The effect of levocetirizine and montelukast on clinical symptoms, serum level and skin expression of COX-1 and COX-2 enzymes in patients suffering from chronic autoimmune urticaria - a pilot study.

INTRODUCTION: Chronic autoimmune urticaria (CAU) lasts over 6 weeks and is characterized by circulating IgE autoantibodies or IgG against IgE or IgE receptor. AIM: To assess the clinical, laboratory and histological effects of 4-week levocetirizine and montelukast therapy in patients suffering from CAU. MATERIAL AND METHODS: Of 296 tested patients with chronic urticaria 40 had a positive ASST test. Only 17 (16 female/1 male; medium age: 44 years) fulfilled all study inclusion/exclusion criteria. The study was designed as an open, randomized trial with two arms: levocetirizine or montelukast treatment for 4 weeks following a 2-week wash-out period. All participants completed urticaria activity score (UAS) and visual analogue scale (VAS) questionnaires before and after both therapies. Blood samples and skin bioptats were obtained before and after treatment to evaluate COX-1 and COX-2 serum concentrations and skin expression. RESULTS: Clinical response to therapy measured with the UAS and VAS was better in the levocetirizine group. Both drugs caused a significant decrease in COX-1 and COX-2 serum level. COX-1 and COX-2 expression in epidermal and dermal inflammatory infiltration did not change significantly in either study group, but a significant decrease of COX-1 expression was observed when the groups were combined for analysis, and the decrease in COX-2 expression in the epidermis was of borderline significance. CONCLUSIONS: The effectiveness of levocetirizine and montelukast in treating CAU may be partly related to the reduction of COX-1 and COX-2 serum level and tissue expression, but further studies on a larger group of patients are needed to support this observation.

Serum concentrations of selected proinflammatory cytokines in children with alopecia areata.

INTRODUCTION: Alopecia areata (AA) is considered an autoimmune disorder characterized by patchy loss of hair from the scalp and other body parts. Many patients develop the disease in childhood. AIM: To answer the question whether abnormal production of some proinflammatory cytokines (IL-2, IL-6, IL-15, IL-17A and IFNγ) in children with AA may facilitate the development or progression of the disease. MATERIAL AND METHODS: The study group consisted of 42 children with AA, the control group - 37 healthy children. Peripheral venous blood samples were collected from patients with AA and healthy controls and the concentrations of serum cytokines, namely IL-2, IL-6, IL-15, IL-17A, IFN-γ were determined quantitatively by ELISA method. RESULTS: The serum IL-6, IL-15, IL-17A and IFNγ levels were significantly increased in patients with AA compared with control subjects (p < 0.05). The serum IL-15 level was found to be increased when the total duration of AA was increased (q = 0.30; p = 0.05). The serum cytokine level of IL-17A was found to be decreased when duration of the current episode was longer than 2 years (p < 0.05), but the correlation between IL-17A serum level and duration of the current episode was not confirmed in the Spearman test (q = -0.06; p = 0.68). The serum IL-17A level was found to be significantly decreased when the thyroiditis was present (q = -2.378; p < 0.05). CONCLUSIONS: The increased levels of serum IL-6, IL-15, IL-17A and IFNγ in children suggest imbalance in the serum proinflammatory cytokines production in AA.

Role of primary and secondary prevention in atopic dermatitis.

Atopic dermatitis (AD) is a serious epidemiological problem in industrialized countries. The incidence of AD has increased considerably over the last 30 years. Atopic dermatitis is a chronic, recurrent, inflammatory skin disease accompanied by strong itching. It is characterized by typical features depending on age. The parents of children suffering from AD must be prepared to change their lifestyle. They should avoid factors which can promote skin lesions and apply appropriate, regular skin care. The article describes primary prevention of AD as well as prophylactic measures to avoid skin eczema. It presents the role of infections, vaccinations, breastfeeding and the influence of domestic animals, house renovation and moulds on development of AD. The article also describes the significance of the epidermal barrier, skin colonization by microbial agents, pruritus, stress, food and inhalant allergy among people who suffer from AD.

Amorolfine vs. ciclopirox - lacquers for the treatment of onychomycosis.

Amorolfine 5% and ciclopirox 8% nail lacquers are commonly used in topical treatment of onychomycosis. These formulations may be used alone or in combination with oral antifungal agents. Amorolfine and ciclopirox are valuable therapeutic options, however, their usage in monotherapy should be limited. Proper amorolfine and ciclopirox penetration through the nail plate is provided by transungual drug delivery systems. Although amorolfine and ciclopirox have a different mode of action, they both exhibit a broad antifungal activity. The use of antifungal nail lacquers in combination with oral agents, such as terbinafine and itraconazole, improves efficacy of antifungal therapy.

The potential of use basil and rosemary essential oils as effective antibacterial agents.

The considerable therapeutical problems of persistent infections caused by multidrug-resistant bacterial strains constitute a continuing need to find effective antimicrobial agents. The aim of this study was to demonstrate the activities of basil (Ocimum basilicum L.) and rosemary (Rosmarinus officinalis L.) essential oils against multidrug- resistant clinical strains of Escherichia coli. A detailed analysis was performed of the resistance of the drug to the strains and their sensitivity to the tested oils. The antibacterial activity of the oils was tested against standard strain Escherichia coli ATCC 25922 as well as 60 other clinical strains of Escherichia coli. The clinical strains were obtained from patients with infections of the respiratory tract, abdominal cavity, urinary tract, skin and from hospital equipment. The inhibition of microbial growth by both essential oils, presented as MIC values, were determined by agar dilution. Susceptibility testing to antibiotics was carried out using disc diffusion. The results showed that both tested essential oils are active against all of the clinical strains from Escherichia coli including extended-spectrum ß-lactamase positive bacteria, but basil oil possesses a higher ability to inhibit growth. These studies may hasten the application of essential oils in the treatment and prevention of emergent resistant strains in nosocomial infections.

Topical calcineurin inhibitors in dermatology. Part I: Properties, method and effectiveness of drug use.

Topical calcineurin inhibitors (TCI) are a relatively new class of drugs used in dermatology. There are two drug forms available - tacrolimus 0.03% or 0.1% ointment and 1.0% pimecrolimus cream. The drugs act by inhibiting synthesis of proinflammatory cytokines. The only approved indication for using TCI is treatment of atopic dermatitis. The TCI may be used as an alternative therapy to corticosteroids. Tacrolimus is used to treat moderate-to-severe atopic dermatitis, pimecrolimus - mild-to-moderate atopic dermatitis. Topical calcineurin inhibitors do not cause skin atrophy and the drug absorption through the skin is minimal. The TCI have been well-studied, their efficacy was evaluated in a number of vast, long-term studies. The anti-inflammatory potency of tacrolimus ointment is similar to a corticosteroid with moderate activity, while the latter is clearly more active than pimecrolimus cream. Topical calcineurin inhibitors significantly relieve pruritus in atopic eczema.

A 6-year-old boy with Sulzberger and Garbe dermatosis: a case report and literature review.

Sulzberger-Garbe disease was described in 1937. Not more than a hundred of cases of the disease have been reported in the literature. Despite a quite specific picture, there are no features that could undeniably be attributed to this particular disease entity. Discoid exudative and lichenoid lesions are main lesions in this dermatosis. The disease is associated with severe pruritus. The lesions are located on the trunk and extremities as well as the genitals. Eosinophilia is frequently found in the course of the disease. Sulzberger-Garbe dermatosis has been diagnosed mainly in middle-aged males of Jewish origin but it can occur in both sexes at any age. Good therapeutic response to systemic corticosteroids has been observed. It is still controversial whether the disease should be classified as an independent clinical entity.

[Age-related macular degeneration--a complex genetic disease]. / Zwyrodnienie plamki zwiazane z wiekiem (AMD)--choroba o wieloczynnikowym podlozu genetycznym.

Age-related macular degeneration (AMD,) is the most common cause of severe visual loss and blindness in the population over 60 years old, especially in the developed world. Two types of AMD are distinguished: the dry (non-exudative or atrophic) and the wet (exudative or neovascular) form. Family and twins studies have shown that the susceptibility for this disease is genetically influenced and the heritability has been estimated to be up to 75%. Until now, many of the candidate-genes associated with AMD have been discovered using studies on genetically engineered and naturally mutated animals, linkage studies, studies of monogenic degenerative retinal diseases and association studies. Recently genes have been described that significantly contribute to the etiopathogenesis of AMD: CFH, PLEKHA1/LOC387715/HTRA1 and C2/BF genes. AMD is considered to be a genetic complex disease in which multiple genes and environmental factors play a role in pathogenesis. Identification of other genes involved in development of AMD will improve our knowledge about new pathways and pathological mechanisms of the disease, as well as avenues for novel more effective treatments. The aim of this article is to survey published data on genetic aspect of AMD, with emphasis of several recently discovered genes described to be particularly important in the pathogenesis of AMD, and /or somehow associated with the occurrence of the disease.

[Age-related macular degeneration (AMD): etiopathogenesis and therapeutic strategies]. / Zwyrodnienie plamki zwiazane z wiekiem (AMD): etiopatogeneza i strategie terapeutyczne.

Age-related macular degeneration (AMD) is a disease leading to severe visual loss and legal blindness in the population over 60 years of age. Its pathogenesis is likely multifactorial, involving a complex interaction of metabolic, functional, genetic, and environmental factors, and remains poorly understood. For these reasons, currently used therapeutic approaches are insufficiently effective. Although major abnormalities are seen in four functionally interrelated tissues, i.e. photoreceptors, retinal pigment epithelium (RPE), Bruch's membrane, and choriocapillaries, the impairment of RPE cell functions is an early and crucial event in the molecular pathways leading to clinical relevant AMD changes. The RPE progressively degenerates, which results in an irreversible degeneration of photoreceptors. Four processes: lipofuscinogenesis, drusogenesis, inflammation, and neovascularization, specifically contribute to the development of the disease. Two types of AMD are distinguished: the dry and the wet form. This paper briefly describes major molecular and cellular events leading to AMD, and presents currently used and new, forthcoming therapeutic strategies.