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Introduction: Darier’s disease (DD) is a rare autosomal dominant genodermatosis characterized by hyperkeratotic papules, primarily located on seborrheic areas as well as with palmoplantar, nail or oral mucosa involvement. The course of the disease is chronic with the possible occurrence of coinfection, most commonly with the herpes simplex virus. Each new infection can significantly intensify the symptoms. Case description: A 42-year-old patient presented with a prolonged history of undiagnosed brownish-grey papules on the limbs and trunk, worsening in the summer was admitted to the dermatology department, to diagnose and treat the one-week history of skin lesions on his arms, chest, and neck, and partially face. Lesions were more intensified on the left side, initially displaying as intense erythema, then covered with multiple papules and grouped vesicles, accompanied by a burning sensation and fever. Laboratory tests showed elevated inflammatory markers. Ultrasonography revealed oedema of the subcutaneous tissue and enlarged cervical lymph nodes on the left side. In the blood culture methicillin-resistant Staphylococcus Aureus (MRSA) was detected. Systemic intravenous treatment with antibiotics and acyclovir resulted in slow clinical improvement with normalization in laboratory tests. Histopathological examination in correlation with the clinical data suggested a Poxviridae infection along with a typical Darier’s disease picture. Conclusions: Darier’s disease, particularly when complicated by cutaneous viral infections, may be misleading, as seen in this case. Eczema herpeticum, eczema vaccinatum, or other pox-zoonoses may explain the severe course observed. The histopathological examination is crucial for accurate diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Urticaria is a heterogeneous disease which affects nearly 1 in 5 individuals in their lifetime and significantly worsens the quality of life. The aim of this study is a five-year retrospective analysis of epidemiological and clinical aspects of patients hospitalized for urticarial. Material and methods: Analysis of medical records of patients hospitalized for urticaria at the department of dermatology. The clinical and epidemiological data were analysed and compared to a control group composed of 137 healthy individuals’ body mass index (BMI) and sex-matched. Statistical analysis was performed using the chi-square test, a statistically significant difference was at p < 0.05. Results: In the analysed period 137 patients were hospitalized for urticaria, 93 females (68%) and 44 males (32%), with mean age 48.53. Thirty-eight per cent of patients have been previously diagnosed with an allergy. Over 60% of patients (60 women, 18 men) suffered from acute and 38% from chronic urticaria. A causal factor was identified in 62% of all cases, the most common were drugs (48%). Urticaria patients had significantly higher levels of C-reactive protein (CRP), neutrophils and glucose than controls (all p < 0.05). The patients were treated with antihistamines (94%), glucocorticosteroids (81%), and one patient was classified for omalizumab treatment. Conclusions: Urticaria still poses a challenge as the cause often remains unknown which highlights the need for novel diagnostic methods and interdisciplinary treatment. Recommended treatment includes antihistamines but among patients with chronic, treatment-resistant urticaria omalizumab should be considered. [ABSTRACT FROM AUTHOR]

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Psoriasis is one of the most common dermatoses worldwide. It is a chronic, immunologically mediated, inflammatory disease associated with the polygenic predisposition and stimulated by environmental factors. The most characteristic skin lesions include well-demarcated, erythematous plaques with silvery-white scales. Psoriasis is often misdiagnosed with other skin conditions, particularly dermatitis and fungal infections. Their coexistence is also possible. We present a case of a 23-year-old patient with a history of recurrent skin lesions with accompanying mild pruritus. The first lesions were diagnosed as allergic dermatitis and successfully treated with topical steroids several times. Three years after the first episode, the exacerbation of skin lesions resistant to previous treatment occurred. The direct mycological examination was positive. Fungal cultures indicated Trichophyton verrucosum and Candida spp. The patient was treated systemically with terbinafine and topical ciclopirox olamine. Although clinical improvement was achieved after a few weeks, still partial activity with papules within the residual lesions remained. The performed skin biopsy ruled out fungal infection and pointed to psoriasis. The antipsoriatic treatment resulted in remission. [ABSTRACT FROM AUTHOR]

Objective: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a well- known risk factor of atherosclerotic vascular diseases which are common comorbidities in psoriasis. The aim of this study was to evaluate serum Lp-PLA2 level in psoriatic patients and elucidate possible associations with disease activity, metabolic or inflammatory parameters and systemic treatment. Methods: We enrolled 33 patients with active plaque-type psoriasis and 11 healthy controls. Blood samples were collected before and after 3 months of systemic treatment with acitretin or methotrexate. Serum Lp-PLA2 level were evaluated by enzyme-linked immunosorbent assay. Results: Serum Lp-PLA2 level in patients with psoriasis did not statistically differ comparing to the control group (p =.2). However, in patients with severe psoriasis Lp-PLA2 was significantly higher than in the controls before and after treatment (p =.03, p =.01, respectively). The lipase did not correlate with BMI (p =.22); however, a statistical significance was noted between psoriatics with obesity compared to the controls (p =.03). No significant effect of systemic treatment combined (p =.5) nor separately with acitretin (p =.5) or methotrexate (p =.1) on the Lp-PLA2 level was found, despite clinical improvement. Conclusion: Lp-PLA2 assay might be helpful in assessment of the risk of cardiometabolic comorbidities development especially in patients with severe psoriasis and obesity. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic inflammatory skin disease that is accompanied by metabolic disturbances and cardio-metabolic disorders. Fatty acids (FAs) might be a link between psoriasis and its comorbidity. The aim of the study was to evaluate serum concentrations of FAs and to investigate their association with the disease activity, markers of inflammation and possible involvement in psoriatic comorbidity: obesity, type 2 diabetes and hypertension. We measured 14 total serum fatty acids content and composition by gas-liquid chromatography and flame-ionization detector after direct in situ transesterification in 85 patients with exacerbated plaque psoriasis and in 32 healthy controls. FAs were grouped according to their biologic properties to saturated FA (SFA), unsaturated FA (UFA), monounsaturated FA (MUFA), n-3 polyunsaturated FA (n-3 PUFA) and n-6 PUFA. Generally, patients characteristic included: Psoriasis Area and Severity Index (PASI), Body Mass Index, inflammatory and biochemical markers, lipid profile and presence of psoriatic comorbidity. We have observed highly abnormal FAs pattern in psoriatic patients both with and without obesity compared to the control group. We have demonstrated association of PASI with low levels of circulating DHA, n-3 PUFA ( p = 0.044 and p = 0.048, respectively) and high percent of MUFA ( p = 0.024) in the non-obese psoriatic group. The SFA/UFA ratio increased with the duration of the disease ( p = 0.03) in all psoriatic patients. These findings indicate abnormal FAs profile in psoriasis which may reflect metabolic disturbances and might play a role in the psoriatic comorbidity. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Fibroblast growth factors 21 and 23 are used as markers of cardiometabolic disorders which are common comorbidities in psoriasis. The study aimed to evaluate the serum level of these factors in psoriatic patients and elucidate the possible interplay between disease activity, metabolic or inflammatory parameters, and systemic treatment. A total of 33 patients with active plaque-type psoriasis and 11 healthy controls were enrolled in the study. Patients were divided into subgroups based on their BMI, disease severity, and treatment. Blood samples were collected at the beginning of the study and after 3 months of systemic treatment with acitretin or methotrexate. Serum FGF21 levels in psoriatic patients were higher versus control group (p < 0.05). FGF21 levels regarding psoriasis activity were significantly increased in all three subgroups compared to the controls (p < 0.05). Regarding FGF23, no significant changes were found beside positive correlation with aspartate transferase (p < 0.05). No significant effect of systemic treatment on FGF21 and FGF23 levels was found. Interestingly, a nearly threefold decrease in FGF21 concentration after acitretin-based treatment was observed (p < 0.05). After methotrexate therapy, FGF21 levels remained unchanged. FGF21 levels might be helpful in prediction of the risk of cardiometabolic comorbidities development especially in patients with severe psoriasis and obesity. [ABSTRACT FROM AUTHOR]