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Abstract Physical activity offers numerous physical and mental health benefits for individuals with disabilities, while nutrition plays a crucial role in maintaining bodily homeostasis. This study aimed to assess the relationship between body composition and dietary habits among physically active people with disabilities. Fifty-five participants aged 16 to 61, including 28 with disabilities and 27 without, were included in the study. The FFQ-6 questionnaire, Tanita body composition analyzer, and Stadiometer were utilized. No significant differences in BMI were observed between the two groups. However, individuals with disabilities showed higher body fat, metabolic age, or pulse values, whereas the control group exhibited higher muscle mass, muscle quality, body type, or bone mass. Participants with disabilities were more likely to consume vegetables (p = 0.004) and animal fats (p = 0.027), while those without disabilities were more inclined to consume fast food, instant products (p = 0.006), sweetened beverages (p

Acne vulgaris is the most common dermatosis among adolescents, but it can also affect adults. Acne lesions located on the face cause discomfort and lead to impaired quality of life for many patients. Acne is a dermatological condition with multiple causes and clinical manifestations, as well as varying degrees of severity. Dermatological treatment alone does not always bring good therapeutic effects, and occasionally it may result in symptoms of skin irritation. Therefore, using appropriate dermocosmetics is crucial in managing the condition. Dermocosmetics play a potentially important role in minimizing the adverse effects of acne medications, providing a synergistic effect by addressing other acne-causing factors and/or enhancing the efficacy of other treatment modalities, and protecting the skin against the adverse impacts of the exposome. In cases of mild acne, dermocosmetics can be used in monotherapy as an alternative to acne medications or for maintenance therapy. It is also advisable to combine dermocosmetics with topical or systemic therapies to achieve a synergistic effect or to prevent and reduce drug-induced adverse reactions. Dermocosmetics have keratolytic and anti-inflammatory properties, regulate sebum production, and help maintain the balance of the skin’s natural microbiome.

Dermocosmetics (active cosmetics, functional cosmetics, cosmeceuticals) are preparations for external use, supporting pharmacotherapy of skin diseases during the active phase of the disease and in remission. They are also used for healthy skin (preventive) care. Historically, topical skin care products have been divided into cosmetics and drugs, as defined by the Federal Food, Drug and Cosmetic Act of 1938. A cosmetic was defined as ”articles intended to cleanse, care, beautify and improve the appearance of the skin”. Drugs were defined as ”products intended to affect the structure or any function of the body, or products intended for use in the diagnosis, treatment, mitigation, treatment or prevention of human diseases”. Dermocosmetics (cosmeceuticals) remain cosmetics from a legal point of view, but they fill the gap between cosmetics and drugs. These products achieve a cosmetic effect with active substances however are not subject to drug regulations.

The treatment goal in alopecia areata is induction of hair regrowth and halting the progression of the disease. Treatment decisions depend on the severity of the alopecia areata as assessed by the Severity of Alopecia Tool (SALT) or the Alopecia Areata Scale (AAS). In mild alopecia areata, very ultra-high potency topical glucocorticoids and intralesional triamcinolone acetonide are the mainstay of treatment. In moderate to severe alopecia areata, systemic treatment is usually required. Currently, the only drug dedicated for alopecia areata, approved in Europe and the United States is baricitinib. Ritlecitinib, a JAK3/TEC inhibitor is approved in the United States for individuals 12 years of age and older with severe alopecia areata and is expected to be approved in Europe soon. Other systemic medications used in alopecia areata include glucocorticoids, cyclosporine, and methotrexate. Contact immunotherapy may be considered. In alopecia areata, long-maintenance treatment is of substantial significance.

The existence of two types of alopecia areata is suggested (probably genetically different): early-onset, with more severe symptoms, longer disease duration, higher tendency to relapse, often with a positive family history, and late-onset, in which the first symptoms occur after the age of 50, the course is milder and the family history is negative. Alopecia areata may exist in the form of: focal alopecia areata, multifocal alopecia areata, ophiasis, diffuse alopecia areata, alopecia totalis and alopecia universalis. Alopecia areata incognita remains a form with a discussed relationship to alopecia areata. Occasionally hair loss associated with alopecia areata may occur only in locations outside the scalp (e.g. beard, eyebrows, eyelashes, body hair). The diagnosis of alopecia areata can be made on the basis of clinical examination and trichoscopy. There are two main scoring systems for assessing the severity of alopecia areata. This is the Severity of Alopecia Tool (SALT) and the Alopecia Areata Score (AAS), which is also partly based on the SALT assessment. Both scoring systems allow differentiation between mild, moderate, and severe alopecia areata. These assessment results have a direct impact on therapeutic decisions.

Rosacea is a chronic inflammatory skin disease characterised by periods of remission and subsequent relapses typically provoked by environmental factors. Eruptions located on the face are easily visible and may be difficult to conceal, which leads to a decrease in patients’ self-esteem, quality of life, and general well-being. Since the aetiology of rosacea is multifactorial and not entirely understood, and the clinical characteristics and course of the disease are heterogeneous, therapy may be challenging. While a complete cure is not possible, in the majority of cases clinical improvement and long-term remission are satisfying both to the patient and physician. In recent years, the therapeutic approach has been significantly modified. Currently, the focus is placed on the need to personalise the treatment process and adapt it to the patients’ phenotypic characteristics. Combination therapies and new variants of existing topical and systemic drugs are increasingly being recommended. The mainstays of therapy are antiinflammatory agents. Proper skin care – along with the identification and avoidance of factors known to trigger consecutive episodes of rosacea – are also essential.

Abstract Trigeminal trophic syndrome (TTS) is a rare condition resulting from self‐manipulation of the skin after an injury to the trigeminal nerve. We describe the case of a 70‐year‐old woman who was hospitalized because of erythema, ulceration, and crusts on the right side of her face, accompanied by itching, burning, and irritation forcing self‐manipulation of the skin. She had been previously repeatedly treated with antibiotics, acyclovir, and topical medications without any improvement. Her medical history revealed an episode of ischemic stroke in 2016, after which a deformation and partial atrophy of the right ala nasi appeared. Trigeminal neuropathy was confirmed by a neurological consultation. Diagnosis and treatment of TTS requires a multidisciplinary approach. Awareness of this disease should be raised to enable proper diagnosis and management of difficult‐to‐treat facial ulcers that cannot be explained by common causes.

Abstract This is a report of one of the most serious complications of the cardiac pacemaker implantation ‐ infection of the implanted system. We present the case, which was misdiagnosed at the beginning and after cardiological consultation it was decided to immediately remove the peacemaker and transfer the patient to the Cardiological Department.

Rosacea is a chronic, relapsing, inflammatory, but not infectious, skin disease. The prevalence of rosacea is relatively high in the adult population of Northern Europe. Its characteristic symptoms include recurrent flushing, erythema, telangiectasia, papules and pustules, localized on cheeks, nose, chin and forehead. At present, four, not mutually exclusive subtypes of acne are classified: erythematotelangiectatic, maculopapular, hypertrophic and ocular. The clinical presentation of this dermatosis is heterogeneous. Clinical symptoms and their severity may vary individually. For this reason, treatment should be individualized and take into consideration the type of cutaneous lesions, presence of comorbidities, patient’s occupation, impact of the disease on the quality of life, and patient’s preferences. In addition to topical and systemic medications, adequate skin care is important.

Introduction Studying cerebral autoregulation, particularly PRx (Pressure Reactivity Index), is commonly employed in adult traumatic brain injury (TBI) and gives real-time information about intracranial pathophysiology, which can help in patient management. Experience in paediatric TBI (PTBI) is limited to single-centre studies despite disproportionately higher incidence of morbidity and mortality in PTBI than in adult TBI.Project We describe the protocol to study cerebral autoregulation using PRx in PTBI. The project called Studying Trends of Auto-Regulation in Severe Head Injury in Paediatrics is a multicentre prospective ethics approved research database study from 10 centres across the UK. Recruitment started in July 2018 with financial support from local/national charities (Action Medical Research for Children, UK).Methods and analysis The first phase of the project is powered to detect optimal thresholds of PRx associated with favourable outcome in PTBI by recruiting 135 patients (initial target of 3 years which has changed to 5 years due to delays related to COVID-19 pandemic) from 10 centres in the UK with outcome follow-up to 1-year postictus. The secondary objectives are to characterise patterns of optimal cerebral perfusion pressure in PTBI and compare the fluctuations in these measured parameters with outcome. The goal is to create a comprehensive research database of a basic set of high-resolution (full waveforms resolution) neuromonitoring data in PTBI for scientific use.Ethics and dissemination Favourable ethical approval has been provided by Health Research Authority, Southwest-Central Bristol Research Ethics Committee (Ref: 18/SW/0053). Results will be disseminated via publications in peer-reviewed medical journals and presentations at national and international conferences.Trial registration number NCT05688462.

Psoriasis is a chronic inflammatory skin disease which concerns approx. 1-3% population worldwide. In children psoriasis is less common, with the peak of morbidity in teenagers. Because of its more common prevelance in children in last decade, especially the disease with moderate and severe course, it is necessary to remind its clinical features and comorbidities. The aim of the recommendation of Polish Dermatological Society was to give the newest data on the psoriasis treatment in pediatric population which may be extremely important for everyday dermatological treatment. We described both topical and systemic treatments in details, including biological therapies.

Abstract The behavioral immune system posits that disgust functions to protect animals from pathogen exposure. Therefore, cues of pathogen risk should be a primary driver influencing variation in disgust. Yet, to our knowledge, neither the relationship between current pathogen risk and disgust, nor the correlation between objective and perceived pathogen risk have been addressed using ecologically valid measures in a global sample. The current article reports two studies addressing these gaps. In Study 1, we include a global sample (n = 361) and tested the influence of both perceived pathogen exposure and an objective measure of pathogen risk—local communicable infectious disease mortality rates—on individual differences in pathogen and sexual disgust sensitivities. In Study 2, we first replicate Study 1’s analyses in another large sample (n = 821), targeting four countries (US, Italy, Brazil, and India); we then replaced objective and perceived pathogen risk with variables specific to the SARS-CoV-2 pandemic. In Study 1, both local infection mortality rates and perceived infection exposure predicted unique variance in pathogen and sexual disgust. In Study 2, we found that perceived infection exposure positively predicted sexual disgust, as predicted. When substituting perceived and objective SARS-CoV-2 risk in our models, perceived risk of contracting SARS-CoV-2 positively predicted pathogen and sexual disgust, and state case rates negatively predicted pathogen disgust. Further, in both studies, objective measures of risk (i.e., local infection mortality and SARS-CoV-2 rates) positively correlated with subjective measures of risk (i.e., perceived infection exposure and perceived SARS-CoV-2 risk). Ultimately, these results provide two pieces of foundational evidence for the behavioral immune system: 1) perceptions of pathogen risk accurately assay local, objective mortality risk across countries, and 2) both perceived and objective pathogen risk explain variance in disgust levels.

Erysipelas is an acute bacterial disease of the skin and subcutaneous tissue. Its most commonly caused by group A beta-haemolytic Streptococci. Factors predisposing to infection include: old age, chronic diseases and immunodeficiency. Erysipelas the most typically develops on lower limbs. Very rarely the lesions are located on the trunk or the genital area. The clinical course is characteristic and includes: sudden onset, high fever, chills, pain as well as swelling, redness and excessive heat of the skin. The article describes a case of a female patient with erysipelas located in the back with a history of chronic myeloid leukaemia. In the differential diagnosis, skin lesions in the course of leukaemia and carcinomatous erysipelas had to be taken into account. The atypical location of skin lesions may have been caused by impairment and dysregulation of the immune system, both secondary to leukaemia and the use of an immunosuppressive drug. In dermatological practice, less typical locations of the infection have to be considered. Early implementation of appropriate treatment allows achievement of therapeutic success and avoiding complications.

Psoriasis is one of the most common chronic inflammatory dermatoses. We present the second part of the diagnostic and therapeutic guidelines on psoriasis. The second part discusses the principles of treatment of plaque psoriasis, with a particular emphasis on systemic drugs. The second part of the guidelines constitutes an integral whole with the first part which addresses the general principles of diagnostic management, prevention of cardiovascular complications, therapeutic goals, and selected specific forms of psoriasis. The guidelines have been updated to take account of access to new therapies which have recently been approved in Poland, ongoing improvements in the efficacy of available therapeutic methods, and changing needs of patients. We hope that the current guidelines will assist physicians in making diagnostic and therapeutic decisions, and contribute to the improvement of medical care provided to patients with psoriasis.

Psoriasis is a chronic inflammatory disease affecting approximately 1–3% of the general population. Although skin lesions are the primary clinical manifestation of the condition, psoriasis – especially moderate to severe – is currently regarded as a systemic disease, not only associated with the development of psoriatic arthritis but also linked to a range of other health consequences including cardiovascular complications. In view of new data on the pathogenesis of psoriasis, very rapid progress in the development of new therapeutic approaches, and in particular the registration of new drugs, a need arose to update the guidelines for the diagnosis and treatment of this nosological entity. The aim of the recommendations of the Polish Dermatological Society is to summarise the most recent literature and formulate guidelines for the treatment of psoriasis that may be useful in daily dermatological practice. However, the final decision regarding the diagnostic and therapeutic procedure should always be made individually for each patient based on the patient’s current clinical status and the most up-to-date scientific reports.

Chemotherapy is a basic treatment method of neoplasms at a systemic stage. Chemotherapy regimens including docetaxel are commonly used in every day clinical practice. Docetaxel is a chemotherapeutic agent that causes skin toxicity among other side effects. It involves alopecia and periungual lesions. The latter may cause pain as well as discomfort, and constitute a cosmetic problem. Sometimes they may lead to termination of the therapy due to negative effects on the quality of life and everyday activities. The aim of the article is to present clinical problems of patients undergoing chemotherapy with docetaxel that experience periungual lesions, and show treatment methods from a dermatologist’s perspective. Moreover, prophylactic methods that prevent appearance of severe lesions are presented.

Dermatitis herpetiformis is a rare, chronic, autoimmune blistering disease with hypersensitivity to gluten with the presence of intense pruritus. Symptoms of the disease are symmetrical, polymorphic skin lesions in a typical location. It is thought that dermatitis herpetiformis is a specific skin manifestation of celiac disease, with frequent asymptomatic gluten enteropathy. Both diseases are characterized by the same tissue compatibility antigens, the presence of circulating IgA antibodies against endomysium and transglutaminases, and clinical remission on a gluten-free diet. Non-adherence to this diet predisposes to the development of some tumours, autoimmune and thyroid gland diseases. The diagnosis of dermatitis herpetiformis is based on the findings of the characteristic IgA deposits in the skin papilla in the direct immunofluorescence test. Specific serum antibodies are used as an aid in the diagnosis and for monitoring the compliance with gluten free diet.

Light is a component of the electromagnetic waves. The electromagnetic wave consists of mutually inducible electrical and magnetic components that generate variable electric field. This then turns into magnetic field, causing alternating current to flow. Electromagnetic waves include radio waves, microwaves, infrared light, visible light, ultraviolet light, X-rays and gamma radiation. The length of these waves determines their properties. An increase in wavelength is accompanied by a decrease in its radiation energy. Dermatological phototherapy uses the following types of light: broadband UVB, narrow-band monochromatic UVB, laser UVB, UVA in combination with psoralens – PUVA, UVA1, visible light, monochromatic light within the visible spectrum: violet, yellow, red, deep red and infrared. Phototherapy and photochemotherapy nowadays uses equipment emitting radiation at the following lengths: UVB 311, UVB 313, UVB 308, UVA 320–400 nm with a peek at 365 nm and 340–400 nm UVA1. In Poland, the most commonly used radiation is UVB 311 and UVA 320–400 mm (mainly with psoralens). Photochemotherapy is a form of treatment by light, in which the effect of ultraviolet in combination with chemical substances acting as photosensitizers (psoralens) is utilized. The term PUVA was introduced in 1974 by Parrish et al. in a publication assessing the results of psoriasis treatment with orally administered 8-methoxypsoralen and whole-body exposure to long-wave UVA radiation. This article contains the recommendations of the Polish Dermatological Society for photoherapy and photochemoterapy in dermatology.

Incidence of skin cancers is constantly increasing, what constitutes a significant epidemiologic problem of modern medicine. Basal cell carcinoma is the most common neoplasm affecting Caucasians. Histopathological examination is a gold standard that allows for diagnosing skin cancers. The presented recommendations discuss clinical and pathomorphological sub-types of basal cell carcinoma, their dermoscopic features, stage assessment, and methods for treatment as well as prevention of recurrence of this cancer. Surgical excision of the lesion is a basic and preferred therapeutic option. Other non-surgical options show lower treatment efficacy, and thus, should be considered in cases of cancers with low risk of recurrence, when a surgery is contraindicated or impossible.

Chronic obstructive pulmonary disease is a chronic inflammation affecting the peripheral airways and pulmonary parenchyma, leading to irreversible and progressive airflow limitation. In recent years attention has been paid to more frequent coexistence with psoriasis. Both diseases are provoked by similar factors, such as smoking, abdominal obesity, lack of physical activity, and concomitance with the metabolic syndrome. In addition, similarities in pathogenesis, regarding the roles of Th1 and Th17 can be found, resulting in an increase in the proinflammatory cytokines levels. Both in psoriasis and chronic obstructive pulmonary disease, an increased activity of proteases produced by neutrophils and adhesion molecules is observed. In addition, neutrophils are an abundant source of inflammation mediators, including reactive oxidants and lipid mediators with chemotactic activity. Awareness of the increased risk of developing chronic obstructive pulmonary disease in psoriatic patients, allows to implement preventive and therapeutic actions such as smoking cessation or treatment of the inflammatory processes.

The clinical, pathological and dermoscopic features, including recommended diagnostic procedures for cutaneous squamous cell carcinoma (SCC) and Merkel cell carcinoma (MCC) are presented. The therapeutic standard for both cancers is surgical removal. In the case of SCC Mohs microsurgery may be performed, with the intraoperative analysis of the completeness of excision. The recommendations also include non-surgical methods of treatment, including systemic therapies used in advanced forms of the disease. The aim of the recommendations is to provide help in choosing the optimal diagnostic and therapeutic options for individual patients with SCC or MCC. These recommendations take into consideration similar documents published by other scientific organizations and expert opinions of the authors.

Vitiligo is an idiopathic chronic dermatosis manifested by depigmented patches of skin due to the loss of normal pigment-producing cells (melanocytes) and pigment (melanin). The disease develops more commonly in genetically predisposed individuals affected by various adverse external and internal factors inducing cellular stress in melanocytes. Cellular stress activates autoimmune and autoinflammatory mechanisms leading to melanocyte destruction. The disorder affects 0.5–4.0% of the world population, with no predilection for either sex. Manifestations can appear at any age, however in more than half of patients vitiligo starts before the age of 20 years. The course of the disease is varied – from stable cases with small isolated vitiligo patches to the rapid progression of lesions resulting in large areas of the skin being affected. There are multiple methods of treating vitiligo including pharmacological and surgical modalities, and phototherapy. Another essential aspect is patient education. Available treatment methods do not always yield the expected therapeutic effect. The Recommendations contain information about the diagnosis of vitiligo, and describe the recommended therapeutic methods.

Syphilis (lues) is a systemic bacterial disease transmitted mainly by sexual contacts and caused by Treponema pallidum subsp. pallidum . Due to its numerous symptoms, including various cutaneous and mucosal manifestations, diagnosis and treatment should be performed by dermatology and venereology experts. The incidence of syphilis has been increasing in the last years and syphilis has become a significant epidemiological problem in contemporary medicine. Contrary to a number of other infectious diseases, etiological agents of syphilis have never been cultured. Thus, diagnostic standards are based on indirect methods, such as serological tests. They are also used for monitoring treatment efficacy. Parenteral penicillin remains the gold standard in therapy of syphilis. Part 2 of recommendations discusses in detail clinical presentation, diagnostics, and treatment of neurosyphilis, syphilis in pregnancy and congenital syphilis.

Syphilis (lues) is a systemic bacterial disease caused by Treponema pallidum subsp. pallidum , which is mainly sexually transmitted or can be acquired by an unborn foetus via the placenta. Due to its numerous symptoms, including various cutaneous and mucosal manifestations, diagnosis and treatment should be performed by dermatology and venereology experts. The incidence of syphilis has been incresing in the last years and syphilis has become a significant epidemiological problem in contemporary medicine. Contrary to a number of other infectious diseases, etiological agents of syphilis have never been cultured. Thus, diagnostic standards are based on indirect methods, such as serological tests. They are also used for monitoring treatment efficacy. Parenteral penicillin remains the gold standard in therapy of syphilis. Part 1 of recommendations discusses in detail the clinical presentation, diagnostics, and treatment of early and late syphilis, excluding central nervous system syphilis and syphilis in pregnancy.

Mantle cell lymphoma is a rare neoplastic disease of the lymphatic system derived from mature B lymphocytes. It very commonly affects extranodal sites including the bone marrow, gastrointestinal tract and Waldeyer’s ring, but skin involvement is seen extremely rarely. The disease often has a recurrent and aggressive course. The diagnosis is usually established late, at an advanced stage of the disease. We present the case of a patient with skin lesions developing as the first manifestation of a haematological disease. After the appearance of symptoms the patient had several medical consultations before the final diagnosis was made at a dermatology outpatient clinic. Only few cases of cutaneous manifestations of mantle cell lymphoma have been described.

Breast cancer is the most common malignant neoplasm among women in Poland and in the European Union. According to most recent data of the Polish National Cancer Registry, in 2014 breast cancer was diagnosed in over 17,000 women. Based on the National Health Fund records, it is estimated that there are about 55,000–60,000 women in Poland who have a history of breast cancer diagnosis and are potentially at a risk of relapse. The most common sign of breast cancer is the presence of a nodule, however women also seek medical attention because of skin lesions. The aim of the study is to present diverse clinical manifestations of direct infiltrates and/or skin metastases of breast cancer. Attention is drawn to the importance of including breast cancer in the differential diagnosis of skin lesions.

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.

Primary cutaneous lymphomas are a group of rare lymphoproliferative diseases with incompletely understood pathogenesis. They comprise cutaneous T-cell lymphomas, cutaneous B-cell lymphomas and T/NK-cell lymphomas. The aim of the guidelines is to provide physicians with a tool to facilitate the diagnostic and therapeutic process in patients with this group of diseases. The updated recommendations are consistent with the guidelines for haematologists and oncologists, which will enable the unification of diagnostics and therapy conducted by physicians of all specialties. However, it is important to note that therapeutic decisions must be made individually on the basis of the general condition of the patient, history of internal diseases and medicines used, with careful consideration of the potential efficacy and safety profile of the proposed treatment, which may differ from patient to patient.

The nature of fatigue is very complex and involves physiological, psychological and social phenomena at the same time, and the mechanisms leading to occurrence and severity of fatigue are still poorly understood. The condition of chronic inflammation associated with psoriatic arthritis can be regarded as a potential factor affecting development of fatigue. Only a few studies so far have focused on the occurrence of fatigue in psoriatic arthritis. The problem of chronic fatigue is underestimated in everyday clinical practice. Identification and analysis of subjective fatigue components in each patient can provide an objective basis for optimal fatigue treatment in daily practice. This review presents a definition of chronic fatigue and describes mechanisms that may be associated with development of fatigue, highlighting the role of chronic inflammation, selected fatigue measurement methods and relations of fatigue occurrence with clinical aspects of psoriatic arthritis.

Uric acid is a final product of purine metabolism, and its concentration in the blood serum of healthy individuals is 3–7 mg/dl. Hyperuricemia is associated with higher cardiovascular risk, and its prevalence related to nutrition profile is characteristic for highly developed societies. It can lead to the appearance of certain skin lesions. On the other hand, uric acid is an important antioxidant, which is responsible for 2/3 of the antioxidant capacity of the body. In this article, the authors present skin lesions associated with gout (tophi, "miliarial gout", gouty panniculitis) and review the data of the literature and discuss the importance of hyperuricemia in psoriasis. Dermatologists’ awareness and knowledge about hyperuricemia may favor a faster diagnosis of this metabolic disorder based on skin lesions.

Rosacea is a common dermatosis more prevalent in females, significantly impairing quality of life. Currently erythematous, papulo-pustular and phymatous subtypes are distinguished, which do not necessarily represent consecutive stages. Recent findings indicate in the pathogenesis of rosacea the role of the impaired innate immune system and vascular abnormalities. Additionally, the role of genetic and infectious factors is suggested. The therapy of rosacea is directed not only against inflammatory changes but also anti-parasitic. In topical treatment the most commonly used are metronidazole and azelaic acid. Other drugs are topical antibiotics, antiparasitic agents such as ivermectin and preparations directly influencing erythema. In more severe cases tetracyclines or macrolides are used, and in the most severe cases, isotretinoine. As ultraviolet light is a recognized trigger for rosacea, regular sunscreen use is necessary. Also, proper diet is indicated. Presently in the treatment of rosacea more and more techniques using different lights are employed.

Stem cells are capable of self-renewal of their population and differentiation into specialized cells. There are several “niches” in the skin: 1) interfollicular stem cells – responsible for skin regeneration after injury; 2) in the hair follicle as follicular stem cells (“bulge”) and mesenchymal stem cells in the hair bulb and follicular papilla; 3) stem cells of mesodermal origin associated with blood vessels, giving rise to fibroblasts and myofibroblasts; and 4) melanocyte stem cells. Treatment with stem cells of skin diseases is still considered experimental. Intensive research is being carried out on their use in treating dystrophic epidermolysis bullosa, systemic lupus erythematosus, vitiligo, different types of alopecia and ulcers and slow-healing wounds. Stem cells due to their flexibility and ability to differentiate into other specialized cells create the possibility for regenerative medicine.

Skin tags are classified as benign lesions. They occur mainly on the skin of the neck, eyelids, armpits, and groin as pedicles and soft nodules. Their occurrence is associated with obesity, insulin resistance, atherogenic lipidemia, and metabolic syndrome, as well as increased risk of atherosclerosis. In the pathogenesis factors which are impaired in obesity, such as leptin, insulin resistance associated with obesity (IGF-1), androgens and estrogens believed to stimulate the receptors on keratinocytes and fibroblasts to grow, may play a role. In addition, these receptors are stimulated by tryptase released from the mast cells by mechanical injuries. Probably HPV plays a role as a cofactor. The dermatological literature does not provide much information about this subject, so the authors draw attention to the link between the presence of skin tags and the development of metabolic disorders.

Dermatitis herpetiformis (Duhring’s disease) is an autoimmune blistering dermatosis with a characteristic polymorphic, itchy rash. The autoimmune process against transglutaminases (TGs) is connected with asymptomatic or with mild symptoms of gluten-sensitive enteropathy (GSE). The diagnostic approach in DH should rely on clinical evaluation, direct immunofluorescence of perilesional skin and evaluation of serum IgA antibodies with ELISA with one substrate of four substrates from which to choose (tTG, eTG, npG, neo-tTG) using the ELISA method. In cases showing an equivocal clinical-laboratory picture such an approach should be broadened by performing histopathology of lesional skin and examining the HLA DQ2/DQ8 haplotype. Combined treatment with dapsone and a gluten-free diet in individualized combinations is generally the therapeutic method of choice in DH.

Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease affecting elderly people, more than 65 years old. Patients aged over 80 are the main group of interest. The incidence of BP has been significantly increasing for the last 15 years in the whole of Europe. The diagnosis of BP is established on the basis of typical clinical features and in vivo bound IgG/C3 along the basement membrane zone, whereas characterization of target antigens for circulating antibodies may be established using tests containing BP antigens, i.e. ELISA test with recombinant NC16a domain of BP180 antigen and BIOCHIP. The goal of therapy of BP is to inhibit development of new lesions, healing the older ones and elimination of pruritus. At present only monotherapy with 0.05% clobetasol propionate cream used topically on the whole body has been proved to be the best for BP patients. Alternative therapies include methotrexate and the combination of tetracycline and nicotinamide. Prednisone, especially in doses higher than 0.5 mg per body weight daily, should be avoided in old patients with comorbidities such as diabetes, hypertension, stroke or osteoporosis. Duration of therapy in general should be around 12 months. Discontinuation of therapy should be considered if clinical remission lasts at least 6 months and the DIF test is negative. Recurrence of pruritus, blisters or erythemas may suggest relapse of BP.

Introduction . Chilblain lupus erythematosus is a chronic form of lupus erythematosus (LE) reported mostly in middle-aged female patients. Its characteristic manifestations are painful erythematous lesions on the acral parts of the body appearing after exposure to cold. Chilblain lupus erythematosus may either precede the development of systemic lupus erythematosus (SLE) or occur after the diagnosis of SLE is established. It can also be an isolated form of lupus erythematosus. There are no well-defined and reported treating approaches in this form of LE. Objective. Presentation of a case of chilblain lupus erythematosus with reference to current therapeutic options. Case report . We report a 44 year-old patient diagnosed with chilblain lupus (according to Mayo Clinic Proposal of Diagnostic Criteria) who over the years fulfilled the American College of Rheumatology (ACR) classification criteria and was diagnosed with SLE. The patient was treated with different medications with no response. Finally a complex therapy with mycophenolate mofetil, methylprednisolone and pentoxifylline during the exacerbation managed to control the symptoms and brought partial improvement. Conclusions . Chilblain lupus may constitute a therapeutic challenge. The reported case suggests that in therapy-resistant cases, a complex treatment with mycophenolate mofetil, methylprednisolone and pentoxifylline during the exacerbation of symptoms might be considered.

Classic methods for assessing cerebral autoregulation involve a transfer function analysis performed using the Fourier transform to quantify relationship between fluctuations in arterial blood pressure (ABP) and cerebral blood flow velocity (CBFV). This approach usually assumes the signals and the system to be stationary. Such an presumption is restrictive and may lead to unreliable results. The aim of this study is to present an alternative method that accounts for intrinsic non-stationarity of cerebral autoregulation and the signals used for its assessment.Continuous recording of CBFV, ABP, ECG, and end-tidal CO2 were performed in 50 young volunteers during normocapnia and hypercapnia. Hypercapnia served as a surrogate of the cerebral autoregulation impairment. Fluctuations in ABP, CBFV, and phase shift between them were tested for stationarity using sphericity based test. The Zhao-Atlas-Marks distribution was utilized to estimate the time-frequency coherence (TFCoh) and phase shift (TFPS) between ABP and CBFV in three frequency ranges: 0.02-0.07 Hz (VLF), 0.07-0.20 Hz (LF), and 0.20-0.35 Hz (HF). TFPS was estimated in regions locally validated by statistically justified value of TFCoh. The comparison of TFPS with spectral phase shift determined using transfer function approach was performed.The hypothesis of stationarity for ABP and CBFV fluctuations and the phase shift was rejected. Reduced TFPS was associated with hypercapnia in the VLF and the LF but not in the HF. Spectral phase shift was also decreased during hypercapnia in the VLF and the LF but increased in the HF. Time-frequency method led to lower dispersion of phase estimates than the spectral method, mainly during normocapnia in the VLF and the LF.The time-frequency method performed no worse than the classic one and yet may offer benefits from lower dispersion of phase shift as well as a more in-depth insight into the dynamic nature of cerebral autoregulation.

Psoriasis is a chronic inflammatory skin disease affecting about 1–3% of the general population. Recent years have seen great development in the treatment of this dermatosis, especially regarding moderate to severe psoriasis. More numerous and more widely available systemic therapies raise new challenges for all physicians treating patients with psoriasis. New questions arise about patients’ follow-up and long-term safety of such therapies. To meet the expectations of Polish dermatologists, we have prepared a second part of guidelines on the treatment of psoriasis, particularly concentrated on the therapy of severe forms of this disease. We hope that our suggestions will be valuable for physicians in their daily clinical practice. However, we would like to underline that every guideline is characterized by some vagueness, and the final decision about diagnosis and therapy should always be made individually for every patient based on the patient’s current clinical status and the most up-to-date scientific literature data.

Psoriasis is a systemic disease, associated with the occurrence of metabolic disorders (obesity, diabetes, hyperuricemia, lipid disorders) and rapid development of atherosclerosis; therefore diet can be an important adjuvant therapy. A low-calorie diet is an important complement treatment of patients with psoriasis, particularly those with concomitant obesity. There are a lot of studies indicating that obesity is a risk factor for psoriasis and vice versa. Visceral adipose tissue produces numerous proinflammatory cytokines (TNF-α, IL-6, Il-8, Il-17, Il-18), the same ones that participate in development of psoriatic lesions. Important factors in the diet are the essential polyunsaturated omega-3 fatty acids. They have an anti-inflammatory effect because they inhibit the production of proinflammatory cytokines (I-1b, IL-6, IL-8, TNF-α) and adhesion molecules (ICAM-1, VCAM-1). In addition, supplementation of omega-3 and natural antioxidants in the diet may help to reduce "oxidative stress" and systemic inflammation. The use of a gluten-free diet is controversial, but in patients with positive anti gliadin antibodies it seems justified. An essential element of the procedure is to avoid alcohol and all its forms and stimulants that have pro-inflammatory effects. We should advise our patients to avoid grapefruit juice during treatment with cyclosporine and limit the supply of simple sugars, animal fats and alcohol during treatment with retinoids. Dietary recommendations for patients with psoriasis are an important part of a holistic approach to patients who expect comprehensive care, not just the prescription.

Nowadays it is known that psoriasis belongs to the group of autoimmune diseases and may coexist with other diseases in this group. Most often patients have psoriatic arthritis, rheumatoid arthritis, inflammatory bowel disease, autoimmune thyroid diseases and multiple sclerosis. The coexistence of these disorders can be a diagnostic and therapeutic problem (there is controversy over the use of corticosteroids). The common pathogenesis is still not explained. We know that the loss of immunotolerance leads to formation of autoreactive Th1 and Th17 lymphocytes which recognize self-antigens and lead to their destruction in the target organ. Some features of immune mechanisms, observed in psoriasis, suggest its autoimmune background. In psoriasis the main role is played by the activation of the axis IL-12/Th1/IFN- and Th17/Il-23. Il-12 probably acts on naive T cells and the Th1 response is initiated. Il-23 maintains the Th1-mediated inflammatory reaction, stimulates maturation and effects of Th17, and maintains a certain amount of memory cells. We also observe dysfunction of Treg cells, which are responsible for the destruction of autoreactive lymphocytes. In addition, psoriatic keratinocytes have increased resistance to apoptosis, which eliminate damaged cells so that they cannot be recognized as a foreign antigen. However, researchers have suggested that initially the polyclonal activation of T lymphocytes is induced by superantigens (e.g. streptococcal M protein, peptidoglycan) or skin trauma (Koebner phenomenon), whereas in the later phase self-antigens in the epidermis are recognized by autoreactive T cells (keratin K 17, HPV 5 proteins L1, Pso p27), leading to autoimmunity.