Magdalena Czarnecka-Operacz

Acne fulminans: explosive systemic form of acne.

Acne fulminans (AF) is a rare severe form of acne vulgaris associated with systemic symptoms. It primarily affects male adolescents. Although the aetiology of AF remains unknown, many theories have been advanced to explain it. There have been reported associations with increased androgens, autoimmune complex disease and genetic pre‐disposition. The disease is destructive, with the acute onset of painful, ulcerative nodules on the face, chest and back. The associated systemic manifestations such as fever, weight loss and musculoskeletal pain are usually present at the onset. The patients are febrile, with leucocytosis and an increased erythrocyte sedimentation rate. They may require several weeks of hospitalization. The treatment of AF has been challenging; the response to traditional acne therapies is poor. The recommended treatment is aggressive and consists of a combination of oral steroids and isotretinoin. To avoid the relapses, duration of such treatment should not be less than 3–5 months. Although the prognosis for patients treated appropriately is good, these acute inflammatory nodules often heal with residual scarring.

Contact allergy in patients with chronic venous leg ulcers-- possible role of chronic venous insufficiency.

The purpose of this study was to evaluate frequency of contact allergy in patients with chronic venous leg ulcers (CVLU) and to estimate possible relationships between allergic contact reactions and characteristics of both chronic venous insufficiency (CVI) and CVLU. We performed patch tests with the European standard series, antibiotics, glucocorticosteroids and ointment vehicles in 50 patients with CVLU. Patients underwent detailed CVI diagnostics using colour flow duplex ultrasound examination, ankle brachial pressure index determination and leg ulcers area measurement. Positive patch tests results were found in 80% and polyvalent allergy in 56% of patients. Statistically significant correlations were recorded between CVI and CVLU duration, CVLU duration and CVLU area and between CVI duration and polyvalent allergy frequency. Statistically significant differences were observed between coexistence of superficial and deep system insufficiency and CVLU duration, characteristics of contact allergic reactions and CVI duration, frequency of allergic contact reaction and presence or absence of long saphenous vein insufficiency, incidences of vein thrombosis and characteristics of contact allergic reactions as well as between characteristics of contact allergic reactions and both CVLU duration and area. Complex pathophysiological processes, including inflammatory reactions, in course of CVI may influence development of allergic contact reaction in CVLU patients.

European consensus-based (S2k) Guideline on the Management of Herpes Zoster – guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 2: Treatment

Herpes zoster (HZ, shingles) is a frequent medical condition which may severely impact the quality of life of affected patients. Different therapeutic approaches to treat acute HZ are available. The aim of this European project was the elaboration of a consensus‐based guideline on the management of patients who present with HZ, considering different patient populations and different localizations. This interdisciplinary guideline aims at an improvement of the outcomes of the acute HZ management concerning disease duration, acute pain and quality of life of the affected patients and at a reduction in the incidence of postherpetic neuralgia (PHN) and other complications. The guideline development followed a structured and pre‐defined process, considering the quality criteria for guidelines development as suggested by the AGREE II instrument. The steering group was responsible for the planning and the organization of the guideline development process (Division of Evidence‐Based Medicine, dEBM). The expert panel was nominated by virtue of clinical expertise and/or scientific experience and included experts from the fields of dermatology, virology/infectiology, ophthalmology, otolaryngology, neurology and anaesthesiology. Recommendations for clinical practice were formally consented during the consensus conference, explicitly considering different relevant aspects. The guideline was approved by the commissioning societies after an extensive internal and external review process. In this second part of the guideline, therapeutic interventions have been evaluated. The expert panel formally consented recommendations for the treatment of patients with HZ (antiviral medication, pain management, local therapy), considering various clinical situations. Users of the guideline must carefully check whether the recommendations are appropriate for the context of intended application. In the setting of an international guideline, it is generally important to consider different national approaches and legal circumstances with regard to the regulatory approval, availability and reimbursement of diagnostic and therapeutic interventions.

Neurogenic markers of the inflammatory process in atopic dermatitis: relation to the severity and pruritus

Introduction Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease, characterized by eczematous skin lesions and intensive pruritus. Recent studies have shed light on the role of the nervous system in the pathogenesis of AD. It can influence the course of the disease through an altered pattern of cutaneous innervation and abnormal expression of neuropeptides in the lesional skin. Aim The aim of the study was to evaluate plasma concentrations of the nerve growth factor (NGF), substance P (SP) and vasoactive intestinal peptide (VIP) in AD patients in comparison to two control groups (healthy volunteers and patients suffering from psoriasis). Correlations between plasma levels of evaluated parameters, severity of the disease and selected clinical parameters (skin prick tests, total and antigen specific IgE levels) were also analysed. Material and methods Seventy-five patients with AD, 40 patients with psoriasis and 40 healthy volunteers were included into the study. Patients with AD included 52 persons suffering from an extrinsic and 23 from an intrinsic type of the disease. The severity of skin lesions was assessed with SCORAD index. Pruritus was evaluated on the basis of the questionnaire assessing the extent, frequency and intensity of pruritus. Commercial enzyme-linked immunosorbent assays (SP, NGF: R&D Systems; and VIP: Phoenix Pharmaceuticals) were used to assess the neuropeptide and NGF plasma levels. Results Nerve growth factor and VIP plasma concentrations were significantly higher in AD patients compared to psoriatic patients and healthy subjects. Substance P plasma concentrations were elevated in the extrinsic type of AD and psoriasis comparing to healthy volunteers. There were no statistically significant differences in NGF, SP and VIP plasma concentrations between the extrinsic and intrinsic type of AD. There was also no correlation between plasma levels of evaluated parameters (NGF, SP, VIP) and SCORAD index in both types of AD. However, plasma SP concentration correlated with intensity of pruritus in AD patients. Plasma VIP concentrations correlated with intensity of pruritus in the intrinsic type of AD and with IgE-mediated sensitization to moulds in the extrinsic type of disease. Conclusions Our findings confirm that NGF and VIP play a prominent role in atopic inflammatory reactions and may serve as good alternative biomarkers of AD. The results of this study also suggest a similar important role of neuroimmune interactions in both variants of AD. Increased SP plasma concentrations in both AD and psoriasis point to its possible role in modulating immune-mediated inflammation in different chronic inflammatory skin diseases. Moreover, SP and VIP seem to influence the course of AD by increasing pruritus, whereas an elevated plasma VIP level in AD patients may be related to a risk of developing IgE-mediated sensitization to certain airborne allergens.

Eosinophilic fascitis: a report of two cases treated with ultraviolet A1 phototherapy.

Eosinophilic fascitis (EF) (synonyms: Shulmans syndrome, diffuse fascitis with eosinophilia) is a disease characterized by a complex set of symptoms with scleroderma‐like skin lesions, the absence of Raynauds phenomenon and other non‐mandatory symptoms including eosinophilia, elevated erythrocyte sedimentation rate, hypergammaglobulinemia and high levels of circulating immune complexes. EF is probably not a separate disease entity, but an acute variant of localized scleroderma. This rare disease of unknown etiology is usually seen in middle‐aged adults. Sclerodermiform indurations without Raynauds symptoms develop rapidly usually on the extremities and more rarely on the trunk or the face. The skin becomes hard, tightly bound to the underlying structures, so that contractures can develop in as little as a few weeks. The course of the disease is usually chronic but spontaneous remission is possible. Standard therapy includes high doses of corticosteroids, immunosuppressive drugs such as methotrexate, cyclosporin A, cyclophosphamide or azathioprine and others such as psoralen and ultraviolet A radiation.

The possibilities and principles of methotrexate treatment of psoriasis – the updated knowledge

Psoriasis is a chronic multifactorial disease affecting 2–4% of the general population. Due to its nature, psoriasis has a negative impact on the quality of life of patients. Therefore, the choice of an appropriate and individually tailored treatment controlling the symptoms of the disorder is necessary and continues to be a challenge for dermatologists. Therapeutic modalities in psoriasis should on the one hand be effective and on the other hand present a good safety profile. Methotrexate (MTX) is one of treatment options for psoriasis and can be administered both as monotherapy or in combination schemes. The paper presents the current state of knowledge about the possible treatment of psoriatic patients with MTX according to contemporary guidelines.

Seemingly healthy skin in atopic dermatitis: observations with the use of high-frequency ultrasonography, preliminary study.

Background: Atopic dermatitis (AD) is a chronic, relapsing skin disorder which is strictly determined by the epidermal barrier function. In previous studies, there is conclusive evidence that normal‐looking, nonlesional skin presents meaningful barrier function defect and a sub‐clinical eczematous skin reaction.

Topical calcineurin inhibitors in the treatment of atopic dermatitis – an update on safety issues

Atopic dermatitis is a common chronic skin disorder whose management is complex. Topical corticosteroids have been the mainstay of atopic dermatitis treatment for more than 50 years but have multiple side effects. Topical calcineurin inhibitors including tacrolimus and pimecrolimus are safe and efficacious in atopic dermatitis. In 2005 the FDA issued “black box” warnings for pimecrolimus cream and tacrolimus ointment because of potential safety risks, including skin cancers and lymphomas. However, these concerns are not supported by current data. Topical calcineurin inhibitors are particularly indicated for treating patients with atopic dermatitis in whom topical corticosteroid therapy cannot be employed or may cause irreversible side effects. They can be used advantageously in problem zones. A novel regimen of proactive treatment has been shown to prevent, delay and reduce exacerbations of atopic dermatitis. Therapy with topical calcineurin inhibitors should be managed by an experienced specialist and each patient should receive proper education on how to use them and what possible unwanted effects may be expected.

European Surveillance System on Contact Allergies (ESSCA) : Results with the European baseline series, 2013/14

Contact allergy is a common condition and can severely interfere with daily life or professional activities. Due to changes in exposures, such as introduction of new substances, new products or formulations and regulatory intervention, the spectrum of contact sensitization changes.

Mesoscale atmospheric transport of ragweed pollen allergens from infected to uninfected areas

Allergenic ragweed (Ambrosia spp.) pollen grains, after being released from anthers, can be dispersed by air masses far from their source. However, the action of air temperature, humidity and solar radiation on pollen grains in the atmosphere could impact on the ability of long distance transported (LDT) pollen to maintain allergenic potency. Here, we report that the major allergen of Ambrosia artemisiifolia pollen (Amb a 1) collected in ambient air during episodes of LDT still have immunoreactive properties. The amount of Amb a 1 found in LDT ragweed pollen grains was not constant and varied between episodes. In addition to allergens in pollen sized particles, we detected reactive Amb a 1 in subpollen sized respirable particles. These findings suggest that ragweed pollen grains have the potential to cause allergic reactions, not only in the heavily infested areas but, due to LDT episodes, also in the regions unaffected by ragweed populations.