High-frequency ultrasonography-New non-invasive method in assessment of skin lymphomas.

BACKGROUND: Mycosis fingoides (MF) is the most common subtype of primary cutaneous T-cell lymphomas. Current evaluation of disease extent and severity is based on mSWAT scoring system, which seems to be relatively subjective. The aim of this subject was to present the usefulness of 20 MHz in objective 5-year long monitoring of response to therapy in MF patients. MATERIALS AND METHODS: The 5-years long follow-up based on 19 skin USG images of patients diagnosed as early stages of MF was studied. The assessed USG parameter was the mean diameter of subepidermal low echogenic band (SLEB). RESULTS: In every MF patient during exacerbation within lesional skin we could observe SLEB, which thinning or complete disappearance was detected after finishing the therapy. Lack of complete absence of SLEB was related to the lack of complete remission assessed by mSWAT. CONCLUSION: We present for the first time the possibility of monitoring patients' clinical state on the base of non-invasive USG imaging. We recommend additional use of 20 MHz USG to reduce intra-observer variability and to assess residual disease. USG imaging can complement evaluation of skin lesions in MF and can support clinical judgement.

Circulating adipokines and organ involvement in patients with systemic sclerosis.

BACKGROUND: In recent years, mediators synthesized in the adipose tissue, the so-called adipokines, have been reported to play important roles in the pathogenesis of autoimmune rheumatic diseases. OBJECTIVE: To compare serum leptin, adiponectin and resistin levels in patients with systemic sclerosis (SSc) and healthy controls. To find possible relationship between serum levels of adipokines and organ involvement with focus on interstitial lung disease in SSc patients. PATIENTS AND METHODS: Lung involvement was assessed functionally (body plethysmography, diffusing capacity of the lung for carbon monoxide (DLCO) and six-minute walk test) and radiologically (using average disease extent on high resolution computed tomography (HRCT) of the lungs according to the percentage of interstitial changes) in 29 SSc patients. Quantitative sandwich ELISA was used to measure resistin, leptin and adiponectin concentrations in sera of patients and 30 healthy controls. RESULTS: We found no statistically significant differences in serum resistin, leptin and adiponectin levels between SSc patients and the controls. However, serum adiponectin concentrations were significantly lower in active than in inactive patients, they also correlated positively with vital capacity (VC) (p=0.04) and negatively with Valentini activity score (p=0.04). Serum resistin levels were significantly elevated in patients with digital ulcers (p=0.03) and serum concentrations of leptin were associated with the duration of SSc symptoms other than Raynaud's phenomenon (p<0.01) CONCLUSIONS: Serum adiponectin should be further investigated as a candidate for SSc activity marker and resistin may play a role in ulcer development in SSc patients.

Monitoring of therapy in atopic dermatitis--observations with the use of high-frequency ultrasonography.

BACKGROUND: In reactive and proactive therapy of atopic dermatitis a well established agent is tacrolimus, a member of calcineurin inhibitors' family. The clinical safety and efficacy of this drug were evaluated previously in randomized multicenter trials. However, so far in clinical studies the assessment of its action on the skin has been made only on the basis of different scores and scales. We present the 6-month observations of tacrolimus therapy in atopic dermatitis patients monitored with the use of noninvasive techniques like high-frequency ultrasonography and evaporimetry. METHODS: The study consisted of 39 patients with AD and their mean age was 26.3 ± 12.8 years. The study lasted 6 months and every 4 weeks patient visited the outpatient clinic (totally 7 visits). The evaluation of disease severity within right antecubital fossa was obtained on the basis of Investigator's Global Assessment (IGA) score. During every control visit noninvasive measurements were carried in the form of HF-USG (with determination of subepidermal low echogenic band, SLEB) and evaporimetry. RESULTS: 39 patients started the study and 22 of them (54.6%) finished it. Out of 39 patients, 31 (79.5%) received at least 4 week long proactive treatment. We observed statistically significant change of IGA, mean SLEB value and TEWL during underwent therapy. There were also statistically significant differences in mean SLEB and TEWL values between lesional and nonlesional measures. CONCLUSIONS: This report shows the usefulness of HF-USG in monitoring tacrolimus therapy in atopic dermatitis. It is worth emphasizing, that this tool is easily reproducible and allows clinicians to visualize pathologic changes of all skin in vivo. As a noninvasive and independent of subjective judgment method, HF-USG should be included in overall evaluation of atopic dermatitis disease severity together with common scores or scales, especially in the era of evidence based medicine.

Topical tacrolimus vs medium-dose ultraviolet A1 phototherapy in the treatment of atopic dermatitis - a preliminary study in relation to parameters of the epidermal barrier function and high-frequency ultrasonography.

INTRODUCTION: Atopic dermatitis (AD) is a chronic, relapsing skin disorder, which is characterized by intense pruritus, skin dryness and concomitant epidermal barrier dysfunction. The basic therapy involves the application of anti-inflammatory topical drugs like; glucocorticosteroids and calcineurin inhibitors. Phototherapy in AD is regarded as an additional form of treatment. The latest invention, ultraviolet A1-UVA1 phototherapy (340-400 nm), was introduced to the treatment of AD by Krutmann et al in 1992. It appears that the main mode of action of UVA1 phototherapy in AD is through activation of apoptosis of T lymphocytes. Additionally, new studies show that UVA1 can also inhibit the activity of calcineurin phosphatase, similarly to calcineurin inhibitors such as cyclosporin A or tacrolimus. The aim of this study is to, for the first time, compare the efficacy of medium dose UVA1 phototherapy and tacrolimus ointment in patients with moderate-severe AD. PATIENTS AND METHODS: This study involved 20 AD patients. Half of the patients were treated with UVA1 phototherapy, while another 10 participants were treated with the application of tacrolimus ointment. The severity of the disease progress was assessed on the basis of EASI score (Eczema Area Severity Index). Moreover, the clinical condition of patients was assessed using non-invasive techniques such as measurement of transepidermal water loss - TEWL and skin capacitance, as well as high-frequency ultrasonography (20 MHz). RESULTS: This study described above confirmed the beneficial influence of both therapies on the course of moderate-severe AD. Tacrolimus induced a greater reduction in TEWL, while phototherapy caused the reduction of subepidermal low echogenic band-SLEB within sites affected with pathological lesions. CONCLUSIONS: Both tacrolimus and phototherapy treatment seemed to significantly reduce EASI.

Health-related quality of life, optimism, and coping strategies in persons suffering from localized scleroderma.

The clinical course of localized scleroderma may consist of bodily deformations, and bodily functions may also be affected. Additionally, the secondary lesions, such as discoloration, contractures, and atrophy, are unlikely to regress. The aforementioned symptoms and functional disturbances may decrease one's quality of life (QoL). Although much has been mentioned in the medical literature regarding QoL in persons suffering from dermatologic diseases, no data specifically describing patients with localized scleroderma exist. The aim of the study was to explore QoL in localized scleroderma patients and to examine their coping strategies in regard to optimism and QoL. The study included 41 patients with localized scleroderma. QoL was evaluated using the SKINDEX questionnaire, and levels of dispositional optimism were assessed using the Life Orientation Test-Revised. In addition, individual coping strategy was determined using the Mini-MAC scale and physical condition was assessed using the Localized Scleroderma Severity Index. The mean QoL score amounted to 51.10 points, with mean scores for individual components as follows: symptoms = 13.49 points, emotions = 21.29 points, and functioning = 16.32 points. A relationship was detected between QoL and the level of dispositional optimism as well as with coping strategies known as anxious preoccupation and helplessness-hopelessness. Higher levels of optimism predicted a higher general QoL. In turn, greater intensity of anxious preoccupied and helpless-hopeless behaviors predicted a lower QoL. Based on these results, it may be stated that localized scleroderma patients have a relatively high QoL, which is accompanied by optimism as well as a lower frequency of behaviors typical of emotion-focused coping strategies.

Ultraviolet A1 phototherapy for mycosis fungoides.

BACKGROUND: Mycosis fungoides (MF) is the most common form of primary cutaneous lymphoma, and is characterized by a malignant proliferation of CD4+ cells. Psoralen ultraviolet A (PUVA) irradiation is the most common treatment for cutaneous lesions. However, PUVA carries the risk of adverse reactions to psoralens and long-term risk of skin cancer. UVA1 may be a safer alternative. AIM: To assess the efficacy of UVA1 phototherapy in patients with early-stage MF (T1-T2). METHODS: Four patients with early-stage MF were treated with 1630-2710 J/cm(2) UVA1 given in 29-40 fractions, and the effect was assessed by clinical examination and by high-resolution ultrasonography. RESULTS: Complete clinical remission of MF was achieved in all cases. CONCLUSIONS: This preliminary report indicates that UVA1 phototherapy might be an efficient treatment for early-stage MF.