Afamelanotide in protoporphyria and other skin diseases: a review.

Afamelanotide is a synthetic alpha melanocyte stimulating hormone presenting a higher activity than natural hormones. Its main properties are related to the enhanced production of eumelanin by agonistically binding to the melanocortin-1 receptor. Since 2016 afamelanotide has been especially applied to treat cases of erythropoietic porphyria (EPP), where painful photosensitivity has been observed since early childhood. The positive effect of afamelanotide in EPP administered subcutaneously improved tolerance to artificial white light and increased pain-free time spent in direct sunlight. In this review we summarize the possible use of afamelanotide in dermatology, with special emphasis on EPP and encourage including afamelanotide as a treatment option in patient care.

DRESS syndrome - A dermatological emergency - Sulfasalazine-related acute drug reaction case report.

Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) or drug-induced hypersensitivity syndrome (DIHS) is a severe skin reaction associated with general symptoms and mortality reaching up to 10% of cases. DRESS/DIHS is one of the few dermatological emergencies which need to be taken into consideration when dealing with a patient with acute exanthema and systemic symptoms like: fever, lymphadenopathy, muscle pain, hepatosplenomegaly, abnormal blood count results and systemic inflammation. The aim of this article is to summarize the literature finding regarding this dermatological emergency and present the case of a 42-year-old male suffering from DRESS syndrome as a consequence of sulfasalazine intake due to an inflammatory bowel disease, who was effectively treated with oral prednisolone and immediate drug withdrawal.

Fatty Acids Profile and the Relevance of Membranes as the Target of Nutrition-Based Strategies in Atopic Dermatitis: A Narrative Review.

Recently, the prevalence of atopic dermatitis has increased drastically, especially in urban populations. This multifactorial skin disease is caused by complex interactions between various factors including genetics, environment, lifestyle, and diet. In eczema, apart from using an elimination diet, the adequate content of fatty acids from foods (saturated, monounsaturated, and polyunsaturated fatty acids) plays an important role as an immunomodulatory agent. Different aspects regarding atopic dermatitis include connections between lipid metabolism in atopic dermatitis, with the importance of the MUFA levels, as well as of the omega-6/omega-3 balance that affects the formation of long-chain (C20 eicosanoic and C22 docosaenoic) fatty acids and bioactive lipids from them (such as prostaglandins). Impair/repair of the functioning of epidermal barrier is influenced by these fatty acid levels. The purpose of this review is to drive attention to membrane fatty acid composition and its involvement as the target of fatty acid supplementation. The membrane-targeted strategy indicates the future direction for dermatological research regarding the use of nutritional synergies, in particular using red blood cell fatty acid profiles as a tool for checking the effects of supplementations to reach the target and influence the inflammatory/anti-inflammatory balance of lipid mediators. This knowledge gives the opportunity to develop personalized strategies to create a healthy balance by nutrition with an anti-inflammatory outcome in skin disorders.

The prevalence of contact hypersensitivity in patients with oral lichen planus.

Introduction: Oral lichen planus (OLP) is a chronic autoimmune inflammatory disease with an unknown aetiology and a higher prevalence in women. Oral lichenoid lesions both clinically and histologically resemble oral lichen planus and are often associated with contact allergy to dental materials. Aim: To investigate the prevalence of delayed hypersensitivity reactions in patients with OLP and to identify the most common allergens that may exacerbate the disease. Material and methods: Twenty patients diagnosed with OLP and undergoing treatment in the Gerodontology and Oral Pathology Department of the Poznan University of Medical Sciences were enrolled in the study. The subjects underwent a detailed oral examination consisting of anamnesis and a clinical evaluation by a qualified dentist, while an assessment of the skin and skin appendages was carried out by a dermatologist. Patch testing was performed using the Polish Baseline Series and Dental Screening Series. Results: Fifty percent of the examined patients displayed positive patch test reactions. A total of 18 allergic reactions were revealed, but only four appeared during the first test. The most common allergens were found to be nickel, gold, and a fragrance mix. Only 1 patient had a positive reaction to more than three allergens. Conclusions: There seems to be a high contact reaction rate in patients with oral lichen planus, which is not related to contact with synthetic dental materials. However, further investigations on a larger population with the introduction of additional tests administered 7 days after exposure are required to confirm the effects of delayed hypersensitivity reactions on patients with OLP exacerbation.

Pathogenetic aspects of chronic urticaria. Retrospective and prospective analysis of the patients of the Department of Dermatology, Poznan University of Medical Sciences.

Introduction: Urticaria is a disease with a complex pathomechanism. Confirmation of the cause in chronic urticaria seems to be a great challenge for specialists. Aim: To assess the frequency of different types of urticaria and their coexistence in 1 patient, diseases associated with chronic urticaria and the frequency of accompanying oedema. Material and methods: The study was divided into two parts. Retrospective analysis included 441 chronic urticaria patients at the age of 15 or older hospitalized in 10 years. Information from history of the disease has been placed in a specially designed form. For the prospective analysis 78 patients have been chosen out of 441 subjects previously qualified for retrospective analysis. Results: The most common type of urticaria was autoimmune (27.9% R; 30.8% P), spontaneous (19.3% R; 39.7% P) and aspirin-induced urticaria (17.5% R; 25.6% P). The most common coexisting types of urticaria were autoimmune with aspirin-induced (7.5% R; 10.3% P) and autoimmune with dermographic urticaria (3.2% R; 5.1% P). In more than half of the patients (66.7%) one type occurs only. Angioedema coexisted in over half of the patients (58% R; 69.2% P) Among the coexisting comorbidities in people with accompanying angioedema, statistically significant differences appeared in patients with thyroid diseases (19.9% with oedema and 4.9% without oedema). Among drug users, there was a greater difference between the percentage of patients with or without angioedema than among non-drug users. Conclusions: It was found that among the inducing factors - pressure and stress and among drugs taken for diseases other than urticaria - NSAIDs had an influence on the persistence of symptoms in P patients.

Phytoecdysteroids from Serratula coronata L. for Psoriatic Skincare.

Phytoecdysones from Serratula coronata seem to be promising agents for skincare in patients with psoriasis. The aim of the study was to determine the effects of creams containing the extract of S. coronata on psoriatic lesions. Creams with different formulas were prepared: 0-Lekobaza®, 1-Lekobaza®, S. coronata, 2-Lekobaza®, Salicylic acid, 3-Lekobaza®, S. coronata, Salicylic acid. After examination of skin penetration and biosafety, the designated cream was applied twice daily for 6 weeks on 72 psoriatic plaques located on elbows or knees. The lesions were assessed at baseline and follow-up of 6 weeks. The lesions area was measured, and severity of scaling, erythema, and infiltration was assessed using a 5-point scale (from 0-none to 4-very severe). Skin hydration and structure, pH, transepidermal water loss, erythema, and melanin index were analyzed instrumentally. Creams 1, 2, and 3 significantly reduced the area of psoriatic plaques. Improvement in erythema and infiltration was observed for creams 1 and 3. Creams 1-3 reduced scaling. Our study confirmed a beneficial effect of creams containing S. coronata extract on psoriatic lesions.

Taxifolin as a Promising Ingredient of Cosmetics for Adult Skin.

Active substances, effective in the reduction in or delay of skin changes caused by aging occurring in natural compounds, are desirable. Taxifolin (TXF), a flavonoid of strong antioxidant activity found in the plant Stizolophus balsamita (S. balsamita), has been tested for its biological effects on adult human skin. The aim of the study was to investigate the effects of two creams: 3% S. balsamita extract and 3% TXF on the function of adult skin. In total, 97 Caucasian women with clinical signs of skin aging were investigated. The biophysical and biomechanical skin parameters were measured before and after applying the creams, using Colorimeter CL400, Mexameter MX16, Skin-pH-Meter PH900, Skin-Thermometer ST 500, Glossymeter GL200, and Cutiscan SC100. Patch tests were performed with the investigated products to assess their potential irritant properties. The percutaneous penetration of creams was examined with the use of electrospray ionization mass spectrometry (ESI-MS) and confocal Raman spectroscopy. The 3% S. balsamita extract cream reduced hyperpigmentation, erythema, and elevated pH. All the tested preparations were proven to be nonirritant. A higher penetration rate was revealed for the 3% TXF cream than for the 3% S. balsamita extract cream. A total of 3% TXF cream improved skin viscoelasticity. The obtained results suggested that S. balsamita extract and TXF may be considered as ingredients of skincare products for adults.

The use of complementary and alternative medicine by patients suffering from psoriasis and psoriatic arthritis.

INTRODUCTION: Psoriasis is a chronic inflammatory disease, affecting 1-3% of the general population. In recent years there has been an increase in the use of complementary and alternative medicine (CAM) by psoriasis patients. AIM: To assess the frequency of use of CAM by psoriasis patients, depending on selected demographic and clinical factors, and to examine such aspects as sources of knowledge about CAM therapies provided by patients, reasons for their use, and subjective patient satisfaction. MATERIAL AND METHODS: The study involved 117 psoriatic patients (female = 44, male = 73), hospitalised in the Dermatology Department of the Heliodor Swiecicki Clinical Hospital in Poznan. The research tool was the author's questionnaire, consisting of single- and multiple-choice questions about the use of CAM. RESULTS: 57.26% of the respondents declared that they used or had used CAM for psoriasis. The analysis showed that the patients with psoriasis diagnosed in childhood statistically significantly more often used CAM compared to other patients (p = 0.017). The most frequent CAM therapies used by the responders were the use of topical agents (73.13%) and dietary supplements (71.64%). The main reason why psoriasis patients decided to use CAM was curiosity (34.33%), and the most commonly reported source of knowledge about CAM was the Internet (49.25%). The majority of responders monthly expenditure on CAM averaged less than PLN 100 (58.2%), and they were very dissatisfied with the effects of CAM (56.7%). CONCLUSIONS: Psoriasis patients use complementary and alternative medicine quite frequently. Dermatologists should keep this fact in mind and should ask about the use of CAM in interviews.

The relationship between the severity of clinical symptoms of chronic urticaria and serum D-dimer levels.

INTRODUCTION: Urticaria and angioedema belong to a heterogeneous group of diseases and it is often very difficult to determine the specific cause of clinical symptoms. Coagulation factors play an important role, and patients with chronic urticaria have elevated plasma concentrations of coagulation factor VII, prothrombin fragment 1 + 2 and D-dimers. AIM: To assess the relationship between the severity of clinical symptoms of chronic urticaria and serum D-dimer levels. MATERIAL AND METHODS: Sixty patients with a diagnosis of chronic spontaneous urticaria, diagnosed and treated in the Dermatology Department of the Poznan University of Medical Sciences were qualified for the tests. The control group consisted of 35 healthy volunteers. All patients with chronic spontaneous urticaria were previously subjected to individual stages of the diagnostic process, in accordance with the guidelines of EAACI and the Polish team of specialists in the field of dermatology and venereology, and allergology. The dermatological condition was assessed using the UAS scale. The serum D-dimer concentration was determined by immunoturbidimetry. RESULTS: In the basic group, statistically significant, positive and high correlations between the serum D-dimer concentration and the severity of urticaria symptoms were shown, as well as between the severity of pruritus and the value of the disease activity index were shown. CONCLUSIONS: Elevated levels of D-imers are significantly correlated with the severity of urticaria.

Contemporary treatment patterns in plaque psoriasis and psoriatic arthritis.

INTRODUCTION: Psoriasis is a chronic inflammatory skin disease affecting about 2% of the general population. Although there are many treatment options, and new medications have been introduced, the disease is considered not curable, and it may seriously affect patients' quality of life. AIM: The authors present contemporary treatment patterns used by dermatologists in Poland to manage plaque psoriasis and psoriatic arthritis, particularly regarding systemic treatment. The authors also aimed to analyse how these treatment patterns are influenced by the guidelines of the Polish Dermatological Society. MATERIAL AND METHODS: The author's questionnaire, consisting of 13 questions was used. It included demographic and professional characteristics of questioned dermatologists, as well as the assessment of the attitudes towards management of plaque psoriasis and psoriatic arthritis. RESULTS: A total of 132 dermatologists completed the questionnaire. Most of the specialists worked in out-patient clinics and private practices. The most commonly used topicals for psoriasis included: glucocorticosteroids, a combination of glucocorticosteroid and vitamin D analogue and salicylic acid. Regarding the treatment of psoriatic arthritis, most of the specialists declared using systemic therapy and a combination of systemic therapy and phototherapy. The majority of the respondents were particularly concerned with possible side effects or difficulties in qualifying and monitoring the patients, and less frequently on the cost of the therapy. CONCLUSIONS: Observations suggest that 60% of physicians have some reservation to initiate systemic treatment in outpatient clinics, and they admit that they lack additional training. On the other hand, it seems also that the organization of systemic treatment in psoriasis may generate these difficulties and thus necessitate additional effort. Another factor could be the budget - not only regarding healthcare professionals, but also the patient, sometimes financing various investigations from private resources.

High-Frequency Ultrasonography and Evaporimetry in Non-invasive Evaluation of the Nail Unit.

Background: The nail unit (NU) is a complex structure that performs a number of functions, including protection, defense, manipulation, and palpation. Non-invasive research methods can facilitate the recognition of NU structure and function. Evaporimetry and HF-USG due to their availability of equipment and low research costs seem to be particularly noteworthy, but so far have been assessed to a limited extent. The aim of the presented study was to check the usefulness of TOWL and HF-USG in examination of NU. Materials and Methods: A total of 58 volunteers aged 25-65 years (mean age: 41 ± 10.16 years) were qualified for the study. The subjects did not present symptoms of clinically evident onychopathy and did not suffer from any dermatoses associated with lesions occurring within the NU. Additionally, the patients did not suffer from systemic diseases that could affect NU (including heart, lung, and endocrine diseases). In all volunteers, the measurement of TOWL and 20 MHz ultrasonography [high-frequency ultrasonography (HF-USG)] with the special emphasis on determination of nail plate thickness were performed. Results: Analysis of 464 HF-USG images revealed that the nail plate presented as two hyperechoic, parallel streaks (railway sign) with a linear hypoechoic middle layer between them. Matrix was visualized as a hypoechoic structure with blurred boundaries, mostly within the fourth and fifth fingers and more often in women. We found statistically significant correlations between the type of a finger and the thickness of the nail plate both in the entire study group and taking into account gender. In the dominant hand, the results were r = -0.341; p < 0.001; r = -0.417, p < 0.001; and r = 0.337; p = 0.001 (for the whole group, for women, and for men, respectively). In the non-dominant hand, the results were r = -0.465; p < 0.001; r = -0.493, p < 0.01; and r = -0.503; p < 0.01 (for the whole group, for women, and for men, respectively). There were statistically significant differences in the thickness of the nail plates of the corresponding types of fingers between female and male NUs. Statistically significant correlations were found between the type of a finger and the TOWL value in the whole group and taking into account gender (p < 0.05), except for the non-dominant hand in men. There were no statistically significant differences in the TOWL values of the corresponding types of fingers between male and female NUs (p > 0.05). There was no statistically significant correlation between the TOWL value and the nail plate thickness in any of the tested NUs, apart from the one statistically significant correlation in nd5 (r = 0.390, p = 0.021). Conclusions: To sum up, non-invasive methods, such as HF-USG and TOWL, enable assessment of the NU and are useful in examination of its structure and function. HF-USG shows characteristic elements of NUs that can be distinguished because of differences in their echogenicity. The thickness of the nail plate and TOWL depend on the type of finger, and show a relationship with gender.

High-Frequency Ultrasonography-Possibilities and Perspectives of the Use of 20 MHz in Teledermatology.

High-frequency ultrasonography (HF-USG) is a non-invasive and in vivo method of visualization of the skin and upper part of subcutaneous tissue based on ultrasounds above 20 MHz. Although initially HF-USG was introduced to measure skin thickness, it currently gained widespread acceptance in dermato-oncology, primarily when used to determine skin tumor margins. Moreover, its application in different dermatology fields is known, particularly as a rapidly evolving method in the objective evaluation of the severity of various chronic skin diseases. Among different specialties, teledermatology belongs to leading and continually developing areas of successful telemedicine applications. Various skin conditions are visible to the human eye, which makes them particularly suitable for telemedicine. However, HF-USG enables specialists to look into deeper skin layers, thus extending diagnostic options. On the other hand, teledermatology creates the possibility of sending images for consultation and facilitates the therapeutic decision as HF-USG can be used in an asynchronous store and forward manner. It seems that HF-USG and teledermatology may be regarded as a truly matched pair. The aim of this work is to present current applications of 20-MHz ultrasonography in dermatology, including skin neoplasms and chronic skin diseases. Moreover, the authors aimed to analyze the possibilities of HF-USG use as a valuable tool in teledermatology, especially in diagnosing and monitoring patients suffering from long-lasting skin conditions.

Neuroinflammatory Gene Expression Pattern Is Similar between Allergic Rhinitis and Atopic Dermatitis but Distinct from Atopic Asthma.

METHODS: In the study, we included 86 children diagnosed with atopic asthma (n = 25), allergic rhinitis (n = 20), and atopic dermatitis (n = 20) and healthy control subjects (n = 21) of Caucasian origin from the Polish population. The blood leukocyte expression of 31 genes involved in neuroinflammatory response (neurotrophins, their receptors, neuropeptides, and histamine signaling pathway) was analysed using TaqMan low-density arrays. The relative expression of selected proteins from plasma was done using TaqMan Protein Assays. Statistical analysis was done using Statistica. RESULTS: Blood expression of 31 genes related to neuroimmune interactions showed significant increase in both allergic diseases, allergic rhinitis and atopic dermatitis, in comparison to the control group. We found 12 genes significantly increased in allergic rhinitis and 9 genes in which the expression was elevated in atopic dermatitis. Moreover, 9 genes with changed expression in atopic dermatitis overlapped with those in allergic rhinitis. Atopic asthma showed 5 genes with altered expression. The peripheral expression of neuroinflammatory genes in the human study was verified in target tissues (nasal epithelium and skin) in a rat model of allergic inflammation. CONCLUSIONS: A common pattern of neuroinflammatory gene expression between allergic rhinitis and atopic dermatitis may reflect similar changes in sensory nerve function during chronic allergic inflammation.

Anorexia Nervosa with Vomiting Episodes: Dermatological and Oral Complications.

The aim of the study was to highlight the aspect of oral and cutaneous changes in anorexia nervosa (AN) as a purging type. On the basis of three clinical cases, a description has been made of the beginning and the possible course of the disease, teeth, oral mucosa, and skin changes resulting from the illness. The research method was based on the analysis of the available literature on AN supplemented by clinical experience of presented cases. On the basis of the interdisciplinary analysis, it was concluded that the appropriate diagnosis and treatment of AN are possible only with the collaboration of many specialists-psychiatrist or pediatric psychiatrist, general practitioner, dermatologist, dentist, and if necessary other medical specialists. In this context, psychotherapy is an integral aspect of treatment. Therefore, early intervention is essential to obtain good results of treatment.

The role of Staphylococcus aureus in atopic dermatitis: microbiological and immunological implications.

INTRODUCTION: Atopic dermatitis (AD) is an inflammatory disease characterised by chronic and recurrent course. Its predominant symptom is skin pruritus. Therefore, many AD patients have recurrent skin infections and are susceptible to the colonisation of apparently healthy skin and nasal vestibule by Staphylococcus aureus (S. aureus). Some S. aureus strains are capable of producing exotoxins. AIM: To assess the relation between the total IgE (tIgE) and asIgE targeted against SEA (SEA-sIgE) and SEB (SEB-sIgE), as indicators of the severity of the course of AD, and the presence of S. aureus on apparently healthy skin, in skin lesions and in the nasal vestibule. MATERIAL AND METHODS: The research was performed in a population of 134 AD patients (61 men and 73 women) aged 2-86 years. Three smears were collected for microbiological investigations: from the nasal vestibule, from the skin where lesions appeared at the moment of investigations and from the skin which was free from the eczema. On collection the material was cultured on solid and broth mediums. After incubation each medium was thoroughly analysed for the presence of S. aureus. RESULTS: There was a statistically significant correlation between healthy skin colonisation by S. aureus and increased SEA-sIgE. The same correlation was proved between healthy skin colonisation by S. aureus and increased SEB-sIgE. There was a statistically significant correlation between colonisation of the nasal vestibule by S. aureus and the SEA-sIgE and SEB-sIgE serum concentration. CONCLUSIONS: It seems that the colonisation of the lesioned skin, healthy skin and the anterior nares by S. aureus is related with higher tIgE serum concentration, which translates to more severe course of the disease. Significantly increased SEA-IgE and SEB-IgE concentrations were observed in the patients whose tIgE serum concentration was statistically higher.

Acute-phase response and its biomarkers in acute and chronic urticaria.

INTRODUCTION: Since urticaria is a persisting inflammatory disease it is important to establish the prognostic factors for the duration and severity of the disease. AIM: To evaluate serum concentrations of selected acute-phase proteins (APP) in patients with various forms of urticaria as compared to healthy volunteers and also to analyze these concentrations in different types of urticaria. Additionally, to evaluate the correlation between serum levels of selected APP and disease activity. MATERIAL AND METHODS: Serum concentrations of C-reactive protein (CRP), α1-acid glycoprotein (AGP), α1-antichymotrypsin (ACT), α1-antitrypsin (AT), ceruloplasmin (Cp), transferrin (Tf), α2-macroglobulin (α2M) and haptoglobin (Hp) were measured. Quantitative measurement was conducted using the rocket immunoelectrophoresis. Disease activity was assessed with the use of total symptom score. RESULTS: Analysis of serum APP concentrations revealed statistically higher serum concentrations of CRP, AGP and ACT in the entire group of patients with urticaria in comparison with the control group. In the entire group of patients with urticaria, CRP, AGP, ACT, Cp and Hp correlated positively with disease activity, intensity of pruritus and the number and size of urticarial wheals. Statistically lower serum concentrations of CRP, ACT, Cp and Hp were detected in the group of patients with acute urticaria (AU) and angioedema together, compared to the patients suffering from AU only. CONCLUSIONS: Patients with symptoms of various forms of urticaria present a distinct profile of serum APP concentrations. A significant correlation observed between CRP, AGP, ACT, Cp, Hp and clinical activity score points to the potential role of APP as markers of the urticarial activity.