Zjazd Sekcji Forum Młodych Polskiego Towarzystwa Dermatologicznego

W dniach 24-25 października 2019 roku w hotelu DoubleTree by Hilton w Łodzi odbył się kolejny Zjazd Sekcji Forum Młodych Polskiego Towarzystwa Dermatologicznego

Combination therapy with prednisone and cyclophosphamide in a 14-year-old boy with pemphigus foliaceus – a case report

Introduction . Pemphigus foliaceus is a dermatosis rarely occurring in the paediatric population. Objective. To draw attention to diagnostic and therapeutic difficulties associated with pemphigus foliaceus. Case report. A 14-year-old boy was admitted to our department with seborrhoeic crusts over the anterior and posterior surfaces of the chest and erythematous-infiltrative lesions in the axillary and popliteal fossae. Since histopathological examination revealed features of Darier’s disease, acitretin treatment was initiated. No improvement was noted after 3 months. Another skin biopsy was obtained and immunologic tests were carried out. Based on the clinical manifestations and results of additional tests, juvenile pemphigus foliaceus was diagnosed. Prednisone therapy was initiated, however it failed to produce satisfactory improvement in skin lesions. Cyclophosphamide was added to prednisone, causing remission of the disease. Conclusions. In patients with non-characteristic lesions who fail to respond to treatment it is advisable to extend diagnostics by immunologic tests. In the reported case combination therapy with prednisone and cyclophosphamide led to long-term remission, causing no adverse effects

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–

Risk Factors and Clinicopathological Features for Developing a Subsequent Primary Cutaneous Squamous and Basal Cell Carcinomas

Background: Patients with diagnosed keratinocyte carcinomas (KCs) have an increased risk of subsequent skin cancers development. Current studies indicate that patients with subsequent tumors should be followed up regularly. However, none of the studies indicate the connection between the specific subtypes and an increased risk for further KCs development. The study assesses the differences in the risk of developing a subsequent skin cancer after a previous diagnosis of KC, especially considering individual types of skin malignances, and identifies potential factors associated with an increased risk of new cutaneous tumor describing non-invasive diagnosis and monitoring. Methods: Pathology and medical records were examined to identify the characteristics of patients with multiple KCs diagnosed between 1999 and 2019. Results: The study group comprised 13,913 KCs occurring in 10,083 patients. Multiple KCs were observed in 2300 patients (22.8%). The analysis showed aggressive subtypes, multiple tumors, and male sex as significant prognostic factors. Conclusions: The most crucial risk factors for developing subsequent KC are being of a male gender, an aggressive tumor subtype, and previous history of multiple skin cancers. Basal cell carcinoma subtypes, such as infiltrative basosquamous, with aggressive growth patterns predispose not only to increased risk for the recurrence but are also expected to be at higher risk of subsequent KCs