Does molecular scarring in psoriasis exist? A review of the literature.

Plaque psoriasis is a chronic inflammatory dermatosis characterized by a tendency to recur in the same locations after discontinuation of treatment. The implementation of therapy with drugs targeting cytokines like interleukin (IL) 17A (IL-17A) and IL-23 has revolutionized the treatment of psoriasis and enabled the achievement of skin without lesions. However, despite the clinical resolution of psoriatic eruptions, cells that maintain the local memory of the disease remain in the dermis and epidermis, constituting a kind of molecular scar. The cells responsible for maintaining memory in the skin of patients and influencing the rapid relapse of the disease after the triggering factor are primarily tissue resident memory T cells (TRM), but it seems that regulatory T lymphocytes (Treg), dendritic cells (DC), and Langerhans cells (LC) may also play an important role in this process. We reviewed the literature to explain the concept of molecular scarring in psoriasis, and to assess the effect of various therapies on immune memory.

Keratosis follicularis (Darier disease) - clinical characteristics and treatment - a review and update.

Darier disease is one of the most common genodermatoses. Although Darier disease was described in 1886, targeted therapies remain unknown. Current literature lacks specific guidelines for treatment of Darier disease. Treatment remains symptomatic and may be challenging for dermatologists. The aim of this article is to present clinical characteristics and treatment options. In a mild form of the disease with a small number of skin lesions, the symptoms can be reduced by the use of topical medications. Oral retinoids, alternatively doxycycline, seem to be beneficial in extensive and persistent lesions unresponsive to local treatment. In limited, hypertrophic forms, surgical methods, laser therapy and photodynamic therapy could be used.

Spectacular Effect of Massive Facial Angiofibromas Removal With a Carbon Dioxide Laser as a Manifestation of a Tuberous Sclerosis Complex.

Introduction: Tuberous sclerosis complex (TSC) is a rare, genetic disease which leads to neurological, cardiological, nephrological, ophthalmic, pulmonary and skin disorders. Case Presentation: Here, we describe a case of a 64-year-old man with the presence of giant angiofibromas located on his chin and nasolabial folds which caused inconvenience and unaesthetic appearance. All angiofibromas were removed with the use of a CO2 laser. The patient was extremely satisfied with the obtained result. No side effects were observed after a 6-month follow-up. Conclusion: Despite the fact that giant facial angiofibromas may be troublesome not only for patients but also for medical doctors, adequate CO2 laser usage with local anesthesia and control of massive bleeding is a promising treatment option for patients with TSC.

Clinical usefulness of high-frequency ultrasonography in the monitoring of basal cell carcinoma treatment effects.

INTRODUCTION: To date, there has been no consensus either on the method, frequency or total duration of follow-up for patients that have developed a basal cell carcinoma (BCC). AIM: To evaluate usefulness of high-frequency ultrasound in monitoring patients with BCC, particularly to detect residual disease or early recurrence. MATERIAL AND METHODS: Seventy-eight patients with suspicious lesions of BCC were enrolled in this study. Only patients for whom histologic evaluation confirmed diagnosis of BCC (70) continued the study. The dermatoscopic and ultrasonographic observation started before the treatment. Three control examinations were performed 4, 12 and 24 weeks after the treatment. RESULTS: A total of 70 basal cell carcinomas were examined in this study. The presence of cancer formation was observed in the margins of removed nodular BCC in 15% (6/40), in another 25% of cases the margin of surgical removal was narrow and was < 0.2 cm (10/40). For 4 of 6 (66%) lesions, in which histopathological examination demonstrated a positive margin, hypo or heteroechogenic, irregularly shaped focal lesions were found in the ultrasonographic examination just under the entrance echo on the first follow-up visit. In 2 other cases of positive margins of the removed BCC, no signs of residual disease were observed in ultrasonographic examination. For patients with a narrow margin of healthy tissues after surgical removal, hypo or heteroechogenic foci located directly under the entrance echo were also observed in the ultrasonographic examination 4 weeks after the surgery, suggesting the presence of cancer formation. Reduction in the suspected area and scar formation were observed on the subsequent visits. It was found that the characteristic feature of residual disease presence is an enlargement of the hypoechogenic area in subsequent ultrasonographic examinations. CONCLUSIONS: The use of high-frequency ultrasonography in the monitoring of patients after surgery can accelerate and improve the diagnosis of residual disease.

Scabies and Pediculosis in Penitentiary Institutions in Poland-A Study of Ectoparasitoses in Confinement Conditions.

BACKGROUND: Scabies (caused by Sarcoptes scabiei var. hominis) and pediculosis (caused by Pediculus humanus) are infectious diseases common in educational institutions and long-term care centres. The aim of the study was to assess the scale of the phenomenon in confinement conditions favouring the spread of these parasitoses. METHODS: Data on the prevalence of scabies (2001-2015) and pediculosis (2008-2015) in Polish prisoners were provided by the Central Board of Prison Service. The information for the period between 2010 and 2015 in the Lublin Province was obtained from the District Inspectorate of the Prison Service in Lublin. Correlations between the prevalence of scabies and pediculosis and the number of prisoners were analysed, as well as correlations between the number of passes granted to prisoners and the prevalence of scabies and pediculosis in incarcerated individuals. RESULTS: The prevalence of scabies and pediculosis in Polish prisoners has been estimated at 2.3% and 1.9%, respectively. CONCLUSIONS: Pediculosis and scabies are still current issues in Polish prisons. Convicts returning from passes and new prisoners should be carefully examined and monitored for the presence of S. scabiei var. hominis and P. humanus invasion. Education of prisoners could be a promising tool in prevention of scabies and pediculosis in correctional settings.

Evaluation of the clinical usefulness of high-frequency ultrasonography in pre-operative evaluation of cutaneous melanoma - a prospective study.

INTRODUCTION: There are many papers in the available literature on the pre-operative evaluation of malignant melanoma (MM) using a 20 MHz probe. In many Western European countries, this examination is standard in the diagnosis of such lesions in terms of the resection margin. However, few papers describe and compare the results of melanoma thickness measurements using 20 and 50 MHz frequency probes. AIM: The aim of the study was to evaluate the thickness of melanoma using 20 and 50 MHz probes. In addition, the obtained values were evaluated in comparison to the thickness values obtained in the histopathological examination. MATERIAL AND METHODS: Melanoma malignum was confirmed histopathologically in 19 out of 72 patients. Then only those 19 patients were enrolled in the study. RESULTS: A correlation was demonstrated between the thickness of the melanoma measured with the 20 and 50 MHz probes, expressed in mm, and the thickness obtained in the histopathological examination expressed in millimeters (Breslow's scale). It was 0.759 (p < 0.001) and 0.734 (p < 0.001), respectively. The average thickness of melanomas obtained in ultrasound examination was identical for both probes and was 0.74 mm. CONCLUSIONS: It seems that both types of probes can be used to assess melanoma thickness. The demonstrated correlation of high-frequency ultrasonography (HFUS) thickness with Breslow's scale indicates that the HFUS evaluation can be used in determination of melanoma resection margins as a repeatable, painless, non-invasive test.

High-frequency ultrasound in the diagnosis of selected non-melanoma skin nodular lesions.

INTRODUCTION: Ultrasonographic examination is commonly used in an outpatient setting, possibly due to its low cost, low risk for patients and the possibility to obtain real time images. Typically used heads have the frequency ranging from 7.5 to 12 MHz. Higher frequencies ensure higher resolution, yet they are limited by the penetration depth - reaching from several to several tens of millimetres into the skin. High-frequency ultrasonography (HFUS) appears to be a promising method for the detection and differential diagnostics of selected nodular skin lesions. AIM: The study aimed at a comparison of the data obtained by using HFUS, histopathological and dermatoscopic images of selected skin lesions to determine their common features. MATERIAL AND METHODS: Nodular lesions classified as potentially malignant were subjected to clinical, dermatoscopic and high-frequency ultrasonographic examinations. Then the patients were referred for surgical removal with histopathological assessment. RESULTS: A total of 54 nodular lesions were examined, out of which 34 were diagnosed as non-melanoma. The most common lesions were melanocytic naevi dermatofibroma, nodular basal cell carcinoma and pyogenic granuloma. Other examined lesions included blue naevus, seborrheic wart, xanthogranuloma juvenile and Spits naevus. In all lesions except Spitz naevus, HFUS images corresponded at least with dermatoscopic or histopathology images. CONCLUSIONS: HFUS can be used as a supporting diagnostic tool ensuring better pre-operative proceedings. HFUS is a non-invasive, easy and inexpensive screening method for the determination of different skin cancers as it provides valuable information allowing to determine the cutting margins and lesion shape.

Use of laser therapy in the treatment of severe rhinophyma: a report of two cases.

Rhinophyma is a rare manifestation of rosacea. It is clinically characterized by sebaceous hypertrophy, fibrosis, and telangiectasia. Usually, it is considered as a cosmetic defect; however, in some cases, it might cause problems with nasal breathing and food consumption which forces the need for treatment. The following article presents the effectiveness of laser treatment with the neodymium-yttrium-aluminum garnet (Nd:YAG), carbon dioxide laser (CO2), and fractional CO2 laser.

Skin melanoma imaging using ultrasonography: a literature review.

Melanoma is one of the most unpredictable tumours, as regards both morphology and the course of disease. It may have different clinical forms making it very difficult to diagnose. Therefore, it often surprises even the most experienced dermatologists. Despite numerous attempts, no efficient treatment of advanced stages have been elaborated, and early detection and removal of a skin lesion currently constitutes the most efficient treatment method. Diagnostics uses different types of dermoscopic techniques characterised by considerable sensitivity and specificity in detecting melanoma at an early developmental stage. A continuous development of medical technologies leads to improving many methods of skin lesion imaging. Ultrasonography is one of these methods, enabling evaluation of the thickness of melanoma in vivo with high precision. Change thickness is the decisive factor influencing 5-year survival. The paper evaluates the usefulness of high-frequency ultrasonography (HFUS) in pre-operative melanoma imaging on the basis of literature review. Additionally, the use, role and placement of HFUS in skin melanoma diagnostics is determined.

Skin lesions in humans bitten by European pigeon tick Argas reflexus (Fab.) (Ixodida: Argasidae) massively occurring in the Upper Silesian conurbation of south-west Poland.

INTRODUCTION AND OBJECTIVE: The great number of pigeon populations in many European cities promotes the spread of the European pigeon tick (Argas reflexus), the bites of which cause local and systemic reactions. The aim was to study the occurrence of A. reflexus in several cities of Upper Silesia, and skin lesions caused by A. reflexus tick bites in humans. MATERIAL AND METHODS: The results of investigations carried out in 1995-2002 in five cities located in the Upper Silesian conurbation are presented. Specimens of A. reflexus were collected for one hour in attics and lofts inhabited by these ticks. A history of skin lesions caused by bites was taken from residents who had been infested by A. reflexus. The development of skin lesions was monitored for three months in two individuals who had been bitten several times by these arthropods. RESULTS: In the localities, 987 A. reflexus specimens were collected, including 334 females, 269 males, and 384 various nymphal stages. Within one hour, 38-109 ticks specimens were collected at the study sites. Cases of attacks by unengorged A. reflexus were reported in all the habitats located in the residential buildings; the ticks were also found in residents' flats and in staircases. Residents who had been repeatedly attacked by European pigeon ticks developed a strong inflammatory reaction to the components of tick saliva, and had purple papules with necrosis in the centre of the lesion. The tick bite areas exhibited scars and hyperpigmentation. CONCLUSIONS: Individuals attacked by A. reflexus several times are at risk of development of severe persistent local reactions to bites. Pigeon ticks, trophically associated with pigeons present abundantly in the Upper Silesian conurbation and other European urban habitats, pose a serious threat to public health.

Study of the non-parasitic stage in Ixodes ricinus after co-feeding with Dermacentor reticulatus in three infestations.

It was proved that transmission of some pathogens may occur between infected and uninfected ticks co-feeding on a host in the absence of systemic infection. The effect was studied of co-feeding of two different tick species Ixodes ricinus and Dermacentor reticulatus on the course of the non-parasitic stage. Species chosen for the experiment may share their habitats and co-infest animals in nature. In the course of the study the process of egg maturation, oviposition and larval hatching were investigated. In order to estimate if co-feeding influence can counteract host immunity, three subsequent infestations of rabbits were analyzed. Mono-specific groups values of such a parameters as egg amount, number of eggs per 1 mg of female engorgement weight, female oviposition weight loss, hatching success were higher in inter-specific groups were compared. The results indicate that co-feeding with other tick species may partially reduce the influence of host resistance in subsequent infestation.

Linear verrucous epidermal nevi-effects of carbon dioxide laser therapy.

Linear epidermal nevus is a congenital malformation characterized by linear, often one-sided arrangement. The lesions are localized along the Blaschko's lines, are present at birth, or appear in early childhood. They can be single or multiple, and have various colors-from skin color to dark brown. These lesions persist through the whole life making a significant cosmetic defect. Here, we present three clinical cases of epidermal nevus treated with CO2 laser. In a female patient, verrucous, dark brown skin eruptions were observed at the back of earlobe and down the neck. In the cases of the male patients, the lesions were located in the area of the neck and left blade. The removal of nevi was performed in stages, by cutting and evaporation using a CO2 laser. A very good therapeutic effect was obtained. CO2 laser treatment is the method of choice for the removal of extensive epidermal nevi. It is characterized by high efficacy and safety.

Darier-White disease treated with fractional CO2 laser in two cases.

Darier-White disease is one of the most common genodermatoses. The most typical clinical symptoms such as diffuse hyperkeratotic papulae usually appear during puberty or early adulthood in seborrhoeic area. It is connected with substantial deterioration of the quality of life due to aesthetic defect. Although there exist many therapeutic options, the disease still causes considerable therapeutic difficulties. Treatment with fractional CO2 laser seems to be a promising therapeutic method. In this paper, we present two cases of patients with Darier's disease who have been treated with a fractional CO2 laser with very good clinical outcome.

Melanoma and other malignant skin cancers in psoriatic patients treated with phototherapy. Role of the p16 protein in psoriasis.

Recently, the potential risk of malignant cancer development in psoriatic patients has been highlighted. However, the relationship between the therapeutic schemes in psoriasis and possible neoplastic transformation has not been so far clearly explained. Phototherapy is considered a very effective therapeutic method in psoriasis, however, the pathogenesis of some malignancies may be associated with the exposure to UV radiation. p16 protein belongs to the defense mechanisms that protect cells from damage and mutagenic factors, such as UV radiation. In recent years, the altered expression of the p16 protein in the diseases not related to malignant transformation, including psoriasis, has been observed. These new observations suggest participation of the p16 protein in the mechanisms of psoriatic plaque formation.