Radomir Reszke

Skin disorders in elderly subjects.

Skin problems in the elderly population have rarely been the subject of scientific research.

Secukinumab in the treatment of psoriasis: an update

Biological drugs are pharmaceuticals manufactured using biotechnology methods that may target specific cytokines, cytokine receptors or surface molecules, and modulate the immunological response of the organism. Psoriasis is a common cutaneous disease in which biological drugs have been evaluated and widely accepted in clinical practice. Secukinumab is a monoclonal antibody targeting IL-17A which has been extensively researched in clinical trials and registered in treating moderate to severe plaque psoriasis. We performed a literature search in Pubmed database on the pharmacology of secukinumab and randomized clinical trials investigating its efficacy and safety in treating plaque psoriasis in comparison to placebo or biological drugs (etanercept, ustekinumab). The administration of secukinumab in psoriatic subjects resulted in subjective and objective disease parameters reduction while exhibiting high safety profile. Secukinumab is an effective drug with a favorable safety profile. It has already taken an important position in managing plaque psoriasis in clinical practice.

Psychogenic Itch Management

Pruritus is a bothersome and prevalent symptom reported by patients suffering from both cutaneous and extracutaneous diseases. Psychogenic pruritus, also referred to as functional itch disorder, is a distinct clinical entity. According to the definition proposed by the French Psychodermatology Group (FPDG) in 2007, the disorder is characterized by pruritus which is the chief complaint and psychologic factors that contribute to eliciting, worsening, and sustaining the symptoms. Specific diagnostic criteria were proposed, including 3 compulsory and 7 optional, of which 3 have to be met in order to establish the diagnosis. Psychogenic pruritus may require cooperation between dermatologists, psychiatrists, and psychologists. Psychotherapy and psychopharmacotherapy are mainstays of managing the disease. However, publications regarding psychogenic itch management are uncommon. Initially, general measures have to be taken, including avoiding irritating factors, preventing skin dryness, and frequent application of emollients. As in pruritus of other causes, several drugs are used, with more emphasis on substances that influence central nervous system: H1-antihistamines (hydroxyzine, chlorpheniramine, cyproheptadine, diphenhydramine, promethazine), tricyclic antidepressants (doxepin), tetracyclic antidepressants (mirtazapine), selective serotonin reuptake inhibitors (citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline), antipsychotic drugs (pimozide), anticonvulsants (topiramate), and benzodiazepines (alprazolam), preferably depending on the coexisting symptoms.

Disseminated tungiasis in an 8-year-old girl

Introduction. Tungiasis is a neglected tropical disease caused by females of the ectoparasite sand flea Tunga penetrans. It is endemic in economically depressed communities and can be associated with considerable morbidity and poor quality of life. Objective. To present a case of disseminated tungiasis in a patient from rural Ethiopia. Case report. An 8-year-old neglected girl presented with painful nodular lesions on distal parts of the limbs. Physical examination revealed presence of periungually located white eggs. The lesions limited the patient’s mobility, gripping abilities, daily activity and quality of life. The diagnosis of tungiasis was established and the patient was treated with topical salicylated petroleum jelly and systemic ivermectin. Conclusions. Severe tungiasis resulting in physical disability and affecting everyday life is not rare in rural Ethiopia. Even in endemic countries it is worth reporting this condition in order to increase awareness regarding interventions for prevention and design adequate control measures.

Lupoid mucocutaneous leishmaniasis

Introduction. Leishmaniasis is a parasitic infection caused by different species of the intracellular protozoan Leishmania and transmitted through the bite of an infected female sand fly. It occurs in various clinical forms, including cutaneous manifestations. Objective. To present a case of lupoid mucocutaneous leishmaniasis in a patient from Ethiopia. Case report. A 17-year-old man with no significant medical history presented with papular, plaque and ulcerative lesions in the central region of face that had been present for one year. A smear followed by Giemsa stain revealed the presence of amastigotes in monocytes and extracellular matrix. Based on the clinical manifestation and microscopic examination, the diagnosis of mucocutaneous leishmaniasis was established. The treatment was based on N-methylglucamine antimoniate, with subsequent resolution of skin lesions. Conclusions. Mucocutaneous leishmaniasis, including the lupoid subtype, is an important clinical entity in endemic areas. Treatment with antimony derivatives may be beneficial in affected subjects.

End-Stage Renal Disease Chronic Itch and Its Management

End-stage renal disease chronic itch is a frequent symptom that bothers patients with advanced stages of chronic kidney disease. The pathogenesis of the chronic itch symptom is complex and not yet fully understood and includes many metabolic, immunologic, and neurogenic factors. A significant burden of the disease results in decreased quality of life with sleep impairment, depressive symptoms, and increased mortality of affected individuals. No treatment of choice is available; topical therapy (emollients), phototherapy (UV-B), and systemic therapy (antiepileptics, opioid agonists, and antagonists) provide significant relief in varying percentages of patients.

Itch and Stress

Itch is one of the most common symptoms in dermatology, coexisting both with cutaneous disorders (e.g. atopic dermatitis, urticaria, psoriasis, eczema) and systemic disorders (e.g. renal, hepatic, endocrine or neurological). The occurrence of itch may be very bothersome and significantly reduces the health-related quality of life of an affected person. Pathogenesis of pruritus is not fully understood, although it is currently considered as a separate type of sensation. Stress is a complex term, having several definitions and numerous associations with physical, medical and psychological aspects of an individual’s life. Unsurprisingly, itch and stress are closely related to each other, emphasizing the crucial role of central nervous system in generating, sustaining and exacerbating of these symptoms. Stress may induce or exacerbate pre-existing itch while the presence of itch itself is associated with high levels of stress. A vicious itch-scratch-itch cycle appears in a person suffering from pruritus, leading to scratching, additional stress and further worsening of pruritus. The chapter covers main aspects of pathogenesis of pruritus and stress, reviews most common pruritic dermatoses and their relation with stress and describes current treatment modalities applied to alleviate pruritus and coexisting stress.

Urticarial vasculitis coexisting with primary myelofibrosis – a case report

Introduction. Urticarial vasculitis is a subtype of cutaneous leukocytoclastic vasculitis. The disease often accompanies systemic disorders, including hematologic malignancies, connective tissue diseases, and infectious diseases, or may be drug-induced. Case report. A 69-year-old man with an established diagnosis of primary myelofibrosis was admitted to our department because of severe pruritus and cutaneous urticarial lesions. At the time of admission the patient was not receiving treatment for the underlying hematologic disease. Upon physical examination diffuse and confluent firm urticarial lesions were observed on the trunk and limbs. A skin biopsy revealed histological features of urticarial vasculitis. We initiated intravenous hydrocortisone up to 400 mg/day, methylprednisolone 500 mg in a single dose and prednisone orally 20 mg/day, with rapid resolution of skin lesions. Conclusions. Urticarial vasculitis may accompany various systemic disorders, including primary myelofibrosis. To our knowledge this is the second case in the literature of urticarial vasculitis associated with myelofibrosis. Treatment with systemic glucocorticosteroids should be considered, as this method is usually beneficial.

Severe exacerbation of psoriasis after cessation of methotrexate therapy successfully treated with cyclosporin A

Introduction. It is estimated that erythroderma affects about 1–2% of patients with psoriasis. Objective. To present a case of psoriatic erythroderma, which was effectively treated with cyclosporin A. Case report. A 31-year-old man was admitted to the department to treat erythroderma. Approximately 3 weeks prior to hospital admission he discontinued methotrexate treatment which, in addition with upper respiratory tract infection resulted in rapid recurrence of psoriatic lesions and development of erythroderma. Methotrexate 20 mg weekly was re-introduced to treat skin lesions. Despite such treatment, no satisfactory improvement was achieved. On the 13th day of hospitalization it was decided to start cyclosporin A (initially 200 mg/day, next increased to 300 mg/day). Cyclosporin A treatment was effective and well tolerated. Conclusions. Discontinuation of systemic treatment in patients with psoriasis may be associated with an exacerbation of the skin condition including erythroderma. Cyclosporin A is a valuable therapeutic option for patients with psoriatic erythroderma. The treatment is characterized by a rap id onset of action, good efficacy and generally favourable safety profile.

High-frequency ultrasonography (HFUS) as a useful tool in differentiating between plaque morphea and extragenital lichen sclerosus lesions

Introduction Morphea and lichen sclerosus (LS) are chronic inflammatory diseases that may pose a diagnostic challenge for a physician. High-frequency ultrasonography (HFUS) is a versatile diagnostic method utilized in dermatologic practice, allowing monitoring the course of the disease, treatment response and differentiation between certain skin disorders. Aim To prove the usefulness of HFUS in differentiating between plaque morphea and extragenital LS lesions. Material and methods We examined 16 patients with plaque morphea and 4 patients with extragenital LS using 20 MHz taberna pro medicum TM (Germany) device. Results Investigations revealed hyperechogenic entrance echo in both morphea and LS lesions, whereas a distinct polycyclic surface of the entrance echo was detected exclusively in LS. Conclusions High-frequency ultrasonography is a current diagnostic modality that may prove useful in differentiating between morphea and LS lesions.