According to literature data association of psoriasis with other autoimmune diseases is well known, but rare, which is in accordance with our results. The question arises whether this association is the matter of poor coexistence or the matter of genetic mutations. However, once established, these associations can further highlight the autoimmune nature of psoriasis. The research of autoimmunity would lead us to epithelial cells in thymus, and their badly learnt cognitive function about what is own, and what is not.
Introduction. Acronym tick-borne lymphoadenoathy (TI-BOLA (Dermacentor-borne necrosis erythema and lymphoadenopathy-DEBONEL, scalp eschar associated with neck lymphoadenopathy-SENLAT) comprises clinical diagnosis of tick-borne symptoms of cervical or occipital lymphadenopathy with inoculation eschar at the site of tick bite on scalp. Since the first description, it was proved to be associated with several infectious agents, most frequently Rickettsia slovaca, or less often other spotted fever group Rickettsiae (Rickettsia raoulti and Rickettsia rioja), and gained an emerging infectious disease status in Europe. Dermacentor ticks serve as vectors and possible natural reservoir. The course is in most cases benign and infection is limited. Doxicycline is the recommended initial treatment, both for adult and most cases in children. Case report. Two subjects who acquired the desease caused by tick bites in Vojvodina region of Serbia are presented. Both patients are females. A tick was removed from the scalp, and several days later doxicycline treatment started because of the inflammatory symptoms of lymph node enlargement. Diagnostic eschar appeared in both patients during doxicycline treatment. After a switch to ciprofloxacine, inflammatory symptoms subsided, but the complete healing of scalp necrosis took longer than one month, with residual cicatricial alopecia. Conclusion. Although rare, it is necessary to include TIBOLA in a spectrum of epidemiologic risks in cases of tick bites.
Background Individual susceptibility to develop acute respiratory distress syndrome is related to age and most frequent comorbidities. So far, it is known that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily infects the type II pneumocytes in humans, with the help of transmembrane serine protease type 2 (TMPRSS2). Up to now, the only known transcriptional promoters of genes coding TMPRSS2 are androgenic. Theoretically, the elevated level of androgens or androgen receptors would lead to a higher expression of TMPRSS2 and a higher level of viremia as a consequence. Aim The aim of our research was to indirectly investigate if the severity of SARS-CoV-2 infection is dependent on the expression of androgen receptors. Methods This observational study analysed male patients hospitalized for SARS-CoV-2 infection with respect to the length of hospitalisation, the outcome of the disease, the type of necessary oxygen support and the presence of comorbidities and hairiness. In hairiness estimation, we used an adapted version of the Hamilton-Norwood scale and the presence of the Gabrin sign. Results In total, 208 patients were enrolled in the study. There were statistically significant differences comparing the average age of patients with the different types of alopecia when groups were divided according to the presence of the Gabrin sign (t = 4.958, p > 0.01). The outcomes and the type of needed minimal oxygen support, compared with the type of alopecia in the case of Gabrin + / − classification showed a statistically significant difference in the outcome of the disease (p = 0.027). There were no statistically significant differences in the distribution of comorbidities among alopecia groups, but hypertension was related to poor COVID-19 prognosis. Conclusion Our findings suggest that the Gabrin sign and hypertension are related to a poor COVID-19 prognosis.
Dermatosonography offers valuable possibilities in assessing skin morphology at an intermediate level: between clinical assessment and microscopy.
Introduction. Hydroxyurea (HU) is a cytostatic agent, frequently used for the treatment of myeloproliferative disorders, sickle cell anemia and severe forms of psoriasis. Cutaneous side effects occur in up to one third of patients taking hydroxyurea, with the most serious side effect being susceptibility to develop non-melanoma skin cancers. Case report. We report 3 patients using HU that have developed multiple skin malignancies on the head and neck region and dorsa of the hands, arranged according to the level of the overall squamous dysplasia expressed. Conclusion. A cumulative dose of hydroxyurea affects skin cancer promotion in concordance with other risk factors determining cumulative ultraviolet exposure (age of the patients, skin phototype, sun habits), but the exact influence of each of them and enrollment of other possible cofactors remains to be elucidated. We point out the importance of adequate skin cancer preventive and therapeutic approach to the patients treated with hydroxyurea.
Introduction. Localized unilateral hyperhidrosis (LUH) is a rare disorder of unknown origin, with multiple possible triggering factors and unknown pathogenesis. Although there are cases of LUH of the face reported, this is the first to report isolated ipsilateral hyperhidrosis of the face after blunt force trauma. Case outline. A 54-year old Caucasian woman presented with localized unilateral facial hyperhidrosis (LUH) of five years duration. Ipsilateral blunt trauma of the temple that preceded the condition for three months was identified as the most probable cause. For sharp demarcation the Minor or ?starch-iodine? test is performed which revealed presence and extent of the facial sweating on the left side of the face. Treatment with Sol. 20% aluminium chloride hexahydrate (Retrargin sol.) was conducted with partial response. Conclusion. After ruling out underlying diseases as a cause of LUH, a prior trauma should be considered as a potential cause. The possible mechanism could be the lesion of sympathetic chain as a result of cervical traction due to a facial blunt force trauma, although it cannot be positively proven.
Currently, most authors believe that disseminated superficial actinic porokeratosis (DSAP) is an inherited or acquired dermatologic disorder of keratinization that occurs in genetically predisposed individuals after adequate exposure to ultraviolet (UV) rays, or immunosuppression. Lesions in DSAP start in sun-exposed areas most commonly in the third or fourth decade of life. The lesions are pink to brownish papules and plaques with a raised scaling ridge, histologically seen as a column of parakeratotic keratinocytes, the cornoid lamella. DSAP is not only the most common, but also the most often overlooked form of porokeratosis (P). Here we present a 77-year-old male with DSAP, who sporadically developed initial skin lesions at the age of 67, at the time when his personal and medical history were significantly long for chronic intensive sun exposure and type 1 insulin dependent diabetes mellitus. We established the diagnosis of DSAP based on personal and medical history, clinical presentation, auxiliary methods such as dermoscopy, and confirmed with pathohistological findings. We advised the patient to avoid sun exposure and to apply photo-protective sunscreens, emollients and keratolytics. After five years of monitoring his changes, we continue to control his lesions for any possible alteration. Although mutations in several genes and data on sun exposure may be responsible for the onset of the disease, most cases of DSPA occur sporadically and without involving the facial skin, as in our case. Lesions usually begin in the third or fourth decade of life. In the elderly, an additional trigger may be present, such as e.g. age-related decreased immune competence. Diabetes mellitus may also be associated with immunodeficiency in the elderly. Recently, DSPA has been a special subtype of DSPA in the elderly. Malignant alteration can occur in DSPA, most commonly in lesions that are long lasting, large, in the elderly, or in lesions in immunocompromised individuals. In conclusion, this is the case of a 77-year-old male person, who sporadically developed the so-called subtype DSPA in the elderly. In addition to UV radiation, the relevant suggestive trigger factors were the immunosuppressive effects of diabetes mellitus and chronological aging.
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