Search

Vitiligo is a chronic disease characterized by the focal damage of melanocytes, which results in formation of discoloured spots on the skin. This disease affects from 0.5% to even 4% of the general population and the first symptoms appear before the patient reaches the age of 30 in majority of cases. The pathogenesis involves genetic and immunological factors, adhesion of melanocytes to the epithelium, as well as metabolic factors related to cellular oxidative stress. Many methods are used in treatment, including pharmacology, surgery or phototherapy. In our review, we have included either the treatment methods for vitiligo that have been used for years, or new, promising methods that could become the leading treatments for this condition in the future.

Acne vulgaris is the most common dermatosis among adolescents, but it can also affect adults. Acne lesions located on the face cause discomfort and lead to impaired quality of life for many patients. Acne is a dermatological condition with multiple causes and clinical manifestations, as well as varying degrees of severity. Dermatological treatment alone does not always bring good therapeutic effects, and occasionally it may result in symptoms of skin irritation. Therefore, using appropriate dermocosmetics is crucial in managing the condition. Dermocosmetics play a potentially important role in minimizing the adverse effects of acne medications, providing a synergistic effect by addressing other acne-causing factors and/or enhancing the efficacy of other treatment modalities, and protecting the skin against the adverse impacts of the exposome. In cases of mild acne, dermocosmetics can be used in monotherapy as an alternative to acne medications or for maintenance therapy. It is also advisable to combine dermocosmetics with topical or systemic therapies to achieve a synergistic effect or to prevent and reduce drug-induced adverse reactions. Dermocosmetics have keratolytic and anti-inflammatory properties, regulate sebum production, and help maintain the balance of the skin’s natural microbiome.

Dermocosmetics (active cosmetics, functional cosmetics, cosmeceuticals) are preparations for external use, supporting pharmacotherapy of skin diseases during the active phase of the disease and in remission. They are also used for healthy skin (preventive) care. Historically, topical skin care products have been divided into cosmetics and drugs, as defined by the Federal Food, Drug and Cosmetic Act of 1938. A cosmetic was defined as ”articles intended to cleanse, care, beautify and improve the appearance of the skin”. Drugs were defined as ”products intended to affect the structure or any function of the body, or products intended for use in the diagnosis, treatment, mitigation, treatment or prevention of human diseases”. Dermocosmetics (cosmeceuticals) remain cosmetics from a legal point of view, but they fill the gap between cosmetics and drugs. These products achieve a cosmetic effect with active substances however are not subject to drug regulations.

The treatment goal in alopecia areata is induction of hair regrowth and halting the progression of the disease. Treatment decisions depend on the severity of the alopecia areata as assessed by the Severity of Alopecia Tool (SALT) or the Alopecia Areata Scale (AAS). In mild alopecia areata, very ultra-high potency topical glucocorticoids and intralesional triamcinolone acetonide are the mainstay of treatment. In moderate to severe alopecia areata, systemic treatment is usually required. Currently, the only drug dedicated for alopecia areata, approved in Europe and the United States is baricitinib. Ritlecitinib, a JAK3/TEC inhibitor is approved in the United States for individuals 12 years of age and older with severe alopecia areata and is expected to be approved in Europe soon. Other systemic medications used in alopecia areata include glucocorticoids, cyclosporine, and methotrexate. Contact immunotherapy may be considered. In alopecia areata, long-maintenance treatment is of substantial significance.

The existence of two types of alopecia areata is suggested (probably genetically different): early-onset, with more severe symptoms, longer disease duration, higher tendency to relapse, often with a positive family history, and late-onset, in which the first symptoms occur after the age of 50, the course is milder and the family history is negative. Alopecia areata may exist in the form of: focal alopecia areata, multifocal alopecia areata, ophiasis, diffuse alopecia areata, alopecia totalis and alopecia universalis. Alopecia areata incognita remains a form with a discussed relationship to alopecia areata. Occasionally hair loss associated with alopecia areata may occur only in locations outside the scalp (e.g. beard, eyebrows, eyelashes, body hair). The diagnosis of alopecia areata can be made on the basis of clinical examination and trichoscopy. There are two main scoring systems for assessing the severity of alopecia areata. This is the Severity of Alopecia Tool (SALT) and the Alopecia Areata Score (AAS), which is also partly based on the SALT assessment. Both scoring systems allow differentiation between mild, moderate, and severe alopecia areata. These assessment results have a direct impact on therapeutic decisions.

Rosacea is a chronic inflammatory skin disease characterised by periods of remission and subsequent relapses typically provoked by environmental factors. Eruptions located on the face are easily visible and may be difficult to conceal, which leads to a decrease in patients’ self-esteem, quality of life, and general well-being. Since the aetiology of rosacea is multifactorial and not entirely understood, and the clinical characteristics and course of the disease are heterogeneous, therapy may be challenging. While a complete cure is not possible, in the majority of cases clinical improvement and long-term remission are satisfying both to the patient and physician. In recent years, the therapeutic approach has been significantly modified. Currently, the focus is placed on the need to personalise the treatment process and adapt it to the patients’ phenotypic characteristics. Combination therapies and new variants of existing topical and systemic drugs are increasingly being recommended. The mainstays of therapy are antiinflammatory agents. Proper skin care – along with the identification and avoidance of factors known to trigger consecutive episodes of rosacea – are also essential.

Abstract This is a report of one of the most serious complications of the cardiac pacemaker implantation ‐ infection of the implanted system. We present the case, which was misdiagnosed at the beginning and after cardiological consultation it was decided to immediately remove the peacemaker and transfer the patient to the Cardiological Department.

Abstract Introduction The aim of the study is to assess the long-term safety and efficacy of hyaluronic acid (HA) administration in correction of facial morphea lesions and to review the literature on the subject. Morphea is a chronic inflammatory disease of the connective tissue which may lead to serious deformations. The lesions located on the face particularly affect patients’ quality of life and self-esteem; thus, there is a demand for safe and effective methods of treatment. Case Presentation The paper presents three female patients aged 16, 17 and 70 with facial morphea lesions who had HA preparation Juvéderm® Voluma or Volux, Vycross® technology, Allergan, injected. One of the patients had additionally fractional ablative CO2 laser (FAL) therapy. Discussion The literature provides reports on successful use of HA, polymethylmethacrylate and poly-l-lactic acid for the correction of facial defects in localized scleroderma. HA is a natural component of the extracellular matrix and it therefore minimizes the probability of immunogenicity. The application technique also plays an important role. On the other hand, FAL therapy leads to the degradation of the abnormal collagen and the induction of normal collagen synthesis. Conclusions HA injection and combination of HA application with FAL are minimally invasive, effective and safe therapeutic options for patients suffering from morphea.

Light is a component of the electromagnetic waves. The electromagnetic wave consists of mutually inducible electrical and magnetic components that generate variable electric field. This then turns into magnetic field, causing alternating current to flow. Electromagnetic waves include radio waves, microwaves, infrared light, visible light, ultraviolet light, X-rays and gamma radiation. The length of these waves determines their properties. An increase in wavelength is accompanied by a decrease in its radiation energy. Dermatological phototherapy uses the following types of light: broadband UVB, narrow-band monochromatic UVB, laser UVB, UVA in combination with psoralens – PUVA, UVA1, visible light, monochromatic light within the visible spectrum: violet, yellow, red, deep red and infrared. Phototherapy and photochemotherapy nowadays uses equipment emitting radiation at the following lengths: UVB 311, UVB 313, UVB 308, UVA 320–400 nm with a peek at 365 nm and 340–400 nm UVA1. In Poland, the most commonly used radiation is UVB 311 and UVA 320–400 mm (mainly with psoralens). Photochemotherapy is a form of treatment by light, in which the effect of ultraviolet in combination with chemical substances acting as photosensitizers (psoralens) is utilized. The term PUVA was introduced in 1974 by Parrish et al. in a publication assessing the results of psoriasis treatment with orally administered 8-methoxypsoralen and whole-body exposure to long-wave UVA radiation. This article contains the recommendations of the Polish Dermatological Society for photoherapy and photochemoterapy in dermatology.

Chronic obstructive pulmonary disease is a chronic inflammation affecting the peripheral airways and pulmonary parenchyma, leading to irreversible and progressive airflow limitation. In recent years attention has been paid to more frequent coexistence with psoriasis. Both diseases are provoked by similar factors, such as smoking, abdominal obesity, lack of physical activity, and concomitance with the metabolic syndrome. In addition, similarities in pathogenesis, regarding the roles of Th1 and Th17 can be found, resulting in an increase in the proinflammatory cytokines levels. Both in psoriasis and chronic obstructive pulmonary disease, an increased activity of proteases produced by neutrophils and adhesion molecules is observed. In addition, neutrophils are an abundant source of inflammation mediators, including reactive oxidants and lipid mediators with chemotactic activity. Awareness of the increased risk of developing chronic obstructive pulmonary disease in psoriatic patients, allows to implement preventive and therapeutic actions such as smoking cessation or treatment of the inflammatory processes.

Incidence of skin cancers is constantly increasing, what constitutes a significant epidemiologic problem of modern medicine. Basal cell carcinoma is the most common neoplasm affecting Caucasians. Histopathological examination is a gold standard that allows for diagnosing skin cancers. The presented recommendations discuss clinical and pathomorphological sub-types of basal cell carcinoma, their dermoscopic features, stage assessment, and methods for treatment as well as prevention of recurrence of this cancer. Surgical excision of the lesion is a basic and preferred therapeutic option. Other non-surgical options show lower treatment efficacy, and thus, should be considered in cases of cancers with low risk of recurrence, when a surgery is contraindicated or impossible.

The clinical, pathological and dermoscopic features, including recommended diagnostic procedures for cutaneous squamous cell carcinoma (SCC) and Merkel cell carcinoma (MCC) are presented. The therapeutic standard for both cancers is surgical removal. In the case of SCC Mohs microsurgery may be performed, with the intraoperative analysis of the completeness of excision. The recommendations also include non-surgical methods of treatment, including systemic therapies used in advanced forms of the disease. The aim of the recommendations is to provide help in choosing the optimal diagnostic and therapeutic options for individual patients with SCC or MCC. These recommendations take into consideration similar documents published by other scientific organizations and expert opinions of the authors.

Vitiligo is an idiopathic chronic dermatosis manifested by depigmented patches of skin due to the loss of normal pigment-producing cells (melanocytes) and pigment (melanin). The disease develops more commonly in genetically predisposed individuals affected by various adverse external and internal factors inducing cellular stress in melanocytes. Cellular stress activates autoimmune and autoinflammatory mechanisms leading to melanocyte destruction. The disorder affects 0.5–4.0% of the world population, with no predilection for either sex. Manifestations can appear at any age, however in more than half of patients vitiligo starts before the age of 20 years. The course of the disease is varied – from stable cases with small isolated vitiligo patches to the rapid progression of lesions resulting in large areas of the skin being affected. There are multiple methods of treating vitiligo including pharmacological and surgical modalities, and phototherapy. Another essential aspect is patient education. Available treatment methods do not always yield the expected therapeutic effect. The Recommendations contain information about the diagnosis of vitiligo, and describe the recommended therapeutic methods.

Syphilis (lues) is a systemic bacterial disease transmitted mainly by sexual contacts and caused by Treponema pallidum subsp. pallidum . Due to its numerous symptoms, including various cutaneous and mucosal manifestations, diagnosis and treatment should be performed by dermatology and venereology experts. The incidence of syphilis has been increasing in the last years and syphilis has become a significant epidemiological problem in contemporary medicine. Contrary to a number of other infectious diseases, etiological agents of syphilis have never been cultured. Thus, diagnostic standards are based on indirect methods, such as serological tests. They are also used for monitoring treatment efficacy. Parenteral penicillin remains the gold standard in therapy of syphilis. Part 2 of recommendations discusses in detail clinical presentation, diagnostics, and treatment of neurosyphilis, syphilis in pregnancy and congenital syphilis.

Syphilis (lues) is a systemic bacterial disease caused by Treponema pallidum subsp. pallidum , which is mainly sexually transmitted or can be acquired by an unborn foetus via the placenta. Due to its numerous symptoms, including various cutaneous and mucosal manifestations, diagnosis and treatment should be performed by dermatology and venereology experts. The incidence of syphilis has been incresing in the last years and syphilis has become a significant epidemiological problem in contemporary medicine. Contrary to a number of other infectious diseases, etiological agents of syphilis have never been cultured. Thus, diagnostic standards are based on indirect methods, such as serological tests. They are also used for monitoring treatment efficacy. Parenteral penicillin remains the gold standard in therapy of syphilis. Part 1 of recommendations discusses in detail the clinical presentation, diagnostics, and treatment of early and late syphilis, excluding central nervous system syphilis and syphilis in pregnancy.

The prevalence of venous leg ulcers (VLUs) differs between 1.5% and 3% in the general population. The challenge in treating VLUs is common recurrence. Moreover, VLUs can be resistant to healing, despite appropriate treatment. In these cases, advanced wound therapies should be considered. The number of new technologies, applied in VLUs treatment, has increased in the last years. These therapies include biophysical interventions such as ultrasound therapy, electrical stimulations, electromagnetic therapy, or phototherapy. Furthermore, stem cell therapies, biologic skin equivalents, platelet-rich plasma therapy, oxygen therapies, anti-TNF therapy, or negative pressure wound therapy are advanced venous ulcer therapeutic methods that may support the standard of care. Medical devices, such as a muscle pump activator, or intermittent pneumatic compression device, may be especially useful for specific subgroups of patients suffering from VLUs. Some of the above-mentioned technologies require broader evidence of clinical efficacy and are still considered experimental therapies in dermatology.

Hidradenitis suppurativa (acne inversa) is a chronic, inflammatory, recurrent, debilitating disease of hair follicles manifested by painful, deepseated, inflamed lesions localized in intertriginous areas. Establishing a correct diagnosis seems straightforward enough, as it is based on clinical criteria, but a comparative analysis of published papers on hidradenitis suppurativa epidemiology easily reveals substantial discrepancies in the estimation of the obtained results for the general population. Data on the prevalence of hidradenitis suppurativa in European countries and in the United States of America differ by up to four orders of magnitude, ranging from 0.00033% to 4.1%. Based on data obtained from the Polish National Health Fund and HS reference centres, the prevalence of hidradenitis suppurativa in Poland was estimated at 0.001%, which classifies hidradenitis suppurativa as a rare disease.

Primary cutaneous lymphomas are a group of rare lymphoproliferative diseases with incompletely understood pathogenesis. They comprise cutaneous T-cell lymphomas, cutaneous B-cell lymphomas and T/NK-cell lymphomas. The aim of the guidelines is to provide physicians with a tool to facilitate the diagnostic and therapeutic process in patients with this group of diseases. The updated recommendations are consistent with the guidelines for haematologists and oncologists, which will enable the unification of diagnostics and therapy conducted by physicians of all specialties. However, it is important to note that therapeutic decisions must be made individually on the basis of the general condition of the patient, history of internal diseases and medicines used, with careful consideration of the potential efficacy and safety profile of the proposed treatment, which may differ from patient to patient.

The nature of fatigue is very complex and involves physiological, psychological and social phenomena at the same time, and the mechanisms leading to occurrence and severity of fatigue are still poorly understood. The condition of chronic inflammation associated with psoriatic arthritis can be regarded as a potential factor affecting development of fatigue. Only a few studies so far have focused on the occurrence of fatigue in psoriatic arthritis. The problem of chronic fatigue is underestimated in everyday clinical practice. Identification and analysis of subjective fatigue components in each patient can provide an objective basis for optimal fatigue treatment in daily practice. This review presents a definition of chronic fatigue and describes mechanisms that may be associated with development of fatigue, highlighting the role of chronic inflammation, selected fatigue measurement methods and relations of fatigue occurrence with clinical aspects of psoriatic arthritis.

By participating in both the recruitment and activation of T lymphocytes, macrophages and neutrophils at the site of psoriatic inflammation, chemokines play an important role in the pathogenesis of psoriasis and, crucially, may be one indicator of the response to the systemic treatment of the disease. As a result of their major involvement in both physiological and pathological processes, both chemokines and their receptors have been identified as possible therapeutic targets. Due to their presence in the inflammatory process, they play a role in the pathogenesis of diseases that often coexist with psoriasis, such as atherosclerosis and psoriatic arthritis. Chemokines, cytokines and adhesion molecules may be biological markers of disease severity in psoriasis. However, the mechanism of inflammation in psoriasis is too complex to select only one marker to monitor the disease process and improvement after treatment. The aim of this review was to summarize previous reports on the role of chemokines in the pathogenesis of psoriasis, its treatment and comorbidities.

Uric acid is a final product of purine metabolism, and its concentration in the blood serum of healthy individuals is 3–7 mg/dl. Hyperuricemia is associated with higher cardiovascular risk, and its prevalence related to nutrition profile is characteristic for highly developed societies. It can lead to the appearance of certain skin lesions. On the other hand, uric acid is an important antioxidant, which is responsible for 2/3 of the antioxidant capacity of the body. In this article, the authors present skin lesions associated with gout (tophi, "miliarial gout", gouty panniculitis) and review the data of the literature and discuss the importance of hyperuricemia in psoriasis. Dermatologists’ awareness and knowledge about hyperuricemia may favor a faster diagnosis of this metabolic disorder based on skin lesions.

Rosacea is a common dermatosis more prevalent in females, significantly impairing quality of life. Currently erythematous, papulo-pustular and phymatous subtypes are distinguished, which do not necessarily represent consecutive stages. Recent findings indicate in the pathogenesis of rosacea the role of the impaired innate immune system and vascular abnormalities. Additionally, the role of genetic and infectious factors is suggested. The therapy of rosacea is directed not only against inflammatory changes but also anti-parasitic. In topical treatment the most commonly used are metronidazole and azelaic acid. Other drugs are topical antibiotics, antiparasitic agents such as ivermectin and preparations directly influencing erythema. In more severe cases tetracyclines or macrolides are used, and in the most severe cases, isotretinoine. As ultraviolet light is a recognized trigger for rosacea, regular sunscreen use is necessary. Also, proper diet is indicated. Presently in the treatment of rosacea more and more techniques using different lights are employed.

Stem cells are capable of self-renewal of their population and differentiation into specialized cells. There are several “niches” in the skin: 1) interfollicular stem cells – responsible for skin regeneration after injury; 2) in the hair follicle as follicular stem cells (“bulge”) and mesenchymal stem cells in the hair bulb and follicular papilla; 3) stem cells of mesodermal origin associated with blood vessels, giving rise to fibroblasts and myofibroblasts; and 4) melanocyte stem cells. Treatment with stem cells of skin diseases is still considered experimental. Intensive research is being carried out on their use in treating dystrophic epidermolysis bullosa, systemic lupus erythematosus, vitiligo, different types of alopecia and ulcers and slow-healing wounds. Stem cells due to their flexibility and ability to differentiate into other specialized cells create the possibility for regenerative medicine.

Skin tags are classified as benign lesions. They occur mainly on the skin of the neck, eyelids, armpits, and groin as pedicles and soft nodules. Their occurrence is associated with obesity, insulin resistance, atherogenic lipidemia, and metabolic syndrome, as well as increased risk of atherosclerosis. In the pathogenesis factors which are impaired in obesity, such as leptin, insulin resistance associated with obesity (IGF-1), androgens and estrogens believed to stimulate the receptors on keratinocytes and fibroblasts to grow, may play a role. In addition, these receptors are stimulated by tryptase released from the mast cells by mechanical injuries. Probably HPV plays a role as a cofactor. The dermatological literature does not provide much information about this subject, so the authors draw attention to the link between the presence of skin tags and the development of metabolic disorders.

Dermatitis herpetiformis (Duhring’s disease) is an autoimmune blistering dermatosis with a characteristic polymorphic, itchy rash. The autoimmune process against transglutaminases (TGs) is connected with asymptomatic or with mild symptoms of gluten-sensitive enteropathy (GSE). The diagnostic approach in DH should rely on clinical evaluation, direct immunofluorescence of perilesional skin and evaluation of serum IgA antibodies with ELISA with one substrate of four substrates from which to choose (tTG, eTG, npG, neo-tTG) using the ELISA method. In cases showing an equivocal clinical-laboratory picture such an approach should be broadened by performing histopathology of lesional skin and examining the HLA DQ2/DQ8 haplotype. Combined treatment with dapsone and a gluten-free diet in individualized combinations is generally the therapeutic method of choice in DH.

Background and objectives: The shared pathogenesis of psoriasis and atherosclerosis may be determined by assaying the levels of endothelial activation molecules. This study aimed at evaluating vascular cell adhesion molecule 1 (VCAM-1) and E-selectin serum concentrations, and atherosclerosis severity in patients with plaque psoriasis. It also aimed to determine the effects of methotrexate/adalimumab treatment for 12 weeks on the plasma levels of the aforementioned molecules. Materials and Methods: The study included 34 psoriasis patients (17 treated with methotrexate and 17 treated with adalimumab) and eight controls. The 10-year risk of a fatal cardiovascular disease, body mass index, Psoriasis Area and Severity Index, and body surface area were calculated for each subject. VCAM-1 and E-selectin levels were determined via an enzyme-linked immunosorbent assay at baseline and after 12 weeks. Results: Baseline E-selectin and VCAM-1 levels were higher in the adalimumab group than in the methotrexate and control groups. VCAM-1 levels decreased in the adalimumab (p = 0.02) and methotrexate groups (p = 0.008), while E-selectin levels decreased in the methotrexate group (p = 0.004). Conclusions: The results indicate a correlation between systemic psoriasis treatment and E-selectin and VCAM-1 plasma concentrations, which may be associated with the risk of cardiovascular disease development.

Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease affecting elderly people, more than 65 years old. Patients aged over 80 are the main group of interest. The incidence of BP has been significantly increasing for the last 15 years in the whole of Europe. The diagnosis of BP is established on the basis of typical clinical features and in vivo bound IgG/C3 along the basement membrane zone, whereas characterization of target antigens for circulating antibodies may be established using tests containing BP antigens, i.e. ELISA test with recombinant NC16a domain of BP180 antigen and BIOCHIP. The goal of therapy of BP is to inhibit development of new lesions, healing the older ones and elimination of pruritus. At present only monotherapy with 0.05% clobetasol propionate cream used topically on the whole body has been proved to be the best for BP patients. Alternative therapies include methotrexate and the combination of tetracycline and nicotinamide. Prednisone, especially in doses higher than 0.5 mg per body weight daily, should be avoided in old patients with comorbidities such as diabetes, hypertension, stroke or osteoporosis. Duration of therapy in general should be around 12 months. Discontinuation of therapy should be considered if clinical remission lasts at least 6 months and the DIF test is negative. Recurrence of pruritus, blisters or erythemas may suggest relapse of BP.

Alopecia is caused by a variety of factors which affect the hair cycle and decrease stem cell activity and hair follicle regeneration capability. This process causes lower self-acceptance, which may result in depression and anxiety. However, an early onset of androgenic alopecia is associated with an increased incidence of the metabolic syndrome and an increased risk of the cardiac ischaemic disease. The ubiquity of alopecia provides an encouragement to seek new, more effective therapies aimed at hair follicle regeneration and neoregeneration. We know that stem cells can be used to regenerate hair in several therapeutic strategies: reversing the pathological mechanisms which contribute to hair loss, regeneration of complete hair follicles from their parts, and neogenesis of hair follicles from a stem cell culture with isolated cells or tissue engineering. Hair transplant has become a conventional treatment technique in androgenic alopecia (micrografts). Although an autologous transplant is regarded as the gold standard, its usability is limited, because of both a limited amount of material and a reduced viability of cells obtained in this way. The new therapeutic options are adipose-derived stem cells and stem cells from Wharton’s jelly. They seem an ideal cell population for use in regenerative medicine because of the absence of immunogenic properties and their ease of obtainment, multipotential character, ease of differentiating into various cell lines, and considerable potential for angiogenesis. In this article, we presented advantages and limitations of using these types of cells in alopecia treatment.

Introduction . Chilblain lupus erythematosus is a chronic form of lupus erythematosus (LE) reported mostly in middle-aged female patients. Its characteristic manifestations are painful erythematous lesions on the acral parts of the body appearing after exposure to cold. Chilblain lupus erythematosus may either precede the development of systemic lupus erythematosus (SLE) or occur after the diagnosis of SLE is established. It can also be an isolated form of lupus erythematosus. There are no well-defined and reported treating approaches in this form of LE. Objective. Presentation of a case of chilblain lupus erythematosus with reference to current therapeutic options. Case report . We report a 44 year-old patient diagnosed with chilblain lupus (according to Mayo Clinic Proposal of Diagnostic Criteria) who over the years fulfilled the American College of Rheumatology (ACR) classification criteria and was diagnosed with SLE. The patient was treated with different medications with no response. Finally a complex therapy with mycophenolate mofetil, methylprednisolone and pentoxifylline during the exacerbation managed to control the symptoms and brought partial improvement. Conclusions . Chilblain lupus may constitute a therapeutic challenge. The reported case suggests that in therapy-resistant cases, a complex treatment with mycophenolate mofetil, methylprednisolone and pentoxifylline during the exacerbation of symptoms might be considered.

Psoriasis is a chronic inflammatory skin disease affecting about 1–3% of the general population. Recent years have seen great development in the treatment of this dermatosis, especially regarding moderate to severe psoriasis. More numerous and more widely available systemic therapies raise new challenges for all physicians treating patients with psoriasis. New questions arise about patients’ follow-up and long-term safety of such therapies. To meet the expectations of Polish dermatologists, we have prepared a second part of guidelines on the treatment of psoriasis, particularly concentrated on the therapy of severe forms of this disease. We hope that our suggestions will be valuable for physicians in their daily clinical practice. However, we would like to underline that every guideline is characterized by some vagueness, and the final decision about diagnosis and therapy should always be made individually for every patient based on the patient’s current clinical status and the most up-to-date scientific literature data.

Nowadays it is known that psoriasis belongs to the group of autoimmune diseases and may coexist with other diseases in this group. Most often patients have psoriatic arthritis, rheumatoid arthritis, inflammatory bowel disease, autoimmune thyroid diseases and multiple sclerosis. The coexistence of these disorders can be a diagnostic and therapeutic problem (there is controversy over the use of corticosteroids). The common pathogenesis is still not explained. We know that the loss of immunotolerance leads to formation of autoreactive Th1 and Th17 lymphocytes which recognize self-antigens and lead to their destruction in the target organ. Some features of immune mechanisms, observed in psoriasis, suggest its autoimmune background. In psoriasis the main role is played by the activation of the axis IL-12/Th1/IFN- and Th17/Il-23. Il-12 probably acts on naive T cells and the Th1 response is initiated. Il-23 maintains the Th1-mediated inflammatory reaction, stimulates maturation and effects of Th17, and maintains a certain amount of memory cells. We also observe dysfunction of Treg cells, which are responsible for the destruction of autoreactive lymphocytes. In addition, psoriatic keratinocytes have increased resistance to apoptosis, which eliminate damaged cells so that they cannot be recognized as a foreign antigen. However, researchers have suggested that initially the polyclonal activation of T lymphocytes is induced by superantigens (e.g. streptococcal M protein, peptidoglycan) or skin trauma (Koebner phenomenon), whereas in the later phase self-antigens in the epidermis are recognized by autoreactive T cells (keratin K 17, HPV 5 proteins L1, Pso p27), leading to autoimmunity.

Psoriasis is a systemic disease, associated with the occurrence of metabolic disorders (obesity, diabetes, hyperuricemia, lipid disorders) and rapid development of atherosclerosis; therefore diet can be an important adjuvant therapy. A low-calorie diet is an important complement treatment of patients with psoriasis, particularly those with concomitant obesity. There are a lot of studies indicating that obesity is a risk factor for psoriasis and vice versa. Visceral adipose tissue produces numerous proinflammatory cytokines (TNF-α, IL-6, Il-8, Il-17, Il-18), the same ones that participate in development of psoriatic lesions. Important factors in the diet are the essential polyunsaturated omega-3 fatty acids. They have an anti-inflammatory effect because they inhibit the production of proinflammatory cytokines (I-1b, IL-6, IL-8, TNF-α) and adhesion molecules (ICAM-1, VCAM-1). In addition, supplementation of omega-3 and natural antioxidants in the diet may help to reduce "oxidative stress" and systemic inflammation. The use of a gluten-free diet is controversial, but in patients with positive anti gliadin antibodies it seems justified. An essential element of the procedure is to avoid alcohol and all its forms and stimulants that have pro-inflammatory effects. We should advise our patients to avoid grapefruit juice during treatment with cyclosporine and limit the supply of simple sugars, animal fats and alcohol during treatment with retinoids. Dietary recommendations for patients with psoriasis are an important part of a holistic approach to patients who expect comprehensive care, not just the prescription.

Pemphigus is an acantholytic bullous disease with a potentially fatal course. The laboratory diagnosis of pemphigus is based on direct immunofluorescence showing the presence of the in vivo bound IgG in intercellular spaces of the epidermis in skin biopsy. For determining the clinical subtypes of pemphigus serum immunological studies allowing characterization of the target antigen(s) are obligatory. Treatment of pemphigus with prednisone at an initial dose of 1–1.5 mg/kg in combination with azathioprine is currently recommended by most dermatologists as well as by the European Expert Group as the therapy of choice in typical cases, whereas other immunosuppressive agents, biological drugs, and intravenous immunoglobulins should be considered in refractory cases and rare subsets of pemphigus.

The promising results derived from the use of adipose-derived stem cells (ADSCs) in many diseases are a subject of observation in preclinical studies. ADSCs seem to be the ideal cell population for the use in regenerative medicine due to their easy isolation, nonimmunogenic properties, multipotential nature, possibilities for differentiation into various cell lines, and potential for angiogenesis. This article reviews the current data on the use of ADSCs in the treatment of vitiligo, various types of hair loss, and the healing of chronic wounds.

Wprowadzenie: Łuszczyca jest przewlekłą chorobą skóry, w którejetiologii istotną rolę odgrywają czynniki psychologiczne. Funkcjonowaniepamięci operacyjnej wiąże się głównie z czynnością grzbietowo--bocznej części kory przedczołowej, ten obszar mózgu odpowiada zanajbardziej złożone funkcje poznawcze i emocjonalne. Cel pracy: Ocena czołowych funkcji poznawczych, objawów depresjii temperamentu afektywnego oraz ocena zależności pomiędzy nasileniemcech temperamentu afektywnego a dysfunkcjami neuropsychologicznymii depresją u pacjentów z łuszczycą. Materiał i metodyka: W badaniu wzięło udział 125 osób (97 chorychna łuszczycę oraz 28 osób zdrowych). Do oceny neuropsychologicznejgrzbietowo-bocznych części kory przedczołowej zastosowano testStroopa oraz test łączenia punktów TMT. W celu określenia nasileniazmian chorobowych wykorzystano skalę oceny nasilenia łuszczycy –PASI, a do oceny nasilenia objawów depresyjnych skalę depresjiBecka. Do badania temperamentu afektywnego zastosowano skalęTEMPS-A. Wyniki: U pacjentów z łuszczycą częściej występują zaburzenia depresyjne.Osiągają oni gorsze niż osoby zdrowe wyniki w testach neuro -psychologicznych oceniających procesy pamięci operacyjnej i funkcjewykonawcze. Prezentują specyficzne cechy temperamentu afektywnego,szczególnie wyższy poziom w wymiarze depresyjnym, lękowymi drażliwym. Cechy temperamentu depresyjnego, drażliwego i lękowegomogą predysponować do wystąpienia zaburzeń afektywnych i dysfunkcjipoznawczych w łuszczycy, podczas gdy cechy hipertymicznewiążą się z mniejszym ryzykiem tych zaburzeń. Wnioski: U pacjentów z łuszczycą wykazano istotne znaczenie ocenytemperamentu afektywnego z wykorzystaniem skali TEMPS-A orazdysfunkcji poznawczych związanych z neuropsychologiczną ocenąfunkcji czołowych.

Acne vulgaris is a common disease of adolescence that occurs in approximately80% of the population aged 11-30 years. The disease greatlyreduces well-being and self-esteem. In the pathogenesis of acne vulgarismany factors take part: genetic, hormonal, sebaceous gland hyperplasiawith seborrhoea, changes in the composition of sebum, comedonesformation, Propionibacterium acnes colonization and inflammation.In most cases, the disease does not require systemic treatment, and theavailable causal therapy and topical acne skin care are sufficient toimprove skin condition. In acne vulgaris, local systematic treatmentadjusted to the form of the disease, as monotherapy or combinationtherapy, is required. Keratolytic and anti-comedone drugs are salicylicacid, retinoids and benzoyl peroxide. Some antibiotics, such as clindamycin, erythromycin and erythromycini cyclocarbonas, as well as benzoylperoxide, have anti-bacterial properties. Antibiotics such asmacrolides and tetracyclines, benzoyl peroxide, retinoids, azelaic acid,and vitamin B3 have anti-inflammatory properties. Only azelaic acidhas a weak anti-seborrhoeic effect. 17β-oestradiol and zinc ions havethe action of anti-androgens by competitive action on the receptors.The only substances that theoretically affect all elements of the aetiopathogenesisare triethyl citrate, linolan acetate and azelaic acid. Thearticle describes the mechanisms of action of topical preparations andthe main indications for their use according to the form of the acne.

Lichen sclerosus (LS) is a chronic inflammatory disease with a characteristicclinical appearance and specific histopathology. Clinically ischaracterized by plaques of ivory white atrophic lesions licalized,chiefly on genitals, and also in extragenital localisation. Both males andfemales at any age are affected. The aetiology of LS remains unclear. Inthe literature, the hypothesis of possible role of genetic, autoimmune,infectious and hormonal factors are found. Oxidative stress may alsoplay additional role. Understanding of lichen sclerosus pathogenesismay improve its therapy and allow to avoid its complications.

Introduction. Acute myeloid leukaemia is a malignant neoplastic diseaseof white blood cells. About 80% of acute leukaemias in adult arediagnosed as myeloid leukaemias. The presence of transformed cellclones in bone marrow and blood, which originate from very earlystages of myelopoiesis, is characteristic. Beside systemic symptoms(anaemia, thrombocytopenia) there are infiltrations in other organs,including skin. Skin lesions are most frequently non-specific (pruritus,skin spots, erythema multiforme, bullous pemphigoid) but can be alsospecific (skin tumours). Cases of diffuse xanthomatoses and myeloidsarcoma have also been found in patients with acute myeloidleukaemia. Skin lesions are present more often in lymphocytic thanmyeloid leukaemias. They may precede the disease or its relapse, occurconcomitantly or after systemic symptoms, and sometimes may be ofprognostic value.Objective. To present the case of a patient in whom skin lesions werethe cause of detailed examinations, which revealed acute myeloidleukaemia.Case report. We present a case of a 61-year old patient with purplebrownnodular lesions 1-3 cm in diameter on the face, scalp skin, trunk,limbs and the oral cavity’s mucous membranes with coexistent intensepruritus and generalized lymphadenopathy. The first skin lesionsoccurred three months earlier. During hospitalization in the Departmentof Dermatology the renewal of blasts in the circulatory blood wasobserved and skin biopsy revealed a large amount of mononuclearcells. The patient was directed to the haematological ward, where thediagnosis of acute myeloid leukaemia was established.Conclusions. Our case indicates that the presence of skin lesions andthorough diagnostic procedures may contribute to the diagnosis ofmalignant neoplastic diseases of white blood cells.

Introduction. Cutaneous melanoma is a malignant tumour derivedfrom melanocytes that occurs primarily in the skin. It is a result of prolongedexposure to mutagenic factors and an abnormal DNA repairsystem. The pathogenesis of this tumour is complex and depends toa large extent on inactivation of the CDKN2A gene, whose proteinproducts are involved in cell cycle control. The CDKN2A gene encodestwo transcripts – p16 protein, which is an inhibitor of cyclin-dependentkinases (CDK4/CDK6), and p14ARF protein, responsible for stabilizarozpoznationof p53. Mutations in the CDKN2A gene can significantly impair thebiological functions of these two proteins, and may contribute to theirexcessive or inadequate expression and consequently lead to malignancy.Numerous scientific studies have linked mutations in p14 andp16 in the CDKN2A gene with melanoma incidence.Objective. Analysis of p14 and p16 mutations in cutaneous melanomain a test group of 40 tumours.Material and methods. The material consisted of paraffin-fixed biopsieswith a diagnosis of melanoma confirmed histologically andimmunomorphologically. In order to detect the mutation PCR-SSCPwas used.Results. Molecular mutations of p14 and p16 proteins in the CDKN2Agene were detected in 38 out of 40 examined tissues. This represents95% of melanoma biopsies. Mutations were detected in all three exonsof the CDKN2A gene, with the greatest frequency in the second andthird exon.Conclusion. Our results indicate that mutations in p16 and p14 of theCDKN2A gene are associated with cutaneous melanoma.

Wprowadzenie: Atopowe zapalenie skóry (AZS) jest często występującą,przewlekłą chorobą zapalną, w której stwierdza się liczne nieprawidłowościimmunologiczne, m.in.: wysokie stężenie IgE, nadmierną aktywnośćkomórek Langerhansa (KL) oraz zwiększoną ekspresję receptoraCD23. Komórki Langerhansa są komórkami dendrytycznymi pochodzeniaszpikowego. Stanowią one 3–8% wszystkich komórek naskórka,a u osób z chorobami alergicznymi jest ich znacznie więcej. Komórki Langerhansasą zdolne wychwytywać antygeny egzogenne, takie jak haptenyczy antygeny wirusowe, przetwarzać je i prezentować limfocytom T.Komórki Langerhansa na swojej powierzchni mają antygeny HLA-DR,antygen CD4, receptory FcεRIα i CD23, receptory dla przeciwciała IgEi CD1a, a także cząs teczki kostymulujące CD 80/B7-1, CD 86/B7-2. Cel pracy: Ustalenie liczby i cech morfologicznych komórek Langerhansaw naskórku chorych na AZS przy użyciu przeciwciał przeciwantygenom CD1a i HLA-DR w porównaniu z osobami zdrowymi orazoznaczenie receptorów powierzchniowych FcεRIα, CD4, CD23,CD80/B7-1, CD86/B7-2, IgE. Materiał i metodyka: Przebadano 18 wycinków pochodzących od osóbchorych na atopowe zapalenie skóry. Próbę kontrolną stanowiły wycinkiod 10 zdrowych osób pobrane z pośladków lub z grzbietu ręki. Biopsjęu osób chorych pobierano ze zmian chorobowych. Markery KL (CD1a,HLA-DR, FcεRIα, CD4, CD23, CD80/B7-1, CD86/B7-2, IgE) wykrywano,stosując podwójne barwienie immunofluorescencyjne. Wyniki: U pacjentów z AZS stwierdzono w naskórku znacznie więcejKL CD1a+ niż u zdrowych. Wygląd KL w naskórku różnił się u osóbchorych i zdrowych. W naskórku chorych na powierzchni KL stwierdzonoobecność wszystkich badanych receptorów, a u zdrowych tylkoCD1a, HLA-DR, FcεRIα. Wnioski: Rola KL zależy od obecności receptorów na ich powierzchni,a ich morfologia w naskórku osób chorych na AZS i w naskórku osóbzdrowych znacznie się różni. Bardzo duża liczba KL w naskórkuchorych na AZS świadczy o stanie zapalnym.

Pierwotne chłoniaki skóry stanowią heterogenną grupę nowotworówukładu limfoidalnego, wśród których około 75% wywodzi się z limfocytówT i których pierwotnym i dominującym klinicznie umiejscowieniemjest skóra. Pierwotne chłoniaki skóry cechuje odmienny przebiegkliniczny i rokowanie w porównaniu z chłoniakami układowymi.Chłoniaki skóry mają najczęściej przebieg przewlekły, ale całkowitewyleczenie chorego rzadko jest możliwe. Diagnostyka i leczenie pierwotnychchłoniaków skóry jest zagadnieniem interdyscyplinarnym,w które powinni być zaangażowani, obok dermatologów, równieżonkolodzy, hematolodzy i patomorfolodzy. Powstała w 2009 roku SekcjaChłoniaków Skóry Polskiej Grupy Badawczej Chłoniaków podjęłapróbę opracowania jednolitych zaleceń terapeutycznych, które byłybyuznane i stosowane w środowiskach wszystkich zaangażowanych specjalności.Są one oparte na dostępnych europejskich i światowych rekomendacjachoraz na doświadczeniu polskich ośrodków dermatologicznychi hematoonkologicznych w zakresie leczenia chłoniaków skóry.

Łuszczyca jest przewlekłą zapalną chorobą skóry dotyczącą około1–3% populacji rasy kaukaskiej. Wprowadzenie do leczenia tego schorzenialeków biologicznych, które cechują się dobrą skutecznościąi wysokim profilem bezpieczeństwa, spowodowało, że obecnie wieluchorych na łuszczycę może prowadzić normalny tryb życia. Z tegopowodu niezbędne jest, aby leki biologiczne były dostępne również dlapolskiej populacji pacjentów, zwłaszcza tych, u których inne metodyterapii okazały się nieskuteczne lub też nie mogą być stosowane. Obecnewytyczne opracowano w celu ułatwienia polskim dermatologomkwalifikowania pacjentów z łuszczycą do leczenia biologicznego i ichdalsze prowadzenie. Mamy nadzieję, że przedstawione wskazówkibędą cenną pomocą dla lekarzy, którzy dopiero rozpoczynają doświadczeniaz tą grupą leków.W polskich realiach ekonomicznych do leczenia biologicznego powinnibyć kwalifikowani pacjenci z łuszczycą zwyczajną o średnim lubdużym nasileniu, u których nie uzyskano poprawy po leczeniu z zastosowaniemprzynajmniej dwóch różnych metod tradycyjnej terapiiogólnej lub którzy mają przeciwwskazania do stosowania innychmetod terapii ogólnej. W przypadku łuszczycowego zapalenia stawówterapię lekami biologicznymi można rozważyć u pacjentów z jegoaktywną postacią, u których nie uzyskano wystarczającej poprawy pozastosowaniu przynajmniej dwóch przeciwreumatycznych leków modyfikujących przebieg choroby, podawanych w monoterapii lubpoliterapii. Autorzy nie rekomendują żadnego leku biologicznego jakopierwszego leku z wyboru. Decyzję tę lekarz podejmuje sam, w zależnościod indywidualnego przypadku i na podstawie bieżących danychpiśmiennictwa na temat ich skuteczności i bezpieczeństwa.

Cultured human melanocytes are increasingly being used in the treatment of vitiligo. The growth media contain various types of mitogenic factors, both recombinant human (e.g., rhbFGF and rhSCF) and synthetic (e.g., TPA). High concentrations of mitogenic factors accelerate the cell cycle, and consequently may increase the risk of carcinogenesis of transplanted cells. Mutations of genes of the RAS/RAF/MEK/ERK signaling pathway are very often found in the early stages of the development of melanoma. TPA is considered to be an oncogenic factor, but so far there is no evidence to show that it is responsible for damage to the genetic material of cultured melanocytes. The aim of our study was to assess the risk of the development of mutations in selected genes of the RAS/RAF/MEK/ERK signaling pathway during the culturing of melanocytes in various growth media. Based on the results obtained, it can be concluded that TPA and high concentrations of other growth factors intensify the proliferation of melanocytes, without the risk of damage to the HRAS (exon 1 and 2), KRAS (exon 1 and 2), NRAS (exon 1 and 2), and BRAF (exon 11 and 15) genes. In order to assess the total safety of the transplantation of cultured melanocytes, it is necessary to carry out further studies on other signaling pathways as well as carry out biological tests on an animal model.