[Nail diseases in cosmetology]. / Choroby paznokci w praktyce kosmetologicznej.

Clinical symptoms attributed to the nail apparatus and observed in cosmetology include atrophic or hypertrophic lesions, pathologic nail coloration, abnormalities of the nail surface, and disorders of the nail plate and bed junction. These symptoms may reflect pathologic processes limited to the nail apparatus or may be the consequence of a dermal or systemic disease. Even though the etiology of nail lesions is variegated, diseases of the nails are simply classified as infectious or non-infectious. The aim of this work was to present the most common diseases of the nail apparatus encountered in cosmetology. Often, nail diseases worsen the quality of life of the patient. In addition, the variegated symptomatology demonstrates that nail lesions should be viewed in a wider perspective because they often are important signs of pathologic processes taking place in the organism of the patient.

[Erythematotelangiectatic skin--diagnostic difficulties]. / Skóra naczyniowa--problemy diagnostyczne.

Erythematotelangiectatic skin is a common cosmetic and medical problem. Flushing or persistent erythema, teleangiectasias, and occasionally other inflammatory skin lesions can be caused by internal or environmental factors. Certain physiologic reactions and systemic or dermatologic diseases represent internal conditions leading to visible skin flushing in the blush area. Erythematotelangiectatic skin is found in body areas which are particularly exposed to various environmental factors and perform important esthetic functions at the same time. Determination of the main etiopathologic factor responsible for flushing in the blush area precedes the selection of an adequate method of care, correction or treatment of the erythematotelangiectatic skin. The main aim of this study was to analyze fundamental mechanisms of flushing or persistent erythema and their sequellae basing on the literature. Another aim was to review current diagnostic options useful in examining the etiology and severity of erythematotelangiectatic skin symptoms.

Proinflammatory cytokine (IL-1beta, IL-6, IL-12, IL-18 and TNF-alpha) levels in sera of patients with subacute cutaneous lupus erythematosus (SCLE).

Subacute cutaneous lupus erythematosus (SCLE) is a subset of lupus erythematosus that identifies patients with clinically recognized erythematous, nonscarring lesions, photosensitivity and serologic abnormalities. Anti-Ro (SS-A) antibodies are considered to be a typical immunopathologic marker of SCLE. Autoimmune diseases have been also characterized by the disturbances in the cytokine network. The aim of this study was to compare the concentrations of proinflammatory cytokines (IL-1beta, IL-6, IL-12, IL-18 and TNF-alpha) in serum of ANA-positive (antibody against nuclear antigen) and ANA-negative patients with SCLE. Sera samples were collected from 15 patients with SCLE (9 ANA-positive and 6 ANA-negative ones). The preliminary identification of autoantibodies as well as their titers was determined on HEp-2 cells using IIF method. Western blotting (EUROIMMUN) was applied to verify the results of IIF. Proinflammatory cytokine concentrations in the patients' sera samples were determined by enzyme-linked immunosorbent assay (ELISA) (Bender MedSystems). The levels of IL-12 were higher in ANA-positive patients than in ANA-negative subgroups [median (interquartile range), 330 pg/ml (128-708 pg/ml) versus 39.4 pg/ml (31.25-80 pg/ml)]. Similar differences were observed in the level of IL-18 [median (interquartile range), 508.4 pg/ml (180-1222 pg/ml) versus 100.5 pg/ml (78.1-154 pg/ml)]. The differences in TNF-alpha levels between the groups of ANA-positive and ANA-negative patients were at the verge of statistical significance, p<0.05. The sera levels of IL-1beta and IL-6 were low and of no significant difference concerning the ANA-positive and ANA-negative subgroups. Since serum levels of IL-12 and IL-18 were higher in ANA-positive patients than in ANA-negative patients, these cytokines might play an important role in the inflammatory process in SCLE.

[Assessment of mycological and clinical factors on the course and results of treatment of mycotic infections in patients with recurrent onychomycosis]. / Ocena wplywu czynników mikologicznych i klinicznych na przebieg i wyniki leczenia zakazenia grzybiczego u chorych z nawrotowa grzybica dermatofitowa paznokci.

In spite of excellent results of conservative treatment of onychomycosis, there is still a significant number of patients in whom the dermatophyte infection persists in deep layers of the nail plates. Intensive treatment must be undertaken in some of these patients, depending on their clinical state and extent of the persistent dermatophyte infection of the nails. The aim of this study was to determine fungal factors facilitating the persistence of dermatophytosis in nails and to evaluate clinical data of patients in whom conservative treatment was unsuccessful. The study also concentrated on the effectiveness of various kinds of onychomycosis therapy. A total of 704 patients with onychomycosis underwent therapy between 1995 and 2000. 155 patients were previously treated unsuccessfully with terbinafine or itraconazole. Apart from the method of therapy, the main factors influencing the results of therapy in 549 patients visiting the physician for the first time were: age and location and extent of dermatophyte infection. Observation of patients with recurrent mycosis revealed that repeated monotherapy with terbinafine or itraconazole is the least efficient regimen. Significantly better results were obtained with combined itraconazole and pentoxifylline or itraconazole and topical amorolphine. Undoubtedly, surgery is the most efficient method and almost always successful. Surgery remains burdensome and costly, necessitating not only removal of the nail, but also a monthly course of terbinafine and meticulous topical treatment until nail plate regrows. Analysis of factors being potentially capable of influencing the results of treatment revealed that enzymatic activity of dermatophyte is by far the most important one. When enzymatic activity of different dermatophyte species from patients with recurrent onychomycosis was compared with enzymatic activity of control species from patients who were never treated before, significant and characteristic statistical differences were noticed. Statistically significant differences between both groups were detected regarding activities of beta-glucosidase, lipase, arylamidase and N-acetyl-beta-glucosaminidase. Higher activities of these enzymes are characteristic for strains isolated from patients who have been unsuccessfully treated before. Undoubtedly, high enzymatic activity is an important factor favoring survival of dermatophytes in the nail. In conclusion, ineffective pharmacological treatment of fungal infection of nails may depend on both clinical features of the patient and the properties of infecting fungus, in particular on its enzymatic activity.