Bartosz Miziołek

Alopecia areata - hyperactivity of the hypothalamic-pituitary-adrenal axis is a myth?

Psychological stress is known to cause exacerbation of different skin pathologies including alopecia areata (AA). A hyperactivity of the hypothalamic‐pituitary‐adrenal axis (the HPA axis) in patients affected by AA (AA patients) was proposed to be a neuroendocrine response to stress. Still little is known about melanocyte‐stimulating hormone (MSH) and cortisol production in AA settings.

Metastases of malignant melanoma to the skin of abdomen and thorax imitating Herpes Zoster infection.

Ann Saudi Med 2015 November-December www.annsaudimed.net 482 A 77-year-old male patient presented with a dark-brown nodular lesion, which grew within an oval melanocytic nevus of 6×4 cm2 in size and located on the skin of the lower abdomen. The nodule appeared 6 months earlier and reached the size of 2 cm in diameter. The growing cutaneous finding manifested with the bleeding sore and crust. The nevus was excised entirely together with the nodule. The histopathologic examination revealed the nodular type of amelanotic melanoma, which was ulcerated and classified as Clark II and Breslow IV (5 mm of infiltration thickness). Essentially, no clear margins were noted both vertically and horizontally, and the infiltration of the tumor encompassed the border and subcutaneous tissue. Additionally, some satellite metastases were Metastases of malignant melanoma to the skin of abdomen and thorax imitating Herpes Zoster infection

Thermal imaging and dermoscopy for detecting inflammation in frontal fibrosing alopecia

Frontal fibrosing alopecia (FFA) is an inflammatory condition of the scalp, which leads to scarring and slowly progressive recession of frontotemporal and/or frontoparietal hairline. Choice of FFA treatment is highly dependent on accurate assessment of disease phase, as medical treatments are effective only during the initial inflammatory stage.

The safety of isotretinoin in patients with lupus nephritis: a comprehensive review

Abstract Oral isotretinoin (13-cis-retinoinc acid) is a derivative of vitamin A and belongs to the first generation of retinoids, which act as synthetic isomers of retinoic acid (RA). It is a very effective agent in a treatment of acne vulgaris; however, multiple side effects related to therapy with retinoids preclude the use of isotretinoin in less severe acne vulgaris. A significant limitation for the administration of isotretinoin appears in case of concomitant kidney disease with a special attention regarding the safety of the agent in patients with lupus nephritis (LN). The aim of this review is an assessment of the safety of isotretinoin for the treatment of acne vulgaris in patients with LN. We searched both MEDLINE and SCOPUS databases, as well as several dermatological textbooks, to present all limitations and benefits of therapy with isotretinoin or its isomer (ATRA) for patients with kidney diseases. Several mouse models of SLE revealed a significant modulatory influence of retinoids on autoimmune injury of the glomerular unit. Retinoids were demonstrated to affect mononuclear cell infiltrations of renal tissue allowing for a reduction in the overall glomerular damage. Presumptively, they can affect a synthesis of autoantibodies significantly limiting their deposition in the glomerular unit. Moreover, retinoids were also shown to affect the synthesis of different cytokines specific both for lymphocytes Th1 (IL-2, IL-12, INFγ) ant Th2 (IL-4, IL-10). The influence of retinoids on the course of LN seems to be more multidimensional than only restricted to immune aspects and these synthetic RA isomers manifest also antiproteinuric activity in comparable extent to steroidal agents. The agents were demonstrated to counteract a loss of podocytes after the injury of the glomerular unit. They can promote a differentiation of renal progenitor cells (RPCs) within the Bowman capsule into mature podocytes leading to regeneration of podocyte number. Additionally, retinoids can probably protect podocytes from injury limiting their apoptosis, as well as reducing foot process effacement. Although, an endogenous production of RA isomers increases after the injury of the glomerular unit aiming to the restoration of podocyte number, it can be significantly impaired by a loss of albumins into urine. RA isomers are progressively sequestered by albumin within the Bowman’s space and therefore, they are quickly eliminated with urine. It was demonstrated that the administration of exogenous RA isomers (retinoids) can bypass the activity of albumins enhancing the regeneration of podocytes. Finally, retinoids can regulate the production of vasoactive substances influencing on different vascular functions in the kidney. They can beneficially change a balance of angiotensin metabolites through by down-regulation of angiotensin-converting enzyme type 1 and the enhancement of an expression of angiotensin-converting enzyme type 2. Another studies revealed that retinoids could also alter the activity of renal endothelin pathway; however, the significance of this effect requires further elucidation. Taken all these presented effects of retinoids in the kidney into consideration, we can conclude that isotretinoin can be the safe treatment option of acne vulgaris in patients with LN.

Metastases of malignant melanoma on the skin of the abdomen and thorax imitating herpes zoster.

ANN SAUDI MED 2017 JANUARY-FEBRUARY WWW.ANNSAUDIMED.NET 84 A 77-year-old male patient presented with a darkbrown nodular lesion, which grew within an oval melanocytic nevus 6×4 cm in size located on the skin of the lower abdomen. The nodule appeared 6 months earlier and had reached 2 cm in diameter. The growing cutaneous lesion manifested as a bleeding crusty sore. The nevus was completely excised together with the nodule. Histopathology revealed the nodular type of amelanotic melanoma which was ulcerated and classified as Clark II, Breslow IV (5 mm of infiltration thickness). No clear margins were noted neither vertically nor horizontally and the infiltration of the tumor Metastases of malignant melanoma on the skin of the abdomen and thorax imitating herpes zoster

Common lesions in a rare entity – Gardner’s syndrome

Gardner’s syndrome (GS) is a rare genetic disorder which is a variant of familial adenomatous polyposis (FAP). It is characterized by a coexistence of multiple intestinal polyps with bone and soft-tissue tumors, frequently impacted teeth or cutaneous and subcutaneous cystic lesions. The syndrome is caused by a mutation of the adenomatous polyposis coli gene (APC) located at chromosome 5q21. The majority of patients have a family history of this disorder [1, 2]. We demonstrate a female patient with this genetic syndrome, which had not been recognized for a long time A 38-year-old female patient was admitted to the Dermatology Clinic at the Silesian School of Medicine in Katowice due to multiple skin lesions on the trunk. Clinically, these cutaneous findings were oval forms, 2–3 × 1–2 cm in size. All of them were palpable, soft and well circumscribed from the surrounding skin. An initial, clinical diagnosis of epidermoid cysts was further confirmed by histopathology of all five excised lesions (Figures 1, 2). The first skin lesions appeared 12 years earlier and probably resembled cutaneous fibromas due to a previous clinical suspicion of Recklinghausen disease. Since the beginning, the lesions have been localized predominately on the skin of the abdomen and gradually they started to spread over the trunk and into proximal surfaces of the limbs. Presumptively, similar cutaneous findings were present in a father of our female patient. The man died 7 years earlier at the age of 54 due to a lung cancer and the skin lesions could not be investigated. The family history also highlighted a stomach cancer in a grandfather (died 12 years earlier), as well as a bone tumor of a maxillary sinus in a female cousin of our patient.

Bullous pemphigoid in Dermatology Departments of Silesia in years 2001-2014

Summary Introduction. Bullous pemphigoid (BP) is the most common disease from a group of bullous dermatoses. It affects mostly elderly people and the relative risk of disease devel- opment in people at the age 90 is 300-fold higher than in individuals who are 60 years old. It is supposed, that 15-20% of patients with BP may have malignant internal tumor and skin lesions can even precede the recognition of malignancy. Aim. The aim of this retrospective study was to assess the occurrence of BP in relation to age of patients and concomitant systemic diseases, including neoplastic disorders. Further analysis gives a review of therapeutic options and the efficacy of these modalities. Material and methods. A study group comprised of 120 patients who were diagnosed with BP: 74 female and 46 male patients. The mean age of patient was 71.13 ± 11.8. Results. Co-existing of other disease was reported in 87.11% of patients and the his- tory towards neoplastic disorder (active or previously treated) was positive in 19.8% of patients. In therapy of the disease, the drug of choice was Methylprednisolone. Other ther- apeutic options were also glucocorticoids (Dexamethasone, Prednisone, Triamcinolone), immunosuppressive agents (Cyclophosphamide, Chlorambucil or Azathioprine), antibiot- ics (Erythromycin, Doxycycline, Ceftriaxone), niacin and Dapsone. Conclusions. Clinical presentation of BP is distinguished and the recognition of the disease should be always supplemented by diverse diagnostic tests towards potent and hidden tumor. Although, glucocorticoids have remained a first choice therapy with good effects, further studies are necessary to establish the efficacy of other therapeutic mo- dalities.

The power of stereotypes. Findings of a pilot study on the psychosocial aspects and quality of life among patients with androgenetic alopecia

1Andrzej Mielęcki Silesian Independent Public Clinical Hospital in Katowice, Department of Dermatology Head of Department: prof. Ligia Brzezińska-Wcisło, MD, PhD 2School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Department of Skin Structural Studies Head of Department: Associate Professor of Biology Krzysztof Jasik, PhD 3School of Medicine in Katowice, Medical University of Silesia in Katowice, Department of Dermatology Head of Department: prof. Ligia Brzezińska-Wcisło, MD, PhD 4Association by the Department of Dermatology, Silesian Medical University in Katowice Tutor of Association: Dominika Wcisło-Dziadecka, MD, PhD