Psoriasis is a chronic multisystemic disease with predominant skin involvement. In the human population its prevalence reaches 3-5%. Psoriasis is one of the most frequent diseases among chronic dermatoses and reaches 12-15% [1][2][3][4]. Statistical data on psoriasis in Ukraine are significantly different from the average in Europe and the world, as the prevalence of the disease has steadily increased over the last decades -from 114.8 per 100 thousand people in 1994 to 222.5 per 100 thousand in 2014 including over 6,000 children [5,6]. According to official statistics, the largest number of psoriasis patients is in the Carpathian region, so we consider our data to be representative of a much larger region than just the western part of Ukraine.Psoriasis occurs at any age. There are two peaks of the onset of the disease at aged 20-30 and 50-60 years [7]. Psoriasis also occurs at a much younger age; its onset is observed in early childhood. According to literature data, psoriasis is the second most common disease after atopic dermatitis in children. The risk of this disease in boys and girls is the same. Psoriasis is more common in children over 10 years of age, but episodes also occur in early childhood [8][9][10]. This disease is an idiopathic one, but the role of the genetic component is certain. The implementation of genetic conditioning can be at any age. The main causes of psoriasis are stress, infections, immunological processes, diseases of the internal organs, nervous and endocrine system, traumas, medications, etc. Possible causes of psoriasis morbidity in children are psychoemotional overload, social problems and household troubles, ecological pollution, and reduction of immune reactivity [9,11,12].This study aimed at investigating the frequency, clinical features and the course of psoriasis in children under 6 years old.For over 40 years, we have monitored the incidence and clinical course of psoriatic disease in infants. The study materials were case histories, outpatient cards, and counseling logs. The focus was on the onset of the disease, the causes, the family history, clinical manifestations, the effectiveness of therapy, and the duration of remission. The patients were ex-Letter to the editor/List do redakcji Clinical features and the course of psoriasis in childrenCechy obrazu klinicznego i przebieg łuszczycy u dzieci
Basosquamous carcinoma (BSC) is a rare, aggressive non-melanoma skin cancer with features that lie between those of basal cell carcinoma (BSC) and squamous cell carcinoma (SCC). BSC incidence is less than 2% of all non-melanoma skin cancers. A lot of controversies have been raised around the classification, pathogenesis, histologic morphology, biologic behavior, prognosis, and management of this tumor. Clinical differentiation from other BCC subtypes is difficult, although dermoscopic evaluation may provide some important clues. The dermoscopic pattern of BSC combines characteristics of both BCC and SCC including unfocused arborizing vessels, white structureless areas, keratin masses, ulceration or blood crusts, white structures, blue-gray blotches, and blood spots on keratin masses. Biopsy and histologic examination remain the gold standard diagnostic method for BSC. The main published literature describes the presence of both BCC and SCC histologic characteristics with a transition zone between them. However, there is a certain controversy regarding how these features are arranged within the lesions. The correct histologic diagnosis of a BSC can be jeopardized when the biopsy is superficial and not incisional. In this scenario, the lack of deep areas of the lesion in the sample may result in the incorrect interpretation of the tumor as a classic BCC. Intraepidermal carcinoma (IEC) has long been considered a precancerous disease due to the fact that dysplastic and atypical cells are concentrated in the epidermis. They lack the fact of penetration through the basement membrane in order to become SCC. Modern practice refers to IEC as an SCC in situ localized extragenital. We present a case of 63 years old patient. Erythematous macula with desquamation up to 1.3 cm in diameter, located on the chest, was revealed during the survey. At a non-polarised dermoscopy with fluid immersion there was a "gelatinous stroma" through which the dense network of multiple branched vessels is clearly visible, this is typical for BCC. But unfocused arborizing vessels were visible in some sectors, white structureless areas, keratin masses, blue-gray blotches, and blood spots on keratin masses that allow us to suspect a focal transformation in BSC. In the center, there were everal sectors filled with glomerular vessels, which is typical for IEC. The results of clinical and laboratory tests were within normal ranges. The dermoscopic picture combines changes that may point out BSC in the periphery and IEC in the central part of the formation. The fact of BSC worsens the patient's prognosis. BSC is characterized by an aggressive subclinical spread with higher rates of recurrence: 12–51%. We decided that immediate removal should be preferred. Taking into account the patient's age and accompanying pathology, a radical treatment method of removal by cryodestruction was chosen. During follow-up examinations, a normotrophic scar with a characteristic vascular pattern was formed on the patient's skin at the site of tumor removal. Conclusions. In our opinion, such a vascular pattern in the center of the lesion can testify to the picture of the transformation of BCC to BSC. At this stage, BSC, in some parts of the formation, is within the epidermis, and can probably be considered BSC in situ, which could be usefully explored in further research.
Follicular dyskeratosis (Darier-White disease) is a hereditary skin disease that is extremely rare in medical practice, so errors in its diagnosis can occur. It was first described in 1889 by two scientists (independently of each other), Ferdinand-Jean Darier and James White. The disease is inherited in an autosomal dominant pattern with variable gene penetrance. The main cause of this pathological process is a mutation of the ATP2A2 gene, located in the long arm of chromosome 12. Both men and women are affected with the same probability, but clinical manifestations are more severe in males. It appears, as a rule, at the age of 20; children under 10 rarely suffer from DAR; people who are over 30 years have very little chance of contracting this disease. Clinical manifestations slowly progress up to the age of 40-50, and gradually disappear in older age. Typical rashes are follicular papules, 0.2-0.5 cm in size, yellow-brown or dark brown in color, covered with dry or oily layers in the form of horny scales. On the surface layers, black dots are visible which are hair follicle funnels. Papules are rounded, dense, flat or spherical, initially isolated, eventually merging into plaques. They are mostly localized on the skin of the limbs, trunk, chest, in the interscapular area, large folds, less often on the neck, scalp, auricles, and in the ear canals. In 20-30 percent of patients, rashes are localized on the mucous membrane of the oral cavity next to the affected skin. More than 90 percent of patients have nail abnormalities, such as erythro- and leukonychia. Other possible manifestations are fragility, splinter hemorrhages, marked subungual hyperkeratosis, which can be observed on 2-3 nails or affect all nail plates. The dermatoscopy of skin lesions is characterized by the presence of several polygonal, branched, star-shaped or rounded-oval yellow-orange-brown lumps of various sizes, surrounded by a thin whitish halo and pink small-structured areas. The prognosis for recovery is not favorable, the treatment is ineffective. Two cases of Darier-White disease are described in this article.
Cutis verticis gyrata (CVG) is a descriptive term for a rare benign skin condition characterized by the formation of tortuous folds and deep furrows that mimic the gyri of the brain because of excessive skin growth. It is observed mainly in men. The first clinical case of the disease was described in 1837 by Alibert J. There are primary and secondary forms of CVG. Among the cases of primary CVG in 1984, Garden JM and Robinson JK further distinguished the essential and combined subtypes. The reason for the appearance of the essential form is not known. Primary combined CVG can accompany neuropsychiatric disorders, cerebral palsy, epilepsy, seizures, and ophthalmological abnormalities, most commonly cataracts. Secondary CVG occurs as a result of chronic inflammation, such as hysteria, lymphostasis, elephantiasis, eczema, psoriasis, folliculitis, atopic dermatitis, etc. In case of secondary CVG, the lower extremities are more often affected, the skin is congested-red, cyanotic, dense, swollen. Papillomatous growths, layering of crusts and scales are often visible against the background of changed skin. Given the rarity of this disease (it was diagnosed for the first time in our more than 50 years of dermatological practice), we report a clinical case of CVG. Case Presentation. Patient P., 27 years old, complained of wrinkles and increased mobility of the skin of the scalp. He noticed the first manifestations of the disease at the age of 17, but did not pay attention, believing that these were individual features of the skin structure. For the last 3-4 years in a row, he noticed a thickening and increase in the size of the folds of the skin on the scalp, growing mobility. The skin, according to the patient, had the appearance of ribs. During the dermatological examination, the skin is of normal color, turgor and elasticity are preserved, sweat and sebum secretion is moderate. Skin appendages are without pathological changes. The skin of the scalp is uniformly covered with thick hair, hyperelastic, pronounced transverse deep linear furrows resembling brain convolutions are visible. When using dermoscopy without a light-conducting liquid, the vascular pattern is hardly visible, on the surface there is small lamellar peeling. However, after its application, areas of clearly visible vessels of the superficial vascular plexus of the skin, which coincide with the location of the furrows, are determined. The patient was examined; no pathology was detected on the part of internal organs and heart. The results of ultrasound of the thyroid gland and organs of the abdominal cavity were without pathological changes. General analysis of blood, urine, blood sugar within the normal range. Biochemical indicators of liver and kidney function without deviations. The patient is recommended to have a periodic examination by a dermatologist. With increasing clinical manifestations - surgical removal of skin folds. Conclusions. The described clinical case of CVG is of considerable interest to dermatologists, pediatricians, and geneticists as a rare new developmental disease. In our report, the clinical picture of changes on the skin is illustrated, and differential diagnosis with dermatoses that are closest in clinical manifestations is briefly carried out.
Вступ. В роботі працівника деканату факультету підготовки іноземних громадян багато важких моментів. Більшість з них пов’язані з транс культурними конфліктами, різниці в системі цінностей учасників педагогічного процесу, несумісності релігій та психологій, що нашаровується на значний об’єм внутрішнього і зовнішнього документообігу та щомісячної аналітики. Результати дослідження та їх обговорення. Одне з таких завдань - контроль відвідування студентами навчальних занять. Проблема полягає в необхідності помісячно обробляти значний об’єм розрізненої за способом доставки, слабко уніфікованої інформації. В такій ситуації в нагоді може стати доступний за підпискою Office365 інструмент Microsoft Forms, який передбачає створення опитувань та тестувань. В попередньо створеній формі, ми використаємо можливість отримання файлів. Це перетворить інструмент опитування в систему збору звітів з можливістю автоматизованого маркування документів, розміщення їх в захищеному сховищі, попередньої перевірки на відповідність умові формату та розміру, спільної обробки групами допущених осіб, та зведенням опитаної інформації до формату таблиці Microsoft Excel, де можливо, з легкістю, застосовувати сортування за необхідним критерієм, для контролю факту виконання завдання окремими респондентами. Для уніфікації звітньої інформації та забезпечення її придатності до автоматизованої обробки рекомендуємо звіти приймати у форматі захищеної таблиці Excel залишаючи доступними для зміни лише необхідні комірки. Для забезпечення спільного перегляду результатів членами контролюючої команди необхідно роздати права доступу на перегляд форми та можливість перегляду папки, де акумулюються файли звітів. Висновки. За період впровадження отримано 390 звітів від 50 кафедр на яких викладається 106 предметів. Завдяки двох сторонньому контролю підвищилась ефективність та вчасність подачі документів. Скоротився час затрачений на зведення інформації представниками деканату. Зросла достовірність кінцевих даних, завдяки зменшенню числа механічних помилок, а відповідно ефективність контролю успішності студентів факультету.
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