Karolina Olek-Hrab

“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.

Primary cutaneous lymphomas: diagnosis and treatment

Primary cutaneous lymphomas (CLs) are a heterogeneous group of lymphoproliferative neoplasms, with lymphatic proliferation limited to the skin with no involvement of lymph nodes, bone marrow or viscera at the diagnosis. Cutaneous lymphomas originate from mature T-lymphocytes (65% of all cases), mature B-lymphocytes (25%) or NK cells. Histopathological evaluation including immunophenotyping of the skin biopsy specimen is the basis of the diagnosis, which must be complemented with a precise staging of the disease and identification of prognostic factors, to allow for the choice of the best treatment method as well as for the evaluation of the treatment results.

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.

Diagnostics in mycosis fungoides and Sezary syndrome.

AIM The aim of this paper was to present diagnostic methods helping in the recognition of mycosis fungoides (MF) and Sezary syndrome (SS). BACKGROUND Mycosis fungoides is the most common form of primary cutaneous T-cell lymphomas. It is characterized by a distinctive long-term course and malignant T-cell proliferation. MF diagnosis is not easy, mainly due to the atypical clinical presentation of the disease at an early stage. MATERIALS AND METHODS Low specific changes, which can be observed at the histopathological examination. Initially, the skin lesions may resemble psoriasis, atopic dermatitis or chronic eczema. Patients are qualified according to the available, and generally accepted WHO-EORTC classification, based on a combination of clinical and histopathological markers. From a clinical point of view, it is also important to carry out the qualification according to the TNMB assessment, which allows to specify the stage of the disease, and is helpful in the monitoring of the course of disease and therapeutic effects. RESULTS In this paper we try to present currently available diagnostic methods. CONCLUSION Diagnosis of MF and SS still causes many problems due to less characteristic changes in the early stage of disease and requires wide interdisciplinary knowledge.

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.

Biosimilars in dermatology

Over the last decade the availability of biological drugs for the treatment of psoriasis vulgaris, psoriatic arthritis and many other inflammatory diseases has revolutionized the treatment of these diseases around the world. Due to the high cost of therapy, the search has started for biosimilars. In dermatology the greatest interest in biosimilar medicines concerns inhibitors of tumor necrosis factor a (TNF-α), for use in the treatment of psoriasis vulgaris and psoriatic arthritis (infliximab, etanercept, adalimumab). The most important element of the safety of biologicals is their immunogenicity. Therefore, when discussing biosimilars, attention needs to be paid to the dangers of their immune activity. In view of the fact that the drugs contain and aggregates, produced by living organisms or cultures of living cells, they cannot be compared in any way to low molecular weight synthetic generics (called generics). Biosimilars are authorized for use in patients and treated as equivalent to the reference medicine only after passing a number of studies and assessments. As it is well known, the development of medicine and pharmacology is extremely intense, and the market in biological medicine is developing much faster than that of all other drugs, which underlines their important role in modern medicine. Currently, the subject of biosimilars is one of the most important challenges and topics of discussion around the world, including pharmacovigilance and legal and economic regulatory standards. It seems inevitable that biosimilar products will be introduced for the treatment of diseases with indications corresponding to the original product on which they are based.

Co-occurrence of acanthosis nigricans and bladder adenocarcinoma – case report

Acanthosis nigricans (AN) is characterized by the occurrence of symmetrical velvety hyperpigmented plaques that can be observed in each location on the skin. However, the lesions are most frequently located in the axillary, inguinal and nuchal areas. Primarily, the lesions appear as hyperpigmented focuses which later transform into papillary lesions. There are two forms of the disease – benign and malignant. Malignant AN is considered to represent paraneoplastic syndrome co-occurring with advanced cancer, but as such it is not malignant. This article presents a case of a patient diagnosed with AN and coexisting bladder cancer and discusses the case in the context of available literature.

Calcipotriol/betamethasone ointment compared to narrow‐band UVB in plaque psoriasis: first clinical and ultrasonographic study

A wide range of treatments are available for psoriasis, including pharmaceuticals and phototherapy. Calcipotriol/betamethasone dipropionate and narrow‐band ultraviolet phototherapy (NB‐UVB) are both effective monotherapies for psoriasis; however, these two therapies have never been directly compared in a prospective clinical study. In this study, we compared the efficacy of combined calcipotriol/betamethasone dipropionate to NB‐UVB in psoriatic patients with Psoriasis Area Severity Index (PASI) 9–10 treated in a routine clinical practice.

Mycosis fungoides – therapeutic difficulties

Lymphoma belongs to a heterogeneous group of malignant neoplasms of the lymphatic system developing from lymphocytes, precursor cells, or directly from a multipotent stem cell [1]. Cutaneous T-cell lymphoma (CTCL), including mycosis fungoides, first affects the skin [2].