Ligia Brzezińska-Wcisło

A Comparative Clinical Study on Five Types of Compression Therapy in Patients with Venous Leg Ulcers

The aim of this study was to compare five types of compression therapy in venous leg ulcers (intermittent pneumatic vs. stockings vs. multi layer vs. two layer short stretch bandages vs. Unna boots). Primary study endpoints were analysis of changes of the total ulcer surface area, volume and linear dimensions inside observed groups. The secondary end points were comparisons between all groups the number of completely healed wounds (ulcer healing rates), Gilman index and percentage change of ulcer surface area. In total, 147 patients with unilateral venous leg ulcers were included to this study. Participants were randomly allocated to the groups: A, B, C, D and E. After two months the healing rate was the highest in group A (intermittent pneumatic compression) - 57.14%, 16/28 patients, B (ulcer stocking system) - 56.66%, 17/30 patients and C (multi layer short stretch bandage) - 58.62%, 17/29 patients. Significantly much worse rate found in group D (two layer short stretch bandages) - only 16.66%, 5/30 patients and E (Unna boots) - 20%, 6/30 patients. The analysis of changes of the percentage of Gilman index and wound total surface area confirmed that intermittent pneumatic compression, stockings and multi layer bandages are the most efficient. The two layer short - stretch bandages and Unna boots appeared again much less effective.

The use of therapeutic ultrasound in venous leg ulcers: a randomized, controlled clinical trial

Objectives To estimate the usefulness of therapeutic ultrasound for healing of venous leg ulcers. Methods Eighty-one patients were included in this study. Patients in groups 1 and 2 were treated surgically. Patients in groups 3 and 4 were treated conservatively. Patients in groups 1 and 3 were additionally treated with the ultrasound (1 MHz, 0.5 W/cm2) once daily, six times a week for seven weeks. Results Comparison of the number of complete healed wounds indicated statistically significant differences between groups 1 and 4 (P = 0.03), 2 and 4 (P = 0.03), 3 and 4 (P = 0.03) in favour of groups 1, 2 and 3. Comparison of the other parameters also demonstrated more efficient therapy effects in groups 1, 2 and 3 than in group 4. There were no statistical differences in all examined parameters between groups 1, 2 and 3 (P > 0.05). Conclusions The ultrasound is an efficient and useful method only in conservatively treated venous leg ulcers. There are no special reasons for application of the ultrasound in surgically treated patients. A well-conducted surgical operation is much more effective for a healing process than conservative pharmacological procedures.

A Decreased Serum Leptin Level in Patients with Systemic Sclerosis

Abstract Serum leptin levels were determined in 31 women with systemic sclerosis and 24 age-matched healthy controls. Both groups were divided into premenopausal and postmenopausal subgroups. A decreased serum leptin was found in the patients with systemic sclerosis. The premenopausal patients and controls had higher serum leptin than those in the postmenopausal subgroups. Serum leptin correlated with body mass index in the patients with systemic sclerosis.

Acute-phase proteins in patients with systemic sclerosis.

Abstract: Acute-phase proteins were determined in serum of 20 women with systemic sclerosis and 10 age-matched healthy controls. All the patients had had symptoms of the disease less than five years. An increase in only a few proteins (haptoglobin, α1-acid glycoprotein, complement component C3 and α2-macroglobulin) was found. The results indicate for the impaired acute phase response in patients with systemic sclerosis.

Application of various power densities of ultrasound in the treatment of leg ulcers

AIM: The objective of our study was to determine which ultrasound power density (0.5 W/cm2 or 1 W/cm2) is more effective at reducing the area and volume of leg ulceration. METHODS: A total of 65 patients with venous ulcers were randomly divided into three groups: A, B and C. In group A, 22 patients were treated with ultrasound rated at 1 W/cm2 and with compressive therapy. In group B, 21 patients were treated with ultrasound rated at 0.5 W/cm2 and with compressive therapy. In both groups the patients were treated with a pulsed wave of a duty cycle of 1/5 (impulse time=2 ms, pause time=8 ms) and frequency of 1 MHz. The 22 patients in group C (control group) were subjected to topical pharmacological treatment. RESULTS: We found a statistically significant reduction of the ulcer area, volume and linear dimensions in all three groups of patients. The ulcer area reduction rate was highest in group B. The volume reduction rate in group B was higher than in group A only. The rate of reduction of suppurate area was highest in group B. CONCLUSION: We have demonstrated that ultrasound rated at 0.5 W/cm2 causes greater and faster changes in the healing process than ultrasound rated at 1 W/cm2.

Pyoderma gangrenosum coexisting with acute myelogenous leukaemia.

The frequency of occurrence of malignant neoplasms in the cases of pyoderma gangrenosum is not exactly determined, but it can be assessed to be at 7%.

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

Pro-inflammatory cytokines in patients with various kinds of acne treated with isotretinoin

Introduction Acne vulgaris is the most frequently diagnosed dermatosis in patients aged between 11 and 30. It is believed that it affects about 80% of persons in this age group or even, taking into account lesions of low intensity, 100% of young people. The role of cytokines in the pathogenesis of acne is not fully known. The TLR2 receptors play a role in the aetiology of acne. Stimulation of TLR2 by Propionibacterium acnes makes the IL-8 and IL-12 concentrations increase. Aim The aim of this work was to determine IL-1β, IL-1α, IL-8 and TNF-α levels in patients’ sera used to test response to TLR2 stimulation. A decrease in the levels of the above mentioned cytokines together with a decrease in sebum production were defined as an indication of efficient treatment with isotretinoin. Material and methods The tests were performed in 155 patients treated for different clinical forms of acne with an oral isotretinoin preparation in the Dermatology Clinic of the Silesian Medical University in Katowice in 2009–2011 – I group and the patients treated with oral isotretinoin 2 and 5 years ago – II group. The control group consisted of 40 healthy individuals. Conclusions Measurements of IL-1α, IL-1β and TNF-α sera concentrations could be assessed in parallel to the improvement of the clinical condition and can constitute a good indication of the efficiency of the isotretinoin treatment.

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.

A systematic review of tools for determining activity of localized scleroderma in paediatric and adult patients

Localized scleroderma (LoS) is a rare inflammatory skin disorder that affects the dermis and sometimes subcutaneous tissues. LoS can have very long periods of quiescence followed by reactivation, but the progression or activity of the disease is difficult to measure. To review the measuring tools used for the evaluation of LoS activity, to choose the most appropriate technique to facilitate progress towards properly assessing the disease, a systematic review of the literature was carried out using the PubMed MEDLINE. Sixty‐three studies describing groups of children, adults or both were reviewed and included in the analysis. Case reports were excluded. The analysed papers were published between June 1986 and February 2016. Data were extracted with a focus on instruments measuring the clinical signs of LoS, health‐related quality of life (HRQoL), laboratory tests and imaging techniques. Perusal of the literature confirmed that clinical characteristics of the lesions were used to identify activity and scoring systems that focused on a series of signs, and were initially validated in cases of childhood‐onset disease; however, there were no data concerning the adult‐onset form of the disease. Adult patients with LoS scored lower on HDLQI than those with paediatric‐onset LoS. No validated biological markers were available as correlative laboratory parameters of LoS activity. For infrared thermography, ultrasound and other imaging techniques, the features of active lesions were described, but were only useful with appropriate clinical correlation. Measuring tools have not been prospectively validated yet. Summarizing, scoring methods seem to provide the most adequate assessment of LoS and deserve to be further investigated. Combined imaging techniques create optimal conditions for the proper interpretation of the temperature at the skin surface, as well as the structure and vascularity of LoS lesions. Additional scores, musculoskeletal or neuroimaging techniques and laboratory parameters are needed for the specific disease subtypes to monitor extracutaneous manifestations.