Hubert Arasiewicz

Atopic dermatitis exacerbated with ustekinumab in a psoriatic patient with childhood history of atopy

Ustekinumab is a biological agent that is currently approved for the treatment of moderate to severe plaque psoriasis. It is a monoclonal antibody that binds the p40 subunit of IL-12 and IL-23 to limit the progression of the Th1 and Th17 inflammatory immune responses. Recently, it has been suggested that ustekinumab could represent a potential treatment for atopic dermatitis (AD).1e3 However, inadequate response to ustekinumab in AD patients has also been reported.4 We present a case of paradoxically exacerbated AD during the ustekinumab treatment for psoriasis. A 21-year-old man with a 7 year history of severe psoriasis refractory to conventional systemic treatments and childhood history of atopy (atopic dermatitis-AD, asthma, seasonal rhinitis) was treated with ustekinumab. The patient was without major symptoms from respiratory system and AD lesions within a period of 5 years before the date of starting the treatment. He was taking montelukast, antihistamines, inhaled corticosterois and formoterol for asthma. Psoriatic lesions and no clinical sings of AD were found on baseline examination (Fig. 1). Ustekinumab 45 mg (1 injection at week 0 and week 4, then every 12 weeks) was introduced (according to body weight: 76 kg). After 18 months and following excellent results, the patient decided to discontinue therapy. But 8 months later recurrence of psoriasis was observed and ustekinumab was restarted. The baseline PASI fell from 11,4 to 3,0 after 4 weeks of treatment with ustekinumab, complete remission of psoriasis was achieved after 8 weeks of therapy. However, intense generalized itching occurred since the first dose was administered. Severe AD appeared on the neck and lower limbs about 6 weeks after the reintroduction of ustekinumab (Fig. 2). Eczematous drug eruption and AD exacerbation due to stress, infection, or other external factors (i.e. topical treatments of psoriasis) was excluded in the differential diagnosis. Apart from dermatologic findings, physical examination revealed no abnormalities. Laboratory tests showed peripheral blood eosinophilia (1,48 109/L, compared to the baseline of 0,46 109/L, to the 16 weeks of 0,58 109/L, to the 28 weeks of ustekinumab therapy of 0,67 109/L, and to the recurrence of psoriasis of 0,66 109/L), as well as abnormal increase in serum allergen-specific immunoglobulin E (sIgE) level including dog-, cat-, hamster-, and grass pollen-specific IgE. Total IgE level was 12576 IU/ml (0e100,0 IU/l reference range). Other laboratory data (erythrocyte sedimentation rate, C-reactive protein level, complete blood count, biochemical parameters of liver and kidney, urinalysis) were normal at several time points. Spirometry

Neurological abnormalities in localized scleroderma of the face and head: a case series study for evaluation of imaging findings and clinical course.

Abstract Introduction: Localized scleroderma (LoS) of the face and head is often associated with neurological manifestations and/or imaging abnormalities in the central nervous system (CNS). Case series: We present an analysis of 20 cases of LoS affecting the face and head. The CNS symptoms and/or abnormalities in high-resolution computed tomography (HRCT) and/or magnetic resonance imaging (MRI) were observed in 12 patients (60%). In addition to the mild and unspecific disorders (e.g. headaches), serious neurological complications probably in the course of vasculitis were revealed: epilepsy (in two patients), epilepsy and pyramidal sings (in one patient). Neurological disorders and LoS occurred at the same time (in three patients) or at the course of the disease (nine patients) and no later than 29 years since the onset of the disease. No link between neurological disorders and the LoS clinical morphology, immunological and other laboratory parameters has been established. Conclusions: CNS involvement is not correlated with the clinical course of the facial and head LoS and may occur years after the disease initial symptomatology. Imaging follow-up is not required if there is not any emerging neurological symptom. In some cases, however, both HRCT and MRI are useful for monitoring disease evolution and addressing therapeutic choices.

Antiphospholipid antibodies in localized scleroderma: the potential role of screening tests for the detection of antiphospholipid syndrome

Introduction The presence of antiphospholipid antibodies (aPL) is associated with infections, drugs and autoimmune disorders. Those antibodies are also detected in approximately 5–20% of the healthy population. The presence of aPL can lead to the occurrence of thrombotic events or abortion, which define the antiphospholipid syndrome (APS). Aim To evaluate the potential role of aPL in diagnosing APS in patients with localized scleroderma (LoS). Material and methods Serum samples from 45 patients with various forms of LoS were examined. They were screened with the commercially-available immunodot assay Anti-Phospholipid 10 Dot (GA Generic Assays GmbH, Dahlewitz, Germany). A number of clinical and laboratory parameters, especially APS symptoms, were assessed in patients with positive aPL: arterial and venous thrombotic events, obstetric complications, thrombocytopenia and neurological symptoms. Results The following profile of aPL IgG or IgM was obtained from patients with LoS: cardiolipin 15/45, phosphatidic acid 41/45, phosphatidyl-choline 0/45, -ethanolamine 6/45, -glycerole 1/45 (patient with Lyme disease), -inositol 7/45, -serine 14/45, annexin V 34/45, β2GPI 21/45, prothrombin 30/45. Antiphospholipid antibodies profile screening in these individuals revealed two cases of suspected secondary laboratory APS. However, no such clinical and laboratory parameters were found in other LoS patients with positive aPL. Similarly, no association was found between the presence of aPL and either thrombotic events or other APS symptoms. Conclusions Antiphospholipid antibodies are commonly found in patients with LoS but the exact role of these antibodies remains unclear. Clinical manifestations of APS are not frequently seen during LoS.

Determinants of environmental domain of quality of life in economically active population living in Silesian agglomeration, Poland

ObjectivesThe aim of this paper is to identify the factors that determine the environmental domain of quality of life in economically active adults living in the industrial agglomeration in Poland.Materials and MethodsDuring the cross-sectional epidemiological study conducted among the economically active population aged 45–60, we used a short version of the WHOQOL-BREF questionnaire. Respondents were recruited randomly from selected factories located in the Silesian Agglomeration. The statistical analysis used descriptive and analytical methods available in the Statistica 9.0 software.ResultsThe results confirmed the statistically significant association between marital status, type of occupational activity, declared health status, and the environmental domain of quality of life in economically active inhabitants of the Silesian Agglomeration. The best qualities of life in the environmental domain were those of married people, white collars, and persons who declared their health status to be the best.ConclusionsThe major determinants of environmental quality of life in economically active population living in the industrial agglomeration include non-occupational factors, such as marital status and current health status, while a significantly better quality of life was associated with being a white-collar worker and not living in the vicinity of the road with heavy traffic. The results may be useful for future planned activities intended to improve the health and the quality of working life.

Demodex folliculorum in rosacea based on a modified standardized skin surface biopsy

Summary Introduction. Rosacea is a chronic disease characterized by (depending on the sub- type) facial prolonged erythema, sometimes pustules or nodules. Rosacea affects all ages and sex with four subtypes. Pathophysiology aims to many different trigger factors like sun exposure, emotional stress or changed intestinal flora. Studies about Demodex mites according to different authors revealed that they may play a role in rosacea exacerbation in particular along with other triggers. Aim. An attempt to determine the role of Demodex mites among patients with rosacea. Material and methods. The study included patients with rosacea from 22 to 63 years of age. The patient status and content of hair follicles were assessed during two visits in our outpatient clinic. During the first visit, detailed medical history was taken, phys- ical examination and hypoallergenic adhesive were applied (nose, chin, cheeks and forehead) in order to pursue the content of the sebaceous glands. During the second visit, patients qualified to the research were again examined while adhesives have been removed. By using stereoscopic microscope Stemi 2000, Demodex mites from hair fol- licles were analyzed. Results. Initially, contents from hair follicles of 38 patients with rosacea have been examined. The presence of Demodex was confirmed in 11 patients. Most cases of con- firmed Demodex infestation concerned patients with papulopustular rosacea. Live sub- jects were collected only from the ales and the decrease in their motility was observed over the course of time after the removal of plasters from the skin. Conclusions. Obtained results confirming the infestation of 11 out of 38 patients with erythematotelangiectatic rosacea indicates Demodex folliculorum as a direct or indirect pathogen. Based on the results, we can state that among our patients Demodex mites were not a main trigger factor. Standardized skin surface biopsy is not a sufficient screen- ing test.

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.

Serum androgens and prostate‐specific antigen levels in androgenetic alopecia: is there a difference between frontal and vertex baldness?

Androgenetic alopecia (AGA) seems to be a marker of increased risk of prostate cancer (PCa).

Randomized, controlled clinical pilot study of venous leg ulcers treated with using two types of shockwave therapy

Background. Venous leg ulcers are difficult to heal wounds. The basis of their physiotherapeutic treatment is compression therapy. However, for many years, the search for additional or other methods to supplement the treatment of venous ulcers, which would shorten the duration of treatment, is underway. One of such methods is the shockwave therapy. Methods. The purpose of our study was to compare radial shockwave therapy (R-ESWT) with focused shockwave therapy (F-ESWT) in venous leg ulcers treatment. Patients were randomly assigned to tree groups. In the first group the radial shockwave therapy (0.17mJ/mm2, 100 impulses/cm2, 5 Hz), in the second group the focused shockwave therapy (0.173mJ/mm2, 100 impulses/cm2, 5 Hz) was used and in third group standard care was used. Patients in shockwave therapy groups were given 6 treatments at five-day intervals. Total area, circumference, Gilman index, maximum length and maximum width of ulcers were measured. The patients from the third group wet gauze dressing with saline and gently compressing elastic bandages were used (standard wound care SWC). Results. Analysis of the results shows that a complete cure of ulcers was achieved in 35% of patients who were treated with radial shockwave, 26% of patients with focused shockwave used. There is statistically significant difference between the standard care and radial shockwave therapy as well as between the standard care and focused shockwave therapy. There is no statistically significant difference between the use of radial and focused shockwave in the treatment of venous leg ulcers (p> 0.05). Conclusion. There is no statistically significant difference between the use of radial and focused shockwave in the treatment of venous leg ulcers. Treatment of venous leg ulcers with shockwaves is more effective than the standard wound care.

Bilateral atrophoderma linearis: a relationship between atrophoderma linearis Moulin and atrophoderma Pasini–Pierini?

A 26-year-old woman presented with hyperpigmented atrophic lesions on the trunk and extremities. The lesions were probably present since birth, and the size during the patient’s life varied with slow growth. However, according to the patient, the shape, color, and texture of the lesions did not change during her lifetime. Her family and medical history were unremarkable. Because of the suspicion of scleroderma suggested by her family doctor, she decided to visit a dermatologist. Dermatological examination revealed slightly depressed, band-like, hyperpigmented lesions arranged bilaterally and partially symmetric in a linear configuration over the trunk as well as upper and lower extremities (Fig. 1). The lesions on the left side of the trunk and on the left upper limb were more extensive and visible. Furthermore, over the palmar side of the wrist, metacarpus, and fourth finger, the same band-like hyperpigmented lesions were also noticed. Some atrophic, hyperpigmented lesions with sharp, irregular borders were located on the chin. Physical examination as well ophthalmological and neurological consultations were unremarkable. The laboratory tests, including erythrocyte sedimentation rate, full blood count, urinalysis, and biochemical parameters, were within normal limits. Antinuclear antibodies of the granular fluorescence pattern and titer of 160 were detected with indirect immunofluorescence on HEp-2 cells. The histopathologic examination of the biopsy from the lesion on the trunk was nonspecific (Fig. 2). Because of skin xerosis, emollients were recommended.

Cicatricial alopecia: What’s new in etiology?

Cicatricial alopecia is a rare, clinically diversified set of disorders causing permanent and irreversible hair loss, which often results in serious discomfort and patient’s mental problems. Clinically, this form of irreversible hair loss is characterized by visible loss of hair follicle openings in the bald spots. Histologically, it consists in destroying a hair follicle and replacing it with fibrocartilage. Such disorders are perceived as primary if a hair follicle itself is the target of the disease process and secondary if hair follicles are damaged incidentally in the context of more general tissue damage (e.g. deep skin infections, thermal burns, trauma or ionizing radiation). In this article we tried to summarize the knowledge on possible pathogenic mechanisms of cicatricial alopecia. The presented factors usually overlap and affect prognosis of particular patients. Their profound understanding may enable further research on the treatment methods of this challenging disease unit.