Adriana Polańska

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.

“Assessment of chronic sclerodermoid Graft-versus-Host Disease patients, using 20MHz 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.

Allergy to lidocaine injections: comparison of patient history with skin testing in five patients

Introduction True allergy to local anesthetics, especially lidocaine, is uncommon. Most adverse reactions to this group of medications are classified as psychomotor, autonomic or toxic. In the case of suspected hypersensitivity to local anesthetics, skin testing is considered to be a useful tool – patch tests and intradermal tests for delayed hypersensitivity and skin prick tests and intradermal tests for immediate reactions. There is a particular need for such a diagnostic procedure, as patients suspected of hypersensitivity to local anesthetic drugs are frequently admitted. Aim To highlight the problem of hypersensitivity to local anesthetics on the basis of authors’ own experience and literature data. Material and methods We present cases of 5 patients referred to the clinic by their dentists with a suspicion of allergy to local anesthetics, four to lidocaine and 1 to articaine. Results Intradermal tests were positive in 1 out of 5 subjects, with a concomitant episode of urticaria. In 1 patient we obtained a doubtful result of intradermal tests. Skin prick tests and patch tests were negative in all cases. In 2 cases we performed an incremental challenge test also with a negative result. Conclusions It has to be emphasized that, although rare, consequences of true allergy to local anesthetics can be serious considering a patients future management and therapy. That is why this diagnosis may be crucial.

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

The main purpose of this study was the exact comparison of B‐scan images obtained from 16 patients suffering from AD with histological.

Oral mucosal manifestations in primary and secondary Sjögren syndrome and dry mouth syndrome

Introduction One of the most important symptoms of Sjögren syndrome is xerostomia. The oral cavity deprived of saliva and its natural lubricative, protective and antibacterial properties is prone to a number of unfavourable consequences. Aim To present the most important lesions on the oral mucosa in primary and secondary Sjögren syndrome and in dry mouth syndrome. Material and methods The study group comprised 55 patients including 52 women and 3 men aged 20–72 years (average: 28.25 years). Results Basing on the accepted criteria, primary Sjögren syndrome was diagnosed in 22 (40%) patients, secondary Sjögren syndrome in 18 (32.7%) patients, and dry mouth syndrome in 15 (27.27%) patients. The physical examination and the examination of the mouth were performed and history was elicited from every patient. Conclusions The most common pathologies appearing on the oral mucosa in primary and secondary Sjögren syndrome are angular cheilitis, cheilitis, increased lip dryness as well as non-specific ulcerations, aphthae and aphthoid conditions.

Itching sensation in psoriatic patients and its relation to body mass index and IL-17 and IL-31 concentrations

Introduction According to available data, pruritus is a common symptom of psoriasis, however its characteristics and pathogenesis are not clearly understood. Aim The main aim of this study was to assess itching sensation among patients suffering from psoriasis, including its incidence and severity. All factors triggering and worsening pruritic symptoms were also carefully analyzed. The authors assessed the relationship of itch with body mass index (BMI) and severity of disease. Moreover, serum levels of interleukin 17 (IL-17) and IL-31 were analyzed in relation to Psoriasis Activity and Severity Index, BMI and severity of pruritus. Material and methods The study group consisted of 60 patients with plaque-type psoriasis. Analysis of impact of pruritus on the quality of life and worsening factors was based on the questionnaire. The severity of pruritus was assessed with the use of two independent scales. Serum IL-17 and IL-31 levels were measured in 30 patients suffering from psoriasis and in 10 healthy controls using immunoassay tests. Results 88.3% of analyzed patients complained of itch and the most common factor which exacerbated pruritus was stress (39.6%). Pruritus in psoriasis was independent of gender, illness duration and extent of skin lesions. The average intensity of pruritus was assessed as moderate and did not correlate significantly with BMI level, IL-17 and IL-31. Conclusions Since the pathogenesis of pruritus in psoriasis is not fully understood, further investigation in this area needs to be conducted. Pruritus may be considered as a characteristic feature of psoriasis and, besides the skin lesions, should be a target in dermatological treatment to improve patients quality of life.

Nonlesional skin in atopic dermatitis is seemingly healthy skin - observations using noninvasive methods.

Introduction Atopic dermatitis (AD) is a chronic and relapsing skin disorder, which is characterized by abnormal skin barrier function within the entire skin surface. Several noninvasive bioengineering methods have been commonly used to quantify disease severity. High-frequency ultrasonography (HF-USG) is an important contribution to this field. Aim To evaluate noninvolved skin during the external treatment in relation to involved regions in patients with AD skin using noninvasive methods. Material and methods Transepidermal water loss (TEWL), capacitance and erythema assessment and HF-USG were performed in 55 AD patients within 2 regions (involved and uninvolved skin) before and after therapy. The clinical severity of the disease process was based on the eczema area and severity index (EASI) score. A control group consisting of 15 subjects was also included. Results On the basis of 4 bioengineering methods our study revealed that uninvolved skin in AD presents subclinical disturbances and significantly changes during therapy. The HF-USG detects inflammation in the upper dermis in AD patients in the form of a hypoechoic band, which may also be observed to a lesser extent within normal-appearing skin. Conclusions Nonlesional skin differs significantly from lesional skin in AD and from skin of healthy subjects. Noninvasive methods are able to measure subclinical skin disturbances within normal-appearing skin, which are not evaluated using standard clinical scores. They are objective and may facilitate communication between different research groups.

Current applications of high-frequency ultrasonography in dermatology

The era of ultrasounds in dermatology started in 1979, when pioneering use of 15 MHz by Alexander and Miller in measuring the skin thickness was introduced. Since then, some new applications of high-frequency ultrasonography (HF-USG) have emerged providing the clinicians with an extra hand in their everyday practice. The main advantages of HF-USG include the possibility of real-time imaging, measurements of morphological and physiological aspects of the skin, safety associated with the use of non-ionizing media as well as the lack of contraindications to its performance. Currently the main clinical use of HF-USG in dermatology regards preoperative assessment of the depth of invasion in melanomas and basal cell carcinomas. The ultrasound image analysis allows noninvasive follow-up of inflammatory skin diseases, like atopic dermatitis, psoriasis and may be used for monitoring effectiveness of therapy in skin lymphomas and sclerotic skin diseases.

Generalized lichen nitidus: a case report and review of the literature

Lichen nitidus, first described by Pinkus in 1907, is a rare skin disease of unknown aetiology [1, 2]. It is clinically characterized by the presence of multiple discrete papules that are tiny, shiny, and of varied colours. Most commonly, the lesions are localized on the neck, trunk, forearms, abdomen and the genitalia. However, infrequently cases with generalized skin involvement have been reported, mostly affecting children. Herein, we present a generalized form of lichen nitidus in a middle-aged woman, which has been successfully treated with aci-tretin. A 34-year-old woman was referred to the outpatient clinic of the Department of Dermatology due to the skin lesions, which have been observed for 2 years. Dermato-logical examination revealed thousand of shiny, polygonal, 1–2 mm sized papules located on the trunk, upper and lower limbs including palms (Figures 1 A–C). The papules did not show any tendency to coalesce (Figure 1 C). The face, neck, soles, and the genitalia were not affected. In the oral cavity, there were signs of whitening of the mucosa. Onychorrhexis was observed within the nails. The patient did not suffer from any concomitant disease. She did not use any drugs. Two skin biopsy samples from the thumb and trunk were taken for histopathological examination in order to confirm the clinical diagnosis (H + E) (Figure 2). Topical treatment with mild potent glucocorticoste-roids was initiated, but they proved to be ineffective. For this reason, a systemic treatment with methylpred-nisolone at an initial dose of 16 mg/day was introduced. A significant improvement after 2 months of therapy was observed, however the symptoms recurred while tapering the dose. As soon as histopathological confirmation of lichen nitidus in our department was made, acitretin at an initial dose of 50 mg/day was administered with good tolerance. The reduction of the skin lesions within 3–4 months was observed. At present, the patient takes the drug at a dose of 10 mg/day (6 months) showing marked improvement (she presents lesions only on her palms) and is being followed in the outpatient clinic. A typical clinical pattern of lichen nitidus is characterized by the presence of numerous shiny papules which may appear in a variety of shades, from fleshy pink to dark brown, whereas within dark skin they appear as light spots [3, 4]. The papules are 1–2 mm in diameter. Skin lesions are usually not accompanied by any additional symptoms with a sporadic exception of mild pruritus. …

High-frequency ultrasonography-New non-invasive method in assessment of skin lymphomas

Mycosis fingoides (MF) is the most common subtype of primary cutaneous T‐cell lymphomas. Current evaluation of disease extent and severity is based on mSWAT scoring system, which seems to be relatively subjective. The aim of this subject was to present the usefulness of 20 MHz in objective 5‐year long monitoring of response to therapy in MF patients.