A Breakthrough in the Treatment of Necrobiosis Lipoidica? Update on Treatment, Etiopathogenesis, Diagnosis, and Clinical Presentation.

Necrobiosis lipoidica (NL) is a rare granulomatous disease of a not fully understood etiopathogenesis. Classically, NL is associated with insulin-dependent diabetes mellitus. The disease often fails to respond to conventional treatments and adversely affects patients' quality of life. First-line medications are usually topical corticosteroids, but patients respond to them with varying degrees of success. Other options include tacrolimus, phototherapy, cyclosporine, fumaric acid esters, and biologics (adalimumab, etanercept, and infliximab). Our review aims to present new therapeutic approaches potentially effective in patients with refractory lesions, describe the presumed etiopathogenesis, and provide diagnostic guidance for clinicians. The review concludes that Janus kinase inhibitors and biologics such as ustekinumab and secukinumab can be used effectively in patients with recalcitrant NL. Another promising treatment option is tapinarof (an aryl hydrocarbon receptor agonist). However, studies on larger groups of patients are still needed to evaluate the effectiveness of different therapeutic options and to define consistent treatment regimens for NL. It is advisable to improve the awareness of physicians of various specialties regarding necrobiosis lipoidica as lesions diagnosed earlier usually have a better response to treatment.

Dry eye syndrome symptoms in patients with psoriasis.

BACKGROUND: Psoriasis is one of the most common dermatoses associated with a variety of comorbidities. There have been some reports on its possible association with ocular disorders however dry eye syndrome (DES) in such patients has been poorly investigated. OBJECTIVES: To investigate the frequency of DES symptoms in psoriatic patients, also regarding psoriasis severity in PASI, manifestation and therapy. METHODS: 40 patients with psoriasis and 40 volunteers without dermatoses were enrolled in the study. They completed Ocular Surface Disease Index (OSDI) questionnaire and were objectively examined by IDRA® device to perform automatic interferometry, automatic meibography of lower eyelid glands, non-invasive break-up time (NIBUT), blink quality and tear meniscus height. RESULTS: Patients with psoriasis had statistically significantly thicker lipid layer (p = 0.0042 left eye, p = 0.0313 right eye) and greater loss of Meibomian glands compared to controls (p = 0.0128 left eye, p = 0.048 right eye). The patients had lower, although insignificantly, eye blink quality and tear meniscus height than the control group, as well as shorter NIBUT and higher score in OSDI. After the division of patients into two groups-with or without nails involvement/psoriatic arthritis/systemic treatment- we did not observe any significant differences between the groups. PASI did not correlate with any DES parameter. CONCLUSIONS: This is the first study of DES symptoms with an objective IDRA® analyzer. We managed to observe that patients with psoriasis have thicker lipid layer and higher Meibomian glands' loss in lower eyelids. Based on all assessed objective and subjective parameters psoriatics do not seem to have an increased risk of DES. The presence of psoriatic arthritis or nail involvement does not seem to be a predisposing factor for DES development. PASI probably cannot be a prognostic factor for any of the DES-associated parameters. Nevertheless, DES in psoriasis requires further research on bigger samples to establish reliable recommendations.

E-learning as a tool of suicide prevention training: A meta-analysis and systematic review.

Suicide is a global health challenge. One prevention strategy is teaching individuals how to detect and respond to suicidality. These training have increasingly been delivered online. We searched WoS, Scopus, and PubMed from inception until the 20 September 2023 to evaluate e-learning efficacy as standardized mean changes and standardized mean differences. We synthesized main results using multilevel meta-analyses and subgroups using random-effects meta-analyses. Robins-I, RoB-II and trim-and-fill were used to assess the risk of bias. Of the 6516 initially screened articles, 26 were included. Overall, e-learning increased suicide prevention skills. Subgroups reported differing results: e-learning affected knowledge and self-efficacy more than behavior and attitudes. Efficacy, short duration, and low-cost suggest that e-learning may be feasible in teaching basic suicide prevention skills to lay people. However, current evidence suggests that health care professionals should not rely on e-learning as a training modality, except when no other form of training is available. Preregisteration: CRD42020218978.

Lipid Alterations and Metabolism Disturbances in Selected Inflammatory Skin Diseases.

Lipidomics is a term used to define the field that analyzes the structure, functions, and interactions of lipids. Inflammatory dermatoses and lipid disturbances are interrelated, especially due to chronic inflammatory conditions. This review discusses lipidomics in selected inflammatory skin diseases: psoriasis, lichen planus, and atopic dermatitis, as well as the less commonly mentioned hidradenitis suppurativa, rosacea, and acne vulgaris. Lipid homeostasis disorders are common; they are especially well-documented in psoriasis, lichen planus, and atopic dermatitis. Future studies are required for better insight into this issue, particularly on the skin lipidome. Understanding lipidomics, in particular skin diseases, increases our knowledge about their pathogenesis, and may become useful in adjusting tailored management for each patient as well establishing prognosis. Noteworthily, it seems advisable to alert doctors to the need to analyze lipid parameters and the complications of abnormal lipid metabolism in dermatological patients, which could decrease their comorbidities and improve the life quality and health condition of dermatological patients.

Gasdermin D (GSDMD) Is Upregulated in Psoriatic Skin-A New Potential Link in the Pathogenesis of Psoriasis.

Psoriasis is an important issue in daily dermatological practice. Not only is it an aesthetic defect but it is also a matter of decreased life quality and economic burden. However frequent, the pathogenesis of psoriasis remains uncertain despite numerous investigations. Gasdermins are a family of six proteins. Gasdermin D (GSDMD) is the best-studied from this group and is involved in the processes of inflammation, proliferation, and death of cells, especially pyroptosis. GSDMD has never been studied in psoriatic sera or urine before. Our study involved 60 patients with psoriasis and 30 volunteers without dermatoses as controls. Serum and urinary GSDMD concentrations were examined by ELISA. The tissue expression of GSDMD was assessed by immunohistochemistry. The serum-GSDMD concentration was insignificantly higher in the patients than controls. There were no differences in the urinary-GSDMD concentrations between the patients and controls. Strong tissue expression of GSDMD was significantly more prevalent in psoriatic plaque than in the non-lesional skin and healthy skin of the controls. There was no correlation between the serum-GSDMD concentrations and the psoriasis severity in PASI, age, or disease duration. Taking into consideration the documented role of gasdermins in cell proliferation and death, the increased expression of GSDMD in psoriatic skin may demonstrate the potential involvement of this protein in psoriasis pathogenesis. Neither serum, nor urinary GSDMD can be currently considered a psoriasis biomarker; however, future studies may change this perspective.

Great hopes or disappointment - a survey-based study on patients' and doctors' perception of telemedicine during the COVID-19 pandemic in Poland.

Introduction: During the COVID-19 pandemic health care systems worldwide rapidly implemented telemedicine solutions in order to avoid spreading the coronavirus among doctors and patients. Aim: To analyse the knowledge, usage, and attitude towards telemedicine among patients, dermatologists, and other doctors during the COVID-19 pandemic. Material and methods: An original anonymous online survey was carried between 22 September 2020 and 29 December 2020 in Poland among 121 patients, 63 dermatologists, and 50 doctors of other specialties. Statistical analysis was performed using the χ2 test, and a statistically significant difference was considered at p < 0.05. Results: In the analysed period in the patient group 58.7% suffered from a skin disease and 79.3% used telemedicine during the COVID-19 pandemic, 54.5% of all respondents viewed teleconsultations unfavourably, and 96.6% of dermatologists and 88% of other doctors had to schedule in office visit or ask for additional pictures because of an unclear clinical picture during teleconsultation. There was a statistical significance between dermatologists and other specialty doctors regarding telemedicine's ability to replace office visits, its usefulness in the elderly, and the duration of the teleconsultation compared to a traditional in-person visit (all p < 0.05). Conclusions: The results showed that in many cases issues raised during teleconsultations could not have been solved using telemedicine. The results obtained highlight the unfavourable perception of telehealth. Overall, telemedicine is a safe and useful tool for communicating with patients, increasing access to medical care, but it needs to be evaluated in the context of potential limitations and optimizing the patients' experience.

Decreased levels of vaspin and its potential association with cardiometabolic risk in patients with psoriasis: preliminary results.

Introduction: Omentin and vaspin are considered to have beneficial effects preventing the development of metabolic disorders which are common comorbidities in psoriasis. Aim: To evaluate the serum level of these adipokines in psoriatic patients and elucidate possible associations with disease activity, metabolic or inflammatory parameters and systemic treatment. Material and methods: Thirty-three patients with active plaque-type psoriasis and 11 healthy controls participated in the study. Blood samples were collected before and after 3 months of treatment with acitretin or methotrexate. Results: Serum vaspin concentration in psoriatic patients was significantly lower than in the control group (p < 0.05). No correlation between adipokines and severity of disease evaluated with PASI was found. However, median vaspin levels decreased with the severity of skin lesions and the omentin level was higher in patients with severe disease versus those with moderate form (p < 0.05). The vaspin level correlated with BMI of psoriatic patients (p < 0.05), with cholesterol and triglycerides levels (p = 0.054, p = 0.049, respectively). No significant effect of systemic treatment on omentin levels was found. Regarding vaspin, we observed an upward trend in its concentration after treatment. Conclusions: Omentin and vaspin may play a modulating role in the systemic inflammation present in psoriasis and thus may contribute to the development of metabolic complications.

Aberrations in Lipid Expression and Metabolism in Psoriasis.

Psoriasis (PSO) is a common skin disease that affects about 1%-3% of the general population. It is a great medical, social and economic burden since PSO is associated with many comorbidities, of which the most common are cardiometabolic disorders. Psoriatic patients suffer more frequently from obesity, dyslipidemia, atherosclerosis, and nonalcoholic fatty liver disease. Research shows that lipid expression and metabolism disorders are present more often in such patients. This review focuses on a variety of aberrations in lipids in the skin, blood, and adipose tissue in psoriatic patients and their multifactorial impact on the pathogenesis of psoriasis.

Elevated circulating Krüppel-like factor 4 level as a novel independent marker of the proatherogenic risk in patients with psoriasis: a preliminary study.

INTRODUCTION: Krüppel-like factor 4 (KLF4) is a transcription factor of anti-inflammatory and anti-thrombotic properties not studied in psoriasis yet. AIM: To analyze the clinical value of the serum KLF4 level in psoriatics and elucidate the interplay between disease activity, metabolic or inflammatory parameters and systemic therapy. MATERIAL AND METHODS: The study enrolled thirty-four psoriatics and fifteen healthy subjects. Blood samples were collected before and after twelve weeks of treatment with methotrexate or acitretin. Serum KLF4 levels were measured using immune-enzymatic method. RESULTS: Serum KLF4 levels in psoriatic patients did not statistically differ comparing to the controls (p > 0.05). However, in severe psoriasis, KLF4 was significantly higher than in healthy ones before treatment and normalized after treatment to baseline levels of controls (p < 0.05, p > 0.05, respectively). KLF4 positively correlated with body mass index (p = 0.038) but not with psoriasis severity, nor inflammatory or metabolic markers. Interestingly, many pro-atherogenic parameters were shown as variables independently predicting the levels of KLF4. No significant effect of three-month systemic treatment on KLF4 was found. CONCLUSIONS: KLF4 may be a novel independent indicator of the proatherogenic risk in psoriatics, especially with a severe form or obesity.

Varicella-zoster virus infection in the pediatric population with acute lymphoblastic leukemia in Poland.

Varicella-zoster virus (VZV) infection in pediatric hemato-oncology patients can be a therapeutic problem when children are exposed to immunosuppression. The aim of this study is to evaluate the incidence of VZV infection, antiviral therapy and outcome in children with ALL treated in polish hemato-oncological centers between 2012 and 2019 years. This study included medical records of 1874 patients, aged 1 to 18 years, with newly diagnosed acute lymphoblastic leukemia. During chemotherapy, 406 children out of 1874 (21.6%) experienced viral infections. The incidence of VZV infection in the whole group children with ALL was 1.8%. Among them, 34 (8.4%) patients were diagnosed with VZV infection. Thirty-five episodes of viral infections were identified. The median time of VCV therapy was 12 days. Herpes zoster infection occurred in 24 (70.6%) children, and varicella in 10 (29.4%) ones. The average time from the start of chemotherapy to the appearance of herpes zoster was 7.26 ± 4.05 months. VZV infection occurred mainly during the maintenance therapy, the reinduction and induction phases. There was no correlation between steroid dosage or type and subsequent zoster. The total lymphocyte count of these patients on the first day of zoster was reduced. No serious complications were observed due to this infection. All patients survived. In conclusion, a low incidence of VZV infection was observed among pediatric patients with ALL in Poland. This analysis indicates that currently used therapeutic methods are effective in children with cancer and VZV infection. The main focus should be on the prevention of delayed chemotherapy.

Proprotein Convertase Subtilisin/Kexin Type 9, Angiopoietin-Like Protein 8, Sortilin, and Cholesteryl Ester Transfer Protein-Friends of Foes for Psoriatic Patients at the Risk of Developing Cardiometabolic Syndrome?

Psoriasis is a systemic, immune-metabolic disease with strong genetic predispositions and autoimmune pathogenic traits. During psoriasis progression, a wide spectrum of comorbidities comes into play with the leading role of the cardio-metabolic syndrome (CMS) that occurs with the frequency of 30-50% amongst the psoriatic patients. Both conditions-psoriasis and CMS-have numerous common pathways, mainly related to proinflammatory pathways and cytokine profiles. Surprisingly, despite the years of research, the exact pathways linking the occurrence of CMS in the psoriasis population are still not fully understood. Recently published papers, both clinical and based on the basic science, shed new light into this relationship providing an insight into novel key-players proteins with plausible effects on above-mentioned interplay. Taking into account recent advances in this important medical matter, this review aims to discuss comprehensively the role of four proteins: proprotein convertase subtilisin/kexin type-9 (PSCK9), angiopoietin-like protein 8 (ANGPLT8), sortilin (SORT1), and cholesteryl ester transfer proteins (CEPT) as plausible links between psoriasis and CMS.

Higher Serum Selenoprotein P Level as a Novel Inductor of Metabolic Complications in Psoriasis.

Selenoprotein P (SeP), a member of hepatokines, is involved in the development of various metabolic diseases closely related to psoriasis, but it has not been explored in that dermatosis so far. The study aimed to evaluate the clinical value of serum SeP concentrations in patients with psoriasis and its interplay between disease activity, metabolic or inflammatory parameters and systemic therapy. The study included thirty-three patients with flared plaque-type psoriasis and fifteen healthy volunteers. Blood samples were collected before and after three months of treatment with methotrexate or acitretin. Serum SeP levels were evaluated using the immune-enzymatic method. SeP concentration was significantly higher in patients with psoriasis than in the controls (p < 0.05). Further, in patients with severe psoriasis, SeP was significantly increased, compared with the healthy volunteers before treatment, and significantly decreased after (p < 0.05, p = 0.041, respectively). SeP positively correlated with C-reactive protein and platelets and negatively with red blood counts (p = 0.008, p = 0.013, p = 0.022, respectively). Therapy resulted in a significant decrease in SeP level. Selenoprotein P may be a novel indicator of inflammation and the metabolic complications development in psoriatics, especially with severe form or with concomitant obesity. Classic systemic therapy has a beneficial effect on reducing the risk of comorbidities by inhibiting SeP.

Rare coexistence of unilateral erythema nodosum with erysipelas in the area of previous adder bite.

INTRODUCTION: Erysipelas is an acute inflammation of skin and subcutaneous tissue. Erythema nodosum is the most frequent form of panniculitis considered as a reaction to different factors, most commonly infections, especially streptococcal. CASE PRESENTATION: A 74-year-old male presented to hospital due to skin lesions involving the same area he was bitten by an adder six months earlier. On the admission well-demarcated erythema and oedema on the right shin with accompanying fever were noted. Erysipelas was diagnosed and intravenous ceftriaxone was administered. Two days later a few tender nodules within that unilateral location appeared. Based on the clinical and histopathological picture diagnosis of Bävferstedt subtype (erythema nodusum migrans, ENM) was made. The treatment was continued, further followed by doxycycline orally resulting in clinical improvement. CONCLUSIONS: This case presents an unusual coexistence of erysipelas and erythema nodosum migrans, the more it was observed on the primary adder bite area and occurred in a man. Most probably, adder's venom could lead to disturbed blood and lymph flow what predisposed to erysipelas, which, as streptococcal infection, could trigger ENM.

What do you know about sexually transmitted infections? Survey concerning knowledge and risky behaviors among students of Bialystok universities.

INTRODUCTION: Sexually-transmitted infections (STIs) are serious public health problem, being acquired by more than 1 million people every day worldwide. OBJECTIVE: Assess the knowledge, attitudes, risky behaviors and preventive practices related to STIs among medical and non-medical faculties students from Bialystok. MATERIALS AND METHODS: In 2018 an original anonymous survey was carried among 168 subjects from medical and 142 from non-medical universities. They filled 37 questions: general and specific regarding STI. Statistical analysis was performed using Chi-Square test, statistically significant difference was at p=0.05. RESULTS: In the group 80,6% were females and 19,4% males, with a mean age of 21,9 years. Over 73% were sexually active and almost half of them admitted risky sexual behavior in the past. Almost 16% have ever done an examination for STIs. HIV remains the best known STIs, while hepatitis B was known mainly among medical students. Three fourth students knew that STIs could be asymptomatic. Over half of the students knew that vaccinations against STIs were available and 88,6% of them heard about the HPV vaccine. There was statistically significant difference between the groups regarding the knowledge of diseases transferred sexually, causative agents, history of STI examination, vaccines against STIs. CONCLUSIONS: Almost all participants identified HIV as STIs. Unfortunately, knowledge about other STIs is still at lower level. Both groups have indicated the Internet as a source of knowledge about STIs and the need to acquire additional education about these diseases. To conclude, non-medical students have less awareness about STIs.

Infectious profile in children with ALL during chemotherapy: A report of study group for infections.

INTRODUCTION: The treatment-related mortality in currently published studies of acute lymphoblastic leukemia (ALL) in children is 2-4%, mainly due to infections. The aim of the study was to analyse the incidence, epidemiology, profile of infection and the death rate in children with ALL. PATIENTS AND METHODS: The retrospective analysis included 1363 patients, aged 1-18 years, with newly diagnosed ALL, who were treated in 17 pediatric hematology centers between 2012 and 2017 in Poland. The patients received therapy according to the ALL IC-BFM 2002 and 2009 (International Berlin-Frankfurt-Munster Study Group) protocols. RESULTS: In our study, 726 out of 1363 (53.2%) children were reported to have a microbiologically documented bacterial infection during chemotherapy. 1511 episodes of these infection were diagnosed. A total number of 251/1363 (18.4%) children experienced a viral infection. 304 episodes were documented by PCR test (polymerase chain reaction). A fungal infection was reported in 278 (20.4%) children, including 10.1% of probable, 6.0% of proven, 83% of possible diagnosis. A higher frequency of fungal infection was noted in the recent years. In our material, the rate of death was 2.4%, mainly due to fungal infection. CONCLUSIONS: Our results present the epidemiology of infectious disease in the Polish ALL patient population. The most frequent were bacterial infections, followed by fungal and viral ones. Similar to the previously published data, the mortality rate in our material was 2.4%.

Epidemiology and outcome of invasive fungal disease in children after hematopoietic cell transplantation or treated for malignancy: Impact of national programme of antifungal prophylaxis.

The objective of the study was the analysis of incidence and outcome of invasive fungal disease (IFD) in children treated for malignancy (PHO, paediatric hematology-oncology) or undergoing hematopoietic cell transplantation (HCT) over a period of six consecutive years in nationwide study. A total number of 5628 patients with newly diagnosed malignancies and 971 patients after HCT (741 allo-HCT and 230 auto-HCT) were screened for infectious complications in biennial reports. IFD incidence was lower among PHO patients: 8.8% vs 21.2% (P < .0001) and survival from IFD was better: 94.2% vs 84.1% (P < .0001). Auto-HCT patients had lower incidence (10.9% vs 24.4%) and lower mortality than allo-HCT patients. Introduction of national antifungal prophylaxis programme in HCT and acute leukaemia patients decreased incidence of IFD in HCT (from 23.1% to 13.4%) and AML on conventional chemotherapy (from 36% to 23%) but not in ALL patients during chemotherapy. In multivariate analysis, the incidence of IFD was higher in patients after HCT, diagnosed for ALL, AML or NHL, and in patients > 10 years old. Factors contributing to death with infection were as follows: undergoing HCT, diagnosis of acute leukaemia (ALL or AML) and duration of treatment of infection > 21 days. In conclusion, the incidence of IFD in allo-HCT and in AML patients on chemotherapy has decreased after introduction of national programme of antifungal prophylaxis, while the incidence of IFD in ALL patients on chemotherapy did not change significantly. The outcome of IFD both in PHO and HCT patients has largely improved in comparison with historical international data.

Scabies ­still current medical and social problem. A retrospective analysis of 193 cases

INTRODUCTION: Scabies is a parasitic skin disease caused by Sarcoptes scabiei. About 200 million casesworldwide each year in people of all ages are reported. AIM OF STUDY: Retrospective analysis of records of patients hospitalized at the Department with scabies. MATERIALS AND METHODS: Six-year retrospective analysis of medical records of patients hospitalized with scabies at the Department of Dermatology. Gender, age of patients, comorbidities, clinical course of the disease and treatment were considered. RESULTS: In this period 193 patients were hospitalized with scabies, 96 females (49.7%) and 97 males (50.3%), including 33 children (17%). Mean age of patients was 52.9. Skin lesions persisted 142 days in average; reoccurrence was noted in 14% of cases. Lesions were observed most often in winter (31%). The most common manifestations were erosions (80.8%), excoriations (73.6%), papules (72.6%) and crusts (24.3%), localized mainly on trunk (92%), lower (91%) and upper (86%) limbs. 181 patients (93.8%) reported pruritus which intensified at night in 35.8%. Previous contact with people with scabies reported 41 patients (21%). The most common comorbidity was hypertension, diabetes mellitus and coronary heart disease. Accompanying dermatoses were eczema, secondary superinfection and psoriasis. 85 patients (44%) were overweight or obese. Patients received mostly topical permethrin (57%), crotamiton (29%), glicocorticosteroids (73%) and antibiotics (11%), also oral antihistamines (91%). CONCLUSIONS: Analysis revealed more frequent occurrence in adults with no evident sex prevalence. Greater incidence in winter may be caused by people's tendency to spend more time indoors closer to each other at this time of year. Pruritus, the most common subjective symptom, typically worsens at night.

[The influence of living conditions and lifestyle on the anxiety level in women in the postpartum period-questionnaire study].

Introduction: Due to the high incidence of postpartum anxiety disorders and their serious health and social consequences, it is essential to analyze the possible risk factors to identify groups of women particularly vulnerable to cover their proper care and control. The aim of our study was to investigate the relationship between the anxiety in women in the postpartum period, and their living conditions and lifestyle. Materials and Methods: The study was conducted from April to July 2016. We included 102 women in the postpartum period, living in the city of Cracow and the Cracow district. The study was based on a survey of our own authorship, State Anxiety Inventory (STAI) and the Jurczynski's Inventory of Health Behavior (IZZ). Results: The anxiety level in women in the postpartum period depends on the conditions of life and health behaviors. The level of health behavior of women in the postpartum period is an average and independent of age, number of children, and the material situation. Residents of cities, women with higher education, who planned pregnancy, have a higher level of health behavior. Good housing conditions have a positive influence on health behavior. Low levels of health behavior significantly affect the severity of maternal anxiety. Residents of the village, women with lower education and who not planning pregnancy have higher levels of anxiety during the postpartum period. Anxiety level of women in the postpartum period is inversely proportional to their housing conditions. Women with a job have lower levels of anxiety than non-working. The anxiety level in women in childbirth does not depend on age or financial situation. Conclusions: The anxiety level in women in the postpartum period, significantly depends on the living conditions and health behaviors. Verification of distinguished factors should be applied appropriately in health promotional activities and prevention programs.

Clinical and epidemiological assessment of patients hospitalized for primary and recurrent erysipelas / Ocena kliniczna i epidemiologiczna pacjentów hospitalizowanych z powodu rózy pierwotnej i nawrotowej

INTRODUCTION: Erysipelas is a bacterial infection, caused by group A ß-hemolytic streptococci (Streptococcus pyogenes), rarely other bacteria. It is characterized by sudden onset and rapid course, with the presence of systemic symptoms. OBJECTIVE: A retrospective analysis of patients hospitalized for primary and recurrent erysipelas with particular consideration of clinical profile of patients, causes, complications and risk factors of the recurrence. MATERIAL AND METHODS: We have analyzed the medical records of patients hospitalized for erysipelas at the Dermatology and Venereology Department of the Medical University of Bialystok from 2011 to 2015. RESULTS: One hundred twenty female (53,8%) and 103 male (46,2%) were included in the study. The median age was 61. The first episode of clinical symptoms was observed in 78% patients, while 22% of them were diagnosed as recurrent erysipelas. Skin lesions in both cases were located in the lower extremities most often. Mechanical trauma was statistically more frequently cause of the disease in men, while venous insufficiency and ulcers in women. Complications such as abscess, ulceration, phlegmon and thrombosis were observed in 22% of patients, significantly more common in men. Patients who were hospitalized more than 10 days were more likely to have higher body mass index and higher indicators of inflammation than patients who required a shorter hospital stay. Recurrent erysipelas was more often diagnosed in patients with co-morbidities, including hypertension, overweight, venous insufficiency and diabetes. CONCLUSIONS: Erysipelas located in the lower extremities, high temperature on admission, higher indicators of the inflammation, complications and coexistence of obesity and diabetes are the risk factors of the prolonged hospital stay. Primary and recurrent erysipelas have a similar course, severity of the disease and duration of hospitalization.