Rafał Białynicki-Birula

The lupus band test in systemic lupus erythematosus patients.

The lupus band test (LBT) is a diagnostic procedure that is used to detect deposits of immunoglobulins and complement components along the dermoepidermal junction in patients with lupus erythematosus (LE). The LBT is positive in about 70%–80% of sun-exposed non-lesional skin specimens obtained from patients with systemic LE (SLE), and in about 55% of SLE cases if sun-protected nonlesional skin is analyzed. In patients with cutaneous LE only, the lesional skin usually shows a positive LBT. The LBT helps in differentiating LE from other similar skin conditions and may also be helpful in making the diagnosis of SLE in subjects with no specific cutaneous lesions. Furthermore, a positive LBT may be applied as a prognostic parameter for LE patients. However, the correct interpretation of this test requires detailed knowledge of the site of the biopsy, deposit components, morphology and brightness of the immunofluorescent band, and other associated serologic findings, as well as the response to treatment. It must be emphasized that LBT is a laboratory procedure that should always be interpreted in conjunction with clinical findings and other serological and immunopathological parameters.

Drug-induced subacute cutaneous lupus erythematosus resulting from ticlopidine.

Drug-induced subacute cutaneous lupus erythematosus resulting from ticlopidine Dear Sir, Ticlopidine hydrochloride is a platelet aggregation inhibitor frequently used to prevent thrombotic complications in higher risk patients. 1 The most commonly observed adverse effects are gastrointestinal, including diarrhea, nausea and vomiting. Relatively frequent neutropenia and other hematological abnormalities are noted. 1

Emerging role for the killer-cell immunoglobulin-like receptors genotype, in the susceptibility of skin diseases

NK cells are a major group of immune cells responsible for the phenomenon of natural, innate cytotoxicity. One of the better studied receptors of human NK cells are killer cell immunoglobulin-like receptors (KIR) responsible for checking the presence of MHC class I molecules, which serve as their ligands. Although previously treated as specific for NK cells, nowadays these receptors are known to also occur on T cells. Genetics of KIR molecules is very complicated, what create a great variability of haplotypes in various populations world-wide. In addition, some KIR are known to recognize HLA-C (epitopes C1 or C2), HLA-B (Bw4) or HLA-A (A3 and/or A11) molecules. Therefore, this makes a huge diversity of reactions among individuals, depending on the presence or absence of given KIR and their ligands, hence differential susceptibility to several diseases, including various dermatoses. This paper underlines the important role of both KIR genotypes and HLA class I genes with reference to the various skin diseases.

Drug-induced subacute cutaneous lupus erythematosus caused by amlodipine

Introduction. Drug-induced subacute cutaneous lupus erythematosus is a variant of lupus caused by exposure to certain drugs. It presents as annular or psoriasiform lesions located in regions which are exposed to UV radiation. Objective. To report a case of subacute cutaneous lupus erythematosus induced by amlodipine. Case report. A 78-year-old woman was admitted to our department with annular erythematous lesions which had appeared 5 months earlier on the upper extremities and trunk. Six months prior to the admission, amlodipine was added to the cardiac drugs previously used by the patient. The clinical findings and results of additional diagnostic tests suggested the diagnosis of drug-induced subacute cutaneous lupus erythematosus. Amlodipine was discontinued and adjuvant treatment was introduced, resulting in a significant improvement in skin condition. Conclusions. In cases of subacute cutaneous lupus erythematosus, particularly those developing in patients aged 50 and older drugs, including amlodipine should always be considered as possible causative factors. A detailed analysis of medications used by such patients is necessary to determine the potential of the drugs to induce lesions and the time frame during which such lesions typically arise.

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.

Diagnostic and therapeutic guidelines of dermatitis herpetiformis (Duhring’s disease) – consensus of Polish Dermatological Society

Dermatitis herpetiformis (Duhring’s disease) is an autoimmune blistering dermatosis with a characteristic polymorphic, itchy rash. The autoimmune process against transglutaminases (TGs) is connected with asymptomatic or with mild symptoms of gluten-sensitive enteropathy (GSE). The diagnostic approach in DH should rely on clinical evaluation, direct immunofluorescence of perilesional skin and evaluation of serum IgA antibodies with ELISA with one substrate of four substrates from which to choose (tTG, eTG, npG, neo-tTG) using the ELISA Diagnostyka i postępowanie terapeutyczne w opryszczkowatym zapaleniu skóry (chorobie Duhringa) – konsensus Polskiego towarzystwa Dermatologicznego Diagnostic and therapeutic guidelines of dermatitis herpetiformis (Duhring’s disease) – consensus of Polish Dermatological Society Agnieszka Żebrowska1, elżbieta Waszczykowska1, cezary Kowalewski2, Katarzyna Woźniak2, Małgorzata Olszewska2, Waldemar Placek3, rafał czajkowski4, Jacek Szepietowski5, rafał białynicki-birula5, Marian Dmochowski6 1Katedra i Klinika Dermatologii i Wenerologii Uniwersytetu Medycznego w Łodzi 2Klinika Dermatologiczna Warszawskiego Uniwersytetu Medycznego 3 Klinika Dermatologii, Chorób Przenoszonych Drogą Płciową i Immunologii Klinicznej Uniwersytetu Warmińsko-Mazurskiego

The protective melanocytic nevus sign: a new finding.

Cutaneous signs are important findings that often reflect underlying diseases or describe tendencies of established disorders. We observed the protective effect of a halo around a melanocytic nevus against cutaneous hemorrhage, and postulate that a similar pattern may explain why few cutaneous metastases are located within melanocytic nevi. In essence, this might be viewed as a reverse Köbner phenomenon, the so-called Renbök phenomenon. There are many signs that are beneficial in dermatology. One of the most important was described by Köbner in 1872. He observed that mechanical trauma, frequently occurring as a result of physical injury in a psoriatic patient, induces the onset of psoriatic papules in an area of otherwise healthy skin, and expanded the observation as a general phenomenon in which sarcoidosis and other disorders preferentially appear at sites of trauma. Another important sign was described by Nikolsky in 1896. It is characteristic for diseases with acantholysis, such as pemphigus, in which friction upon skin that is close to a blister, but clinically appears normal, induces epidermolysis. A 43-year-old man with a fracture of the left humerus presented for evaluation of a large cutaneous hemorrhage on the upper limb. After several days, the swelling diminished and the hemorrhage developed a characteristic yellow and purple coloration (Fig. 1). The subject also exhibited a melanocytic nevus on the flexor side of the left forearm, which had been present since childhood, and a typical skin wrinkle was evident over the carpal joint. This melanocytic nevus retained its normal skin color and became surrounded by a bright halo 3 mm in diameter, which apparently protected it against blood deposition. It was simultaneously observed that the wrinkle seemed to concentrate blood. 987 Figure 1 Protective melanocytic nevus sign: a melanocytic nevus surrounded by a bright halo 3 mm in diameter enveloped by hemorrhage, giving a yellowish–purple color to the skin. Note the wrinkle concentrating blood