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Reparation of damaged tissues is an essential biological process that ensures maintenance of homeostasis. Basically it includes phases of inflammation, proliferation and remodeling. The result of healing of damaged tissues is scar formation. Abnormalities in the course of wound healing may lead to keloid formation. The pathophysiology of keloids is characterized by improper migration, proliferation and apoptosis of cells as well as imbalanced synthesis and secretion of proteins, cytokines, proteolytic enzymes and their inhibitors. To date, applied therapeutic methods do not lead to satisfactory cosmetic results of the treatment. Current research focuses on developing methods for direct inhibition of the fibroproliferative process, mainly through modulation of cytokine expression and in consequence suppression of fibroblast proliferation and balancing of synthesis and degradation of extracellular matrix components.

Introduction. Alopecia areata (AA) is an autoimmune condition characterized by T-cell-mediated attack on hair follicles. Objective. Evaluation of efficacy of 308 nm excimer light in the treatment of alopecia areata. Material and methods. Patches of AA were treated twice weekly, but not on 2 consecutive days, with UVB excimer 308 nm light. In all patients, half of the AA patch was irradiated and the other half was spared, covered with a black rubber shield and taken as a control. Therapy was started with an initial dose of 300 mJ/cm 2 , with an incremental dose of 100 mJ/cm 2 at every sitting until fine erythema appeared. Results. At the end of the treatment, one patient (3.33%) at the test site showed > 50% hair regrowth vs. none at the control site. After a 2-month post-treatment period, successful hair regrowth (grades 3 and 4) was seen in 12 patients at test sites and in 2 patients at control sites. The differences were statistically significant (p < 0.05). After 4 months successful hair regrowth (grades 3 and 4) was seen in 16 patients at test sites and in 5 patients at control sites. The differences were statistically significant (p 0.05). Conclusions. Excimer light has the potential to stimulate hair regrowth in patches of alopecia areata.

Dermatomyositis (DM) is one of the so-called idiopathic inflammatory myopathies (IIM). Dermatomyositis is an autoimmune disorder characterized by the presence of cutaneous lesions and/or symptoms of muscle involvement with the following variants: the “classic” variant of DM, juvenile DM, paraneoplastic DM, drug-induced DM and amyopathic DM. Dynamic discoveries of novel autoantibodies, including anti-TIF1, anti-NXP2, anti-SAE or anti-MDA5, related to certain DM variants, have been described in recent years. It seems that these antibodies will contribute to better recognition of DM and its particular variants, a better risk stratification for predicting internal organ involvement, and to a global improvement of treatment outcome. Corticosteroids remain the mainstay of DM therapy, but new immunomodulatory and immunosuppressive agents, including biologicals, resulted in a significant increase of the survival rate of DM patients. Here, we review the current literature data on DM with special emphasis on new trends in its diagnostics and treatment.

Mastocytosis is characterized by excessive proliferation and accumulation of mast cells in skin and/or other organs. Two forms of the disease, cutaneous and systemic mastocytosis, differ significantly in symptomatology and clinical course. KIT mutations play an important role in the pathogenesis of the disease. The presence of p.D816V KIT mutation was detected in the vast majority of adults with systemic mastocytosis. The role of KIT mutations in childhood-onset mastocytosis remains a matter of discussion. More recent studies have shown that cutaneous mastocytosis, which is the most common clinical manifestation of the disease in children, has a genetic background. In contrast to adults, different types of KIT mutations have been described in pediatric and familial mastocytosis. The understanding of the molecular mechanisms in mastocytosis enables targeted therapy using tyrosine kinase inhibitors.

Introduction . Genital herpes is one of the most common sexually transmitted viral diseases and the most common cause of mucous membrane ulcerations in the genital area. The number of sexually transmitted infections caused by herpes virus (HSV), especially by HSV-1, is increasing. In the Polish population, there are no precise and current epidemiological data on herpes virus infections, especially in the anogenital area. A major problem concerns HSV infections in pregnancy, which are connected with the risk of in-utero and perinatal virus transmission. Herpes simplex virus infection in pregnancy threatens the life and health of an infant. Objective . To obtain information regarding the occurrence of herpes simplex in people of reproductive age as well as the assessment of knowledge on HSV infection and transmission, especially in pregnancy. Material and methods. Two hundred people (133 women and 67 men) aged 18–35 years, attending a dermatological clinic in the first half of 2014 with typical dermatological diseases, took part in the study. The subjects filled in the questionnaire including information on age, occurrence of erosions, scabs in the facial and genital area, diagnosis of oral and genital herpes virus infection, information given by the medical staff on the herpes infection, treatment with oral antivirus drugs, danger of herpes infection in pregnancy and risk of transmission of the HSV virus to fetuses and newborns. Results . Among the 200 people who took part in the study, 27% indicated the occurrence of herpes or recurring lesions in the form of vesicles and scabs on the border of skin and mucous membranes; in 1.5% of them genital herpes was diagnosed. Only 12% of investigated persons were treated with antiviral medicines. Sixty-eight percent of subjects stated that HSV is an infectious disease, 16% claimed that it is non-infectious, and a similar number did not know if it is an infectious disease or not. Only half of the studied group answered that it is dangerous for pregnant women and newborns, and 86% had never received sufficient information on herpes virus infection from medical staff. Conclusions . Our results confirm the lack of sufficient knowledge on HSV infection, especially in pregnancy, and the necessity of educating patients.

Genital herpes is one of the most common sexually transmitted viral diseases and the most common cause of mucosal erosions and ulcerations in the genital area. According to epidemiological data, the infection caused by genital herpes virus is common in developing countries. The number of sexually transmitted infections is increasing, and infections caused by herpes simplex virus 1 (HSV-1) in the genital area are becoming more common. In Poland there are no current epidemiological data on these infections. Genital herpes infection is dangerous for pregnant women, who can transmit it to infants. There is a significant risk of primary infection in pregnant women, transmitted by their seropositive partners. The early diagnosis and treatment are of utmost importance. The effective method of prevention and treatment is aciclovir, which in numerous studies was proven to be safe in pregnancy. In the article, the course of infection, treatment and prevention, especially in pregnant women and newborns, are discussed.

Sebaceous carcinoma (sebaceous gland carcinoma – SC) is a very aggressive malignant skin tumor that arises from the epithelium of sebaceous glands. Sun exposure and long-term immunosuppression, mainly in organ transplant recipients, are the most common risk factors. The tumor was first well described by Allaire in 1891. Sebaceous carcinoma is rare and accounts for less than 1% of all cutaneous malignancies and from 1% to 5.5% of all eyelid malignancies. The most common localization is the eyelids, where it derives from the Meibomian and Zeiss glands. Most cases occur in woman between 60 and 80 years of age, but the tumor can be seen at any age, even in childhood. It appears mostly as a small, slowly growing, painless and firm mass, sometimes as a small yellowish plaque or ulceration. SC has a tendency for local recurrence and distant metastases. The local recurrence rate ranges from 9 to 36% and tends to appear within the first 5 years from diagnosis. The most effective method of treatment is surgical excision (Mohs’ microsurgical excision if it is possible). The rate of metastases is about 14-25%. The sites of metastases are usually lymph nodes, liver, lungs, bones, and brain. The mortality rate is about 22% but it increases to 50% at 5 years in patients with metastatic disease.

Acne vulgaris is a chronic inflammatory skin condition with a high global prevalence. Light-based therapies can be used in acne treatment on account of their good safety profile, lack of potential for developing resistance, and mechanism of action. Despite variations in research methodologies and diverse findings among researchers, numerous clinical studies have shown a statistically significant improvement in the skin condition of acne patients treated with light. In the majority of studies, the follow-up period is comparatively short, preventing the evaluation of long-term effects of therapy. This paper examines the literature on the effects of various light therapies (based on LED devices, photodynamic therapy, intense pulsed light, and laser therapy), on the clinical signs of acne.

Reflectance confocal microscopy is a non-invasive diagnostic method that enables real-time visualization of tissues in near-histological resolution. Pemphigus is a chronic autoimmune skin disease in which intra-epidermal blisters are formed as a result of acantholysis, i.e., loss of connection between epidermal cells. A systematic review of the literature on the use of reflectance confocal microscopy in the diagnosis of pemphigus has been carried out in this paper. Reflectance confocal microscopy enables identification of intra-epidermal acantholytic blisters in patients with pemphigus vulgaris and pemphigus foliaceus. The method also enables to identify the localization of blisters – the spinous layer in pemphigus vulgaris, and in the granular layer in pemphigus foliaceus. Thus, reflectance confocal microscopy may allow establishing non-invasively an initial diagnosis of pemphigus and differentiating pemphigus vulgaris from pemphigus foliaceus.

Psoriasis is a chronic skin disease characterized by systemic inflammation associated with an increased risk of metabolic and cardiovascular complications. A special role in maintaining systemic inflammation is attributed to obesity. Adipose tissue is an active endocrine organ which, through adipokine secretion, is involved in the regulation of many systemic metabolic pathways. Obesity increases the risk of developing type 2 diabetes mellitus, atherosclerosis, cardiovascular diseases and hypertension. The paper presents the characteristics of two relatively recently discovered and little known adipokines: omentin and vaspin. They are considered to have beneficial effects preventing the development of metabolic disorders associated with obesity. In addition, attention was given to their possible involvement in the pathogenesis of psoriasis and potential use as markers of disease severity and the risk of developing metabolic complications.

Hidradenitis suppurativa (acne inversa) is a chronic, inflammatory, recurrent, debilitating disease of hair follicles manifested by painful, deepseated, inflamed lesions localized in intertriginous areas. Establishing a correct diagnosis seems straightforward enough, as it is based on clinical criteria, but a comparative analysis of published papers on hidradenitis suppurativa epidemiology easily reveals substantial discrepancies in the estimation of the obtained results for the general population. Data on the prevalence of hidradenitis suppurativa in European countries and in the United States of America differ by up to four orders of magnitude, ranging from 0.00033% to 4.1%. Based on data obtained from the Polish National Health Fund and HS reference centres, the prevalence of hidradenitis suppurativa in Poland was estimated at 0.001%, which classifies hidradenitis suppurativa as a rare disease.

Gastrointestinal tumors are among the most common neoplastic causes of death worldwide. Presence of characteristic skin lesions can allow faster diagnosis and therapy and this way can increase the probability of a cure. In the paper we present the most important paraneoplastic syndromes that can coexist with gastrointestinal malignancy including colon, gastric, esophagus and pancreatic cancers. We take into account genetic syndromes such as Cowden syndrome, familial atypical multiple mole melanoma syndrome (FAMMM) (melanoma/pancreatic cancer), Clarke Howel-Evans, Peutz-Jeghers, Muir-Torre, Gardner syndromes and acquired syndromes such as acantosis nigricans maligna, tripe palms, Leser-Trelat, Bazex, hypertrichosis languinosa, erythema gyratum repens , carcinoid and glucagonoma syndrome. We also include cutaneous metastases and coexistence of neoplasia in some cases of dermatomyositis.

Introduction. The limited outdoor activity of contemporary people results in deficiency of vitamin D. An adequate vitamin D level cannot be achieved due to random insolation. A scenario of pro-healthy outdoor behavior is needed that takes into account climatic conditions in Poland. Objective . To present the outdoor activity scenario in Poland for people with phototype II and III to get an adequate vitamin D 3 dose without the risk of erythema. Material and methods. The paper presents the results of mathematical simulations of UV doses received by persons with phototype II and III in the spring/summer season in Poland (Jastrzębia Góra, Zakopane). The following scenarios are examined: using all the time a sunscreen with SPF30, short sunbathing without photo-protection and application of a sunscreen with SPF30 for the rest of the day. Results. During late spring and summer in Poland it is possible to get a vitamin D 3 dose of 2000 IU due to solar radiation without the risk of erythema. For persons with phototype II and III short (20–30 min) near-noon exposure without photo-protection then application of sunscreen with SPF30 for the rest of the time spent outdoors is recommended. Clothing should allow insolation of at least 1/4 of the whole skin area. Conclusions . Avoiding near-noon solar radiation or using sunscreens with high SPF always while staying on the sun does not allow one to obtain a proper vitamin D status.

Azelaic acid (AZA) is a naturally occurring substance produced by Malassezia furfur which exerts various effects on the skin. Azelaic acid has antibacterial, anti-inflammatory, keratolytic, comedolytic, sebostatic and tyrosinase-inhibiting properties. Topical application of AZA as 20% cream or 15% gel is a well-established therapeutic method in various common dermatoses, mainly acne vulgaris, rosacea and disorders associated with hyperpigmentation. Azelaic acid is used as a component of chemical peels as well. The paper summarizes the most relevant issues concerning AZA application in dermatological treatment based on current knowledge.

Chronic urticaria is a condition characterized by the appearance of wheals and/or angioedema that last for at least 6 weeks. According to the recent recommendations, if H1-antihistamines used in four times licensed doses remain ineffective, add-on treatment with omalizumab, cyclosporine A or montelukast should be applied. This paper offers a literature review of the studies on using omalizumab in chronic spontaneous urticaria (CSU) treatment. Moreover, it presents our own experience with the use of omalizumab in the treatment of two patients with CSU. Both patients were treated with H1-antihistamines in four times licensed doses recommended by European guidelines, oral corticosteroids, montelukast, and methotrexate – all without satisfactory results. During the time of the omalizumab therapy both patients achieved a significant improvement measured by the decrease in the Average Urticaria Activity Score for 7 days (UAS7) – the first patient from 34 to 11.8 points, the second one from 41 to 5.76.

The innate immune system has the ability to recognize pathogens through Toll-like receptors (TLRs), which are transmembrane glycoproteins on the cell surface. These receptors present on the surface of immunological cells – macrophages, dendritic cells, mast cells and some populations of lymphocytes – play an important role in the defense against bacterial, viral and fungal infections. The connection of a Toll-like receptor with the microbial cell component known as pathogen associated molecular pattern (PAMP) induces intracellular mechanisms leading to the synthesis of proinflammatory cytokines. Depending on the kind of the recognized ligand, TLRs are classified into subfamilies. So far, 13 TLRs have been described in mice and 11 in humans. These receptors may be expressed extracellularly (TLRs 1, 2, 4, 5, 6, 10, 11) or intracellularly, located in endosomes (TLRs 3, 7, 8, 9). Recent studies also indicate their role in the development of many dermatoses. Occurrence of these receptors has been found on the surface of epidermal and dermal cells: keratinocytes, Langerhans cells, fibroblasts, endo-thelial cells, melanocytes and adipocytes. This paper presents the structure and function of Toll-like receptors and their role in the pathogenesis of some infectious skin diseases, autoimmune and allergic dermatoses as well as skin neoplasms. The knowledge about the role of Toll-like receptors in the development of skin diseases creates the possibility to use them in treatment in the future.

Introduction. The most commonly diagnosed cancer group in humans is cancers of the skin. One pre‑invasive form of squamous cell carcinoma is Bowen's disease. It manifests in the form of single or multiple lesions, which may be located on the skin of any part of the body. Most often it appears in the form of a well-demarcated, oval patch covered with a small crust. Risk factors are immunosuppression, exposure to arsenic, HPV viruses, solar radiation and X-rays. Objective. Presentation of a case of extensive Bowen’s disease, in which combined therapy methods had to be used. Case report. In this paper we present a case of extensive Bowen's disease of the face in an 86-year-old female patient. Due to the difficult location and a large lesion, the combined therapy was used: CO 2 laser, photodynamic therapy and imiquimod. Satisfactory results were achieved. Conclusions . In extensive Bowen’s disease in order to remove it and achieve a satisfactory cosmetic effect, combined therapy may be necessary.

In recent years we can observe a dynamic increase in skin cancers in whose pathogenesis exposure to ultraviolet radiation (UVR) plays an important role. Actinic keratosis (AK) is a common skin disease, characterized by hyperkeratotic lesions located on skin damaged by UVR (photodamaged skin) or senile skin, most frequently present in people of Caucasian origin. The most frequent risk factors for AK development are: elderly age, male sex, cumulative UVR dose, low skin phototype, living in equatorial regions and long-lasting administration of immunosuppressive agents. In various papers on pathogenesis of AK it was revealed that it is an initial form of lesions leading in consequence to development of skin cancers, especially squamous cell carcinoma (SCC). To date there clinical features of AK predisposing to development of SCC are not known, however, inflammation, diameter over 1 cm, rapid enlargement, bleeding and ulceration are considered as risk factors. AK may spontaneously regress, remain stay stable for many years or progress to SCC. This new concept on pathogenesis of AK caused a new approach to its treatment, with a special emphasis on field of cancerisation, with the use of 5-fluorouracil, imiquimod, photodynamic therapy and ingenol mebutate. In the article we present current knowledge on the pathogenesis of actinic keratosis, a review of therapeutic options and principle rules of prophylaxis.

Introduction . Dermatomyositis (DM) is an autoimmune disease that mainly affects skin and muscles. It has an incidence of approximately 5–10/1000 000 in adults. The association between dermatomyositis and internal organ cancers seems to be extremely important. Objective. The aim of this paper is to present a patient with dermatomyositis as a paraneoplastic syndrome. Case report . A 37-year-old woman was admitted to the Department of Dermatology due to skin lesions and proximal muscle weakness. The skin lesions consisted of edema and erythema of eyelids and neck; in addition erythema and papules were found above small joints of both hands. Based on the clinical presentation the diagnosis of dermatomyositis was established and systemic corticosteroid therapy (prednisone 60 mg/day) was introduced. Despite initial improvement, in the following days exacerbation of the disease was observed, and the patient reported severe vaginal bleeding. Gynecological consultation and histopathological examination were performed, which revealed cervical cancer. The patient was qualified for treatment with chemoradiotherapy. After completion of the treatment, the skin lesions and muscular symptoms resolved completely. Conclusions . According to different authors, the frequency of co-existence of dermatomyositis and internal organs cancers is estimated to be 6-45%. Most frequently DM is associated with ovary, lung and gastrointestinal cancer; and non-Hodgkin lymphoma. Cancer can be present before, during, or after the diagnosis of dermatomyositis, as it was in our patient. That is why it is so important to conduct the oncological search in this group of patients, especially in the absence of response to conventional therapy or with relapses of the disease.

Introduction. Gastrointestinal stromal tumour (GIST) is a rare mesenchymaltumour of the gastrointestinal tract and mesentery. Standardtreatment is surgical resection. First-line therapy of unresectable ormetastatic GIST is imatinib mesylate – a tyrosine kinase inhibitor.Objective. The aim of this paper is to present a patient with GIST inwhom treatment with imatinib caused dermatitis as an adverse effectand a change of therapy was necessary.Case report. We present a case of a 57-year-old woman with nonoperativeGIST diagnosed 2 years ago in whom, after 3 months of treatment with imatinib, papulo-erythematous, pruritic eruption on the trunk,lower and upper extremities and face occurred. The histopathologicalpicture corresponded with lichenoid reaction caused by the drug.Despite lowering the dose of imatinib, new infiltrated lesions with atendency to disintegration were observed. Due to systemic (intravenouspulses of corticosteroids, antihistaminics) and topical treatment(corticosteroid ointments) and the change of imatinib for a second-linedrug, sunitinib, improvement of skin lesions was observed.Conclusions. Therapy with imatinib is generally well tolerated, butdermatitis can appear in 30% of patients taking this drug. In the presentedcase with unresectable GIST therapy with imatinib caused skincomplications.