[Show abstract][Hide abstract] ABSTRACT: Fungal infections are very commonly occurring diseases in everyday dermatological practice, and knowledge of the wide spectrum of antifungal preparations available nowadays is helpful in almost all medical disciplines. The treatment of fungal infections should be preceded with a proper diagnosis based on the patient's history, precise clinical examination and diagnostic mycological procedures. A correct diagnosis of fungal infection is possible by its confirmation with proper investigations carried out in a mycological laboratory. The main criteria of diagnosis of fungal infection justifying its therapy is isolation and identification of the fungal pathogen from the patient. In the review of the treatment of the fungal infections most commonly occurring in dermatological practice, the best known antifungals currently used in our country, whose usefulness in clinical practice has been confirmed by long-term observations, are presented. We hope that the presented treatment proposals of the most commonly occurring superficial fungal infections will be helpful in everyday medical practice.
No preview · Article · Aug 2015 · Przegla̧d dermatologiczny
[Show abstract][Hide abstract] ABSTRACT: The E318K mutation in the MITF gene has been associated with a high risk of melanoma, renal cell carcinoma, and pancreatic cancer; the risk of other cancers has not been evaluated so far. Herein, we examined the possible association of E318K and a novel variant of the MITF gene, V320I, with the risk of cancers of different sites of origin in a Polish population. We assayed for the presence of the E318K and V320I missense mutations in 4,226 patients with one of six various cancers (melanoma or cancer of the kidney, lung, prostate, colon, or breast) and 2,114 controls from Poland. The E318K mutation was detected in 4 of 2,114 participants (0.19%) in the Polish control population, the V320I in 3 of 2,114 participants (0.14%) in the control group. We found no statistically significant differences in the prevalence of the E318K and V320I variants among cases and controls. We found two carriers of the E318K variant among melanoma patients (P = 0.95), one carrier among breast cancer patients (P = 0.77), one carrier among colorectal cancer patients (P = 0.82), and one carrier among kidney cancer patients (P = 0.64). Our study demonstrates a lack of strong association of E318K and V320I with increased risk of melanoma or cancers of the kidney, breast, prostate, lung, or colon.
[Show abstract][Hide abstract] ABSTRACT: The Schimmelpenning-Feuerstein-Mims (SFM) syndrome is a rare phakomatosis which comprises a nevus sebaceous of Jadassohn, seizures and developmental delay associated with a wide spectrum of extracutaneous abnormalities including neurological, skeletal, ocular, cardiovascular and urogenital defects. We are presenting a case of an 18-year-old patient with systemic features of the SFM syndrome and an extensive linear nevus sebaceous partially removed with a carbon dioxide (CO2) laser. The treatment options of skin lesions in patients with SFM are discussed.
Preview · Article · Oct 2013 · Postepy Dermatologii I Alergologii
[Show abstract][Hide abstract] ABSTRACT: Psoriasis vulgaris is a genetically heterogenous disease with unclear molecular background. We assessed the association of psoriasis and its main clinical phenotypes with common variants of three potential psoriasis susceptibility genes: ZNF750, RPTOR and TRAF31P2. We genotyped 10 common variants in a cohort of 1,034 case-control individuals using Taqman genotyping assays and sequencing. Minor alleles of all four TRAF3IP2 variants were more frequent among cases. The strongest, significant association was observed for rs33980500 (OR = 2.5, p = 0.01790). Minor allele of this SNP was always present in two haplotypes found to be associated with increased psoriasis risk: rs13196377_G + rs13190932_G + rs33980500_T + rs13210247_A (OR = 2.7, p = 0.0054) and rs13196377_A + rs13190932_A + rs33980500_T + rs13210247_G (OR = 1.8, p = 0.0008). Analyses of clinically relevant phenotypes revealed association of rs33980500 with pustular psoriasis (OR = 1.2, p = 0.0109). We observed significant connection of severity of cutaneous disease with variation at rs13190932 and suggestive with three remaining TRAF3IP2 SNPs. Another positive associations were found between age of onset and familial aggregation of disease: smoking and younger age of onset, smoking and occurrence of pustular psoriasis, nail involvement and arthropatic psoriasis, nail involvement and more severe course of psoriasis. We found no statistically significant differences in the prevalence of the examined variants of RPTOR and ZNF750 genes among our cases and controls. We have replicated the association of TRAF3IP2-_rs33980500 variant with the susceptibility to psoriasis. We have found new associations with clinically relevant subphenotypes such as pustular psoriasis or moderate-to-severe cases. We ascertain no connection of RPTOR and ZNF750 variants with psoriasis or its subphenotypes.
Preview · Article · Sep 2013 · Archives for Dermatological Research
[Show abstract][Hide abstract] ABSTRACT: Follow-up studies of psoriasis patients indicate an increased risk in the occurrence of malignancies at different sites of origin. Population stratification and/or complicated interpretation of evidence on the risk of cancer (due to the small number of patients included in most series) lead to inconsistent data. Herein we investigated the risk of occurrence of malignancies at different sites of origin in a series of 517 psoriasis patients and their 1st degree relatives.
We evaluated the tumour spectrum as well as the age of the patient at diagnosis of cancers in psoriasis families along with the observed and expected frequencies of malignancies. The distribution of 17 common mutations/polymorphisms in 10 known cancer susceptibility genes among psoriasis patients and 517 matched healthy controls were examined. No such study has been published to date.
The statistical comparison of the observed and expected frequencies of cancers revealed a higher than expected occurrence of Hodgkin's lymphoma among males in psoriasis families when compared to the general population (OR=1.8, 95%CI 1.6-2.1, p=0.002). There was a non-significant tendency towards a younger age of onset and overrepresentation of laryngeal cancer and leukaemia in psoriasis families. We found no major differences in the distribution of cancer susceptibility mutations among our cases and the healthy controls.
The results of our study suggest an increased risk of Hodgkin's lymphoma for male members of psoriasis families. Further studies are needed to confirm the findings and to evaluate whether or not the application of cancer surveillance protocols for Hodgkin's lymphoma, leukaemia and laryngeal cancer are justified in these families.
Preview · Article · Jun 2013 · Hereditary Cancer in Clinical Practice
[Show abstract][Hide abstract] ABSTRACT: Introduction: Laser procedures are being commonly performed in dermatological practice. Ablative fractional lasers are used in therapy of photoaging, pigmentary disorders, teleangiectases, acne scarring, hypertrophic and atrophic scars, keloids and striae. Aim of the study: Presentation of therapeutic possibilities of CO2 fractional laser application in dermatological practice based on the own experience and the literature data available in medical databases. Material and methods: The survey comprised 117 people, in whom one or more CO2 fractional laser procedures were performed due to the various dermatological indications. All procedures were performed with the use of eCO2™ Premium, Lutronic fractional laser. The choice of parameters depended on the indications, severity of skin lesions and individual characteristics of the patients, including the age and skin phototype. Results: In the group of 117 patients 169 laser procedures were performed, in 37 patients more than one treatment was carried out. The main indications to the procedure included photoaging and acne scars. Side effects of the laser therapy depended on the chosen parameters - the power and energy density of a laser beam. No late side effects, including pigmentary disorders and scarring were observed. In patients treated due to hypertrophic scars and keloids no exacerbations of disease activity were observed. Conclusions: 1. Photoaging and acne scars are the most common indications for the treatment with fractional CO2 laser. 2. This therapy is currently the most effective method of skin rejuvenating and removal of acne scars, improving skin condition even after one procedure. 3. The own observations and literature data confirm the effectiveness, safety and low risk of complications of ablative fractional laser therapy, therefore it remains the method of choice in the treatment of deep wrinkles, symptoms of photoaging and scars.
No preview · Article · Jan 2013 · Dermatologia Kliniczna
[Show abstract][Hide abstract] ABSTRACT: Introduction: The lipophilic yeast - like fungi of genus Malassezia comprise a part of physiologic microbiota of human skin, however they can be an infectious pathogen of various dermatological diseases. Aim of the study: Evaluation of the activity of hydrolytic enzymes produced by Malassezia spp. isolated from diseased and clinically healthy skin in patients with seborrheic dermatitis, pityriasis versicolor, acne vulgaris and from healthy controls. Material and methods: The investigation comprised of 133 people - 102 patients with seborrheic dermatitis, pityriasis versicolor and acne vulgaris and 31 healthy controls, in whom a mycological examination was performed in order to isolate Malassezia fungi from the skin. Activity of 19 hydrolytic enzymes produced by isolated fungi was assessed using API ZYM® system (bioMérieux). Results: Statistically significant differences in the enzymatic activity between particular Malassezia species were proved. Fungi isolated from areas of diseased skin in patients with seborrheic dermatitis showed significantly higher activity of secreted hydrolytic enzymes in comparison to fungi isolated from clinically healthy skin. Statistically significant differences in esterase lipase (C8) activity between isolates from skin lesions in seborrheic dermatitis and fungi from clinically healthy skin in the same patients were confirmed for two most often isolated species: Malassezia globosa and Malassezia sympodialis. Considerable disparities in activity of the other enzymes of Malassezia globosa and Malassezia sympodialis isolated from patients with seborrheic dermatitis in comparison to enzymatic activity of fungi isolated from healthy controls were certified. These differences were related to esterase (C4) and alcalic phosphatase activity of M. globosa and esterase (C4), esterase lipase (C8) and leucine arylamidase activity of M. sympodialis. Conclusions: Enzymatic activity of isolated with the highest frequency species: M. globosa and M. sympodialis is diverse and may be a significant factor determining clinical manifestation of disease symptoms in the course of seborrheic dermatitis.
No preview · Article · Jan 2013 · Mikologia Lekarska
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Psoriasis is a chronic inflammatory dermatosis leading to the development of systemic inflammatory reaction. Previous data indicated the coexistence of psoriasis and the occurrence of metabolic disorders, with the common background of both processes determined by a chronic inflammation. The coexisting disorders, including type 2 diabetes, hypertension, heart ischemic disease, dislipidemia and obesity may have an important impact on intensity of psoriasis activity.
Material and methods:
The analysis comprised of 82 randomly matched patients with various clinical forms of psoriasis, aged 17 to 81 years. In patients PASI and BSA indexes, BMI value and laboratory parameters of metabolic status (glucose and ureic acid levels, lipid fractions and CRP level in the serum) were evaluated.
An average age in examined group was 54,3 years, an average time of presence of psoriasis symptoms was approximately 20 years. An average PASI value was 21,4; an average BSA value was 39.7%. The coexistence of type 2 diabetes was found in 14.6% of patients, hypertension in 42.7% and heart ischemic disease in 17%. Particularly large group of examined patients comprised persons with overweight (34.1%) and obesity (30.5%). Positive correlation between BSA and body weight, BSA and BMI value, BSA and abdominal circumference as well as positive correlation between PASI and body weight, PASI and BMI value, PASI and abdominal circumference were observed. Abnormal serum glucose levels were observed in 19.5% persons, ureic acid level in 2.9%, total cholesterol in 37.8% LDL cholesterol in 48.8%, and HDL cholesterol in 46.3%. CRP level was elevated in 43.9% patients. Positive correlation between BSA and ureic acid level, as well as PASI and ureic acid level was estimated. No correlation between PASI and the other laboratory parameters was found.
The occurrence of metabolic syndrome is more common in patients with psoriasis in comparison to the general population. The extent and severity of psoriatic lesions correlate with high body weight, BMI and the level of ureic acid.
No preview · Article · Jan 2013 · Annales Academiae Medicae Stetinensis
[Show abstract][Hide abstract] ABSTRACT: Xeroderma pigmentosum is a rare autosomal recessive disease that is associated with a severe deficiency in nucleotide excision repair. The presence of a distinct the nucleotide excision repair (NER) mutation signature in melanoma suggests that perturbations in this critical repair process are likely to be involved with disease risk. We hypothesized that persons with polymorphic NER gene(s) are likely to have reduced NER activity and are consequently at an increased risk of melanoma development. We assessed the association between 94 SNPs within seven XP genes (XPA–XPG) and the melanoma risk in the Polish population. We genotyped 714 unselected melanoma patients and 1,841 healthy adults to determine if there were any polymorphisms differentially represented in the disease group. We found that a significantly decreased risk of melanoma was associated with the Xeroderma pigmentosum complementation (XPC) rs2228000_CT genotype (odds ratio [OR] = 0.15; p p XPC revealed the rs2228001_A + G1475A_G + G2061A_A + rs2228000_T + rs3731062_C haplotype (OR = 0.26; p XPD) showed a modest association between two haplotypes and a decrease in melanoma risk. There were no major differences between the prevalence of the XP polymorphisms among young or older patients with melanoma. Linkage disequilibrium of XPC: rs2228001, G1475A, G2061A, rs2228000 and rs3731062 was found. The data from our study support the notion that only XPC and XPD genes are associated with melanoma susceptibility.
No preview · Article · Jan 2013 · International Journal of Cancer
[Show abstract][Hide abstract] ABSTRACT: The case of a 62-year-old female patient diagnosed with an extremely rare clinical variant of pemphigoid--nodular pemphigoid, imitating prurigo nodularis, is presented in the paper. In connection with the existence of the typical prurigo nodularis-like appearance in the patient, the diagnosis was maintained for several months. However, because of no response to the treatment and the remarkably chronic course of the disease, the patient was admitted to the Department in order to extend the diagnostics and verify the previous diagnosis. The direct and indirect immunofluorescence examinations performed on the patient enabled the final diagnosis of a rare variant of pemphigoid without typical blisters, and effective treatment was carried out.
No preview · Article · Jan 2013 · Annales Academiae Medicae Stetinensis
[Show abstract][Hide abstract] ABSTRACT: Scabies, caused by mite Sarcoptes scabiei var. hominis, is one of the most common parasitic skin diseases. Classic manifestations of scabies include highly itch papular eruption, involving interdigital webs of hands, skin folds and flexure creases. The disease affects all age and social groups, although its prevalence vary in different countries and regions of the world. New IUSTI/WHO guidelines reflect significant progress made both in diagnostics and treatment of the disease over the last decades. Epidemiology, variety of clinical presentation, possible complications, as well as modern diagnostic and treatment methods were described in our article.
No preview · Article · Jan 2013 · Dermatologia Kliniczna
[Show abstract][Hide abstract] ABSTRACT: Matrix metalloproteinases (MMPs) are implicated in the development of cancers including malignant melanoma (MM) and breast cancer. We tested the possible association of MMP1 and MMP8 gene variation with these two types of cancer. We genotyped 300 unselected patients with MM, 300 consecutive breast cancer cases, 300 controls for melanoma, and 300 controls for breast cancer (age-matched and sex-matched healthy adults with negative cancer family histories). Our study showed that the MMP8 gene rs11225395 polymorphism was associated with the risk of developing MM (odds ratio: 1.69; 95% confidence interval: 1.02-2.80; P=0.040) for the A/A genotype and 1.49 (95% confidence interval: 1.03-2.17; P=0.035) for the A/G genotype compared with the G/G genotype. The A allele was over-represented among MM cases compared with controls (odds ratio=1.54; P=0.017). In-vitro assays showed that the A allele had a higher promoter activity than the G allele in melanoma cells. No association was detected between this variant and breast cancer susceptibility. We found no strong association between MMP1 variation and the risk of MM or breast cancer. The finding of this study indicates an influence of MMP8 gene variation on melanoma susceptibility.
No preview · Article · Jun 2011 · Melanoma research
[Show abstract][Hide abstract] ABSTRACT: Antimalarial drugs--chloroquine, hydroxychloroquine and quinacrine, initially devised for the treatment of malaria, have been used in the therapy of diverse skin diseases, including lupus erythematosus, dermatomyositis, porphyria cutanea tarda, and sarcoidosis. The mechanism of action of these drugs involves stabilization of lysosomal enzymes, inhibition of antigen-presenting cells and T lymphocyte stimulation, blocking of the pro-inflammatory cytokine cascade and endosomal toll-like receptor signaling. The understanding of potential mechanisms of action of antimalarials may extend their use to new areas in dermatology. This work describes the pharmacologic properties of antimalarial drugs and indications for their use in clinical practice. Moreover, the most important limitations of therapy with antimalarials and their adverse side effects are discussed.
No preview · Article · Jan 2011 · Annales Academiae Medicae Stetinensis
[Show abstract][Hide abstract] ABSTRACT: Vitiligo is an idiopathic chronic skin disease that is notable for depigmented macules forming by destruction of melanocytes mediated by cells of the immune system. Vitiligo occurs in 1-2% of the population irrespective of race and without predilection to gender or age. The dynamics and extent of the disease vary widely, ranging from stable cases with isolated minor foci to states showing rapid progression and occupying large areas of the skin. For many patients, the disease represents a serious cosmetic defect which limits their activities in various spheres of life. There are many noninvasive methods of treatment but none of them offers a guarantee of complete therapeutic success. PUVA- and UVB-therapy are recognized as the most effective and most commonly used methods. The management of vitiligo should also include education, cosmetic correction options, and psychotherapy in some cases.
No preview · Article · Jan 2011 · Annales Academiae Medicae Stetinensis
[Show abstract][Hide abstract] ABSTRACT: Malignant melanoma (MM) represents one of the most aggressive neoplasms and its frequency is rapidly increasing. Familial aggregations of this malignancy are present in around 3-15% of all cases. CDKN2A is the major "high-risk" MM susceptibility gene. Recently new selection criteria for CDKN2A genetic assessment of patients - the so-called mnemonic "guideline of three" - have been proposed: 1) individuals with three or more primary melanomas, 2) three or more melanomas among first or second degree relatives, 3) presence of three or more cases of melanoma and/or pancreatic cancer on the same side of the family. In the Polish population a common CDKN2A variant (A148T) significantly increases melanoma risk regardless of the cancer family history. A recent multi-centre genome-wide association study identified three loci strongly associated with melanoma risk: 16q24, 11q14-q21, 9p21. The list of mutations/polymorphisms which are believed to be associated with moderate MM risk includes: Lys751Gln-CC/Gly156Gly-CC of the XPD gene; R151C, V60L, R160C, R163Q of the MC1R gene; N991D of the BRCA2 gene and haplotype rs731236-A + rs1544410-T of the VDR gene. Appropriate management may reduce morbidity and mortality. Genetic testing and clinical evaluation should be performed, and family history should be obtained in all patients affected with MM, including those with apparently sporadic tumours.
[Show abstract][Hide abstract] ABSTRACT: Acrodermatitis enteropathica is a rare, autosomal recessive disorder proceeding with hypozincemia. Characteristic erythematous, scaly plaques are localized on periorificial and acral areas. Skin lesions are often accompanied by diarrhea, alopecia and rarely with emotional or neurological disturbances. The disease is a result of mutation in the SLC39A4 gene which encodes a zinc-regulated transporter-like protein ZIP4. Zinc as a component of many enzymes effects the course of metabolic processes, especially the structural protein synthesis and hormones and a proper function of the immune system. The characteristic clinical picture in relation to the decreased level of zinc and alkaline phosphatase in serum and histopathological examination of skin biopsy enables for the final diagnosis of acrodermatitis enteropathica. The treatment of acrodermatitis enteropathica is a long-lasting process but leads to the rapid and radical improvement of the patient's condition. A case of twelve-year-old girl with recognized acrodermatitis enteropathica in childhood, in which regularly occurring aggravations of skin lesions despite a solid oral zinc supplementation were observed, is reported in the article. Due to insufficient therapeutic effect an intravenous injections of a solution of trace elements containing zinc chloride were administered. After each supplementation of a drug a remission lasting about two to three weeks was observed.
No preview · Article · Jan 2011 · Dermatologia Kliniczna
[Show abstract][Hide abstract] ABSTRACT: In nails various pathological changes caused by infectious agents are very often observed. Among infections of nails the most commonly occurring are those caused by fungi, which might represent up to 50% of all nail disorders, and due to the anxiety of onychomycosis, patients with nail changes report to see a dermatologist. Dermatophyte onychomycosis is definitely the most frequent fungal nail infection. Onychomycoses caused by yeasts of Candida genus occur rarely. Among onychomycoses caused by moulds in Central Europe, infections of the toe nails are caused almost exclusively by the mould Scopulariopsis brevicaulis. In nails bacterial infections caused mainly by Staphylococcus aureus, Pseudomonas aeruginosa and warts caused by HPV (human papilloma virus) may also be observed. Infections of nails may develop in previously unchanged nail plates, as well as in the course of other noninfectious nail disorders. Most commonly they affect nails changed by psoriasis, lichen planus and trauma. With regard to the frequent similarity of the clinical picture of different infectious and non-infectious nail disorders, and also coexistence of infectious changes and already existing nail diseases, it is very important to perform proper diagnostic examinations before starting a therapy.