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The use of hyaluronic acid fillers in aesthetic medicine has changed over the years and the procedure became one of the most common in the world. Understanding the ageing process of the face and the anatomical interrelationships in the face have dramatically influenced the use of the hyaluronic acid fillers and the assessment of the patient. It was supported by a new technology of products and by the delivery of tools (eg, blunt cannulas), face imaging, and innovative injection techniques. The whole-face approach challenges the practitioner to look at the face as a whole, and the patient to trust and rely on the treatment plan. Over the years, we have understood, that the most important outcome of aesthetic procedures is what does the whole face look like not static but in motion, and how do people read emotions from it. Nowadays, the result changes “the face information” and makes aesthetic procedures more satisfactory. In this manuscript, we reviewed essentials of the current treatment approach including patient’s consultations, product selection and injection techniques used in different parts of the face. One size fits none; thus, we provided a general overview of hyaluronic acid fillers used in different indications and presented several treatment approaches to each region of the face.

Introduction: Psoriasis is a chronic inflammatory skin disease with immunologic etiology. Aim: To investigate the levels of the proinflammatory cytokines tumor necrosis factor \alpha ($TNF-\alpha$), interleukin 23 (IL-23) and IL-17 in patients with psoriasis and psoriatic arthritis with concomitant metabolic syndrome. Material and methods: This study included 60 patients with severe psoriasis. Results: In patients with arterial hypertension concomitant with psoriasis, no statistically significant differences in cytokine levels were observed. On the other hand, in the group of patients diagnosed with diabetes, an increased level of IL-17 was observed. In patients with lipid disorders, the results were similar to the results of patients with diabetes. Conclusions: It is very important to study immunologic mechanisms responsible for the presence and severity of psoriasis, in order to personalize the therapy in the future and optimize the effect of action on the basic disease and on concomitant disorders.

Introduction: The incidence of metabolic syndrome is estimated at 15-24% in the general population and at 30-50% in patients with psoriasis. A probable cause of the described correlation is a constant release in chronic dermatosis of proinflammatory cytokines and their influence on individual systems and organs. Aim: Assessment of the concentration of the proinflammatory cytokines (IL-12, IL-23, IL-17 and $TNF-\alpha$) in blood serum and their correlation with the intensity of skin lesions, the presence of psoriatic arthritis and the risk of development of obesity and metabolic syndrome. Material and methods: The concentrations of subunit p70 IL-12, IL-17 and IL-23, and $TNF-\alpha$ in subjects with psoriasis and metabolic syndrome were determined. Results: The level of the studied cytokines, IL-17, IL-23 and $TNF-\alpha$ was higher in patients diagnosed with psoriasis. Higher levels of IL-17, IL-23 and $TNF-\alpha$ were observed in patients with metabolic syndrome accompanying psoriasis. A higher level of IL-17 and IL-23 was found in sera of patients with psoriatic arthritis in comparison to normal psoriasis. Conclusions: In the study, a higher level of IL-17 and IL-23 was also shown in patients with psoriatic arthritis in comparison to patients with normal psoriasis. The effectiveness of anti-IL12/23 drugs in psoriatic arthritis is a confirmation of the obtained results of the studies. Additionally, the increased level of IL-17, both in patients with metabolic syndrome and with psoriasis, could indirectly indicate an increased cardiovascular risk in patients with affected joints in comparison to psoriasis affecting only the skin.

Radial cheek lines (RCL) may convey an older, potentially less attractive appearance.To evaluate the effectiveness of hyaluronic acid-based dermal filler VYC-17.5L for correcting RCL.Fifty-three women (40-65 years) received injections of VYC-17.5L in both cheeks on Day 1 (optional Day 14 touch-up). Effectiveness was evaluated on Day 45 by subject-rated dynamic RCL improvement (Global Aesthetic Improvement Scale [GAIS]; primary end point) and independent, noninjecting investigator-rated GAIS; subject Self-Perception of Age (SPA); subject-assessed satisfaction with and natural look of treatment; and instrument-assessed changes in static and dynamic RCL roughness, amplitude, and texture (secondary end points). Safety assessments included injection site responses (ISRs).On Day 45, 98% of subjects rated RCL as improved or much improved (investigator rated: 95%). Subjects with same or older SPA before treatment (n = 38) perceived themselves as 2.0 and 5.5 average years younger after treatment, respectively. Day 45 mean satisfaction with and natural look of treated areas was 7.9/10 and 7.2/10, respectively. Treatment significantly improved RCL roughness, amplitude, and texture (all p.001). Most common ISRs were hematoma (35.9%), bruising (30.2%), and irregularities/bumps (22.6%); most ISRs were mild.VYC-17.5L effectively corrected dynamic RCL, improved instrument-assessed indicators of skin quality, and resulted in younger age perception.

Introduction The tumor necrosis factor (TNF-α) was initially described as lymphotoxin or cachectin. The discovery of therapies blocking the action of TNF-α, in 1988, started a new era in the therapy. One of often reported adverse effects related to the use of TNF-α antagonists is induction of the formation of autologous antibodies and antibodies neutralizing anti-TNF drugs. The development of anti-TNF-induced lupus or classical drug-induced lupus is more rarely reported.

Introduction Palisaded neutrophilic and granulomatous dermatitis (PNGD) are terms which include such diseases as rheumatoid nodules, Churg-Strauss granuloma, and interstitial granulomatous dermatitis with arthritis. This heterogeneous group was first described in 1965. It is associated with immunological diseases. There are reported cases of coexistence with systemic lupus erythematosus, rheumatoid arthritis, Wegener's granuloma, inflammatory bowel disease, generalized vascular inflammation, and lymphoproliferative disorders. The etiology of the disease is unknown. It is probable that the deposition of immune complexes in blood vessels leads to cutaneus leukocytoclastic vasculitis, degeneration of collagen fibres and palisaded granulomatous inflammation. Ultimately, this leads to fibrosis of the skin. Objective The aim of the study is to present a patient with skin lesions and histopathological features of palisaded neutrophilic and granulomatous dermatitis during the course of infection Borrelia burgdorferi. Several cases of this disease have been reported worldwide (30 entries in the PubMed database). To-date, there have been no reports of PNGD in Polish literature. Materials and method The patient, aged 72, was admitted to hospital because of erythematous, indurated lesion of the skin on the side surface of the left thigh. Diagnosis of PNGD was made on the basis of typical histopathologic features due to clinical symptoms. Conclusions Clinical diagnosis of PNGD is difficult, and is based mainly on the histopathological picture. Systemic therapy is incorporated mainly due to the systemic disease. The patient requires further observation in the direction of associated systemic disorders.

Irritant contact dermatitis (ICD) is a common skin condition and a risk factor for allergic contact dermatitis. The prevalence of this disease in the general population varies between 1.7% and 6.3% and is increasing. The role of the patch test in detection of contact sensitivity is of prime importance. Patch tests should be used to identify topical agents that may be responsible for exacerbation or aggravation of eczema, especially in patients who do not improve despite adequate treatment. A 53-year-old woman suffering from recurrent, long-lasting dispersed eczematous skin lesions, mainly on her face and hands, was admitted to the Allergy Unit of the Dermatology Department of Jagiellonian University Medical College in Krakow for treatment, extended diagnostics and finding the reason for her illness. She was generally in a good physical condition and not taking any drugs. Skin symptoms were accompanied by an intensive itch and unrelated to work. After the discontinuation of treatment and after 2 months of full remission of skin lesions, patch tests were performed, using European standard (Chemotechnique Diagnostics) series. A positive, erythemato-papular reaction to both colophony and parabens, corresponding to “++”, was observed after 48 h. After 96 h, a strong intensification of the reaction was found only in the test site for colophony. Additionally, the reaction was accompanied by a local oedema with blisters and estimated as “+++”. In the test site for parabens, the 48-hour reaction was maintained (Figure 1). Figure 1 Positive results of the patch test Between the first and second test readings, eczematous lesions with faint borders, growing gradually but quickly, appeared on the face and hands of the patient (Figure 2). Figure 2 Erythemato-papular-oedematous rash localized on face On the basis of the symptoms of acute allergic contact dermatitis, the flare-up phenomenon was suspected. Systemic and topical corticosteroids were prescribed. The initial dose of steroids (prednisone) was 30 mg a day. After 24 h, in view of a clear, sustained improvement of the local state, the dose of prednisone was gradually reduced and finally the drug was stopped after 10 days. The appearance of multifocal eczematous lesions during the testing was considered a hardly predictable complication in the course of a standard diagnostic procedure. The flare-up dermatitis was first time described in 1981, in a patient with nickel contact eczema [1]. In the daily practice, patch tests remain a basic diagnostic procedure for distinguishing allergic contact dermatitis from irritant contact dermatitis. Their sensitivity and specificity reaches 70% [2]. Although the safety of patch tests is proven, we have to remember the risk of complications in some cases [1–3]. In the patient, we confirmed an allergic contact dermatitis for colophony and parabens, triggering the flare-up reactions of distant dermatitis. The flare-up reactions consist of the reactivation of a previous dermatitis following the patch testing [4]. It has been frequently described as related to nickel and also in patients with multiple contact allergies – differently from our patient [1, 5]. The pathogenesis of the flare-up phenomenon during the patch testing is not completely understood. Probably it is a result of a reactivation of specific memory T cells that remained in the previous area of contact [1, 6]. On the basis of the clinical picture, history and the results of patch testing, the colophony was suspected to be the main reason for the flare-up reaction, because of the strong reaction to it in the patch testing and because of its cross-reactivity with many environmental substances in our daily life. A contact allergy to cosmetics used by our patient was suspected, as the colophony may provoke cross-reactions with many substances often present in cosmetics, like the Balsam of Peru, resins or dihydroabietyl alcohol [7, 8]. The presented case reminds us that side effects may appear during patch testing, even though this method is considered to be very safe [1]. Therefore, it is necessary to perform these tests in medical centres with well-trained personnel, with the patient supervision available during the whole testing time.

Parry-Romberg syndrome or progressive facial hemiatrophy was first described by Caleb Parry in 1825 and Moritz Romberg in 1846. This disorder is characterized by slowly progressing acquired unilateral hemifacial atrophy, which affects subcutaneous tissue together with the muscles and underlying bones. The pathogenesis and precise incidence of the syndrome remain unclear. Immune-mediated processes and disturbed central regulation, leading to the hyperactivity of the sympathetic nervous system, are primarily considered in the pathogenesis of this disorder. Parry-Romberg syndrome and localized scleroderma are considered to be interrelated as both of them have a similar clinicopathological appearance. We report the case of a 46-year-old man affected by both progressive atrophy of the left side of the face and homolateral, segmental vitiligo in the left side of the trunk and face.

Background Linear immunoglobulin A (IgA) bullous dermatosis (LABD) is a rare autoimmune blistering disorder. The disease may be either idiopathic or druginduced. Over the past 30 years, approximately one hundred LABD cases have been described as induced by a wide range of drugs, chiefly antibiotics.

Taurine bromamine (TauBr), the product of taurine and hypobromous acid (HOBr), exerts anti-inflammatory and antibacterial properties. Recently we have shown that Propionibacterium acnes, a potential pathogenic agent of acne, is extremely sensitive to TauBr. As topical antibiotics are associated with the emergence of resistant bacteria, TauBr seems to be a good candidate for topical therapy for acne vulgaris. In our double blind investigation, the efficacy and safety of 3.5 mM TauBr cream was evaluated. 1% Clindamycin gel (Clindacin T), one of the most common topical agents in the treatment of acne vulgaris, was used as a control. Forty patients with mild to moderate inflammatory facial acne vulgaris were randomly treated with either TauBr or clindamycin for 6 weeks, twice-a-day. More than 80% of the patients markedly improved with both treatments, without any adverse effects observed. Both TauBr and clindamycin produced a significant reduction in inflammatory skin lesion counts (papules/ pustules). After 6 weeks, comparable reductions of acne lesions, 65% and 68%, were observed in the TauBr and clindamycin groups, respectively. In conclusion, these data support our concept that TauBr can be used as a topical agent in the treatment of acne vulgaris, especially in patients who have already developed antibiotic resistance.

The pathogenesis of skin scleroderma (LS) is still unknown. Disturbances of vessels system, connective tissue metabolism and humoral and cellular immunological response is observed. Antinuclear antibodies are detected in 30-80% of patients with different types of skin scleroderma. They are present more often in patients with disseminated lesions and linear type of LS compared to morphoea au plaque. In our own analysis 28.5% of patients had also antibodies directed against Borrelia burgdorferi. It is believed that the injury of endothelial cells and proliferation in medial part of small vessels - which both lead to chronic ischemia - are the earliest disturbances observed in histopathological examination of the skin taken from systemic as well as from skin scleroderma patients. During last few years, there were some interesting reports concerning functional changes of endothelial cells which led to disturbances in tension of vessels smooth muscles. Free radicals - in genetically predispose people--can also provoke scleroderma lesions through their injury action on endothelial cells and stimulation of fibroblasts. In morphoea, the process of fibrosis begins around vessels. Deposition of connective tissue matrix is observed, especially collagen type I and III. This stimulation of fibroblasts as well as accumulation of connective tissue matrix are secondary to some stimulatory factors. These are: PDF, bFGF, TGFbeta and some cytokines. In morphoea patients serum levels of IL-1, IL-2, IL-4, IL-6 and IL-8 were elevated. In literature, levels and production of collagenases were decreased, although more authors say that tissue inhibitors of metalloproteinases are the main factor in fibrosis. The analysis of data tends to suspicion that enormous fibrosis observed in different types of scleroderma can be the result of increased production of collagen and other components of connective tissue as well as their incomplete degradation. Presented clinical and laboratory data show how many different factors influence etiopathogenesis of morphoea.

For the first time eosinophilic fasciitis (EF) was described by Shulman. It occurs predominantly in young men, rarely in older women and sporadically in children. The illness was characterised by swelling of the extremities, skin changes, myalgia, and elevation of the peripheral blood eosinophils count and hypergammaglobulinemia. It is followed by rapidly progressive cutaneous and subcutaneous indurations. The histopathologic examination of affected skin shows thickening of the fascia, deep dermal fibrosis and infiltration mainly consists of lymphocytes, plasmocytes, eosinophils. It is suggested that the cells from infiltration induce fibrosis. The tryptophan disturbance has significant influence on development of EF in predisposed persons. Eosinophilic fasciitis is classified into wide spectrum of scleroderma disorders by many authors. The authors tried to show differences between EF, morphea and systemic scleroderma.

First time eosinophilic fasciitis (EF) was described by Shulman. It occurrences predominantly in young men, rarely older women, sporadic in children. The illness was characterised by swelling of the extremities, skin changes, myalgia, and elevation of the peripheral blood eosinophil count and hypergammaglobulinemia. It is followed by rapidly progressive cutaneous and subcutaneous induration. The histopathologic examination in the region of affected skin shows thickening of the fascia, deep dermal fibrosis and infiltration mainly consists of lymphocytes, plasmocytes, eosinphils. It is suggested that the cells from infiltration induce fibrosis. The tryptophan disturbance has significant influence on development of EF in predisposed persons. Eosinophilic fasciitis is classified to wide spectrum of scleroderma disorders by many authors. The authors tried to show differences between EF, morphea and systemic scleroderma.

The so-called sexually transmitted diseases (STD) are the ones in which the transmission of pathogenic factors is mostly caused by sexual intercourse. Every year 333 million of documented new cases of STD occur all over the world. Due to an increase of incidence of STD, which was observed in the Province of Małopolska, the authors decided to check the knowledge of basic clinical symptoms and risk factors of transmission of venereal diseases. A group of 104 soldiers (quartered in military bases in Cracow) and a group of 41 medical students (the 1st and the 2nd year of medical studies at the CMUJ in Cracow) were included in the analysis. The investigated population was exclusively consisting of men, aged 19-25. The authors used their own questionnaire consisting of 25 multiple-choice questions. The result of the research revealed a very poor knowledge of basic clinical symptoms and risk factors of STD in both analysed groups. It implies the necessity of conducting educational activities on prophylaxis, risk factors and symptomatology of venereal diseases.

Systemic sclerosis (SSc) is a multisystem connective tissue disorder characterized by excessive accumulation of the extracellular matrix. About 90% of the patients with SSc have detectable gastrointestinal tract involvement, 50% of these patients have clinically important manifestations. The aim of the study was estimation of the connection between subjective symptoms from the esophagus and results of the esophageal scintigraphy. 30 patients with systemic sclerosis were comprised to the study. Esophageal scintigraphy was performed in each patients, as well as questionnaire about type, intensity and frequency of esophageal dysmotility. Also it estimated was stiffness of the skin according to modified Rodnan score. Independent of esophageal dysmotility symptoms which were noted by patients, esophageal scintigraphy registered changes in 97% of the patients. The most often esophageal dysmotility was observed in lower part of the esophagus. Statistically Dysmolity of the central portion of the esophagus was observed more often in patients with diagnosed ISSc.

Acanthosis nigricans is a rare disease, occurring with the same frequency in females and males. Eight clinically practical types of this disease have been presented. Authors also observed a coexistence of this disease with neoplasms, which obligates doctors to perform more accurate diagnosis of the patient. The clinically practical scale of the intensification of skin lesions in acanthosis nigricans has been also presented. This scale is helpful in therapy monitoring.

Wrinkles are the most visible sign of the aging skin. The author presented characteristic changes in the epithelium and dermis for that type of skin and therapeutic possibilities utilised in the esthetic dermatology. They also undertook an attempt to classify patients for particular types of revitalization interventions (implants, botulin toxin, peelings).

Dermatomyositis (DM) and polymyositis (PM) are diseases displaying the symptoms of the idiopathic muscle inflammation (IZM). The skin lesions are visible most often 3 months to 3 years prior to appearance of the muscle inflammatory process. A frequent coexistence of DM with internal organ neoplasms obliges doctors to diagnose their patients quickly. The knowledge of skin lesions allows to begin this diagnosis earlier and to initiate proper therapy. Based on the latest medical literature, the authors present: the actual classification of the idiopathic muscle inflammation, the attempt to differentiate between DM and PM regarding prognostic factors and therapy possibilities based on conducted world trials.