Recurrent haemorrhagic erysipelas of a lower limb — case report

Róża (erysipelas) jest to ostry stan zapalny skóry i tkanki podskórnej, któremu towarzyszy znacznie podwyższona temperatura ciała i dreszcze. Jedną z postaci klinicznych choroby jest róża krwotoczna, która charakteryzuje się bardziej intensywnym przebiegiem, wydłużonym czasem terapii oraz zwiększonym ryzykiem powikłań. Istotne znaczenie w patogenezie róży mają schorzenia towarzyszące. Ważnym problemem klinicznym jest brak jasno określonych zasad profilaktyki i związana z tym nawrotowość choroby. Celem niniejszej pracy jest przedstawienie przypadku 47-letniego pacjenta, u którego róża krwotoczna wystąpiła trzykrotnie w odstępach dwumiesięcznych.Erysipelas is an acute infection of the skin and subcutaneus tissue, accompanied by fever and chills. One of the clinical form of this disease is haemorrhagic erysipelas characterized by the aggressive and prolonged course of illness with increased risk of complications. Accompanying diseases play a significant role in pathogenesis of erysipelas. The main clinical problem is lack of well defined rules of antibiotic prophylaxis and therefore a high risk of recurrence. The aim of this case report is to introduce a 47-year-old man who has been suffering from erysipelas three times with a two month interval between each time

Alergiczne lub leukocytoklastyczne zapalenie naczyń (vaculitis allergica, vasculitis leukocytoclastica)

Lekarz dermatolog spotyka się dość często z różnymi zmianami krwotocznymi na skórze, u podłoża których, jak wykazuje badanie histologiczne, leżą zmiany martwiczo-zapalne drobnych naczyń krwionośnych, określane najczęściej jako: purpura hyperergica, vasculitis allergica, necrotica lub vasculitis leukocytoclastica. Zmiany te dotyczą naczyń włosowatych, drobnych naczyń żylnych oraz arterioli i polegają na procesie zapalnym ścian tych naczyń z odkładaniem się w nich immunoglobulin i komplementu. Proces ten często prowadzi do tworzenia wewnątrznaczyniowych zakrzepów i ognisk martwicy włóknikowatej ścian naczyń, czemu towarzyszy naciek zapalny ściany i otoczenia naczynia, złożony głównie z neutrofili z obecnością fragmentów jąder (leukocytoclasia). Wśród czynników wywołujących wymienia się infekcje, leki, obce białko, niektóre środki chemiczne, układowe choroby tkanki łącznej, ukąszenia owadów, nowotwory. W ponad połowie przypadków choroba ma tło idiopatyczne. Krwotoczne zmiany skórne mogą niekiedy wyprzedzać lub towarzyszyć zmianom w narządach wewnętrznych (zwłaszcza w nerkach), a dalsze losy chorego zależą wówczas od właściwego wczesnego rozpoznania i leczenia

Activity of Antimicrobial Peptides and Conventional Antibiotics against Superantigen Positive Staphylococcus aureus Isolated from the Patients with Neoplastic and Inflammatory Erythrodermia

Superantigens are proteins comprising a group of molecules produced by various microorganisms. They are involved in pathogenesis of several human diseases. The aim of the study was the comparison of susceptibility to antibiotics and antimicrobial peptides (AMPs) of Staphylococcus aureus (SA) strains producing staphylococcal enterotoxins SEA, SEB, SEC, SED, and TSST-1 and nonproducing ones. In the group of the total 28 of the patients with erythrodermia the presence of SA was confirmed in 24 cases. The total of 14 strains of SA excreted enterotoxins SEA, SEC, SED, and TSST-1. We did not observe that strains producing mentioned superantigens were less susceptible to AMPs (aurein 1.2, citropin 1.1, lipopeptide, protegrin 1, tachyplesin 3, temporin A, and uperin 3.6). The opposite situation was observed in conventional antibiotics. SA strains excreting tested superantigens had higher MICs and MBCs than nonproducing ones. The interesting finding considering the high efficacy of AMPs, against all examined strains of SA, makes them attractive candidates for therapeutic implication

Rola lekarza pierwszego kontaktu w diagnostyce znamion barwnikowych skóry

Introduction. Early diagnosis and surgical excision of melanoma leads to an over 90% recovery. General practitioners may play an important role in its detection by making an initial assessment. Aim of the study. The aim of this study was to evaluate the role of the general practitioner in the diagnosis of pigmented skin lesions. Materials and methods. The study included 75 doctors working in the primary health care (PHC). The questionnaire defined the frequency of visits in PHC to diagnose skin lesions, knowledge about melanoma, the need to expand it, as well as a self-estimation of a GP role in pigmented skin lesions diagnostic process. Results. The study showed that 92% of surveyed physicians carry out a medical evaluation of skin lesions during each visit, but only 10% assess their knowledge about them as a very good. Over 90% of respondents highlighted the need to expand the knowledge about the pigmented skin lesions with the risk of developing melanoma and 95% indicated the need of urgent consultation with a specialist in this field. Conclusions. The study confirmed that primary care physicians may play an important role in the skin melanoma screening.Wstęp. Wczesne rozpoznanie i usunięcie czerniaka prowadzi do uzyskania wyleczenia sięgającego ponad 90%. W diagnostyce ważną rolę mogą odegrać lekarze pierwszego kontaktu, dokonując wstępnej oceny podejrzanych znamion. Cel pracy. Celem badania jest ocena roli lekarza pierwszego kontaktu w diagnostyce znamion barwnikowych skóry. Materiał i metody. Badaniem ankietowym objęto 75 lekarzy z placówek podstawowej opieki zdrowotnej (POZ). Kwestionariusz określał częstość zgłaszania się pacjentów do lekarza POZ z powodu znamion skórnych, wiedzę lekarzy na temat czerniaka oraz samoocenę roli w diagnostyce znamion barwnikowych skóry. Wyniki. Badanie wykazało, że 92% lekarzy przeprowadza podczas każdej wizyty lekarskiej ocenę znamion skórnych, a jedynie 10% ocenia swoją wiedzę na ich temat jako bardzo dobrą. Ponad 90% badanych podkreśliło chęć pogłębiania wiedzy o znamionach skórnych niosących ryzyko rozwoju czerniaka, a 95% wykazało potrzebę pilnych konsultacji ze specjalistą w tej dziedzinie. Wnioski. Analiza wyników potwierdziła, że lekarze POZ mogą odegrać ważną rolę w badaniu przesiewowym w celu wczesnego wykrycia czerniaka

Assessment of Cardiovascular Risk Factors in Patients with Psoriasis

Psoriasis is a chronic inflammatory skin disorder associated with increased cardiovascular risk. Aim of this work was to evaluate the association between psoriasis and chosen cardiovascular risk factors, echocardiographic parameters, and carotid intima-media thickness. A total of 50 patients with psoriasis and 50 controls were enrolled in the study. Psoriasis area severity index was calculated in the study group. Systolic and diastolic blood pressure, body mass index, waist circumference, lipids, fasting glucose, and D-dimer levels were assessed in all patients. In addition, echochardiographic parameters and carotid intima-media thickness were measured. Patients with psoriasis had higher blood pressure (P=0.001), elevated triglycerides (P=0.0218), lower high-density lipoprotein cholesterol (HDL-C) (P=0.0014), elevated D-dimer levels (p=0.0009), and were more frequently overweight (P=0.0198) in comparison to controls. There were no differences in echocardiographic parameters and carotid intima-media thickness between the psoriasis and control groups. Moreover, a positive correlation between psoriasis area severity index and blood pressure was observed (P=0.0088). The study confirmed that psoriasis is associated with increased cardiovascular risk. The association between psoriasis, intima-media thickness, and echocardiographic parameters should be evaluated in large prospective studies. </p

ERAP1 and HLA-C*06 are strongly associated with the risk of psoriasis in the population of northern Poland

Introduction: HLA-C*06 is a major psoriasis genetic risk marker. Recent reports have been focused on the role of different polymorphisms within genes involved in the functioning of the epidermal barrier and antigen processing in the pathogenesis of psoriasis. Data on the association between genetic variants of LCE3B_LCE3C, CSTA, ERAP1, ZAP70 and this dermatosis in the population from Eastern Europe are lacking. Aim: To compare the association between known genetic risk markers and psoriasis in a cohort of northern Polish patients with psoriasis and healthy controls. Material and methods: Based on previous studies’ results, five susceptibility loci: HLA-C, LCE3C_LCE3B, ERAP1, ZAP70 and CSTA were selected for genotyping in 148 patients with chronic plaque psoriasis and 146 healthy controls. Each patient with this disease was clinically assessed with the Psoriasis Area and Severity Index. Results: The study population showed a significant association of psoriasis and a single nucleotide polymorphism in the ERAP1 – rs26653 (p = 3.11 × 10–5) and HLA-C*06 allele (p = 1.02 × 10–11) when compared with the control group. The presence of HLA-C*06 or rs26653 G allele significantly increased the risk of psoriasis by 2.4 times or twice, respectively. Carrying rs26653 C allele considerably decreased the risk of psoriasis by 1.5 times. Conclusions: In the context of pathogenesis of psoriasis, our findings might give the evidence on disturbances in the proteolytic processing of N-terminal fragments of antigens presented via major histocompatibility complex class I to T cells

Lysosome Alterations in the Human Epithelial Cell Line HaCaT and Skin Specimens: Relevance to Psoriasis

Despite the constantly updated knowledge regarding the alterations occurring in the cells of patients with psoriasis, the status and the role of the lysosome, a control center of cell metabolism, remain to be elucidated. The architecture of the epidermis is largely regulated by the action of lysosomes, possibly activating signaling pathways in the cellular crosstalk of keratinocytes—epidermal cells—with infiltrating immune cells. Thus, in the present study, lysosome alterations were examined in vitro and in situ using a two-dimensional (2D) keratinocyte model of HaCaT cells with “psoriasis-like” inflammation and skin specimens, respectively. Specific fluorescence and immunohistochemical staining showed an augmented level of acidic organelles in response to keratinocyte activation (mimicking a psoriatic condition while maintaining the membrane integrity of these structures) as compared with the control, similar to that seen in skin samples taken from patients. Interestingly, patients with the most pronounced PASI (Psoriasis Area and Severity Index), BSA (Body Surface Area), and DLQI (Dermatology Life Quality Index) scores su�ered a high incidence of positive lysosomal-associated membrane protein 1 (LAMP1) expression. Moreover, it was found that the gene deregulation pattern was comparable in lesioned (PP) and non-lesioned (PN) patient-derived skin tissue, which may indicate that these alterations occur prior to the onset of the characteristic phenotype of the disease. Changes in the activity of genes encoding the microphthalmia family (MiT family) of transcription factors and mammalian target of rapamycin complex 1 (MTORC1) were also observed in the in vitro psoriasis model, indicating that the biogenesis pathway of this arm is inhibited. Interestingly, in contrast to the keratinocytes of HaCaT with “psoriasis-like” inflammation, LAMP1 was up-regulated in both PP and PN skin, which can be a potential sign of an alternative mechanism of lysosome formation. Defining the molecular profile of psoriasis in the context of “the awesome lysosome” is not only interesting, but also desired; therefore, it is believed that this paper will serve to encourage other researchers to conduct further studies on this subject

Genetyka łuszczycy – od badań serologicznych antygenów zgodności tkankowej do badań asocjacyjnych całego genomu

Psoriasis is a complex disease with multifactorial mode of inheritance,whichmeans that its clinicalmanifestations depend uponmultiple genesinteracting with environmental agents. The major genetic factor responsiblefor 35-50% susceptibility for early psoriasis in the Caucasian population,HLA-Cw*06, is located within the major histocompatibility complex(MHC) on the sixth chromosome. Whole genome associationstudies, the newest research trend, revealed three genetic, non-MHCrelated pathways connected with psoriasis susceptibility: Th17, Th2 andNF-κB-dependent. These genes are responsible for inflammation, epidermalproliferation and epidermal barrier function in psoriasis