A 12-year old girl with severe plaque psoriasis and Down syndrome treated successfuly with etanercept

Microsporum (M.) canis is the most common fungus to cause tinea capitis in Europe, especially in the Mediterranean region and South and Central Europe. Fungal scalp infections caused by M. canis tend to be non-inflammatory. Recently, a growing number of cases of tinea capitis characterized by inflammatory infection caused by M. canis and M. gypseum have been registered. We present a case of highly inflammatory tinea capitis, also known as kerion celsi, caused by M. canis in a 6-year-old-patient. Scalp infections due to M. canis are a growing problem in dermatological practice. Changes in epidemiology, etiology, and clinical patterns of fungal infections due to M. canis are significant. Greater awareness of this problem is needed in order to establish proper diagnosis and successful treatment strategy for these patients. </p

A 12-year old girl with severe plaque psoriasis and Down syndrome treated successfuly with etanercept

Microsporum (M.) canis is the most common fungus to cause tinea capitis in Europe, especially in the Mediterranean region and South and Central Europe. Fungal scalp infections caused by M. canis tend to be non-inflammatory. Recently, a growing number of cases of tinea capitis characterized by inflammatory infection caused by M. canis and M. gypseum have been registered. We present a case of highly inflammatory tinea capitis, also known as kerion celsi, caused by M. canis in a 6-year-old-patient. Scalp infections due to M. canis are a growing problem in dermatological practice. Changes in epidemiology, etiology, and clinical patterns of fungal infections due to M. canis are significant. Greater awareness of this problem is needed in order to establish proper diagnosis and successful treatment strategy for these patients. </p

The role of VEGF in psoriasis: an update

Psoriasis is a common, chronic immune-mediated multifactorial skin disease. In its pathogenesis altered differentiationand hyperproliferation of keratinocytes, dysregulation of immunological cell functions, together withabnormal angiogenesis are involved. Angiogenesis is defined as the formation of new blood vessels from thepre-existing vascular bed. This complex and multistep process is regulated by different factors among whichvascular endothelial growth factor (VEGF) is considered to be the most important. The aim of this paper isa review of the current literature considering the role of vascular endothelial growth factor in psoriasis. Manystudies have focused on the role of VEGF in psoriasis and revealed its increased serum and tissue levels whichcorrelated with disease severity. Recent data indicate that VEGF is not only responsible for angiogenesis, butalso regulates keratinocyte differentiation. Moreover, it has been suggested that vascular endothelial growthfactor could be a link between psoriasis and its comorbidities. So far, there are single clinical cases that reportedclearance of psoriasis after anti-VEGF therapy. Therefore, the VEGF pathway might be a potential new therapeuticalternative leading to improvement of psoriasis. However, further clinical studies are needed to evaluatethe efficacy and safety of this therapy in psoriasis

Xylan decomposition in plant cell walls as an inducer of surfactin synthesis by Bacillus subtilis

Hemicellulose is the second most abundant plant heterogenous biopolymer. Among products obtained from a wide range of agro-residues, biosurfactants, e.g., surfactin (SU), are gaining increasing interest. Our previous studies have shown that a Bacillus subtilis strain can successfully produce a significant amount of SU using a rapeseed cake. This work aimed to investigate plant hemicellulose components as substrates promoting SU's efficient production by B. subtilis 87Y. Analyses of SU production, enzymatic activity and cell wall composition of hulled oat caryopses suggest that the main ingredients of plant hemicellulose, in particular xylan and its derivatives, may be responsible for an increased biosurfactant yield

Genes and structure of selected cytokines involved in pathogenesis of psoriasis.

Psoriasis is a common skin disease involving 1-4% of human population worldwide, of strong genetic background. The following cytokines are directly involved in psoriasis: TNF, IL-1, IL-2, IL-6, IL-7, IL-8, IL-15, IL-18, IL-19, IL-20, IL-23 whereas IL-4, IL-10, IL-12 as well as IL-11, IL-17 and IFN-gamma are rather indirectly engaged. This work is a review of some genetic factors and structure of selected cytokines and receptors and their genes location

Uncontrolled postoperative bleeding in woman with pemphigus and undiagnosed acquired haemophilia A

Nabyta hemofi lia A (AHA) jest skazą krwotoczną wywołaną przez nagłe pojawienie się przeciwciał przeciw czynnikowi krzepnięcia VIII u osoby z negatywnym wywiadem w kierunku zaburzeń krzepnięcia krwi. W obrazie klinicznym choroby dominują wynaczynienia krwi, które prowadzą do zgonu nawet w 22% przypadków. Pacjentka w wieku 55 lat z rozpoznaniem pęcherzycy liściastej była hospitalizowana z powodu nasilenia zmian skórnych, pod postacią sączących się nadżerekz tendencją do erytodermii. W trakcie hospitalizacji obserwowano znaczne pogorszenie stanu ogólnego, narastanie niedokrwistości, silne bóle brzucha oraz wydłużenie czasu częściowej tromboplastynypo aktywacji. W badaniu tomografi i komputerowej stwierdzono obecność rozległych krwiaków w obrębie jamy otrzewnej oraz przestrzeni zaotrzewnowej. Chorej przetoczono świeżo mrożoneosocze (FFP) i poddano ją zabiegowi chirurgicznej ewakuacji krwiaków. Dodatkowo w trakcie zabiegu usunięto torbiel jajnika oraz śledzionę z powodu krwawienia w lewej okolicy podprzeponowej. W okresie pooperacyjnym obserwowano uporczywe krwawienie z rany pooperacyjnej mimo codziennych transfuzji FFP. Podejrzenie nabytej hemofi lii A potwierdzono, oznaczając aktywnośćczynnika VIII (20 jm./dl) i stwierdzając obecność inhibitora czynnika VIII w mianie 1,8 jB./ml. Zastosowano rekombinowany aktywny czynnik VII (rFVIIa) i rozpoczęto leczenie immunosupresyjne. Podczas zmniejszania dawki rFVIIa obserwowano nawrót krwawienia. Chora otrzymywała koncentraty omijające inhibitor łącznie przez 39 dni. W trakcie terapii rozpoznano zewnętrzną przetokę moczową oraz obserwowano przetrwałe krwiaki o podobnej lokalizacji i rozmiarze, jakwyjściowo. Po 6 tygodniach leczenia immunosupresyjnego wyeliminowano inhibitor, a chorą poddano operacjom chirurgicznym, których celem było usunięcie zhemolizowanych krwiaków orazrekonstrukcja pęcherza moczowego. W okresie okołooperacyjnym nie obserwowano skłonności do nadmiernych krwawień. Podsumowując, u chorego z obrazem niewyjaśnionej skazy krwotocznej nie należy przeprowadzać żadnych procedur inwazyjnych. W przypadku rozpoznania AHA zabiegi chirurgiczne, o ile to możliwe, należy odłożyć do czasu wyeliminowania inhibitoraAcquired haemophilia A (AHA) is caused by sudden appearance of autoantibodies against factor VIII (FVIII). The disease presents with severe or life-threatening haemorrhage in patients with nopersonal history of bleeding. The mortality in AHA patients is estimated at even 22%. A 55-year-old female was admitted to the local hospital due to exacerbation of pemphigus foliaceus. After admission she presented rapid deterioration of general condition. Laboratory tests revealed rapidly increasing anaemia and prolongation of activated partial thrombin time (APTT). Truncal CT-scan showed extensive haematomas localized intra-abdominally as well as within left iliac and obturatormuscles. The patient received fresh frozen plasma (FFP) followed by surgical intervention. Additionally, an ovarian cyst was removed. Due to unlocalized intraoperative bleeding from leftsubphrenic area a formal splenectomy was performed. The uncontrolled bleeding from postoperative wound was observed after surgery. Daily FFP transfusions did not reduce blood loss and theAPTT was not corrected. Detailed hematological tests revealed decreased factor VIII activity to 20 IU/dl and the presence of antibodies against factor VIII in the titer of 1.8 BU/ml. The AHAwas diagnosed. To control the bleeding recombinant FVIIa was used successfully. Synchronously, the immunosupressive treatment was administered. Due to recurrent bleeding the treatment withby-passing agents was continued for 39 days. During therapy urinary cutaneous fi stula was observed. In the control CT-scan a persistent intraabdominal and intramuscular haematomas were presented (localized similarly as before the treatment). Six weeks of immunosupressive therapy eradicated the FVIII inhibitor. After eradication of FVIII inhibitor a surgical bloodless removal of hematomas and open bladder reconstruction were performed. The additional transfusions of red blood cells and fresh frozen plasma were not necessary. In conclusion, in patients presenting spontaneous bleeding to muscles and/or retroperitoneal space we suggest the delaying of surgical intervention until the detailed coagulation tests have been performed. Ideally, patients diagnosed with AHA should not undergo surgical interventions

Psoriasis vulgaris and digestive system disorders: is there a linkage?

Psoriasis is well-known immune-mediated skin disease often associated with co-morbidities, including dyslipidaemia and obesity. Few reports imply that the disease might be also related to pathology of mucosal surfaces, especially that of the digestive system. The authors present a case of psoriasis and concurrent digestive system abnormalities, and review the literature regarding the topic. A 40-year-old man suffered from an exacerbation of exudative psoriasis for about 6 months. Topical antipsoriatics proved ineffective and the disease gradually progressed to a severe disseminated form. Subsequent detailed examinations revealed persistent gastroduodenitis due to H. pylori infection, pancreatic dysfunction and fatty change of the liver, although the patient denied any gastrointestinal symptoms. As a result appropriate treatment of the diagnosed digestive system disorders was added to topical antipsoriatic therapy. Within 2 weeks of treatment clinical symptoms and laboratory signs showed a marked trend to normalisation. The presented medical history seems to suggest that there may be some kind of interplay between psoriasis and digestive system disorders

High Frequency Ultrasonography of the Skin and Its Role as an Auxillary Tool in Diagnosis of Benign and Malignant Cutaneous Tumors – A Comparison of Two Clinical Cases

The number of dermatologic entities that can be studied by ultrasound examination (US) of the skin is increasing. Conventional US and high frequency US (HFUS) are considered useful additional tools in improving the diagnosis and management of common benign and malignant skin tumors. US may help in positive and differential diagnosis of primary melanocytic neoplasms and of locoregional spread in melanoma patients. US preoperative evaluation of primary melanoma thickness correlates with histologically estimated melanoma thickness, and can help determine surgical margins and indications for sentinel lymph node biopsy. It is also useful during follow-up after surgical treatment for early detection of recurrence or metastases. In this case report, we present two cases of skin lesions clinically suspicious for malignancy. The first lesion was a round nodule 3 mm in diameter, resembling a blue nevus. In HFUS it was well delimited, hypoechoic, and well vascularized. The second lesion presented as an elevated, well-circumscribed nodule, 5-6 mm in diameter, inhomogeneous in color. HFUS depicted a poorly delimited, irregular, hypoechoic lesion crossing the dermoepidermal junction. At the first exam it was not vascularized, but 6 months later a number of vascular flow signals within the lesion were found. In histopathological examination the lesions were finally diagnosed as, respectively: benign cavernous hemangioma and melanoma. In both presented cases HFUS proved to be useful in a differential diagnosis of suspicious skin lesions. Noninvasive and easy to perform, HFUS is a valuable diagnostic method in dermatology.</p