients' quality of life (QoL) and mental health. Itch and pain are prevalent symptoms of psoriasis and contribute to the psychosocial burden of this disease. This study aimed to evaluate the impact of skin pain on the prevalence and severity of symptoms of anxiety and depression and on the QoL in psoriasis patients. Methods: The studied population comprised 106 adults with psoriasis (34% female; mean age 42.1 ± 13.0 years). Disease severity was measured with the Psoriasis Area and Severity Index (PASI). The intensity of skin pain was assessed with the NRS and the Short Form McGill Pain Questionnaire (SF-MPQ). The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) questionnaires were used to estimate the severity of depression and anxiety, respectively, as was the Hospital Anxiety and Depression Scale (HADS). Quality of life (QoL) was studied using the Dermatology Life Quality Index (DLQI). Results: Regarding anxiety assessment, females reported significantly higher scores with the HADS-A (8.42 ± 4.85 points vs. 5.14 ± 3.9 points; p < 0.001) and the GAD-7 compared to men (7.50 ± 5.58 points vs. 5.24 ± 4.79 points; p = 0.036). Similarly, the severity of depression was significantly higher in women, as measured with the PHQ-9 (7.50 ± 5.58 points vs. 5.24 ± 4.79 points, p = 0.021). Psoriasis patients with skin pain scored significantly higher in HADS Total score (p = 0.043), HADS-A (p = 0.022), PHQ-9 (p = 0.035), and DLQI (p < 0.001) than the rest of the studied group. The intensity of skin pain measured with the SF-MPQ correlated significantly with HADS Total score (p = 0.021), HADS-A (p < 0.001), HADS-D (p = 0.038), and PHQ-9 (p < 0.001). Additionally, there was a significant correlation between the intensity of cutaneous pain assessed using the VAS and the PHQ-9 (p = 0.022). Conclusions: Skin pain significantly influences the well-being of patients with psoriasis as well as the symptoms of anxiety and depression. In particular, women with psoriasis are at increased risk of developing anxiety and depression. Our findings underline the necessity for a multidisciplinary approach to the management of this dermatosis.

Clinical Characteristics of Cutaneous Pain in Psoriasis.

Background: Psoriasis is a common inflammatory disease that is often associated with itch and pain. This study aimed to evaluate the clinical characteristics of skin pain among patients with psoriasis. Materials: A total of 106 patients diagnosed with psoriasis were included in the study (34% female; mean age 42.1 ± 13.0 years). Disease severity was assessed using the Psoriasis Area and Severity Index (PASI). Itch severity was evaluated using the numeric rating scale (NRS) and 4-Item Itch Score (4IIS). The intensity of skin pain was measured through the NRS, short-form McGill pain questionnaire (SF-MPQ), visual analog scale (VAS), and Douleur Neuropathique-4 questionnaire (DN4). Results: In the past week, 84.9% of psoriasis patients reported itch, while 50% of them reported skin pain. The average NRS for itch was 4.52 ± 2.88 points, and the 4IIS yielded a mean score of 6.79 ± 4.37 points. In terms of the intensity of cutaneous pain, the mean NRS was 2.42 ± 2.96 points; the SF-MPQ score averaged 4.84 ± 7.51 points; and the VAS score was 1.92 ± 2.65 points. Furthermore, 17% of adult psoriasis patients reported neuropathic pain. In 84.9% of the participants, skin pain was concurrent with areas affected by itch, while 18.9% of patients exhibited cutaneous pain encompassing all itchy areas. The pain NRS demonstrated significant correlations with the SF-MPQ (r = 0.531, p < 0.001), VAS (r = 0.779, p < 0.001), itch NRS (r = 0.551, p < 0.001), and 4IIS (r = 0.569, p < 0.001). No association was found between the pain NRS and PASI or disease duration. Conclusions: Skin pain of mild intensity and itch of moderate intensity are prevalent symptoms in psoriasis patients. Strong correlations between skin pain and itch can be explained by the process of neurogenic inflammation.

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 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.

Immediate Response to Brentuximab Vedotin in a Patient with Localized MF-LCT.

The large cell transformation of mycosis fungoides (MF-LCT) is a phenomenon observed in the advanced stages of mycosis fungoides (MF), which is the most common primary cutaneous lymphoma. The diagnostic criteria of MF-LCT are a minimum of 25% of large cells or a formation of microscopic nodules of them in the histological examination of skin samples. The clinical outcomes for MF-LCT are poor, as less than 20% of patients survive 5 years after diagnosis, but the expression of the CD30 antigen is generally considered to be associated with a better prognosis. We present a case of a patient with the diagnosis of MF with LCT, with an ulcerated tumor lesion approximately 30 × 20 cm in size on the right lateral abdominal wall. Brentuximab vedotin (BV) treatment was started due to the presence of the CD30 antigen, with a quick and impressive regression of the cutaneous lesion and tumor mass and good treatment tolerance. After follow-up of 20 months, patient remains in complete remission. A schedule of treatment for MF-LCT is directed mainly by the clinical stage of the disease and the comorbidities; the more severe clinical course of the disease requires systemic treatment. If at least 5% of the cells found in the skin lesions biopsy sample express the CD30 antigen, a beneficial effect of BV treatment could be expected. It may seem that the use of BV is one of the optimal therapeutic options in patients with advanced MF-LCT showing expression of CD30.

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.

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.

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.

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 as an Antioxidant and Immunomodulator in Atopic Dermatitis-A New Look on an Old Story: A Review.

Atopic dermatitis (AD) is common inflammatory dermatosis, typically with chronic and recurrent course, which significantly reduces the quality of life. Sleep disturbances are considered to be remarkably burdensome ailments in patients with AD, and are routinely included during assessment of disease severity. Therefore, endogenous substances engaged in the control of circadian rhythms might be important in pathogenesis of AD and, possibly, be used as biomarkers of disease severity or even in development of novel therapies. Melatonin (MT), the indoleamine produced by pineal gland (but also by multiple other tissues, including skin), plays a pivotal role in maintaining the sleep/wake homeostasis. Additionally, it possesses strong antioxidant and anti-inflammatory properties, which might directly link chronic skin inflammation and sleep abnormalities characteristic of AD. The objective of this work is to systematically present and summarize the results of studies (both experimental and clinical) that investigated the role of MT in the AD, with a focus on the antioxidant and immunomodulatory effects of MT.

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.

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.

Adipokines as Biomarkers of Atopic Dermatitis in Adults.

Atopic dermatitis (AD) is characterized by chronic, relapsing, pruritic skin inflammation and does not have a well-understood pathogenesis. In this study, we addressed the contribution of adipokines to AD eczema based on the assessment of blood levels of adiponectin, resistin, leptin, lipocalin-2, and vaspin in adult non-obese patients suffering from chronic extrinsic childhood-onset AD. We investigated 49 AD patients with a median age of 37 years. The control group consisted of 30 age-matched healthy subjects. Adipokines were assessed in the serum by ELISA assays and the severity of AD with the SCORing Atopic Dermatitis (SCORAD) index. We found that adiponectin and resistin decreased and leptin appreciably increased in AD patients when compared to those in healthy subjects. Further, the levels of adiponectin and resistin were inversely related to the intensity of eczema. In conclusion, apart from the formerly investigated role of leptin in AD, this study points to adiponectin and resistin as the potential candidate adipokine biomarkers involved in shaping eczema intensity and severity, which may help predict disease exacerbations and enable the development of effective targeted therapeutic interventions.

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.

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.