Risk of Melanoma and Non-Melanoma Skin Cancer in Patients with Psoriasis and Psoriatic Arthritis Treated with Targeted Therapies: A Systematic Review and Meta-Analysis.

Targeted therapies represent major advancements in the treatment of chronic skin conditions such as psoriasis. While previous studies have shown an increased risk of melanoma and non-melanoma skin cancer (NMSC) in patients receiving TNF-α inhibitors, the risks associated with newer biologics (IL-12/23 inhibitors, IL-23 inhibitors, IL-17 inhibitors) and Janus kinase (JAK) inhibitors remain less known. Using a systematic and meta-analytical approach, we aimed to summarize the currently available literature concerning skin cancer risk in patients treated with targeted therapies. The MEDLINE/PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched to find studies reporting the incidence rates (IR) of melanoma and NMSC in patients with psoriasis and psoriatic arthritis treated with biologics or JAK inhibitors. Nineteen studies were included in the analysis with a total of 13,739 patients. The overall IR of melanoma was 0.08 (95% CI, 0.05-0.15) events per 100 PYs and the overall IR of NMSC was 0.45 (95% CI, 0.33-0.61) events per 100 PYs. The IRs of melanoma were comparable across patients treated with IL-17 inhibitors, IL-23 inhibitors, and JAK inhibitors, while the IRs of NMSC were higher in patients treated with JAK inhibitors than in those treated with biologics. Prospective, long-term cohort studies are required to reliably assess the risks associated with novel targeted therapies.

Characteristics of Injuries Sustained Under the Influence of Alcohol in a Group of Adolescents: Is it Possible to Establish a Typical Clinical Picture of an Underage Patient Who Suffered From an Injury Under the Influence of Alcohol?

OBJECTIVES: Fractures of the limbs and craniocerebral trauma are the most common injuries in children and adolescents. Their frequency ranges widely from 32% to 85% and is the main reason for hospitalization in pediatric population. The number of injuries sustained under the influence of alcohol is increasing although the data concerning that subject is limited and usually includes both adult and teenage patients. METHODS: A group of 111 adolescents (age, 9-18 years), hospitalized after traumatic brain injury with and without alcohol intoxication, was included in the study. We performed the assessment of the severity of the course of the multiorgan and craniocerebral injuries. The study was accepted by the Ethics Committee of the Jagiellonian University Medical College (no: KBET/8/B/2010). RESULTS: The injuries of upper limbs and head and their serious consequences were observed more often in the examined group. The differences of the degree of head and neck injuries measured in the Injury Severity Score between the groups were statistically significant, although the injuries within the examined group were less often serious. There was a negative correlation between the patients' condition according to the Glasgow Coma Scale and the concentration of alcohol in their blood. No link between the patients' assessment in the Injury Severity Score and concentration of alcohol in the blood was noticed. CONCLUSIONS: Traumatic brain injury under the influence of alcohol in adolescents differs from trauma in patients who had not drunk alcohol. Similar areas of injury result in a more severe course of illness in the examined group.

Predictive value of global dermoscopic pattern in patients diagnosed with cutaneous melanoma.

INTRODUCTION: Dermoscopy is one of the most commonly used methods in early diagnosis of melanoma. It is conducted to differentiate between benign and malignant patterns in melanocytic lesions. AIM: To determine if there is a predominance of one dermoscopic pattern in patients with melanoma and if there is a significant difference in dominant global dermoscopic pattern in patients with cutaneous melanomas correlated with patients' sex and the location of the primary tumor. MATERIAL AND METHODS: The study included 162 patients with prior diagnosis of cutaneous melanoma. Dermoscopic and videodermoscopic pictures and patient data were analyzed with regard to the pattern: reticular, globular, homogeneous and mixed pattern (two-component pattern; reticular-globular pattern) with central or peripheral globules and multicomponent (mixed - at least 3 types of structures in one nevus). RESULTS: The reticular pattern was significantly more prevalent in male patients (38.57%, 27 patients) in comparison to female patients (18.45%, 17 patients). We also found a statistically significant lower prevalence of reticular pattern in patients diagnosed with melanomas located on upper limbs. The homogeneous pattern was statistically significantly more prevalent in patients in whom primary tumors were located on the head and upper limbs. CONCLUSIONS: Our study suggests that predominant complex patterns are more commonly observed in patients diagnosed with cutaneous melanoma, although there is a significant number of patients with predominant reticular and homogeneous patterns, which are not often associated with an increased risk of development of melanoma.

Bacillary Angiomatosis in Renal Transplant Recipient: A Case Report.

INTRODUCTION: Bacillary angiomatosis (BA) is a rare, opportunistic infectious disease caused by the aerobic Gram-negative bacilli Bartonella henselae or Bartonella quintana. The main reservoir for those microbes are cats. The disease mostly affects immunocompromised patients with human immunodeficiency virus infection, after organ transplantation, undergoing corticosteroid and methotrexate therapy or with oncological history. CASE REPORT: We represent the case of a 65-year-old man who reported to the Department of Dermatology with a high fever and numerous nodular skin lesions on the 5th month of kidney transplantation. At that time, his immunosuppressive therapy consisted of tacrolimus 6 mg/day, mycophenolate mofetil 2 g/day, and prednisone 5 mg/day. Laboratory tests revealed an increased leukocyte count and elevated values of acute-phase proteins, but blood cultures were negative. Skin biopsy was performed and BA was diagnosed. The patient was given oral doxycycline 100 mg twice a day. During antibiotic therapy, his body temperature normalized and skin lesions began to resolve. The patient continued the above treatment for the next 3 months with good tolerance, and no relapse occurred in 1 year. CONCLUSION: BA should be listed among possible opportunistic infections in organ transplant recipients.

Level of inflammatory cytokines tumour necrosis factor α, interleukins 12, 23 and 17 in patients with psoriasis in the context of metabolic syndrome.

INTRODUCTION: Psoriasis is a chronic inflammatory skin disease with immunologic etiology. AIM: To investigate the levels of the proinflammatory cytokines tumor necrosis factor α (TNF-α), interleukin 23 (IL-23) and IL-17 in patients with psoriasis and psoriatic arthritis with concomitant metabolic syndrome. MATERIAL AND METHODS: This study included 60 patients with severe psoriasis. RESULTS: In patients with arterial hypertension concomitant with psoriasis, no statistically significant differences in cytokine levels were observed. On the other hand, in the group of patients diagnosed with diabetes, an increased level of IL-17 was observed. In patients with lipid disorders, the results were similar to the results of patients with diabetes. CONCLUSIONS: It is very important to study immunologic mechanisms responsible for the presence and severity of psoriasis, in order to personalize the therapy in the future and optimize the effect of action on the basic disease and on concomitant disorders.

Paragangliomas of head and neck - A surgical challenge.

Paragangliomas of the head and neck region are rare and predominantly asymptomatic tumors. These neoplasms arise from widely distributed paraganglionic cells, which originate from both mesodermal elements of third branchial arch and the neural crest residues. Despite the rare occurrence of paragangliomas, problems encountered in their diagnosis, unclear malignancy and treatment ensure that they still remain in the focus of head and neck surgeons. This is a retrospective study of the medical records of patients treated in the ENT Department of the 5th Military Hospital in Krakow during the period 2010-2014. All the preoperative, intraoperative and postoperative data were carefully analyzed for each patient. Thirteen patients (16 tumors) were treated during the study period. All the patients with a pre-operative suspicion of paraganglioma underwent computed tomography angiography. The whole cohort of patients was treated surgically. Paraganglioma should be always considered in the differential diagnosis for painless neck masses. These tumors require thorough radiological pre-operative evaluation and skilled operative technique. Surgical treatment occurs to provide good cure rates with minimal recurrence and morbidity rates.

Effects of nanoporous anodic titanium oxide on human adipose derived stem cells.

The aim of current bone biomaterials research is to design implants that induce controlled, guided, successful, and rapid healing. Titanium implants are widely used in dental, orthopedic, and reconstructive surgery. A series of studies has indicated that cells can respond not only to the chemical properties of the biomaterial, but also, in particular, to the changes in surface topography. Nanoporous materials remain in focus of scientific queries due to their exclusive properties and broad applications. One such material is nanostructured titanium oxide with highly ordered, mutually perpendicular nanopores. Nanoporous anodic titanium dioxide (TiO2) films were fabricated by a three-step anodization process in propan-1,2,3-triol-based electrolyte containing fluoride ions. Adipose-derived stem cells offer many interesting opportunities for regenerative medicine. The important goal of tissue engineering is to direct stem cell differentiation into a desired cell lineage. The influence of nanoporous TiO2 with pore diameters of 80 and 108 nm on cell response, growth, viability, and ability to differentiate into osteoblastic lineage of human adipose-derived progenitors was explored. Cells were harvested from the subcutaneous abdominal fat tissue by a simple, minimally invasive, and inexpensive method. Our results indicate that anodic nanostructured TiO2 is a safe and nontoxic biomaterial. In vitro studies demonstrated that the nanotopography induced and enhanced osteodifferentiation of human adipose-derived stem cells from the abdominal subcutaneous fat tissue.

Expression of metalloproteinases (MMP-2 and MMP-9) in basal-cell carcinoma.

The aim of this study was to compare the expressions of mRNA for metalloproteinases (MMP-2 and MMP-9) and type IV collagen in two different histological types of basal-cell carcinoma (BCCs; nodular and infiltrative) and in normal tissues from the tumor interface. The study included biopsy specimens of the skin involved with BCC and normal skin adjacent the lesion. The expressions of mRNA for MMP-2, MMP-9 and type IV collagen were determined by means of RT-PCR (Reverse transcription polymerase chain reaction). The level of type IV collagen mRNA in nodular and infiltrative BCCs turned out to be significantly lower, and the expressions of MMP-2 and MMP-9 mRNA significantly higher than in normal tissues adjacent to these tumors. The expression of mRNA for MMP-9 but not for MMP-2 was significantly higher in infiltrative BCCs than in the nodular BCCs. In turn, normal tissues adjacent to nodular BCCs showed significantly higher levels of mRNA for MMP-2 and significantly lower levels of type IV collagen mRNA than the normal tissues from the interface of infiltrative BCCs. The findings suggest that MMP-2 and MMP-9 could be used as prognostic factors of BCCs.

Primary cutaneous lymphomas: the analysis of cases treated in the Department of Dermatology University Hospital in Krakow.

Introduction: Primary cutaneous lymphomas are lymphoproliferative skin infiltrates of T-, B- or NK-cells, classified according to the World Health Organization - European Organization of the Research and Treatment of Cancer (WHO-EORTC) criteria. They are the second most common group of extranodal non-Hodgkin lymphomas, that present in the skin with no evidence of systemic involvement at the time of diagnosis. Aims: The aim of the study was the analysis of clinical profile of cutaneous lymphomas in the tertiary referral center in Poland. Material and Methods: We analyzed case records of 63 patients (26 women, 37 men aged 19 - 86) referred to the Department of Dermatology, University Hospital in Cracow for the diagnosis and treatment of cutaneous lymphoma. Results: After analysis of clinical and histological data, the final diagnoses were: mycosis fungoides (42 patients), primary cutaneous CD30+ lymphoproliferative disorder (7), Sezary syndrome (3), parapsoriasis (3), primary cutaneous B-cell lymphoma (1), acute myeloid leukemia (1), Hodgkin lymphoma coexistent with mycosis fungoides (1), generalized allergic contact dermatitis (2) and erythema elevatum diutinum (1). We excluded 2 patients due to incomplete data. The most common location of skin lesions was the lower limb (52.46%) and most common clinical presentation was raised erythematous lesion (26.23%). Pruritus was present in 45.9% of the patients and 39.3% had extracutaneous symptoms, with lymphadenopathy as the most common symptom. 37.7% of patients presented with mild eosinophilia and another 37.7% with mild monocytosis. Prior to referral to our center, general practitioners misdiagnosed the lymphomas commonly as: atopic and contact dermatitis, borreliosis, drug-induced exanthema. Conclusions: The diagnosis of cutaneous lymphoma is often delayed due to their indolent, often recurring course, non-specific symptoms and uncommon appearance. The cooperation of a clinician and pathologist is essential in the diagnostic process.

Suspicion of pulmonary embolism during treatment of pemphigoid gestationis.

Pemphigoid gestationis (PG), first described in 1872 by Laws Milton, is a rare autoimmune bullous disease of pregnancy and puerperium. Pemphigoid gestationis has been estimated to occur in 1: 50 000 pregnancies and usually presents in the second or third trimester with exacerbation after partum. This disease is caused by circulating IgG1 immunoglobulin against hemidesmosomal protein bullous pemphigoid BP180 (BPAG2) type XVII collagen and less frequently BP230. We present a case of pemphigoid gestationis in primigravida with complications during treatment due to the suspicion of pulmonary embolism.

The role of focal infections in the pathogenesis of psoriasis and chronic urticaria.

INTRODUCTION: The Focal Infection Theory, originally presented at the beginning of the 20(th) century, postulates that systemic diseases can be caused by microorganisms that arise from the focus of infection. Foci of infections have been described as sinuses, adenoids, tonsils, teeth, genitourinary tract, gall bladder and kidneys. A focus of infection is defined as the area that can occur in any part of the body, contains a pathogen (microorganism) and is usually asymptomatic. There are discordant opinions about the role of focal infections in the pathogenesis of psoriasis and urticaria. AIM: To establish whether there is a higher incidence of focal infections in patients with chronic urticaria and psoriasis. MATERIAL AND METHODS: We retrospectively reviewed 129 patients with a history of psoriasis and chronic urticaria: 58 women and 71 men treated in the Department of Dermatology of the Jagiellonian University Medical College in Krakow. RESULTS: In the analyzed group, 11 patients had a dental consultation, 58 - laryngological consultation and 29 women had a gynecological consultation. The most common examples of focal infection were tonsillitis, upper respiratory tract infections, sinusitis, dental caries and genitourinary tract infections. Aggravating factors were similar to previously described. CONCLUSIONS: A high incidence of focal infections in patients with psoriasis and urticaria suggests that infections may play a significant role in the pathogenesis of these skin disorders. Treatment of infection foci may play the key role in the remission of skin changes.

[A case of acne infantum--reviews of the literature regarding therapy]. / Przypadek tradziku dzieciecego--przeglad pismiennictwa dotyczacego terapii.

We report a case of a 19 month old boy that presented with acneform eruption on his cheeks since birth. This condition was left untreated until the age of one. At that time the lesions developed into inflammatory nodules that resolved after topical treatment (Aknemycin fluid, cynober-sulfer pastae) and remission exist during 6 months. Based on presented case authors describe etiopatogenesis of acne and have done rewies of the literature regarding therapy, indications and safety of administration of oral retinoids to children.