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Biomedical subjects

Jacek C Szepietowski

Publications and source records attributed to Jacek C Szepietowski.

At least 19 recordsLinked to original sources
PubMed2006

Factors influencing coexistence of toenail onychomycosis with tinea pedis and other dermatomycoses: a survey of 2761 patients.

OBJECTIVE: To evaluate the prevalence and factors influencing the presence of concomitant dermatomycoses in patients with toenail onychomycosis. DESIGN: Prospective study based on a specially designed questionnaire completed by dermatologists. PATIENTS: A total of 2761 patients with toenail onychomycosis. MAIN OUTCOME MEASURES: The diagnosis of fungal skin infections was confirmed by direct microscopic examination or by culture. RESULTS: In 1181 patients (42.8%) with toenail onychomycosis, concomitant fungal skin infections were noted. Tinea pedis was the most common and was found in 933 patients (33.8%). Other concomitant fungal skin infections were fingernail onychomycosis (7.4%), tinea cruris (4.2%), tinea corporis (2.1%), tinea manuum (1.6%), and tinea capitis (0.5%). The presence of concomitant fungal skin infections depended on number of involved toenails; duration of onychomycosis; sex, age, and education level; area of residence; and type of isolated fungus. CONCLUSIONS: The coexistence of toenail onychomycosis with other types of fungal skin infections is a frequent phenomenon. It could be hypothesized that infected toenails may be a site from which the fungal infections could spread to other body areas. Effective therapy for onychomycosis might therefore be essential not only to treat the lesional toenails but also to prevent spreading the infection to other sites of the skin.

Adolescent↗
PubMed2006

Psoriasiform lupus vulgaris with 30 years duration.

Lupus vulgaris is a progressive form of cutaneous tuberculosis occurring in a person with a moderate to high degree of immunity. It is the most common type of cutaneous tuberculosis. Lupus vulgaris can be mimicked by several other skin conditions, and a 69-y-old female is described with an extremely long history of extensive infiltrative skin lesions with abundant scaling. The lesions were localized on the right arm and forearm, and on the right lateral surface of the chest. The diascopic test was positive. Moreover, a large atrophic scar was seen in the region of right cubital fossa resulting in contracture of the right elbow joint. The histopathology strongly suggested the diagnosis of tuberculosis. The final diagnosis of tuberculosis was confirmed by PCR examination. A polychemotherapeutic regimen (ethambutol 1250 mg/d, rifampicin 600 mg/d and isoniazid 300 mg/d) was successfully employed for the treatment of skin lesions.

Aged↗
PubMed2006

Cutaneous manifestations in a patient with a long-term history of untreated ACTH-dependent Cushing's syndrome.

Cushing's syndrome is accompanied by many different skin symptoms. A case of a 43-year-old female patient with unrecognized adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome is reported. Besides numerous skin lesions, the patient presented with a rapidly progressive leg ulcer due to venous thrombosis. The initial skin symptoms appeared on her lower leg one month prior to admission. The patient was treated with oral prednisone, however, rapid progression of the skin lesion was observed. On admission the patient presented with a large, very painful ulceration, partially covered with a crust, on the right lower leg with several satellite smaller ulcerations. The other leg showed no changes. Moreover, the patient had pronounced hirsutism and skin darkening on the face, and Muehrcke's lines were observed on all her nails. Microscopic findings of skin biopsy were uncharacteristic, with some signs of angiopathy and vasculitis. Based on the elevated serum levels of ACTH and cortisol, and the result of dexamethasone suppression test, ACTH-dependent Cushing syndrome was diagnosed. Sonography of leg veins revealed a recanalized thrombus of the right popliteal vein with reflux. The patient was transferred to surgical department where both suprarenal glands were removed. Upon suprarenal gland removal, significant improvement of the patient's general condition and rapid healing of the leg ulcer were observed. Briefly, this patient is presented to point out that a leg ulcer caused by venous insufficency may mimic fulminant purpura or some other type of vasculitis in patients with Cushing syndrome.

Adrenocorticotropic Hormone↗
PubMed2006

A - 308 promoter polymorphism of tumor necrosis factor alpha gene does not associate with the susceptibility to psoriasis vulgaris. No difference either between psoriasis type I and type II patients.

BACKGROUND: Genes encoded within the MHC complex on chromosome 6 are thought to play an important role in the pathogenesis of psoriasis. A potential candidate is tumor necrosis factor alpha (TNF-alpha) gene. Psoriasis features an increased activity of the proinflammatory cytokine TNF-alpha in affected lesions. TNF-alpha promoter region contains several polymorphisms, including G/A transition at position -308, which influences transcriptional activity of TNF-alpha. This study was performed to investigate the association between TNF-alpha single nucleotide polymorphism and susceptibility for psoriasis vulgaris. MATERIAL AND METHODS: DNA from 78 patients with psoriasis vulgaris and 74 healthy volunteers with no personal and family history of psoriasis was investigated. TNF-alpha promoter gene single nucleotide polymorphism (SNP) in position 308 was evaluated by PCR-SSP. The results were compared between group of psoriatic patients, divided into early onset of psoriasis (type I) and late onset of psoriasis (type II) subgroups, and healthy subjects. RESULTS: There were no significant differences in the polymorphism of TNF-alpha promoter -308 (genotype distribution, allele frequencies) between psoriasis patients and healthy controls. Similar results were obtained analyzing subgroups of psoriasis patients (type I and type II of psoriasis) and gender groups. CONCLUSION: TNF-alpha promoter single nucleotide polymorphism (-308) is not associated with susceptibility to psoriasis vulgaris.

Adult↗
PubMed2005

Expression of vascular adhesion protein-1 in atopic eczema.

BACKGROUND: Vascular adhesion protein-1 (VAP-1) is an adhesion molecule with an enzymatic activity which partakes in the migration process of lymphocytes. The aim of this study was to investigate VAP-1 expression in atopic eczema (AE) in comparison with healthy controls and psoriatic individuals. MATERIAL AND METHODS: Forty adult patients suffering from AE aged between 18 and 56 years were included in the study. The control group consisted of 35 healthy volunteers aged between 19 and 49 years and of 71 psoriatic patients aged between 23 and 89 years. The serum concentration of soluble VAP-1 (sVAP-1) was evaluated by ELISA and VAP-1 expression in the skin by immunohistochemistry. RESULTS: Serum level of sVAP-1 in AE patients before treatment was significantly higher compared with healthy volunteers. Similarly, a higher mean number of VAP-1-positive vessels was found in both lesional and nonlesional atopic skin compared with healthy skin. Treatment of AE resulted in a significant reduction in the serum level of sVAP-1. On the other hand, both the serum level of sVAP-1 and the number of dermal vessels with expression of VAP-1 were significantly lower in AE patients compared with psoriatic individuals. CONCLUSION: This study indicates the important role of VAP-1 in the pathogenesis of chronic inflammatory cutaneous disorders, including AE.

Adolescent↗
PubMed2005

Intertrigo and common secondary skin infections.

Intertrigo is inflammation of skinfolds caused by skin-on-skin friction. It is a common skin condition affecting opposing cutaneous or mucocutaneous surfaces. Intertrigo may present as diaper rash in children. The condition appears in natural and obesity-created body folds. The friction in these folds can lead to a variety of complications such as secondary bacterial or fungal infections. The usual approach to managing intertrigo is to minimize moisture and friction with absorptive powders such as cornstarch or with barrier creams. Patients should wear light, nonconstricting, and absorbent clothing and avoid wool and synthetic fibers. Physicians should educate patients about precautions with regard to heat, humidity, and outside activities. Physical exercise usually is desirable, but patients should shower afterward and dry intertriginous areas thoroughly. Wearing open-toed shoes can be beneficial for toe web intertrigo. Secondary bacterial and fungal infections should be treated with antiseptics, antibiotics, or antifungals, depending on the pathogens.

Anti-Infective Agents↗
PubMed2005

Sun protection in renal transplant recipients: urgent need for education.

BACKGROUND: Renal transplant recipients (RTR) are considered as a high-risk group of skin cancer development. OBJECTIVE: The aim of the present studywas to find out the knowledge about the harmfulness of sunlight and the methods of sun protection among RTR. MATERIAL AND METHODS: 151 RTR (91 males and 60 females) were surveyed using a specially designed questionnaire. RESULTS: The knowledge about the danger of sunlight exposure among RTR appeared to be very unsatisfactory. Only 40.4% of patients knew that the development of skin cancer is connected with the exposure to sunlight. Moreover, only 68.2% of investigated individuals considered RTR as a high-risk group of skin cancer development. Although 74.8% of patients were informed about the necessity of sun protection, only 11.3% could explain what the number of the SPF (sun protection factor) means. Females significantly more often knew that RTR are especially predisposed to the development of skin cancers (p = 0.0001) and significantly more frequently could explain what the SPF number means (p = 0.006). 72.8% of RTR (females significantly more often, p = 0.02) made efforts to avoid sunlight irradiation. However, only 5.3% of the examined patients routinely used creams with SPF (females significantly more often, p < 0.0001). More than a half of the patients (62.3%) did not apply any sun protection. CONCLUSIONS: The present study revealed the urgent necessity of education concerning the harmfulness of sunlight and the methods of sun protection among RTR. Moreover, it is postulated that every patient should be routinely examined by a dermatologist in a dedicated transplant patient clinic.

Adult↗
PubMed2005

Body dysmorphic disorder: more than meets the eye.

Body dysmorphic disorder is a relatively common yet long unrecognized problem affecting mainly adolescents and young adults of both sexes. It is an obsessive disease of such intensity that it interferes with daily activities. Patients typically focus on imagined major defects in the face, nose, skin or hair. Patients often seek multiple physician assessment, but body dysmorphic disorder may be disabling and even life-threatening as a result of depression and suicidal ideation. Treatment with serotonin reuptake inhibitors and cognitive behavioral therapy may be beneficial in many patients.

Adolescent↗
PubMed2005

Expression of p53 protein in psoriasis.

INTRODUCTION: Psoriasis is characterized by hyperproliferation and abnormal differentiation of keratinocytes,by the presence of inflammatory cell infiltrate in both the dermis and the epidermis and by alterations of capillaries. p53 protein is an important transcription factor which plays a central role in cell cycle regulation mechanisms and cell proliferation control. OBJECTIVES: This study was performed to identify the expression and localization of p53 protein in lesional and non-lesional skin samples taken from psoriatic patients in comparison with healthy controls. MATERIAL AND METHODS: Sections of psoriatic lesional and non-lesional skin (n=18) were examined. A control group (n=10) of healthy volunteers with no personal and family history of psoriasis was also examined. The expression of p53 was demonstrated using the avidin-biotin complex immunoperoxidase method and the monoclonal antibody DO7. The count and localization of cells with stained nuclei was evaluated using a light microscope in 10 fields for every skin biopsy. RESULTS: In lesional psoriatic skin the count of p53 positive cells was significantly higher than in the skin samples taken from healthy individuals (p<0.01) and non-lesional skin taken from psoriatic patients (p=0.02). No significant difference between non-lesional psoriatic skin and normal skin was observed (p=0.1). A strong positive correlation between mean count and mean per cent of p53 positive cells was found (p<0.0001). P53 positive cells were located most commonly in the basal layer of the epidermis of both healthy skin and non-lesional psoriatic skin. In lesional psoriatic skin p53 positive cells were present in all layers of the epidermis. CONCLUSION: P53 protein appears to be an important factor in the pathogenesis of psoriasis.

Female↗
PubMed2005

Efficacy and tolerance of the cream containing structured physiological lipids with endocannabinoids in the treatment of uremic pruritus: a preliminary study.

Uremic pruritus is still a common phenomenon in patients with end-stage renal failure, however, there is no effective treatment of choice for this condition. This study was undertaken to evaluate the efficacy and tolerance of the cream with structured physiological lipids (DMS, Derma Membrane Structure) and endogenous cannabinoids in controlling pruritus in patients on maintenance hemodialysis. Twenty-one subjects with uremic pruritus completed the trial. All patients applied the tested cream twice daily for a period of three weeks. Pruritus was evaluated using two pruritus scoring methods: standard visual analog scale (VAS) and a questionnaire method. Moreover, all patients had dry skin scored according to the 5-point scale. Global pruritus and xerosis were examined before the trial, on study visits at weekly intervals, and on follow-up visit performed two weeks of study discontinuation. After 3-week therapy pruritus was completely eliminated in 8 (38.1%) patients. Pruritus evaluation by both scales revealed significant reduction of pruritus scores (p<0.0001) during the tested product application. At the beginning of the trial there was no significant correlation between the intensity of dry skin and severity of pruritus. The 3-week treatment period resulted in complete reduction of xerosis in 17 (81%) patients, while xerosis scores were significantly reduced (p=0.0001) throughout the study period. The test product was very well tolerated by all patients. The test product appeared to be effective in reducing both pruritus and xerosis in hemodialysis patients. It is very probable that the observed decrease of pruritus with the test product therapy was not only the result of dry skin improvement but that the addition of endocannabinoids may have also played a role. These preliminary results are encouraging, however, additional controlled studies are needed to clarify the exact usefulness of this product in therapy of uremic pruritus.

Adult↗
PubMed2005

Surgical treatment of axillary hyperhidrosis with liposuction equipment: risks and benefits.

Axillary hyperhidrosis poses a serious problem to the affected patients. So far, the conservative measures employed seem to be disappointing, operations with axillary skin excision, undermining and/or skin reconstruction may cause secondary functional and cosmetic problems, whereas botulinum A toxin injections need to be repeated frequently. The aim of this study was to establish the safety, efficacy, and durability of subdermal (subcorial) suction sweat gland curettage in the treatment of axillary hyperhidrosis. So far, the method seems to be devoid of possible risks and drawbacks. In the last 4.5 years, 15 patients with axillary hyperhidrosis were operated on with the use of liposuction tools. First operations were performed in general anesthesia, then in tumescent anesthesia. The procedure of suction curettage was performed with the use of 3- to 4-mm wide liposuction cannulas. The patients were closely monitored during early stages of the healing process; then they were evaluated at 1 and 3 months, and finally at 1-4 years of the operation, when they were asked to assess the effects of the operation. Four patients had recurrence of the disease within 3 months; three of them were reoperated on, with good result. At 1-4 years of the operation, all our responders (ten of 15 patients) stated that the disease had completely subsided. The following complications were observed during the process of healing: hematomas, transient skin unevenness, and partial skin flap necrosis. In conclusion, subdermal suction curettage seems to be superior to botulinum A toxin injections by the effect durability, and to the surgical methods with skin excision and undermining by the probably lower complication rates.

Adult↗
PubMed2004

Uraemic xerosis.

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Emollients↗