Comparison of the incidence of skin cancers in patients on dialysis and after kidney transplantation

Introduction: Kidney transplant (KTx) patients on immunosuppressive therapy are predisposed to the development of infections and cancers. Aim: To compare the incidence and type of malignant skin lesions in kidney transplant patients and the dialyzed population based on the initiated dermatologic screening. Material and methods: The study included 598 patients: 486 kidney transplant recipients and 112 patients on maintenance dialysis. All the patients underwent dermatological examination. Only histologically confirmed cancers were included in this study. Age, gender and immunosuppressive therapy administration were also considered. Patients were followed up by a dermatologist for a period of 5 years. Results: Fifty-eight skin cancers; 39 basal cell carcinomas (BCC), 13 squamous cell carcinomas (SCC), 1 Bowen disease, 2 Kaposi sarcoma, 1 malignant melanoma, 1 Merkel cell carcinoma, and 1 fibrosarcoma protuberans were diagnosed in 30 (6.2%) kidney transplant patients, and 8 lesions (7 BCC and 1 SCC) were found in 4 (3.6%) patients on dialysis. Conclusions: The initiated dermatologic screening program indicates that the risk of skin cancer incidence in post kidney transplant patients receiving immunosuppressive therapy was significantly higher than in patients on dialysis

Comparison and evaluation of three different molecular methods for detection of human Betapapillomaviruses in skin biopsies from patients with nonmelanoma skin cancer and precancerous lesions

Betapapillomaviruses have been linked to the development of nonmelanoma skin cancers. A great diversity of these viruses in skin specimens requires the use of sensitive and reliable detection methods. There are currently no standardized assays for diagnostic purposes. A combination of several molecular methods has great practical significance and gives the opportunity to broaden the spectrum of detected Beta-HPV types. In the present study, different molecular methods for Beta-HPVs detection and genotyping were used: PCRs with different sets of primers, PCR followed by reverse hybridization and direct sequencing of PCR amplimers; all performed in skin biopsies from lesions and perilesional healthy area of 118 patients with NMSC or precancerous lesions. Beta-HPVs were detected in 41% of 261 biopsies examined. The RHA for 25 types of Beta-HPVs showed a significantly higher sensitivity than PCR-based methods and allowed to detect 172 genotypes in 86 samples, including 39 with multiple infections. The most frequently identified types were HPV23, HPV24 and HPV93. HPV5 and HPV8, considered high-risk carcinogen types, were detected only in a small percentage of samples. Direct sequencing confirmed the presence of Beta-HPV genotypes from outside of RHA panel in the analysed biopsies. This allowed detecting thirty-two additional genotypes in 5 samples, that were positive only in RHA with the universal probe, which failed to identify the virus genotypes. Our findings confirmed the need to apply different methods to detect Beta-HPV infections

Clinical study on single-organ cutaneous small vessels vasculitis (SoCSVV)

Leukocytoclastic vasculitis (LCV) is a heterogenous group of disorders that may manifest as a mild disease isolated to the skin or be a part of life-threatening systemic vasculitis. According to the 2012 Chapel Hill Consensus Conference nomenclature, patients presenting symptoms of LCV confined only to the skin should be defined as suffering from a single-organ cutaneous small vessel vasculitis (SoCSVV). SoCSVV is a benign disease with a good clinical outcome but with a significant risk of relapse and skin ulcer formation. The aim of the current study was to characterize SoCSVV and to identify factors that may be associated with the risk of recurrence and skin ulcers. Medical records of patients with LCV hospitalized at the Department of Dermatology at University Hospital in Cracow in the years 2010 to 2015 were analyzed. A total of 24 patients fulfilled criteria of SoCSVV. Drugs and preceding infections were identified as precipitating factors in 40% and 20% of cases, respectively. Skin lesions other than palpable purpura (i.e., macules, urticarial vasculitis, or ulcers) were identified in almost half of the patients. Interestingly, the presence of macules independently increased the risk of skin ulcer formation (odds ratio = 16; 95% confidence interval: 1.5–176.6; P = 0.0075) in the multivariate logistic regression analysis. One-quarter of patients with SoCSVV experienced relapse during the 6-month follow-up. The greater number of affected skin areas was an independent risk factor of recurrence (odds ratio = 5; 95% confidence interval: 2–45; P = 0.02). SoCSVV was usually associated with drugs and preceding infections. The disease relapses in approximately one-quarter of the patients. The more severe the skin involvement in the course of SoCSVV, the higher is the risk of recurrence

Oestrogens and skin : slowdown of skin aging

Starzenie się skóry będące wynikiem upływu czasu, jak również działania wielu czynników zewnętrznych (UV, palenie tytoniu, dieta, stres) i wewnętrznych (hipoestrogenizm, niedobór hormonów podwzgórza) upośledza ją i ogranicza wiele jej funkcji. Zaburzenia gospodarki hormonalnej są ważnym i stosunkowo dobrze poznanym czynnikiem wpływającym istotnie na proces starzenia się skóry. Podkreślana jest zwłaszcza rola estrogenów, których stężenie zmniejsza się w okresie menopauzy, czemu towarzyszy nasilenie procesów starzenia zarówno związanych z wiekiem, jak i spowodowanych działaniem czynników środowiskowych. Precyzyjny mechanizm indukcji produkcji kolagenu przez estrogeny nie jest znany. Wydaje się, że może on być związany z wpływem na stężenie TGF-β – czynnika wzrostu promującego produkcję kolagenu przez fibroblasty. Wyniki wielu badań potwierdzają korzystny wpływ egzogennych estrogenów na naskórek – zwiększają jego nawilżenie, zmniejszają przeznaskórkową utratę wody, zwiększają stężenie lipidów powierzchniowych, poprawiają funkcję skóry jako bariery i zapobiegają suchości. Zdecydowana większość badań podkreśla protekcyjny wpływ terapii hormonalnej (HT) na zjawiska związane ze starzeniem się skóry, dokumentują ich korzystny wpływ nie tylko na kolagen, ale i na elastyczność skóry oraz funkcję niektórych przydatków skóry. Jednak niebezpieczeństwo związane ze stosowaniem HT, szczególnie w grupach kobiet, u których stwierdza się dodatkowe czynniki predysponujące do rozwoju schorzeń o potwierdzonym związku z taką terapią, powoduje, że nie pozwala to na rozszerzenie wskazań do stosowania HT w celu poprawy funkcji i wyglądu skóry.Skin aging due to the passage of time and influence of many external (ultraviolet radiation, tobacco smoke, diet, stress) and internal (hypoestrogenism, lack of hypothalamus hormones) factors handicaps many skin functions. Disturbances of hormone management are important and well known agents responsible for skin aging. Particularly emphasized is the role of oestrogens, whose concentration becomes low during the menopausal period, causing intensification of skin aging. A distinct mechanism of induction of production of collagen via oestrogens is not known. There is a possibility of an influence on TGF-β (transforming growth factor beta), which stimulates fibroblasts to produce collagen. The data of many studies confirm the beneficial influence of exogenous oestrogens on the epidermis by decreasing transepidermal water loss, enhancing moisturizing abilities and surface lipid levels, improving skin function as a barrier and preventing dryness. Most studies give weight to the protective impact of hormone replacement therapy (HRT) on skin aging. Many studies have testified to good effects not only on collagen but also on skin elasticity and functions of some skin adnexa. However, a hazard connected with HRT in women with additional predisposing factors to development of diseases with a proven association with this therapy rule out the extension of use of HRT to improve skin functions and appearance