Effect of psoriasis therapy on VEGF and its soluble receptors serum concentrations.

BACKGROUND: Vascular endothelial growth factor (VEGF) is recognized a pivotal pro-angiogenic factor responsible for new blood vessels formation in psoriatic lesion. OBJECTIVES: The aim of the study was to analyse serum concentrations of VEGF and its soluble receptors (sVEGF) R1 and R2 in psoriatic patients before and after treatment. METHODS: Serum samples were collected before and after 14 days of standard topical therapy, from 44 patients with exacerbated chronic plaque-type psoriasis and VEGF, sVEGF R1 and sVEGF R2 concentrations were measured using an enzyme immunoassay. Data were analysed with respect to baseline values of the psoriasis area severity index (PASI). RESULTS: Baseline mean serum levels of VEGF and sVEGF R1, but not sVEGF R2 were significantly higher in patients than in healthy controls. VEGF demonstrated significant correlation with PASI score. Treatment resulted in significant reduction of VEGF serum concentration, particularly in patients with severe course of the disease (PASI >20) and increase in sVEGF R1 concentration in patients with mild disease activity (PASI <10). Moreover, serum sVEGF R1 level after treatment termination was significantly higher in patients with mild than severe course of psoriasis. CONCLUSIONS: We confirmed the association between psoriasis activity and serum VEGF concentrations, which can be recognized as an indicator of the disease severity. However, the increase of serum sVEGF R1 concentrations can predict amelioration of clinical signs.

A case of lupus vulgaris with rare localization diagnosed 30 years after onset.

Cutaneous tuberculosis (tuberculosis cutis) is one of the extrapulmonary forms of tuberculosis, which may affect the skin only or co-exist with tuberculosis of other organs, particularly the lungs. We describe a case of lupus vulgaris in a 72-year-old male patient with a single lesion localized on his lower extremity, developing for 30 years before correct diagnosis and previously treated with topical steroids. Bacillus infection in other organs was not detected. Diagnosis of tuberculosis was made based on personal history, clinical picture, hypersensitivity to tuberculin, histopathology and polymerase chain reaction. A multidrug therapy with rifampicin, isoniazid and pyrazinamide resulted in regression of the lesion. The common lack of knowledge about the clinical picture of cutaneous tuberculosis causes its late diagnosis and treatment.

Multifocal necrotizing fasciitis - case report.

PURPOSE: Necrotizing fasciitis (NF) is a rare, life-threatening soft-tissue infection, characterized by rapidly spreading inflammation, with secondary necrosis of the fascia and surrounding tissues. It is mostly caused by group A beta-haemolytic streptococci or multibacterial. A case of the 25-year-old man admitted on September 2006 to the Department of Dermatology and Venereology with suspicion of erysipelas of the left upper limb and left foot is presented. On admission the pain, erythema, diffuse oedema of the left upper limb and erythema of the left foot were observed. Laboratory results revealed elevated: ESR, acute phase parameters (C-reactive protein, D-dimer), CPK and fibrinogen. Within 72-hours, despite treatment with antibiotics and anticoagulants, the oedema and pain increased, initial necrosis of the skin and extreme local tenderness appeared. Suspecting NF the patient had been transported to the Department of Surgery from where, after surgical debridement of devitalized tissue, was moved to the Intensive Care Unit and then transferred to the National Centre of Hyperbaric Medicine of the Medical University of Gdansk. Despite of repeated debridement, aggressive antibiotic therapy and hyperbaric oxygen therapy, necrosis was spreading. The patient developed sepsis and acute respiratory distress syndrome. Amputation of the left upper limb was performed. Five months later patient was admitted to ICU in Bialystok after a suicide attempt. After next four months he died. The dramatic course of the disease is the evidence, that having an adequate knowledge about early symptoms of NF can save patient's life.

Tumour necrosis factor (TNF-alpha) alpha converting enzyme and soluble TNF-alpha receptor type 1 in psoriasis patients in relation to the chronic alcohol consumption.

BACKGROUND: Tumour necrosis factor alpha converting enzyme (TACE) is a major sheddase of TNF-alpha and its receptors, essential for the generation of soluble, mature molecules. The regulation of the TACE activity by ethanol in vitro has been suggested recently. The alcohol abuse is a frequent problem among psoriasis patients. The aim of the study was to analyse the relationship between long-term alcohol consumption and the concentration of TACE in peripheral blood mononuclear cells (PBMC) and its substrate--soluble TNF-alpha receptor type 1 (sTNF-R1) in plasma in psoriasis patients. METHODS: The study has been conducted among 44 patients (aged 30-59 years) with early-onset, plaque-type psoriasis. Thirty-eight patients (aged 29-61 years) with other than psoriasis chronic dermatologic disorders were controls. The data on alcohol consumption during previous 10 years were obtained with a structured questionnaire. The severity of the disease was assessed using Psoriasis Area and Severity Index (PASI), and concentrations of TACE in PBMC lysate and sTNF-R1 in plasma was assessed with a quantitative sandwich enzyme immunoassay technique. RESULTS: The TACE concentration correlated to that of sTNF-R1 (R = 0.52 in psoriasis patients and R = 0.56 in controls, P < 0.05). The concentrations of TACE were 2.62 +/- 0.32 ng/mL in patients and 1.29 +/- 0.25 ng/mL in controls (P < 0.05), and corresponding sTNF-R1 concentrations were 2.54 +/- 0.27 ng/mL and 1.79 +/- 0.14 ng/mL (P < 0.05), respectively. The concentrations of TACE and sTNF-R1 in patients correlated to the intensity of alcohol consumption (R = 0.56, and R = 0.52, P < 0.05, respectively) and were the highest in excessive drinking psoriasis patients (2.94 +/- 0.34 and 2.67 +/- 0.13 ng/mL). CONCLUSION: The alcohol abuse may contribute to the increase of TACE expression in PBMC and also to the elevated plasma sTNF-R1 concentration in psoriasis patients.

Plasma and scales levels of interleukin 18 in comparison with other possible clinical and laboratory biomarkers of psoriasis activity.

The aim of the study was to assess plasma and scales levels of interleukin (IL) 18 collected from psoriatic patients with different disease activity. IL-18 concentrations were measured using an enzyme immunoassay in the plasma and scales of 34 patients with chronic plaque type psoriasis. IL-18 levels were analysed with respect to plasma-transforming growth factor beta1 (TGF-beta1), the disease duration and the duration of the present relapse, and psoriasis area and severity index (PASI). Plasma IL-18 concentration varied from 90 to 1300 pg ml-1 and means (368.2 +/- 42.4 pg ml-1) were significantly elevated in comparison with healthy controls (205.9 +/- 31.8 pg ml-1). The presence of IL-18 was also demonstrated in scales from skin lesions. Treatment caused a significant decrease of plasma IL-18 concentration to 250.2 +/- 13.8 pg ml-1. There was a significant correlation between plasma IL-18 levels and PASI values (r = 0.554). There was no correlation between IL-18 concentration in scales and PASI, between IL-18 concentrations in plasma and scales, and between plasma IL-18 and the disease duration or duration of present relapse. Plasma TGF-beta1 concentration demonstrated a significant correlation with PASI (r = 0.353), but not with IL-18 levels in plasma (r = 0.063) and scales (0.141). The sum of plasma levels of IL-18 and TGF-beta1 divided by the optimal coefficient demonstrated a statistically significant correlation with the highest r-value. The findings confirm an association between plasma IL-18 concentration and psoriasis severity. Moreover, it was shown that combined measurement of IL-18 and TGF-beta1 in plasma can be considered as a possible biomarker of psoriasis activity.

Effect of psoriasis treatment on plasma concentrations of metalloproteinase-1 and tissue inhibitor of metalloproteinases-1.

AIM: The aim of this study was to evaluate the effect of psoriasis treatment on plasma concentrations of metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinases-1 (TIMP-1) with respect to disease severity. METHODS: MMP-1 and TIMP-1 were measured using an enzyme immunoassay in plasma of 32 patients before and after topical treatment. Data were analysed with respect to baseline values of the Psoriasis Area and Severity Index (PASI). RESULTS: Baseline plasma concentrations of both TIMP-1 and MMP-1 (1487 +/- 102 and 21.0 +/- 2.5 ng/mL, respectively) were significantly higher (P = 0.02 and 0.03, respectively) than normal. Both TIMP-1 and MMP-1 decreased significantly after completion of treatment to values similar to normal (1112 +/- 127 and 11.3 +/- 1.3 ng/mL, respectively). There was a significant positive correlation (r = 0.522) between baseline PASI and TIMP-1 values. Significant differences were observed between baseline TIMP-1 concentrations in groups with PASI < 15 and PASI > 20. Baseline values (1697 +/- 162 ng/mL) in patients with severe course of the disease (PASI > 20) were significantly elevated in comparison to normal values. Treatment caused a decrease in TIMP-1 plasma concentrations in all groups, but a significant difference was noted only in patients with pretreatment PASI > 20. Baseline MMP-1 concentrations exceeded significantly normal values only in patients with PASI < 15 (27.2 +/- 6.3 ng/mL) and 15-20 (18.4 +/- 1.4 ng/mL). Treatment caused a significant decrease in MMP-1-values in all groups to levels similar to normal. CONCLUSIONS: Our results confirm the role of TIMP-1 and MMP-1 in the pathogenesis of psoriasis. Pretreatment plasma TIMP-1 increased whereas MMP-1 decreased in patients with a more severe course of the disease. However, successful treatment causes normalization of these plasma protein concentrations irrespective of psoriasis baseline activity.

[The role of selenium in skin]. / Rola selenu w skórze.

The paper reviews the data on the content of selenium in the skin and its appendages and the influence of the micronutrient on skin functions. The paper focuses on antiproliferative, photoprotective and immunomodulatory properties of selenium compounds. Dermatological symptoms due to selenosis are described and skin disorders with low selenium status are mentioned.

[Antibodies against Borrelia afzelli in patients with an early stage of Lyme disease]. / Przeciwciala przeciw Borrelia afzelii u chorych we wczesnym okresie kretkowicy kleszczowej.

The aim of the study was evaluation of specific immune response against Borrelia afzelii in patients with erythema migrans, as a sign of an early stage of Lyme borreliosis. The study was performed in 42 patients, residents of Podlasie province, who were initially evaluated by indirect immunofluorescence assay as a seropositive for Borrelia burgdorferi sensu lato. Antibodies against particular antigens of B. afzelii were demonstrated using a Western-blot technique. Evaluation of results showed the most frequent prevalence of antibodies against 41 kDa antigen in majority of patients, which were predominantly of IgM class in patients with short-lasting lesions, and IgG class in patients with long-lasting lesions. Results of IgM blots were recognized as a positive in 26 patients, and IgG blots in 22 patients. Positive result in at least one class of antibodies was noted in 34 patients (81%), and in both classes in 14 (33%). IgM antibodies against 21 kDa antigen, and IgG antibodies against 43 kDa antigen were two fold more frequent in patients with short-lasting lesions. These results confirm the diagnostic usefulness of determination of antibodies against B. afzelii antigens in Poland. The most important for an early diagnosis can be simultaneous demonstration of IgM antibodies against 21 and 41 kDa antigens.

[Effectiveness of a micronized purified flavonoid fraction (MPFF) in the healing process of lower limb ulcers. An open multicentre study, controlled and randomized]. / Efficacia della frazione flavonoica purificata micronizzata (FFPM) nell'aumentare la guarigione della ulcere agli arti inferiori. Studio multicentrico in aperto, controllato e randomizato.

OBJECTIVE: To determine the increase in healing rate of venous ulcer in patients receiving a micronised purified flavonoid fraction (MPFF) as supplementation to standard local care. DESIGN: A randomised, open, controlled, multicentre study. SETTING: Departments of Dermatology and University Outpatients Clinics. PATIENTS: One hundred and forty patients with chronic venous insufficiency and venous ulcers. INTERVENTION: PATIENTS received standard compressive therapy plus external treatment alone or 2 tablets of MPFF daily in addition to the above treatment for 24 weeks. MAIN OUTCOME MEASURE: Healing of ulcers and their reduction in size after 24 weeks of treatment. RESULTS: The percentage of patients whose ulcers healed completely was found to be markedly higher in those receiving MPFF in addition to standard external and compressive treatment than in those treated with conventional therapy alone (46.5% vs 27.5%; p<0.05. OR=2.3, 95% CI 1.1-4.6). Ulcers with diameters <3 cm were cured in 71% of patients in the MPFF group and in 50% of patients in the control group, whereas ulcers between 3 and 6 cm in diameter were cured in 60% and 32% of patients (p<0.05), respectively. The mean reduction in ulcer size was also found to be greater in patients treated with MPFF (80%) than in the control group (65%) (p<0.05). The cost-effectiveness ratio (cost per healed ulcer) in the MPFF group was 1026.2 compared with 1871.8 in the control group. CONCLUSIONS: These results indicate that MPFF significantly improves the cure rate in patients with chronic venous insufficiency.

Epidemiology of syphilis and gonorrhoea in eastern Poland in the years 1988-1997.

Because of the sexually transmitted diseases (STDs) epidemic in the former Soviet Union and the possibility of a rise in early syphilis and gonorrhoea in the eastern region of Poland it seemed important to calculate the incidence rates for early syphilis and gonorrhoea for 3 border regions (east, west and south) and the central part of the country in the last 10 years. In addition, data were analysed on patients and their sexual partners (from Poland and abroad), and the country where the contact took place obtained from 14 Provincial Skin-VD Out-Patients' Clinics of eastern Poland. The results from 1988/89 and 1996/97 were compared. It was shown that early syphilis morbidity significantly decreased in western and southern Poland, fell in the central part and rose in the east slightly. Gonorrhoea morbidity significantly decreased in all regions. However, the number of provinces with early syphilis and gonorrhoea incidence rates in the 1990s of the same value or higher than in the 1980s, or of the whole of Poland clearly increased in eastern and central regions. The early syphilis and gonorrhoea morbidity in east Poland in the 1990s in relation to 1980s was marked by significant increase in the percentage of the foreigners treated (12.2 vs 1.8, P<0.001 for early syphilis, and 10.0 vs 2.3, P<0.001 for gonorrhoea) and in sexual contacts with foreigners reported by Polish patients (23.7 vs 0.8, P<0.01 for early syphilis and 17.7 vs 4.3, P<0.01 for gonorrhoea). Of the foreign contacts reported in 1996/97 by early syphilis and gonorrhoea patients, 60.4% and 82.2%, respectively, were casual. Contact with foreigners took place, mainly, in the former Soviet Union. The study illustrates that there may be a danger of an increase in the incidence of syphilis and gonorrhoea in Poland due to the epidemics in the neighbouring countries.

PIP: This study examines the epidemiology of syphilis and gonorrhea in eastern Poland from 1988 to 1997. Data on patients and their sexual partners were obtained from 14 provincial skin-VD outpatient clinics of eastern Poland. The results from 1988-89 and 1996-97 were compared. It was shown that early syphilis morbidity significantly decreased in western and southern Poland, fell in the central part, and rose slightly in the east. Gonorrhea morbidity significantly decreased in all regions. Early syphilis and gonorrhea morbidity in east Poland in the 1990s was marked by a significant increase in the percentage of foreigners treated and in sexual contacts with foreigners reported by Polish patients. Among the foreign contacts reported in 1996-97 by early syphilis and gonorrhea patients, about 60.4% and 82.2%, respectively, were casual. Contact with foreigners took place mainly in the former Soviet Union. This study illustrates that there is a probability of an increase in the incidence of syphilis and gonorrhea in Poland due to the epidemics in neighboring countries.

[Application of pentoxiphylline to treatment of leg ulcers: a Polish multicenter study]. / Zastosowanie pentoksyfiliny w leczeniu owrzodzen goleni--polskie badania wieloosrodkowe.

Aim of the study was to evaluate the efficacy, tolerance and safety of treatment of leg ulcer with pentoxiphylline administered orally in daily dose of 1200 mg divided for 3 doses for six months. The study was carried out in 19 centres in Poland. The results of clinical and laboratory (HGB, WBC, PTL) examinations made before, during and after treatment were documented in individual case-records. Pentoxiphylline was administered to 184 patients (124 F and 60 M) aged 22-86 (mean-61.6) yrs. One hundred and thirty-five patients had non-arterial ulcers, 37-partly arterial and 12-arterial. The duration of the disease was 1 to 1620 (mean 158) weeks. Resting pain was reported by 131 patients. In 9 persons the treatment was stopped after 1-2 months; in 6 (3%) of them due to side effects. In 175 patients pentoxiphylline was administered as follows: 1200 mg daily for 6 months in 92 cases, 1200 mg daily for 2-5 months--in 58, 1200 mg daily for 3-5 months and 800 mg daily for next 1-3 months--in 12 cases, and 800 mg daily for 1-6 months--in 13 cases. In 161 (92%) cases a beneficial effect was achieved including complete healing of the ulcers in 79 (45%) or improvement in 82 (47%); in 14 (8%) there was no improvement. The resting pain was significantly reduced in 114 (87%) patients within 1-24 weeks and completely disappeared in 69 (53%) patients within 2-20 weeks of treatment. No significant abnormalities in the results of laboratory tests were found. Transient side effects of the therapy appeared in 11 patients but they did not require administration of the drug to be discontinued. The study showed that pentoxiphylline is a effective, well tolerated and safe drug in the treatment of leg ulcers.

[Selenium nutritional status and the course of psoriasis]. / Stan odzywienia selenem a przebieg luszczycy.

A case-control study was conducted to evaluate the role of dietary selenium (Se) intake and the selenium nutritional status in the course of psoriasis. The cases studied were 30 psoriatic patients with a history of the disease no longer than 10 months and 29 psoriatics with the disease lasting at least 3 years, 24 other dermatological patients and 14 healthy subjects constituted 2 control groups matched to cases studied by sex and age. Se dietary intake was calculated from 24-hours dietary recall and Se status was assessed with plasma Se level as well as plasma and erythrocyte GSH-Px activity. Dietary Se intake was found to be correlated to erythrocyte GSH-Px (r = 0.50, p < 0.05). The selenium nutritional status seemed to be insufficient, especially in females with psoriasis of no longer than 10 months' duration and males with long-lasting psoriasis. In these males plasma and erythrocyte GSH-Px activity were inversely correlated to the severity of the disease (r = -0.64 and r = -0.41, p < 0.05, respectively). The results obtained suggest that Se dietary intake could be one of the contributing factors in the pathogenesis and course of psoriasis. Further studies are needed to explore this relationship.

Clinical features and specific immunological response to Borrelia afzelii in patients with acrodermatitis chronica atrophicans.

Acrodermatitis chronica atrophicans (ACA) occurs mostly in Europe. Borrelia afzelii is considered to be responsible for this manifestation of Lyme borreliosis. The aim of the study was to observe the clinical features of the ACA and evaluate the specific immunological response to Borrelia afzelii. Nine patients from an endemic Lyme borreliosis region in northeastern Poland were studied. The serum samples were tested routinely with IFA and EIA and, following testing, with immunoblots using Borrelia afzelii antigens. ACA was located mainly on the skin of the arms, forearms, thighs and chest. The only extracutaneal manifestation of Lyme borreliosis was paresis of the brachial plexus observed in one patient. Analysis of the immunoblot-banding pattern revealed positive reactions in all patients against flagellar antigen (41 kDa). Interpretation of the immunoblots revealed positive IgG results in all cases and IgM in five of them. Concluding, ACA develops not only on the extremities, but also on the trunk. The immunoblot technique using Borrelia afzelii antigens is of value in the diagnosis of ACA.

Epidemiology of erythema migrans in north-eastern Poland.

The aim of the study was to evaluate erythema migrans (EM) prevalence and treatment in north-eastern Poland during the last 25 years. The material for the study consisted of data sent to the Department of Dermatology by physicians from fifteen regional out-patient clinics. They were collected according to specially prepared questionnaires. The data were analysed with respect to the total number of EM cases, patients' age, seasonal prevalence of the disease, dynamics of its prevalence and treatment methods in successive years. Of the 262,421 case histories, retrospectively analysed 1235 EM cases (0.4%) were found. The age of the patients varied from 4 to 78 years. The highest incidence was observed between August and October (57.7% of all cases). The annual number of cases increased from only a few, in the years 1969-76, to over 436 in 1993. Penicillin or erythromycin were preferred for the treatment of EM before 1981, tetracycline or ampicillin between 1982-90, and amoxicillin or doxycycline in the last three years. Our results showed a significant increase in the number of EM cases in the dermatological clinics of north-eastern Poland in recent years. The treatment of the disease applied at present, complies with the generally accepted guidelines.

[Late consequences of untreated lyme borreliosis]. / Odlegle nastepstwa nie leczonej boreliozy z Lyme.

The study aimed to evaluate late clinical symptoms and serological changes in persons with erythema migrans (EM) diagnosed 4-11 years ago who were not treated with antibiotics. Among initially included into the study 28 untreated EM cases, twelve persons responded for invitation to the Department. The symptoms and signs which could be related to previous Borrelia burgdorferi infection were present in 9 (75%) untreated patients. They included ischialgia (42%), arthritis (33%) and positive serological tests results (33% of patients, including 2 with clinical signs). These results demonstrate that lack of antibiotic treatment in the early LB stage can result in the development of late disease manifestations.

Study on clinical picture of erythema migrans.

Clinical picture of erythema migrans (EM) was evaluated in 83 patients from north-eastern Poland. Patients were in mean age of 42,8. Most of patients (71%) were women. Tick bite remembered 64% patients. Mean incubation period of EM was 33 days. The mean diameter of the skin lesions was 14.8 cm. They persisted for 2-270 (mean-54) days. Lesions were located mostly on the skin of lower extremities. The largest lesions were found on trunk and the smallest on lower extremities. EM of diameter exceeding 20 cm were observed in patients with longer history of the disease. Specific antibodies were found in 53% of cases and were present more frequently (78%) in patients with shorter incubation period (< 30 days).

["Prognostic markers" in serum of active and passive intravenous drug users infected with human immunodeficiency virus (HIV)]. / "Markery prognostyczne" w surowicy czynnychibiernychnarkomanów zakazonych ludzkim wirusem uposledzenia odpornosci (HIV).

The analyse of neopterin (NPT), beta 2-microglobulin (beta 2-M) and immunoglobulin A (IgA) in active and passive intravenous drug users was made to show the influence of intravenous drug taking on the level of so called "prognostic markers" in the serum of HIV infected persons. The intravenous drug users remained in the same, symptom-free stage of infection. The level of NPT in active drug users was higher than in passive drug users (statistically essential difference). In both analysed groups the level of NPT considerably exceeded the norm range (10 nmol/l). The differences in beta 2-M concentrations between analysed groups were not statistically essential, although higher values were observed in active drug users. The concentration of IgA in analysed persons were within the norm range. Current life conditions of the HIV-infected persons should be taken into consideration when estimating prognostic values of analysed indices.

[Levels of neopterin in serum of narcotics abusers infected with human immunodeficiency virus (HIV)]. / Stezenie neopteryny w surowicy krwi narkomanów zakazonych ludzkim wirusem uposledzenia odpornosci (HIV).

Concentration of neopterin (NPT) was measured in 3-6 months intervals in the serum of HIV-infected drug users taking continuously intravenous drugs and those who stopped the habit (MONAR, ZOZ). After 6-12 months of observation the mean NPT concentration was higher in the active drug users what was statistically essential. The outcome of our study indicates that current state of the patient concerning taking of drugs must be taken under consideration when NPT concentration is assessed as marker of progression of HIV disease.