Primary perforating dermatoses – current status

Primary perforating dermatoses (PPD) are a group of skin diseases rarely seen in everyday dermatological practice, which includes elastosis perforans serpiginosa, reactive perforating collagenosis, Kyrle disease and perforating folliculitis. These entities can be associated with chromosomal aberrations, chronic renal, cardiovascular or hepatic diseases. Unique histopathological findings in each PPD are useful in determination of the diagnosis. However, in other more frequently seen dermatoses of heterogeneous etiology, perforation of epidermis with material undergoing transepidermal elimination is also observed. Our article aims to present the most important recent information on epidemiology, pathogenesis, clinical findings, therapeutic options and differential diagnosis of primary perforating dermatoses

The use of isotretinoin in low doses and unconventional treatment regimens in different types of acne: a literature review

High effectiveness of isotretinoin treatment for severe types of acne resistant to antibiotics has been widely recognized. However, the recommended doses in conventional therapy, according to consensus of the Polish Dermatological Society, may cause serious adverse effects. Thus, research into less stressful, alternative treatment regimens with the use of low doses of isotretinoin has been carried out. The aim of the paper was to review the selected papers where authors present the results of their studies on different regimens with the use of isotretinoin in low doses in patients with acne, evaluate their efficacy, patient satisfaction, frequency of adverse effects, recurrences and also treatment costs

Phototoxic reaction due to solar radiation exposure in a psoriatic patient treated with PUVA therapy

Reakcja fototoksyczna może być wywołana ekspozycją na promieniowanie słoneczne w trakcie leczenia fotochemioterapią (psoralen–ultraviolet A – PUVA). Pacjentka została przyjęta do Kliniki Dermatologii i Wenerologii w Łodzi w trybie pilnym z powodu rozległych zmian rumieniowo-pęcherzowych na skórze kończyn dolnych, którym towarzyszyły ból, świąd i pieczenie skóry. W wywiadzie wskazano zmiany łuszczycowe w trakcie terapii PUVA, nadciśnienie tętnicze i nikotynizm. W badaniu przedmiotowym stwierdzono rozległe wypełnione treścią surowiczą pęcherze, zlewne zmiany rumieniowe zlokalizowane na bocznych powierzchniach ud i grzbietach stóp oraz nasilone obrzęki podudzi i grzbietów stóp. Na kończynach górnych i dolnych oraz na brzuchu obecne tarczki pokryte niewielką ilością łuski. Skóra całego ciała intensywnie opalona. Rozpoznano ostrą reakcję fototoksyczną i zastosowano ogólnie preparaty kortykosteroidowe, leki przeciwhistaminowe, antybiotyk, leki hipotensyjne oraz leczenie miejscowe. Ze względu na pojawiające się nowe zmiany o typie pęcherzy, w pierwszych dniach hospitalizacji wykonano również badania immunologiczne, których ujemne wyniki wykluczyły rozpoznanie pemfigoidu i pęcherzycy. W wyniku zastosowanego leczenia ogólnego i miejscowego uzyskano stopniową poprawę kliniczną. Ze względu na ryzyko wystąpienia ostrej reakcji fototoksycznej podczas fototerapii niezbędna jest edukacja pacjenta, dotycząca przede wszystkim konieczności unikania ekspozycji na promieniowanie ultrafioletowe oraz stosowania fotoprotekcji w dniu przyjmowania doustnych preparatów uwrażliwiających na działania promieniowania ultrafioletowego. Med. Pr. 2019;70(6):763–768A phototoxic reaction may be induced by additional exposure to solar radiation during photochemotherapy (psoralen, ultra-violet A – PUVA treatment). A woman was admitted to Dermatology and Venereology Clinic in Łódź as an emergency case due to extensive erythematous-vesicular lesions on the skin of the lower limbs, accompanied by pain, itching and burning of the skin. The interview found that the patient was undergoing PUVA phototherapy for psoriatic lesions, with hypertension and nicotine dependence. Physical examination revealed large blisters, filled with serum and congestive erythematous lesions located on the lateral surfaces of the thighs and backs of the feet, as well as marked swelling of the lower limbs. Also, discs coated with thin scales were found on the upper and lower limbs and on the trunk. The entire body was intensely tanned. The patient was diagnosed with acute phototoxic reaction and general corticosteroids, antihistamine drugs, an antibiotic, antihypertensive drugs and topical treatment were introduced. Immunological tests were performed during the first days of hospitalization following the emergence of new blisters. Negative results ruled out bullous pemphigoid and pemphigus. Gradual clinical improvement was observed. To avoid the occurrence of acute phototoxicity during phototherapy, patients require education about the need to avoid UV exposure and to use photoprotection, when receiving UV-sensitizing treatment. Med Pr. 2019;70(6):763–

Acroosteolysis of distal phalanges in patient with systemic sclerosis – case report

Introduction. Acroosteolysis is a recognized, but under-researched and forgotten manifestation of systemic sclerosis (SSc). Objective . To present a case of exuberant acroosteolysis and subcutaneous tissue calcinosis in the course of SSc. Case report. The patient, aged fifty-three with limited systemic sclerosis (lSSc) for 8 years duration, was under dermatological treatment because of ulcerative inflammation of the 2nd and 4th finger of the right hand. Progressive acroosteolysis of the distal phalanx with calcinosis and severe digital ischaemia was diagnosed. Conclusion . There is growing evidence suggesting that acroosteolysis is an important manifestation of SSc due to the correlation with progressive microangiopathy and severity of digital ischaemia