Human endogenous retroviruses and chosen disease parameters in morphea.

INTRODUCTION: Morphea (localized scleroderma) is a relatively rare disease characterized by excessive skin fibrosis. Human endogenous retroviruses (HERV) are largely distributed within the human genome with hundreds of thousands of elements. The HERV have been widely studied in autoimmune disorders, yet hardly ever assessed in diseases with a good prognosis such as morphea. AIM: In this study we focus on the possible relations between the expression of chosen HERV and factors influencing the pathomechanism of the disease, such as age, sex, titres of anti-nuclear antibodies, as well as duration, activity, and severity of the disease (LoSSI index). MATERIAL AND METHODS: Real-time polymerase chain reaction (PCR) targeting six HERV sequences of interest were performed on samples derived from peripheral blood mononuclear cells (PBMC) and skin biopsies. RESULTS: In PBMC we found a statistically significant negative correlation between HERV-W env expression and LoSSI index (p = 0.01). Additionally, HERV-W env was downregulated in patients with the active form of morphea. In all other cases we found no correlation whatsoever nor statistically significant differences below the p = 0.05 threshold. CONCLUSIONS: Morphea seems to be an autoimmune disease where the impact of HERV is not so apparent. It seems that probing many patients for the expression of just a few sequences is not as effective as previously expected. For initial studies of HERV in other diseases we recommend high throughput techniques such as HERV-dedicated DNA microarrays or massive parallel sequencing.

Enzymatic activity of fungi isolated from crops.

AIM: To detect and assess the activity of extracellular hydrolytic enzymes and to find differences in enzymograms between fungi isolated from wheat and rye samples and grown on Czapek-Dox Broth and Sabouraud Dextrose Broth enriched with cereal (wheat or rye). Isolated strains were also classified in the scale of biosafety levels (BSL). MATERIAL AND METHODS: The study used 23 strains of fungi cultured from samples of wheat and rye (grain, grain dust obtained during threshing and soil) collected in the Lublin region (eastern Poland). API ZYM test (bioMérieux) was carried out according to the manufacturer's instructions. Classification of BSL (Biosafety levels) was based on the current literature. RESULTS: High enzymatic activity was found in strains cultured in media containing 1% of wheat grain (Bipolaris holmi, Penicillium decumbens) and with an addition of 1% of rye grain (Cladosporium herbarum, Aspergillus versicolor, Alternaria alternata). The total number of enzymes varied depending on the type of media, and in most cases it was higher in the culture where an addition of cereal grains was used. CONCLUSIONS: Isolated strains of fungi reveal differences in the profiles of the enzyme assay. It can be assumed that the substrate enriched in grains stimulate the higher activity of mold enzymes.

Drugs as important factors causing allergies.

Medications can cause many adverse reactions, both non-immunologic and immunologic ones. Allergies can take many forms, allergic reactions include all types of reactions according to Gell and Coombs. Typically, allergic reactions to drugs are manifested by skin lesions such as maculopapular rash or urticaria and life-threatening systemic reactions such as anaphylaxis. Allergy to drugs is diagnosed based on medical history and a number of specific tests: skin tests, blood tests. In diagnosing the causes of anaphylaxis, the basophil activation test is used to exclude false negative and false positive results of skin tests and specific IgE levels. Allergic reactions to medications usually resolve themselves after discontinuation of the drug. Sometimes in the treatment anti-allergic drugs are used to inhibit the development of skin lesions. After observing any signs of drug allergy it is important to accurately diagnose the cause, since the subsequent exposure to the drug may lead to a strong anaphylactic reaction and consequently death.

The role of selectins in alopecia areata.

INTRODUCTION: One of the main histopathological features of alopecia areata (AA) is a lymphocytic infiltration that surrounds hair follicles. Soluble forms of E, L, P-selectins are known indicators of ongoing inflammation. There are no studies regarding the assessment of their contribution in AA. AIM: To assess serum concentrations of selectins (E-selectin, L-selectin and P-selectin) in patients with AA in relation to selected clinical parameters, including disease severity and activity. MATERIAL AND METHODS: Sixty-four patients with AA were involved in the study. The diagnosis was based on physical examination and photodermoscopy. The control group consisted of 40 healthy subjects. The serum concentrations of soluble E-selectin, L-selectin and P-selectin were detected with ELISA method. RESULTS: Statistically significantly higher levels of E, P, L-selectins were found in AA patients as compared with the healthy group. Serum concentrations of soluble forms of E- and L-selectins correlated with the severity of the disease, while E-selectin with activity of AA. CONCLUSIONS: This study shows that selectins may play an important role in the pathogenesis of AA and may be a target of future therapies in this disease.

Atopic dermatitis: current treatment guidelines. Statement of the experts of the Dermatological Section, Polish Society of Allergology, and the Allergology Section, Polish Society of Dermatology.

Atopic dermatitis (AD) is a condition frequently encountered in medical practices across the country. More than 60% of children with AD are at risk to develop allergic rhinitis or asthma (the atopic march). Patients with AD have a unique predisposition to colonization or infection by Staphylococcus aureus. Treatments for AD need to rapidly control symptoms of the disease, improve quality of life and prevent exacerbations. Given the chronic and relapsing nature of the disease, therapies need to encourage good compliance and be well tolerated.

Probiotic lactic acid bacteria and their potential in the prevention and treatment of allergic diseases.

Allergy is one of the most important and very common health problems worldwide. To reduce the proportion of people suffering from allergy, alternative methods of prevention and treatment are sought. The aim of this paper is to present the possibilities of probiotics in the prevention and treatment of allergic diseases. Probiotics are live microorganisms belonging mainly to the lactic acid bacteria. They modify the microflora of the human digestive system, especially the intestinal microflora. Prophylactic administration of probiotics in the early stages of life (naturally in breast milk or milk substitute synthetic compounds) is very important because intestinal microflora plays a huge role in the development of the immune system. Prevention of allergies as early as in the prenatal and postnatal periods provides huge opportunities for inhibiting the growing problem of allergy in emerging and highly developed societies. Effects of probiotic therapy depend on many factors such as the species of the microorganism used, the dose size and characteristics of the bacteria such as viability and capacity of adhesion to the intestinal walls. Authors of several studies showed beneficial effects of probiotics in the perinatal period, infancy, and also in adults in the prevention of atopic dermatitis or allergic rhinitis. Probiotics, due to their immunomodulatory properties and safety of use are a good, natural alternative for the prevention and treatment of many diseases including allergies. It is therefore important to explore the knowledge about their use and to carry out further clinical trials.

Dermoscopy of accessory nipples in authors' own study.

INTRODUCTION: The accessory nipple (AN) is characterised by its network-like structures, which may suggest the diagnosis of a melanocytic lesion. The knowledge about additional dermoscopic features of AN may greatly minimise the risk of unnecessary surgical excisions. AIM: To analyse and present different clinical and dermoscopic forms, in which the AN may appear. MATERIAL AND METHODS: Ninety AN with dermoscopic features were evaluated in the study, detected in 14 patients between the years 2008 and 2014. RESULTS: The most common dermoscopic features of the AN were central, scar-like areas (15/19) and peripheral network-like structures (12/19). A number of cleft-like appearances (8/19) and central network-like structures (7/19) had also been observed. Moreover, among the dermoscopic features, white cobblestone-like structures (7/19), a central round dimpling with a plug (6/19) and fisheye-like structures resembling comedo-like openings (9/19) have all also been noted. There is a statistical significance in the occurrence of white cobblestone-like structures with central network-like structures (Fisher's exact test p = 0.0449). The presence of peripheral network-like structures with the occurrence of central scar-like areas was statistically highly significant (p = 0.0091). The central round dimpling was never observed alongside any central network-like structures in any of the lesions (p = 0.0436). CONCLUSIONS: Accessory nipples are most commonly characterised by the occurrence of a peripheral network-like structure accompanied by the presence of a scar-like area.

Analysis of selected recurrence risk factors after treatment of head and neck basal cell carcinoma.

INTRODUCTION: Basal cell carcinoma (BCC) is the most common type of non-melanoma malignant skin tumors. Eighty-five percent of all cases are located on the skin of the head and neck. The risk of recurrence after surgery is estimated at 5-15%. AIM: To evaluate the selected risk factors for recurrence after surgical treatment of head and neck BCC at the Department of Head and Neck Surgery in the Greater Poland Cancer Centre of the Poznan University of Medical Sciences. MATERIAL AND METHODS: A retrospective analysis was made of patients treated at the Department of Head and Neck Surgery in the Greater Poland Cancer Centre of the Poznan University of Medical Sciences in 2007-2012 for BCC of the head and neck region. The study covered 312 patients: 198 males (63%) and 114 females (37%), aged 32-96 years. RESULTS: In the study group of 312 tumors, recurrence after initial treatment in this Centre was diagnosed in 18 patients (9%), whereas in patients who were previously operated elsewhere, recurrence was found in 22 cases (17%). The nodular type was the most common BCC type in the study group and concerned 175 patients (56%). The most numerous group (114; 37%) in this study group comprised patients with external nose and cheek tumors. CONCLUSIONS: The importance of preoperative biopsy to assess the histological type as a routine treatment of patients with BCC is essential. Ultrasound evaluation to assess the exact size and depth of tumor invasion should also be implemented.

Diagnostics in mycosis fungoides and Sezary syndrome.

AIM: The aim of this paper was to present diagnostic methods helping in the recognition of mycosis fungoides (MF) and Sezary syndrome (SS). BACKGROUND: Mycosis fungoides is the most common form of primary cutaneous T-cell lymphomas. It is characterized by a distinctive long-term course and malignant T-cell proliferation. MF diagnosis is not easy, mainly due to the atypical clinical presentation of the disease at an early stage. MATERIALS AND METHODS: Low specific changes, which can be observed at the histopathological examination. Initially, the skin lesions may resemble psoriasis, atopic dermatitis or chronic eczema. Patients are qualified according to the available, and generally accepted WHO-EORTC classification, based on a combination of clinical and histopathological markers. From a clinical point of view, it is also important to carry out the qualification according to the TNMB assessment, which allows to specify the stage of the disease, and is helpful in the monitoring of the course of disease and therapeutic effects. RESULTS: In this paper we try to present currently available diagnostic methods. CONCLUSION: Diagnosis of MF and SS still causes many problems due to less characteristic changes in the early stage of disease and requires wide interdisciplinary knowledge.

Comparison between high-frequency ultrasonography (Dermascan C, version 3) and histopathology in atopic dermatitis.

BACKGROUND: The main purpose of this study was the exact comparison of B-scan images obtained from 16 patients suffering from AD with histological. METHODS: Sixteen patients diagnosed with AD aged between 14 and 57 years, were chosen for the study. In all patients before the introduction of proper treatment regimen, the high frequency skin ultrasonography (Derma Scan Cortex Technology, version 3, Hadsund, Germany) has been performed and then a 5 mm wide punch biopsies have been taken from the area of scanned lesions. Control group consisted of 15 healthy individuals without any signs of atopic and chronic diseases. RESULTS: There was 7.8 ± 0.4% mean skin echogenicity from lesional antecubital skin in AD patients (min value 7.2%, max value 8.5%). The skin hypoechoic band was detected in fifteen out of sixteen patients (93.7%). There were statistically significant correlations between the hypoechoic band thickness and the following parameters: degree of epidermal hyperplasia, the degree of epidermal hyperkeratosis, the degree of parakeratosis and the degree of spongiosis as well as the intensity of inflammatory infiltrates. Skin echogenicity strongly correlated negatively with the intensity of inflammatory infiltrates. CONCLUSION: On the basis of analysis of 16 specimens we can conclude that all pathological changes of AD influence ultrasound image and in addition, the USG picture depends on the phase of disease process.

"Assessment of chronic sclerodermoid Graft-versus-Host Disease patients, using 20 MHz high-frequency ultrasonography and cutometer methods".

The development of an adverse graft-versus-host disease (GvHD) is a major complication of stem cell transplantations, which are widely used to cure increasing number of hematologic malignancies. Patients with chronic GvHD are at risk of joint contractures secondary to sclerodermatous skin changes. Several clinical scores or serologic markers have been used to assess skin sclerosis in scleroderma patients. Evaluation of sclerotic skin changes using biometric tools remains to be challenging. The purpose of this study was to illustrate and exemplify ultrasound measurement and measurement of skin elasticity of five chronic sclerodermoid GvHD patients. There is still a substantial lack of studies using objective and non-invasive methods helpful in assessment of patients with skin involvement of GvHD. Although ultrasound is not the ideal method, it is worth emphasizing that it is still useful, non-invasive, and repeatable device in monitoring patients suffering from GvHD. It should also be added, that it seems to be advisable to repeat USG examination at an interval of 3 months after the treatment. In addition, skin echogenicity may be a more sensitive parameter than skin thickness in assessment of cGvHD patients.

[Selected vulvar dermatoses]. / Wybrane dermatozy sromu.

Numerous cutaneous lesions are located in the region of the female genital organs, occasionally presenting a diagnostic and therapeutic challenge. The most common cases include: eczema vulvae, lichen simplex chronius, lichen sclerosus et atrophicus or lichen planus. Clinical presentation of these lesions is not always characteristic for certain dermatoses. Thus, it is important to conduct proper tests, including histopathological or contact allergy examination. Only thorough diagnostics allows to implement correct therapy. This paper shows a detailed description of dermal lesions located in the region of the female genital organs of the allergic and lichenoid origin, together with the literature review on diagnosis and treatment.

Neurogenic markers of the inflammatory process in atopic dermatitis: relation to the severity and pruritus.

INTRODUCTION: Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease, characterized by eczematous skin lesions and intensive pruritus. Recent studies have shed light on the role of the nervous system in the pathogenesis of AD. It can influence the course of the disease through an altered pattern of cutaneous innervation and abnormal expression of neuropeptides in the lesional skin. AIM: The aim of the study was to evaluate plasma concentrations of the nerve growth factor (NGF), substance P (SP) and vasoactive intestinal peptide (VIP) in AD patients in comparison to two control groups (healthy volunteers and patients suffering from psoriasis). Correlations between plasma levels of evaluated parameters, severity of the disease and selected clinical parameters (skin prick tests, total and antigen specific IgE levels) were also analysed. MATERIAL AND METHODS: Seventy-five patients with AD, 40 patients with psoriasis and 40 healthy volunteers were included into the study. Patients with AD included 52 persons suffering from an extrinsic and 23 from an intrinsic type of the disease. The severity of skin lesions was assessed with SCORAD index. Pruritus was evaluated on the basis of the questionnaire assessing the extent, frequency and intensity of pruritus. Commercial enzyme-linked immunosorbent assays (SP, NGF: R&D Systems; and VIP: Phoenix Pharmaceuticals) were used to assess the neuropeptide and NGF plasma levels. RESULTS: Nerve growth factor and VIP plasma concentrations were significantly higher in AD patients compared to psoriatic patients and healthy subjects. Substance P plasma concentrations were elevated in the extrinsic type of AD and psoriasis comparing to healthy volunteers. There were no statistically significant differences in NGF, SP and VIP plasma concentrations between the extrinsic and intrinsic type of AD. There was also no correlation between plasma levels of evaluated parameters (NGF, SP, VIP) and SCORAD index in both types of AD. However, plasma SP concentration correlated with intensity of pruritus in AD patients. Plasma VIP concentrations correlated with intensity of pruritus in the intrinsic type of AD and with IgE-mediated sensitization to moulds in the extrinsic type of disease. CONCLUSIONS: Our findings confirm that NGF and VIP play a prominent role in atopic inflammatory reactions and may serve as good alternative biomarkers of AD. The results of this study also suggest a similar important role of neuroimmune interactions in both variants of AD. Increased SP plasma concentrations in both AD and psoriasis point to its possible role in modulating immune-mediated inflammation in different chronic inflammatory skin diseases. Moreover, SP and VIP seem to influence the course of AD by increasing pruritus, whereas an elevated plasma VIP level in AD patients may be related to a risk of developing IgE-mediated sensitization to certain airborne allergens.

Co-occurrence of acanthosis nigricans and bladder adenocarcinoma - case report.

Acanthosis nigricans (AN) is characterized by the occurrence of symmetrical velvety hyperpigmented plaques that can be observed in each location on the skin. However, the lesions are most frequently located in the axillary, inguinal and nuchal areas. Primarily, the lesions appear as hyperpigmented focuses which later transform into papillary lesions. There are two forms of the disease - benign and malignant. Malignant AN is considered to represent paraneoplastic syndrome co-occurring with advanced cancer, but as such it is not malignant. This article presents a case of a patient diagnosed with AN and coexisting bladder cancer and discusses the case in the context of available literature.

Transforming growth factor-ß1 in plaque morphea.

INTRODUCTION: Morphea (localized scleroderma) is a rare cutaneous disease characterized by skin fibrosis of unknown pathogenesis. Transforming growth factor-ß (TGF-ß) is a potent profibrotic factor. The role of TGF-ß in morphea remains unclear. AIM: The goal of this study was to estimate the expression level of TGF-ß1 in skin and peripheral blood mononuclear cells as well as the plasma levels of TGF-ß1 in plaque morphea (MEP). MATERIAL AND METHODS: The study involved 20 MEP patients. Three control groups were involved: 1 - plasma: 36 healthy volunteers; 2 - PBMC: 47 healthy volunteers; 3 - skin biopsies: 13 samples collected during mastectomy (breast cancer was not skin involved). The analysis of TGF-ß1 plasma levels was performed with the use an adequate ELISA kit, while real-time polymerase chain reaction was employed for the expression of TGF-ß1 in peripheral blood mononuclear cells (PBMC) and skin. RESULTS: In our study we have not detected differences in TGF-ß 1 expression in PBMC, skin, nor in plasma levels of TGF-ß1 between MEP patients and healthy controls, regardless of disease activity and its duration. CONCLUSIONS: The results of our study contradict the claim of the substantial role of TGF-ß1 in the most common morphea subtype - MEP.

Seemingly healthy skin in atopic dermatitis: observations with the use of high-frequency ultrasonography, preliminary study.

BACKGROUND: Atopic dermatitis (AD) is a chronic, relapsing skin disorder which is strictly determined by the epidermal barrier function. In previous studies, there is conclusive evidence that normal-looking, nonlesional skin presents meaningful barrier function defect and a sub-clinical eczematous skin reaction. AIM: The authors intended to visualize nonlesional AD skin with the use of high frequency ultrasonography to show that the normal-looking, nonlesional skin may present significant abnormalities in USG examination. METHODS: We have performed analysis with the use of high-frequency 20 MHz skin sonography in the cases of 15 AD patients of the Department of Dermatology, Medical University, Poznan, Poland. The clinical score has been evaluated on the basis of W-AZS index and EASI. The results were presented in the form of ultrasonographic images. RESULTS: High frequency ultrasonography revealed an echopoor band within nonlesional skin of six (40%) examined AD patients and in all cases within skin lesions. CONCLUSION: Our results indicate the significant role of skin ultrasonography in the complete clinical evaluation of patients with AD, which may serve as an element in selection of the most appropriate topical treatment. An echopoor band beneath the echo entry within nonlesional skin of some AD patients may reflect subclinical eczematous reaction and the readiness for the development of typical skin lesions. For this purpose, we suggest to name an intact skin in AD as seemingly healthy skin.

Skin hypersensitivity reactions to transdermal therapeutic systems--still an important clinical problem.

Transdermal therapeutic systems (TTS) belong to the widely used methods of drug administration, which allow rate-controlled drug delivery and avoidance of first-pass metabolism in the liver Beside scopolamine, nitroglycerin (glyceryl trinitrate), nicotine, clonidine and fentanyl, also transdermal delivery of sex steroids for hormone replacement therapy and contraception is a well-known and popular method in daily clinical practice. It is estimated that approximately 20% of patients using transdermal estradiol may complain of adverse cutaneous side effects. Most of those reactions are mild or moderate, usually limited to the area of drug application. However, prolonged use may increase the chance of developing sensitization. The purpose of this review is to provide up-to date information on the spectrum of cutaneous reactions caused by TTS and the characteristics of potential contact allergens, including sex hormones. Proper management and prophylactic measures were also included.

[The recurrence of facial basal cell carcinoma in patients treated at the Head and Neck Surgery Ward and Laryngological Oncology Clinic of the Greater Poland Cancer Centre in the years 2007-2010]. / Wznowy raka podstawnokomórkowego (BCC) twarzy w materiale Oddzialu Chirurgii Glowy i Szyi i Onkologii Laryngologicznej Wielkopolskiego Centrum Onkologii w latach 2007-2010.

INTRODUCTION: The incidence of basal-cell carcinomas (BCC) in Europe is estimated at 10 cases per 100,000 people and is continuously increasing. Recurrent cases of BCC tend to have a more aggressive progression. The treatment methods include: conventional surgery, Mohs surgery, laser therapy, cryosurgery, curettage and radiotherapy. The recurrence of basalcell carcinoma depends on the method of treatment and ranges between 4% and 18%. In the case of recurrent BCC the treatment method of choice is margin control surgery. AIM OF THE STUDY: The purpose of this paper is to conduct a retrospective analysis of patients with facial BCC treated with classic surgery and laser therapy as well as to present a strategy for action in the case of recurrence. MATERIAL AND METHODS: The retrospective analysis was conducted on patients with diagnosed facial BCC, treated at the Head and Neck Surgery Ward and Laryngological Oncology Clinic of the Greater Poland Cancer Centre in the years 2007-2010. The research included 58 patients aged 56-80; 34 women and 24 men. RESULTS: Out of 58 patients 8 had recurrent BCC - 4 cases after laser therapy (Group A), and 4 cases after classic surgery (Group B). In 2 cases from Group A and all cases from Group B further treatment involved removal of the recurrent tumour by margin control surgery and skin flap plastic surgery. In 2 remaining cases from Group A further CO(2) laser therapy was performed under local anaesthesia and analgosedation. This type of treatment was chosen due to general medical and cardiological concerns which disqualified the use of general anaesthesia and conventional surgery. So far no further local recurrent cases of BCC have been diagnosed, and the follow-up periods range from 4 to 26 months. CONCLUSION: Recurrent cases of BCC are 10% more frequent in patients treated with cryosurgery or laser therapy without margin control than in patients who had the tumour removed by margin control surgery. Margin control surgery remains the method of choice in cases involving large tumours, recurrence or spread by invasion.

Evaluation of HPV DNA HR assay in females as a marker of recurrent disease following treatment of cervical intraepithelial neoplasia.

AIM: The basic assumption of the prevention of cervical cancer is to early detect and treat CIN (cervical intraepithelial neoplasia) as well as to prevent recurrence of neoplasia after therapy This study involved comparison of the cytology test value and determination of HPV (human papilloma virus) DNA in women treated for CIN so as to find a sensitive and specific marker of disease recurrence. METHODS: A group of 107 females after CIN treatment underwent 14-month follow-up and regular cytological and molecular evaluations. RESULTS: Based on the follow-up data the recurrence of CIN was found in 9 females who despite effective therapy for the entire follow-up period were HPV positive. Evaluation of value of HR (high risk)--HPV DNA assay used to detect CIN showed its 100% sensitivity CONCLUSION: The HR-HPV DNA assay is likely to be a valuable diagnostic tool facilitating more precise detection of recurrent neoplasia risk than cytological test alone.

Management of the stressful stigma attached to sexually transmitted disease (preliminary report).

BACKGROUND: Syphilis and other sexually transmitted diseases may cause some psychological problems and anxiety among the infected patients. OBJECTIVES: The aim of the study was to examine the differences in stress level and stress coping strategies of patients infected with syphilis and healthy controls. Also, the authors aimed at establishing types of strategies to cope with the stigma of sexually transmitted diseases. MATERIAL AND METHODS: The study was a survey of 21 syphilis infected subjects and 21 healthy subjects, paired according to age and gender The respondents used the SRRS questionnaire with some additional questions and the Mental Adjustment to Disease Mini-MAC Scale in Polish adapted version. The latter was given to the syphilis-infected subjects only RESULTS: The syphilis infected subjects experienced more acute stress than the healthy subjects. Most healthy subjects used the active task strategy to cope with stress while the infected subjects (particularly females) chose the escape strategy and the 'waiting out' strategy The infected males preferred an active style of coping with the stigma; among the females, the anxiety style was dominant. CONCLUSIONS: Syphilis is a source of permanent stress and awareness of the possible social consequences is a strong stimulus, prompting the stigma bearer to keep its existence a secret.