Jacek Szepietowski

A 5-year survey of dermatomycoses in southwest Poland, years 2003–2007

The study was performed to analyse the spectrum of dermatomycoses in southwest Poland during the period 2003–2007. A total of 10u2003486 patients were investigated for fungal skin infections by means of native specimen and cultivating procedures. Skin scrapings, plucked hairs and nail clippings were examined and identified by direct microscopy and culture. From 2468 patients, 2753 fungi were identified including dermatophytes, yeast and moulds. Among the dermatophytes, the most common pathogen isolated was Trichophyton rubrum (59.4%), followed in descending order by: Trichophyton mentagrophytes var. interdigitale (16.6%), Trichophyton mentagrophytes var. mentagrophytes (9.0%), Trichophyton tonsurans (6.8%), Microsporum canis (5.1%) and Epidermophyton floccosum (2.7%). Among the yeast‐like fungi, a marked predominance of Candida species was observed (86.3%). Scopulariopsis brevicaulis was the most commonly isolated mould (25.2%). The most frequently affected body sites were the toenails (53.9%), followed by the fingernails (19.0%). In children under 15u2003years of age, glabrous skin was the most commonly affected body site with M. canis as the most frequent causative agent.

Protective effect of the KIR2DS1 gene in atopic dermatitis.

Atopic dermatitis (AD) is a common skin disease of complex etiology including affected humoral and cellular immune responses. The role of NK cells in development of this disease has been recently postulated, but is still poorly documented. The current study was undertaken to determine the impact of genes for the most polymorphic NK cell receptors, known as killer cell immunoglobulin-like receptors (KIRs), on the development of AD. We compared 240 patients suffering from AD with 570 healthy controls. Frequencies of the great majority of KIR genes did not differ between patients and controls, except for KIR2DS1, whose frequency was significantly (OR=0.629, CI95% (0.45; 0.87), pcorr=0.0454) lower in patients than in controls. These results were confirmed in a second cohort of 201 patients. When both patient groups were combined and compared to the control group, the result for KIR2DS1 achieved even higher significance (OR=0.658, CI95% (0.5; 0.86), pcorr=0.0158). To the best of our knowledge, this is the first report on KIR gene contribution to AD, and to allergy in general.

Is Renal Function Altered in Patients with Psoriasis Vulgaris?—A Short Review

Psoriasis is a chronic inflammatory dermatosis with distinct microvascular changes. Although it is generally accepted that the psoriatic process is limited to the skin, it is not excluded that similar vascular lesions might be present in internal organs, such as the kidneys. This review summarizes data on renal function in psoriatic patients who were never treated with the potentially nephrotoxic drugs used for treatment of psoriasis. The limited number of such studies is mainly concentrated on microalbuminura. Enhanced urinary albumin excretion at the level of microalbuminuria has been found in some psoriatic individuals. All other routine laboratory renal tests were within their normal ranges. As microalbuminuria is regarded as a subclinical marker of glomerular dysfunction, the authors hypothesize that some psoriatic patients may present subclinical glomerular changes. However, kidney histopathology is necessary to confirm this hypothesis.

Metallothionein 3 Expression in Normal Skin and Malignant Skin Lesions

Metallothionein-3 (MT-3) has been shown to be expressed in several malignancies and to have an impact on patients’ survival in breast and urinary bladder cancer cases. However, its expression has not been determined in normal skin or in its malignant lesions. MT-3 expression was studied using immunohistochemistry in 17 cases of normal skin, 18 of actinic keratosis (AK), 39 of squamous cell carcinoma (SCC), and 23 of basal cell carcinoma (BCC). Low MT-3 expression was observed in normal skin epidermis with faint or no expression in the epidermis basal layer. Significantly higher MT-3 expression was noted in AK (Pu2009=u20090.007) and SCC (Pu2009<u20090.0001), as compared with normal skin epidermis. BCC cases were characterized by the lowest MT-3 expression of all the examined groups, which was significantly lower in comparison to normal skin epidermis, AK, and SCC (Pu2009=u20090.009; Pu2009<u20090.0001 and Pu2009<u20090.0001, respectively). In conclusion, MT-3 may be involved in the development of SCC.

PathoPathogenesis and Management of Itch in Adult Atopic Dermatitis Patients

Autoimmune bullous diseases are a group of intraand subepidermal disorders with different course and prognosis. Most of them are serious diseases which have to be treated for longer period and controlled by experienced dermatologist. Pemphigus group of diseases is characterized by acantholysis in the epithelium of mucous membranes or / and the skin. These diseases can have significant morbidity and morality as a result of complications of the disease or side-effects of the therapy. Mainstay of the therapy of pemphigus are corticosteroids. Usually together with corticosteroids, steroid-sparing agents i.e. azathioprine or mycophenate mofetil are introduced to reduce side-effects of corticosteroids and to make remision periods longer. Patients who do not respond to these therapies should be treated with intravenous immunoglobulins, cyclophosphamide or rituximab.Histamine intolerance (HIT) develops as a result of an impaired diamine oxidase (DA0) activity due to gastrointestinal disease or through DA0 inhibition, as well as through a genetic predis-position which was proven in a number of patients. The intake of histamine- rich foods as well as alcohol or drugs which cause either the release of histamine or the blocking of DA0 can lead to various disorders in many organs (gastrointestinal system, skin, lungs, cardiovascular system and the brain), depending on the expression of histamine receptors. Dermatologic sequels can be rashes, itch, urticaria, angioedema, dermatitis, eczema and even acne, rosacea, psoriasis and other. The recognizing of symptoms due to HIT is especially important in treating such patients. Because of the possibility of symptoms affecting numerous organs, a detailed history of symptoms following the intake of histamine rich foods or drugs that interfere with histamine metabolism is essential for making a diagnosis of HIT. Considering that such symptoms ran be a result of multiple factors, the existence of HIT is usually underestimated, 5 expectations are being made from the future studies.

Psychological Aspects of Vitiligo

Autoimmune bullous diseases are a group of intraand subepidermal disorders with different course and prognosis. Most of them are serious diseases which have to be treated for longer period and controlled by experienced dermatologist. Pemphigus group of diseases is characterized by acantholysis in the epithelium of mucous membranes or / and the skin. These diseases can have significant morbidity and morality as a result of complications of the disease or side-effects of the therapy. Mainstay of the therapy of pemphigus are corticosteroids. Usually together with corticosteroids, steroid-sparing agents i.e. azathioprine or mycophenate mofetil are introduced to reduce side-effects of corticosteroids and to make remision periods longer. Patients who do not respond to these therapies should be treated with intravenous immunoglobulins, cyclophosphamide or rituximab.Histamine intolerance (HIT) develops as a result of an impaired diamine oxidase (DA0) activity due to gastrointestinal disease or through DA0 inhibition, as well as through a genetic predis-position which was proven in a number of patients. The intake of histamine- rich foods as well as alcohol or drugs which cause either the release of histamine or the blocking of DA0 can lead to various disorders in many organs (gastrointestinal system, skin, lungs, cardiovascular system and the brain), depending on the expression of histamine receptors. Dermatologic sequels can be rashes, itch, urticaria, angioedema, dermatitis, eczema and even acne, rosacea, psoriasis and other. The recognizing of symptoms due to HIT is especially important in treating such patients. Because of the possibility of symptoms affecting numerous organs, a detailed history of symptoms following the intake of histamine rich foods or drugs that interfere with histamine metabolism is essential for making a diagnosis of HIT. Considering that such symptoms ran be a result of multiple factors, the existence of HIT is usually underestimated, 5 expectations are being made from the future studies.