Dominika Wcisło-Dziadecka

New aspects of the treatment of alopecia areata.

Alopecia areata (AA) is a disease involving non-scarring hair loss determined by autoimmune disorders and inflammation. The disease affects hair on the scalp and/or other parts of the body. The AA occurs in people of all ages and affects 1–2% of humans. The purpose of this paper is to present the latest knowledge on the treatment of AA. The decision on the type of treatment depends on the type of hair loss, extent of changes, general health status, the patients age, and his/her motivation. Treatment methods should be chosen individually for each patient.

Physiochemical properties and application of hyaluronic acid: a systematic review

Hyaluronic acid is a widely available, biocompatible, polysaccharide with distinguishing physiochemical properties which inspire its application throughout several fields of medicine.

TNF-α in a molecularly targeted therapy of psoriasis and psoriatic arthritis.

Psoriasis is a chronic immunological skin disease and patients with this disorder typically experience a significant decrease in their quality of life. The disease is traditionally managed with topical and systemic agents (retinoids, ciclosporin A, methotrexate), but these treatment options are often long-term and their effects can be inconsistent and not ideal. The use of biological drugs in dermatological treatment is relatively new and began in the early 2000s. It should be noted that, in most countries, in order for biological treatment to be administered, specific criteria must be met. The current treatment options for psoriasis and psoriatic arthritis include tumour necrosis factor alpha (TNF-α) blockers, interleukin (IL)-12 and IL-23 inhibitors, T cell inhibitors and B cell inhibitors. These classes of biological drugs are characterised by protein structure as well as high molecular weight and their effectiveness is evaluated based on the Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA) and the Dermatology Life Quality Index (DLQI). TNF-α antagonists are one such class of biological drugs which includes infliximad, etanercept and adalimumab. Infliximab is a chimeric protein that is administered via intravenous infusions as a monotherapy in psoriasis vulgaris. Etanercept is indicated for use in both psoriasis vulgaris and psoriatic arthritis and it is the only drug that can be used as a treatment for children under the age of 8 with psoriasis. The drug is administered subcutaneously. Finally, adalimumab is a fully human monoclonal antibody that neutralises both free and membrane-bound TNF-α and is used in the treatment of psoriasis vulgaris and psoriatic arthritis. This article reviews the latest research in the use of TNF-α for the treatment of moderate to severe psoriasis and psoriatic arthritis. The results of research in this field are promising and confirm the effectiveness and safety of biological drugs as dermatological treatments for psoriasis. In particular, adalimumab, etanercept and infliximab are promising therapeutic options for patients with moderate to severe psoriasis and psoriatic arthritis who are unresponsive to conventional treatment strategies and they can significantly improve the quality of lives in patients with this disease.

Newer treatments of psoriasis regarding IL‐23 inhibitors, phosphodiesterase 4 inhibitors, and Janus kinase inhibitors

The rapid progress of genetic engineering furthermore opens up new prospects in the therapy of this difficult‐to‐treat disease. IL‐23 inhibitors, phosphodiesterase 4 (PDE4) inhibitors, and Janus kinase (JAK) inhibitors are currently encouraging further research. Two drugs which are IL‐23 inhibitors are now in phase III of clinical trials. The aim of the action of both drugs is selective IL‐23 inhibition by targeting the p19 subunit. Guselkumab is a fully human monoclonal antibody. Tildrakizumab is a humanized monoclonal antibody, which also belongs to IgG class and is targeted to subunit p19 of interleukin 23 (IL‐23). Phosphodiesterase inhibitors exert an anti‐inflammatory action and their most common group is the PDE4 family. PDE4 inhibits cAMP, which reduces the inflammatory response of the pathway of Th helper lymphocytes, Th17, and type 1 interferon which modulates the production of anti‐inflammatory cytokines such as IL‐10 interleukins. The Janus kinase (JAK) signaling pathway plays an important role in the immunopathogenesis of psoriasis. Tofacitinib suppresses the expression of IL‐23, IL‐17A, IL‐17F, and IL‐22 receptors during the stimulation of lymphocytes. Ruxolitinib is a selective inhibitor of JAK1 and JAK2 kinases and the JAK‐STAT signaling pathway. This article is a review of the aforementioned drugs as described in the latest available literature.

Serum human cartilage glycoprotein-39 in patients with systemic sclerosis: relationship to skin and articular manifestation

Human cartilage glycoprotein-39 (HC gp-30) is a secretory protein of several types of cells including chondrocytes. It has been suggested to be a laboratory index of joint damage. Thirty-two patients with systemic sclerosis (SSc) and 22 age-matched controls were investigated. An increased serum HC gp-39 level was shown in SSc patients and was found to correlate with inflammatory indices. There was no correlation with modified Rodnan score, joint involvement, or duration of symptoms of SSc. The obtained results indicate for possible relationship of HCgp-39 to inflammation but do not suggest determination of HC gp-39 as clinically applicable index of articular involvement in SSc patients.

Madelung's disease in a patient with chronic renal insufficiency: a case report and review of literature.

Madelungs disease (benign symmetric lipomatosis, Launois-Bensaude syndrome) was described for the first time in the middle of the 19th century. This disorder concerns mainly men between 30 and 60 years of age. Patients often suffer from coexisting ailments, such as hepatic function disorders, polyneuropathy, diabetes, gynecomastia, hyperuricemia and deviations of lipid management parameters. Treatment of benign symmetric lipomatosis consists mainly in fat tissue sucking or injection lipolysis. Patients often have to wear special clothes correcting the deformed figure. We are presenting a case of a female patient with diagnosed Madelungs disease, without alcohol abuse. Such abuse is reported in 90% of patients with this disease. Nevertheless, the patient has other typical (and described in the literature) hepatic and pancreatic function impairments, but also glomerular nephritis, which very rarely co-exists with benign symmetric lipomatosis.

Body mass index and body surface area in scleroderma patients

Editor Dysfunctions of the digestive tract in the course of systemic sclerosis were observed in as many as 90% cases. It causes fluctuations of body composition and consequently leads to body mass disorders. Among the methods of assessing the nutritional condition, the most traditional is body mass index (BMI) technique. Moreover, the body surface area (BSA) is also used. The aim of the study was an assessment of relationship between BSA and BMI against the age of first symptom occurrence in patients with systemic sclerosis and limited scleroderma. The study included 71 patients (59 women and 12 men) at the average age of 59 with diagnosed systemic sclerosis. As a control group – 41 patients (35 women and six men) at average age of 48.8 with diagnosed limited scleroderma were analysed. Average parameters, that is body mass, body height, BMI, BSA, were calculated for each group. The statistical analysis was performed with the use of Statistica rev. 13.1 (STATSOFT, Cracow, Poland), with the help of U Mann–Whitney’s test, and the results showing the materiality level of P < 0.001 were assumed as statistically significant. To assess the relationship between the data, the Spearman’s correlation test was used, and the results were assumed as statistically significant when the materiality level was P < 0.05. The conducted study showed the statistically significant relationship between the values of BMI and BSA and the occurrence of changes in patients. The said relationship is shown on the basis of calculated R Spearman’s ratios, which – in case of systemic sclerosis, amounted to 0.31 and 0.30 (respectively, for BMI and BSA) while in the control group – 0.44 and 0.23 (Table 1.). Moreover, there is a statistically significant difference between the BMI value: in patients with systemic sclerosis, BMI is significantly lower – 24.79 kg/m, whereas, in case of control group – 27.79 kg/m. Whereas, differences in BSA values in patients from both groups are statistically significant. In case of systemic sclerosis and limited scleroderma, these ratios are, respectively: 1.88 and 1.72 m (Fig. 1.). This study draws attention to the relationship between the occurrence of scleroderma and the values of BMI and BSA. In this case, the fibrosis involves then the epithelial basal membrane and smooth muscle cells in the digestive system. The reasons are to be also found in the activity of muscarinic receptors (M) antibodies, dysfunction of the autonomous nervous system or blockade of calcium canals, which are activated by the potential. It was proved that the above-mentioned factors lead to the development of bacterial infections and consequently, become the reasons for disorders in absorption and intake of less quantities of food. A significant loss of weight is observed in patients, which leads to their undernourishment. According to research’s literature, it is stated that the similar fibrosis phenomenon is present within the fat tissue. The researchers became interested in leptin. There are studies which indicate diametrically lower concentrations of leptin in the patients’ serum in patients than healthy people. Resistin (adipokine group) is important for the etiopathogenesis of the systemic sclerosis too. Its mechanism involves the promoter action on endothelin 1, which cause vasospasms. Summarizing, the most frequently affected organ in the course of systemic sclerosis is the digestive tract. It was observed that functional and structural disorders in the scope of digestive system affect the quantity of food consumed by the patients, and, thus, lead to body mass disorders. This mechanism the most likely explains the significantly lower BMI, in case of systemic sclerosis, when compared with limited scleroderma.

Variances in the mRNA expression profile of TGFβ1-3 isoforms and its TGFΒRI-III receptors during treatment of psoriatic patients with cyclosporin A

Introduction Psoriasis is a chronic, immunologic, multi-factor inflammatory skin disease, strongly associated with a higher level of a number of cytokines, such as isoforms of transforming growth factor β (TGF-β1–3) and its receptors (TGF-βRI–III). One of the most popular and important drugs used to treat this disease is cyclosporin A (CsA). Aim The aim of this study was to investigate the expression of genes encoding the transforming growth factor (TGF)-β isoforms and receptors of the cytokine TGF-βRs in psoriatic patients during an 84-day long observation of the effects of cyclosporin A therapy. It made an attempt to determine the usefulness of testing mRNA expression of TGF-β1–3 and its receptors TGF-βRI–III as the supplementary molecular markers of lost sensitivity to the medicine. Material and methods The study group consisted of 32 patients with psoriasis (20 men and 12 women) treated with cyclosporin A. The changes in expression patterns of TGF-β1-3 and TGF-βRI-III were performed by real-time quantitative reverse transcription PCR (RTqPCR). Results The expression of TGF-β1-3 and TGF-βRI-III were detected in the whole period of therapy with CsA. Changes in transcriptional activities of TGF-β1–3 and TGF-βRI–III during pharmacotherapy were observed. Differences in the expression of these genes were found before and after 42 and 84 days of using CsA. Conclusions The changes in expression profiles of TGF-β1-3 and TGF-βRI-III during CsA therapy can be a useful molecular marker of lost sensitivity to the medicine.

Extensive phlegmon and pyoderma gangrenosum: diagnostic difficulties

Pyoderma gangrenosum (PG) is a relatively rare neutrophilic dermatosis, characterized by progressive skin necrosis. It typically has a chronic course, of unknown etiology. Pyoderma gangrenosum diagnosis can be difficult because both histopathological examination and results of additional laboratory tests are not specific and the clinical state is conclusive, as for other physicians it poses a number of diagnostic dilemmas. Therefore, this condition should be treated interdisciplinary. We present a case of a 40-year-old patient with a diagnosis of PG, which in the early stages of the disease was treated as an extensive phlegmon by physicians of other specialties and it presented a serious diagnostic as well as therapeutic problem.

Clinical and molecular evaluation of therapy with the use of cyclosporine A in patients with psoriasis vulgaris

Psoriasis course involves increased secretion of pro‐inflammatory cytokines, among others, a beta transforming growth factor (TGFβs) and its receptors. Cyclosporine A (CsA), an immunosuppressive medicine with the molecular mechanism of operation connected with the properties of cell cycle suppression, is often used in the treatment of severe forms of psoriasis. The efficacy of therapy is assessed based on the disease clinical progression indexes – Psoriasis Area and Severity Index (PASI), body surface area (BSA), and Dermatology Life Quality Index (DLQI). The aim of the study was the evaluation of the efficacy of the CsA treatment of patients with psoriasis vulgaris, based on the clinical parameters and an assessment of the expression profiles of TGFβs and TGFβRs, depending on the concurrent diabetes and metabolic syndrome.