Introduction: Urticaria is an etiopathologically complex disease. Current guidelines recommend an algorithm for urticaria treatment, which includes omalizumab as third line treatment. Objective: To evaluate clinical efficacy of omalizumab in patients with urti-caria. Case report: Three women were treated with omalizumab for spontaneous chronic urticaria, resistant to standard therapy patterns. The concentration of total IgE determined in patients during omalizumab therapy in the first case was originally maintained at a low level, while during the continuation of the treatment it increased four times. In the second case, originally a near 2-fold decrease of total IgE concentration was observed, then it increased 1.5 times. Conclusions: The obtained data confirm a high efficacy of omalizumab the-rapy in patients with spontaneous chronic urticaria. Fast and complete or nearly complete resolution of urticaria symptoms was observed during the treatment.

Allergic contact dermatitis (ACD) is a common skin disorder caused by contact with an exogenous substance that elicits a hypersensitivity response in susceptible individuals. Changing fashion trends, the process of industrialization as well as official legislations restricting the use of metals in recreational and occupational products change the epidemiological patterns in the European countries.AIM:The aim of the study was to estimate the current prevalence of isolated and concurrent sensitization to nickel sulfate, cobalt chloride and potassium dichromate, as well as to investigate their associations with potentially predisposing epidemiological and clinical factors.MATERIALS AND METHODS:1200 patients with suspected ACD were enrolled for this study. Medical records were taken on the basis of the standardized questionnaire to collect epidemiological and clinical variables. All patients were tested with T.R.U.E. TEST Panel 1.2 and Panel 2.2, including the total of 24 allergens.RESULTS:We observed statistically significant difference in mean age between women allergic to cobalt (41 vs 49; p<0.001) and nickel (41 vs 50; p<0.001) than among women not allergic to metals . Female gender was a significant risk factor for an allergy to nickel (OR 3.7909, CI95%: 2.4081 - 5.9677; p<0.001). Chi2 test showed that atopic dermatitis may influence the prevalence of allergic reaction to cobalt in a group of women and men, as well only among women or men - the most significant association was noted among men (OR=3.8472, CI95%: 1.1518 - 12.8503; p=0.0285). The sensitization any metal was a significant risk factor for an allergy to other metallic allergens.CONCLUSIONS:Our study gives a valuable insight into the metal allergy prevalence in Polish population and sheds some light on the associated risk factors. The results serve to raise questions concerning the relevance of metal allergies and to highlight the need for more effective preventive measures.

INTRODUCTION:Dermoscopy is one of the most commonly used methods in early diagnosis of melanoma. It is conducted to differentiate between benign and malignant patterns in melanocytic lesions.AIM:To determine if there is a predominance of one dermoscopic pattern in patients with melanoma and if there is a significant difference in dominant global dermoscopic pattern in patients with cutaneous melanomas correlated with patients' sex and the location of the primary tumor.MATERIAL AND METHODS:The study included 162 patients with prior diagnosis of cutaneous melanoma. Dermoscopic and videodermoscopic pictures and patient data were analyzed with regard to the pattern: reticular, globular, homogeneous and mixed pattern (two-component pattern; reticular-globular pattern) with central or peripheral globules and multicomponent (mixed - at least 3 types of structures in one nevus).RESULTS:The reticular pattern was significantly more prevalent in male patients (38.57%, 27 patients) in comparison to female patients (18.45%, 17 patients). We also found a statistically significant lower prevalence of reticular pattern in patients diagnosed with melanomas located on upper limbs. The homogeneous pattern was statistically significantly more prevalent in patients in whom primary tumors were located on the head and upper limbs.CONCLUSIONS:Our study suggests that predominant complex patterns are more commonly observed in patients diagnosed with cutaneous melanoma, although there is a significant number of patients with predominant reticular and homogeneous patterns, which are not often associated with an increased risk of development of melanoma.

INTRODUCTION:Chronic urticaria is a complex disease process in which chronic spontaneous urticaria (CSU) and chronic inducible urticaria are distinguished. Its etiopathogenesis still remains unknown. Some recent studies indicated a significant participation of vitamin D in the etiopathogenesis of urticaria. In 40-50% of patients with CSU on the basis of the positive result of the autologous serum skin test (ASST), autoimmunological background of the disease is diagnosed. Moreover, numerous test results confirm involvement of the coagulation system/fibrinolysis and non-infectious inflammatory factors in the pathophysiology of CSU.AIM:To determine whether some factors may play a role in pathogenesis and contribute to the severity of chronic spontaneous urticaria.MATERIAL AND METHODS:One hundred and forty-two patients with diagnosed CSU were enrolled in the study. The activity of urticaria was assessed using the UAS-7 (Urticaria Activity Score). The study participants were divided into 4 groups depending on the UAS-7. ASST was performed and blood was collected to determine the biomarkers (CRP, vitamin D, D-dimers, fibrinogen, MPV, PLT).RESULTS:Statistical analysis was performed using Statistica 13. A statistically significant difference between groups with various activity of urticaria in D-dimer concentration average values (p < 0.05) was observed. Moreover, a statistically significant negative correlation between activity of urticaria and vitamin D concentration (p < 0.001) was noted.CONCLUSIONS:Our results might support the possible involvement of both coagulation and fibrinolysis pathway and vitamin D in the urticaria pathomechanism. Further prospective studies in larger populations conducted at multiple centres are required to expand further our findings.

INTRODUCTION:The incidence and mortality of melanoma are rising rapidly. Despite ongoing research and the introduction of new therapeutic methods, advanced melanoma is still considered incurable. Early detection and surgical excision of the tumor increases patients' survival. Since the diagnostic protocol includes surgical excision of all suspicious lesions, it is burdened with a high rate of unnecessary excisions that cause unwanted scarring. This is why the development of accurate diagnostic techniques is crucial. The most common diagnostic tool in early diagnosis of cutaneous melanoma is dermoscopy, though there are emerging new techniques, such as reflectance confocal microscopy and optical coherence tomography.AIM:To evaluate diagnostic accuracy of reflectance confocal microscopy as a secondary examination in melanocytic lesions previously diagnosed as melanomas by means of dermoscopy.MATERIAL AND METHODS:Forty-six melanocytic lesions presenting dermoscopic features of cutaneous malignant melanoma were examined by means of reflectance confocal microscopy.RESULTS:The RCM evaluation showed sensitivity at the level of 100% and specificity at 62%.CONCLUSIONS:It can be estimated that double evaluation of melanocytic lesions by dermoscopy and reflectance confocal microscopy may allow up to 62% of unnecessary excisions to be avoided.

Introduction Due to the rising incidence of cutaneous melanoma there is a great need for the development of new diagnostic techniques as well as the improvement of those that are already well known, such as dermoscopy. Since early detection and a proper technique for excising the tumor are crucial for patients’ survival, early staging of the tumor is very important. Aim To investigate whether there is a significant difference between the presence of selected dermoscopic features compared to the location on the skin and pathology results: Breslow’s depth, mitotic index and ulceration. Material and methods We examined videodermoscopic images of cutaneous melanomas in 81 patients and compared their features with the histological results such as Breslow’s depth, mitotic index and ulceration. In the study, we divided and compared the tumors in groups: in situ and invasive, ≤ 1.0 mm and > 1.0 mm thick on the Breslow scale. Results In the study we observed statistically significantly higher prevalence of pseudopods (30.5%) and multicomponent pattern (69.5%) in invasive melanomas in comparison to in situ melanomas (9.1% and 36.4% respectively). White regression structures were more commonly described in invasive melanomas thicker than 1.0 mm on Breslow’s scale. Atypical blood vessels and nodules were more specific to invasive melanomas with ulcerations and mitotic index ≥ 1. The atypical pigment network was more specific for thin invasive melanomas. Conclusions Presence of pseudopods, a multicomponent pattern, white regression structures, atypical blood vessels and nodules on dermoscopy suggest invasive (high stage) melanoma.

The term "microbiome" defines the collective genome of all commensal, symbiotic, and pathogenic microbes living in the human body. The composition of microbiota in the gut and skin is influenced by many factors such as the stage of life, nutrition, lifestyle, and gender. In the past few years, several scientific papers have demonstrated an implication of microbiota in many immune-mediated diseases, for example, diabetes, ulcerative colitis, and multiple sclerosis. The alterations in the proportion of gut microbiota have emerged as potential immunomodulators with the capacity to induce physiologic as well as pathologic immune responses against the human body, causing inflammation and destruction of tissues or organs. The microbiota influences the differentiation of adaptive immune cells not only in the gut but also in the skin. Alopecia areata (AA) is a dermatologic disorder which causes hair loss in most cases resistant to treatment. There are some clinical and experimental evidences indicating that AA is the demonstration of autoimmune attack against hair follicles. The factors that may implicate such an autoimmunity in AA still remain unknown. Despite more and more evidences demonstrate that human microbiome plays a key role in human health and diseases, to the best of our knowledge, no study has been conducted to analyze an implication of microbiome in the pathogenesis of AA. Undoubtedly, there is a need to performing a study which might explain the involvement of gut and skin microbiota in the unclear pathogenesis of AA and lead to alternative treatment options for numerous patients suffering from current treatment limitations.

Introduction. Mastocytosis is a heterogeneous group of diseases featuring pathological growth of mast cells in different organs. Mastocytoses have various clinical manifestations. Mastocytosis progress is individual and dependent on many elements: the patient's age, disease form, treatment response and presence of mutations. Objective. To demonstrate the suitability of the determination of mastocyte tryptase (serum tryptase) in patients before and after PUVA therapy. Material and methods. The study included 17 patients who fulfilled the criteria of mastocytosis. Serum tryptase concentration was determined before and after PUVA exposures. Results. The mean tryptase concentration in both of the studied groups before the PUVA exposure was 33.60 mu g/l, and after completing the exposures it increased to 39.62 mu g/l. Analyzing separately the values of the serum tryptase concentration before and after PUVA therapy in patients with cutaneous and systemic mastocytosis, a statistically significantly higher concentration of serum tryptase was found in patients with systemic mastocytosis. Furthermore, it was found that in the systemic form, the mean serum tryptase concentration increased during the PUVA therapy, while in patients with cutaneous mastocytosis this concentration did not change. Conclusions. Serum tryptase concentration in patients with mastocytosis subject to PUVA therapy is a dynamic parameter. In patients with isolated urticaria pigmentosa, tryptase concentration is maintained in a normal range, whilst in patients with systemic mastocytosis it is increased.

Introduction: The incidence of metabolic syndrome is estimated at 15-24% in the general population and at 30-50% in patients with psoriasis. A probable cause of the described correlation is a constant release in chronic dermatosis of proinflammatory cytokines and their influence on individual systems and organs. Aim: Assessment of the concentration of the proinflammatory cytokines (IL-12, IL-23, IL-17 and TNF-alpha) in blood serum and their correlation with the intensity of skin lesions, the presence of psoriatic arthritis and the risk of development of obesity and metabolic syndrome. Material and methods: The concentrations of subunit p70 IL-12, IL-17 and IL-23, and TNF-alpha in subjects with psoriasis and metabolic syndrome were determined. Results: The level of the studied cytokines, IL-17, IL-23 and TNF-alpha was higher in patients diagnosed with psoriasis. Higher levels of IL-17, IL-23 and TNF-alpha were observed in patients with metabolic syndrome accompanying psoriasis. A higher level of IL-17 and IL-23 was found in sera of patients with psoriatic arthritis in comparison to normal psoriasis. Conclusions: In the study, a higher level of IL-17 and IL-23 was also shown in patients with psoriatic arthritis in comparison to patients with normal psoriasis. The effectiveness of anti-IL12/23 drugs in psoriatic arthritis is a confirmation of the obtained results of the studies. Additionally, the increased level of IL-17, both in patients with metabolic syndrome and with psoriasis, could indirectly indicate an increased cardiovascular risk in patients with affected joints in comparison to psoriasis affecting only the skin.

Introduction: Psoriasis is a chronic inflammatory skin disease with immunologic etiology. Aim: To investigate the levels of the proinflammatory cytokines tumor necrosis factor alpha (TNF-alpha), interleukin 23 (IL-23) and IL-17 in patients with psoriasis and psoriatic arthritis with concomitant metabolic syndrome. Material and methods: This study included 60 patients with severe psoriasis. Results: In patients with arterial hypertension concomitant with psoriasis, no statistically significant differences in cytokine levels were observed. On the other hand, in the group of patients diagnosed with diabetes, an increased level of IL-17 was observed. In patients with lipid disorders, the results were similar to the results of patients with diabetes. Conclusions: It is very important to study immunologic mechanisms responsible for the presence and severity of psoriasis, in order to personalize the therapy in the future and optimize the effect of action on the basic disease and on concomitant disorders.

Irritant contact dermatitis (ICD) is a common skin condition and a risk factor for allergic contact dermatitis. The prevalence of this disease in the general population varies between 1.7% and 6.3% and is increasing. The role of the patch test in detection of contact sensitivity is of prime importance. Patch tests should be used to identify topical agents that may be responsible for exacerbation or aggravation of eczema, especially in patients who do not improve despite adequate treatment. A 53-year-old woman suffering from recurrent, long-lasting dispersed eczematous skin lesions, mainly on her face and hands, was admitted to the Allergy Unit of the Dermatology Department of Jagiellonian University Medical College in Krakow for treatment, extended diagnostics and finding the reason for her illness. She was generally in a good physical condition and not taking any drugs. Skin symptoms were accompanied by an intensive itch and unrelated to work. After the discontinuation of treatment and after 2 months of full remission of skin lesions, patch tests were performed, using European standard (Chemotechnique Diagnostics) series. A positive, erythemato-papular reaction to both colophony and parabens, corresponding to “++”, was observed after 48 h. After 96 h, a strong intensification of the reaction was found only in the test site for colophony. Additionally, the reaction was accompanied by a local oedema with blisters and estimated as “+++”. In the test site for parabens, the 48-hour reaction was maintained (Figure 1). Figure 1 Positive results of the patch test Between the first and second test readings, eczematous lesions with faint borders, growing gradually but quickly, appeared on the face and hands of the patient (Figure 2). Figure 2 Erythemato-papular-oedematous rash localized on face On the basis of the symptoms of acute allergic contact dermatitis, the flare-up phenomenon was suspected. Systemic and topical corticosteroids were prescribed. The initial dose of steroids (prednisone) was 30 mg a day. After 24 h, in view of a clear, sustained improvement of the local state, the dose of prednisone was gradually reduced and finally the drug was stopped after 10 days. The appearance of multifocal eczematous lesions during the testing was considered a hardly predictable complication in the course of a standard diagnostic procedure. The flare-up dermatitis was first time described in 1981, in a patient with nickel contact eczema [1]. In the daily practice, patch tests remain a basic diagnostic procedure for distinguishing allergic contact dermatitis from irritant contact dermatitis. Their sensitivity and specificity reaches 70% [2]. Although the safety of patch tests is proven, we have to remember the risk of complications in some cases [1–3]. In the patient, we confirmed an allergic contact dermatitis for colophony and parabens, triggering the flare-up reactions of distant dermatitis. The flare-up reactions consist of the reactivation of a previous dermatitis following the patch testing [4]. It has been frequently described as related to nickel and also in patients with multiple contact allergies – differently from our patient [1, 5]. The pathogenesis of the flare-up phenomenon during the patch testing is not completely understood. Probably it is a result of a reactivation of specific memory T cells that remained in the previous area of contact [1, 6]. On the basis of the clinical picture, history and the results of patch testing, the colophony was suspected to be the main reason for the flare-up reaction, because of the strong reaction to it in the patch testing and because of its cross-reactivity with many environmental substances in our daily life. A contact allergy to cosmetics used by our patient was suspected, as the colophony may provoke cross-reactions with many substances often present in cosmetics, like the Balsam of Peru, resins or dihydroabietyl alcohol [7, 8]. The presented case reminds us that side effects may appear during patch testing, even though this method is considered to be very safe [1]. Therefore, it is necessary to perform these tests in medical centres with well-trained personnel, with the patient supervision available during the whole testing time.

INTRODUCTION Palisaded neutrophilic and granulomatous dermatitis (PNGD) are terms which include such diseases as rheumatoid nodules, Churg-Strauss granuloma, and interstitial granulomatous dermatitis with arthritis. This heterogeneous group was first described in 1965. It is associated with immunological diseases. There are reported cases of coexistence with systemic lupus erythematosus, rheumatoid arthritis, Wegener's granuloma, inflammatory bowel disease, generalized vascular inflammation, and lymphoproliferative disorders. The etiology of the disease is unknown. It is probable that the deposition of immune complexes in blood vessels leads to cutaneus leukocytoclastic vasculitis, degeneration of collagen fibres and palisaded granulomatous inflammation. Ultimately, this leads to fibrosis of the skin. OBJECTIVE The aim of the study is to present a patient with skin lesions and histopathological features of palisaded neutrophilic and granulomatous dermatitis during the course of infection Borrelia burgdorferi. Several cases of this disease have been reported worldwide (30 entries in the PubMed database). To-date, there have been no reports of PNGD in Polish literature. MATERIALS AND METHOD The patient, aged 72, was admitted to hospital because of erythematous, indurated lesion of the skin on the side surface of the left thigh. Diagnosis of PNGD was made on the basis of typical histopathologic features due to clinical symptoms. CONCLUSIONS Clinical diagnosis of PNGD is difficult, and is based mainly on the histopathological picture. Systemic therapy is incorporated mainly due to the systemic disease. The patient requires further observation in the direction of associated systemic disorders.

INTRODUCTION Protein contact dermatitis (PCD) is an IgE-dependent allergic reaction which, despite enormous progress in knowledge, remains a 'non-diagnosed' nosologic unit in contemporary medicine. Skin lesion, with a chronic and recurring course, are analogous with the clinical picture in allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD); skin patch tests, however, are usually negative. This makes the diagnostics difficult, prevents a correct diagnosis and treatment based on the avoidance of allergen. CASE DESCRIPTION A 48-year-old woman presented with erythemato-squamous skin lesions, accompanied by a strong itching, occurring on hands for about 6 months. The patient attributed the occurrence of skin lesions to household chores, above all - cooking and contact with food. The contact allergy was not confirmed. Positive results of the prick-by-prick test were observed for potato. Based on the above results, contact eczema induced by potato protein was diagnosed. Allergen elimination and use of emolients were prescribed. A complete remission of skin lesions was obtained. DISCUSSION PCD is rarely diagnosed, which is why there is no substantial epidemiologic data. It is estimated that about 50% of cases are related to atopy. This occurs more often in patients with a damaged dermal-epidermal barrier. Most often, the same products eaten by subjects do not produce any effects. A correct assessment of the substance provoking the occurrence of skin lesions is very important, as most often the products concerned are those commonly used in the household. A detailed PCD diagnostics is very important for obtaining the optimal treatment results.

The pathophysiology of acne vulgaris depends on active sebaceous glands, implying that selective destruction of sebaceous glands could be an effective treatment. We hypothesized that light-absorbing microparticles could be delivered into sebaceous glands, enabling local injury by optical pulses. A suspension of topically applied gold-coated silica microparticles exhibiting plasmon resonance with strong absorption at 800 nm was delivered into human pre-auricular and swine sebaceous glands in vivo, using mechanical vibration. After exposure to 10-50 J cm(-2), 30 milliseconds, 800 nm diode laser pulses, microscopy revealed preferential thermal injury to sebaceous follicles and glands, consistent with predictions from a computational model. Inflammation was mild; gold particles were not retained in swine skin 1 month after treatment, and uptake in other organs was negligible. Two independent prospective randomized controlled clinical trials were performed for treatment of moderate-to-severe facial acne, using unblinded and blinded assessments of disease severity. Each trial showed clinically and statistically significant improvement of inflammatory acne following three treatments given 1-2 weeks apart. In Trial 2, inflammatory lesions were significantly reduced at 12 weeks (P=0.015) and 16 weeks (P=0.04) compared with sham treatments. Optical microparticles enable selective photothermolysis of sebaceous glands. This appears to be a well-tolerated, effective treatment for acne vulgaris.

Introduction The tumor necrosis factor (TNF-α) was initially described as lymphotoxin or cachectin. The discovery of therapies blocking the action of TNF-α, in 1988, started a new era in the therapy. One of often reported adverse effects related to the use of TNF-α antagonists is induction of the formation of autologous antibodies and antibodies neutralizing anti-TNF drugs. The development of anti-TNF-induced lupus or classical drug-induced lupus is more rarely reported. Aim To evaluate the presence and the level of anti-nuclear antibodies in patients with psoriasis and psoriatic arthritis and the influence of anti-TNF therapy used on the concentration of antinuclear antibody (ANA). Material and methods A total of 28 subjects were included in the study. 71.4% of subjects were diagnosed with psoriatic arthritis and 28.6% with plaque psoriasis. Results Among the patients with plaque psoriasis, the antinuclear antibodies were found in 25% of subjects and in 80% of patients with psoriatic arthritis. After the treatment an increase in the titer or appearance of antibodies was found in 66.7% in the infliximab group, 18.2% in the etanercept group and 54.7% in the adalimumab group. No subjects developed symptoms of drug-induced systemic lupus. Conclusions Our findings have shown that all anti-TNF therapies induced ANA in psoriatic arthritis and psoriatic patients. Considering a mild course of lupus induced by anti-TNF treatment and, usually intrinsic, resolution of symptoms, the biological therapy still appears as a safe treatment for patients.

Material and methods. The determinations were performed in 14 mastocytotic patients, including 6 patients with the systemic mastocytosis and 8 with urticaria pigmentosa, in 14 with innate angio-motor oedema due to C1 inhibitor deficiency, and in 10 healthy controls. Tryptase levels were determined using PhadiaUniCAP TRYPTASE reagents. Histamine concentrations were measured using HISTAMINE ELISA kit (LaborDiagnostikaNord).

Introduction. Tryptase and histamine levels may serve as an indicator of mast cells stimulation related to various diseases, such as mastocytosis, IgE-related allergy, confirming their participation in the pathogenesis.Aim. Analyse tryptase and histamine levels and assess the correlation between tryptase and histamine levels in serum of the different groups of study patients.Material and methods. The determinations were performed in 14 mastocytotic patients, including 6 patients with the systemic mastocytosis and 8 with urticaria pigmentosa, in 14 with innate angio-motor oedema due to C1 inhibitor deficiency, and in 10 healthy controls. Tryptase levels were determined using PhadiaUniCAP TRYPTASE reagents. Histamine concentrations were measured using HISTAMINE ELISA kit (LaborDiagnostikaNord).Results. In 6 patients with systemic mastocytosis, the level of tryptase was high (> 60 mu g/L). In the majority of the patients with urticaria pigmentosa, the level of tryptase was elevated, but it did not exceed 60 mu g/L. In half of the patients with systemic urticaria, the level of histamine was elevated, but it was not correlated with the increased level of tryptase. In the people with hereditary angioedema due to C1 inhibitor deficiency, the serum levels of tryptase and histamine were normal. In that group, no correlation was shown to occur between the levels of the study parameters.Conclusions. No correlation was found between tryptase and histamine levels. Thus, it seems reasonable to conclude that the mediators are released from the mast cells independently.

In the course of radiation therapy different types of adverse reactions of the skin are observed in approximately 95% of patients. Among the various complications encountered after radiotherapy, radiation recall dermatitis (RRD) deserves special attention. Radiation dermatitis is a form of delayed hypersensitivity of irradiated skin, and the direct trigger factors are medicines most chemotherapeutics. The reaction is an inflammatory dermatosis. It is limited to previously irradiated skin and appears a number of months after radiotherapy. The aetiology of RRD is still unclear. Its clinical presentation may vary from mild erythema to necrosis and ulceration. The article presents the case of a 50-year-old patient, who after radiotherapy for breast cancer, during the hormonal therapy (tamoxifen), developed RRD type skin reactions after skin application of Amol. The article presents a detailed differential diagnosis of skin changes of RRD type, and discusses the principles of treatment and prevention.