Praha, 20.–24. 5. 2009
Abstrakta českých a slovenských účastníků
10. světového dermatologického kongresu
a přidružených akcí
P., Arenbergerová M., Gkalpakiotis S.
Hospital Královské Vinohrady, Dept. of Dermatology and Venereology,
Prague, Czech Republic
arteritis or giant cell arteritis is a systemic granulomatous
vasculitis of medium and largesized arterias, involving most
frequently the temporal artery. It is usually presented with
headache, fever, high ESR and anaemia. If untreated, complications
like ischaemic optic neuritis may even lead to blindness. Although
very rare, scalp necrosis and ulcerations are the most common
dermatologic findings. We report a case of 85-year-old woman
with bilateral scalp ulcerations treated as classic ulcers for 3
months, followed by blindness of the left eye, headache, but having
normal ESR. Diagnosis was confirmed by a dermatologist after
a skin biopsy taking from the ulcer margin.
SELF-TREATMENT – ONE OF DECISIVE FACTORS IN COMPLEX LYMPHEDEMA
MANAGMENT: WHY AND HOW?
nemocnice Brno, Radiologická klinika, Brno, Czech Republic
self-treatment is generally accepted to be an unavoidable part of
complete decongestive therapy (CDT), particularly in maintenance
phase. It includes: (a) arangements in life régime, (b) skin care,
(c) self-lymphdrainage, (d) self-bandaging, (e) self-applied
pneumatic compression, (f) physical and breathing exercices, (g)
elevation of the limbs, (h) appropriate sport and recreational
activities and (i) self-measurement.
Since August 2005 till
Sept. 2008 altogether 389 lymphedema pts. from varying cause (97 of
primary and 292 of secondary type) were accepted for CDT and
follow-up on out-patient basis in our lymphocentre.
were gained, how to concept an effective self-treatment programme:
Patients’ management must
begin with clear-enough information about the pathology of lymphedema
and rational treatment strategy in which the basic role of regular
self-care must be emphasized (lymphologist).
- Pts. should be motivated to
reach optimal grade of cooperation - „adherence“.
- Subsequent education in the
art of self-treatment must be carried out by lymphotherapists
(personal teaching, demonstrations, illustrated leaflets etc.).
- Individual strategy according
to pt’s age (children, seniors), physical and psychical condition
limitations, the grade of cooperation (compliance, adherence), manual
ability, nessesity/possibility of somebodys´else help (e.g.
partners, family members etc.).
- The art of self-treatment
must be controled and clinically evaluated regularly by lymphologist
(twice a year) and pt’s psychic condition and motivation for
cooperation monitored by clinical psychologist, if neccessary.
Our approach to
current assessment criteria of self-treatment outcome is based on
objective evaluation of lymphedema reduction/progression photo- and
structured questionnaire evaluation.
PEMPHIGUS VULGARIS (CASE REPORT)
Pediatric Dermatology of 1st Pediatric Clinic, Faculty Hospital Brno
and Faculty of
Masaryk University Brno, Czech Republic
Pathological Anatomy, Faculty Hospital Brno, Faculty of Medicine,
vulgaris is a rare, chronic, autoimmune blistering disease
caused by a defective adhesive function of the epithelial cells
that leads to the acantolysis and blistering. PV occures most
frequently in adults between 40-50 years of age. Neonatal PV due to
a vertical antibody transmission from mother to child is
extremely rare. It has been described 21 cases in the literature so
far. The authors present a case of neonatal pemphigus vulgaris
diagnosed according to the mother illness history and the clinical
manifestation few hours after the delivery. The diagnosis was
confirmed from the skin biopsy by direct and undirect
ALTERNATIVES IN THE DIAGNOSTICS AND THERAPY OF FEMALE ANDROGENETIC
Dermatology, Ústí n. Lab., Czech Republic
In order to be able to
discuss whether apparently excessive hair loss is “real”, an
understanding of the hair cycle is necessary. The most common cause
of hair loss is androgenetic alopecia. Androgenic alopecia is the
best example of an insidious increase in the number of hairs, which
can occur over many years.
Some useful reference
guides are available to assess androgenetic alopecia. Hair analysis
includes estimate of - number of anagen hairs, ratio anagen/telogen
(%), first image of number of hairs (hairs per cm2),
compare image, hair lenth, hair diameter.
Our results are
described. Iron and zinc deficiency are discussed.
FEATURES OF MANUAL LYMPHODRAINAGE – IMPACT ON LYMPHEDEMA TREATMENT
O., Elišková M.
medical faculty, Anatomy, Prague, Czech Republic
is a very important part of the decongestive therapy of
lymhedema. It is performed by specific manual techniques which differ
from the technique of classic massage. The goal of the manual
lymphodrainage is to influence the lymph flow from the lymphedematous
tissue. For these reasons it is necessary to know the physiological
background of this process. For a period of nearly twenty years
we studied on man and experimenttally on dogs, the behaviour of the
lympatic vessels and lymph in normal state and in lymphedema
The repeated manual
lymphodrainage performed with high pressure 100 mmHg alterates the
wall of the superficial lymphatic vessels, mainly the endothelial
lining. The alteration is absent in deeply located vessels. The
pressure of 30–40 mmHg does not harm the structure of
lymphatics.The measured pressures in lymphatics under the quiet
conditions in most cases were in the range of 0–5 mm Hg. In
lymphatics with a diameter of 300–400 μm
the lymph flow in rest position was very low – 2–10 μl.
Every manual lymphodrainage stroke is followed for period by some
seconds of negative presure in lymphatics- which proves suction
effect of manual lymphodrainage. In lymphedema there is a higher
concentration of lymh proteins in lymphatics and intersticial tissue
as well. By manual lymphodrainage a decrease in lymphatics of
the total amount of proteins is noticed, but for a short time
only. After 10-15 minutes the level of the proteins retuns back to
the starting values. For these reasons it is necessary to repeat the
manual lymphodrainage with banndage again and again.
– EXPECTATIONS AND REALITY
K., Bartoňová J, Kolesárová J.
Hospital, Dept. of Dermatology, Hradec Králové, Czech Republic
represents a new therapeutical approach in dermatology with
great promise (hopes). The request for such a therapy is high
effectivity, good cosmetic outcome, simple and cheap technic and
broad indication coverage.
In reality, based on
large clinical studies, PDT reaches 75-95% efficacy in keratoses
clearing, in BCC a little bit lower one. A good cosmetic outcome
is assessed commonly. The therapeutical procedure consists of topical
photosensitiser application, 3 hours of incubation under an occlusion
followed by frequently painfull irradiation. Subsequent skin reaction
could involve often erythema and swelling presented for several days.
Metvix® creme is the only photosensitiser registered in the Czech
Republic for PDT. PDT reimbursement by health insurance companies is
limited to 6 licensed centers under well-defined conditions.
Experience on other therapeutical indication (acne, warts,
leishmaniasis, lichen, etc.) has been collected. The PDT use in
cosmetology seems to be promisible.
Our PDT experience is
summarized here concerning actinic keratosis, BCC, lichen ruber and
PATCH TESTS IN FOOD ALLERGY DIAGNOSTICS IN ADULTS ATOPIC DERMATITIS
Hospital, Dept. of Dermatology, Hradec Králové, Czech Republic
and Clinical Immunology, Outpatient Department, Hradec Králové,
Atopy patch tests
(APT) are carried out by the similar technique as a classic
dermatological patch tests for contact allergy investigation. The
most frequently tested foods include cow milk, hen eggs, wheat,
peanut. It has been confirmed APT can improve food allergy diagnostic
in cases with negative specific IgE results. Other indications for
APT investigation represent severe atopic dermatitis with unknown
triggers and multiple IgE sensitisations without clinical relevance.
The standardisation of
APT (“Position paper” EAACI/GA2LEN, Allergy 2006, 60: 1377-1384)
has been still in process. Use of native food, minimally 24 hours of
occlussion at back skin and response evaluation 48 and 72 hours later
are recommended. Infiltration with papules (not only erythema) are
suggested as a positive reaction. Any serious adverse events
have not been described after APT use.
There are demonstrated
our APT results of 149 adult patients suffering from moderate to
severe atopic dermatitis (and food reaction history) in this lecture.
Allergy to cow milk and wheat has been evaluated by history, SPT,
sIgE, APT and food challenge (DBPCFC included). Only 6 positive APT
responses were mentioned.
Authors suggest APT
have to be interpreted carefully and in context with other
Hospital, Dermatovenerology, Brno, Czech Republic
Faculty of Masaryk University, Dermatovenerology, Brno, Czech
herpetiformis (DH) is an autoimmune blistering disorder. There is an
important association with gluten-sensitive enteropathy. Prevalence
has been reported up to 10 cases per 1,000,000 population. The onset
of DH starts from the second to fourth decade of life. The diagnosis
of DH is based on the clinical features and on the immunofluorescence
findings in the skin biopsy. Antigliadin antibodies are a poor
marker for celiac disease. These antibodies are produced in response
to gliadin and other related prolamins found in wheat. Antigliadin
antibodies are also found in non-enteropathic patients.
Antiendomysial antibodies (AEA) and antireticulin antibodies (ARA)
are found in patients with dermatitis herpetiformis. Antibodies
against tissue transglutaminase (ATA) are detected in about 80% of
patients with dermatitis herpetiformis and in almost 100% of patients
with celiac disease.
gliadin and tissue transglutaminase were detected using ELISA method.
The other antibodies (antiendomysial and antireticulin antibodies)
were detected by indirect immunofluorescence.
We present our
immunofluorescence findings in the skin of patients with suspected DH
and the results of detection of antibodies mentioned above in
patients with DH and celiac disease in the year 2008.
The laboratory blood
tests are important. The typical clinical cases can be easily
distinguished. The characteristic distribution of the eruption is
present. Some special tests are necessary to determine unusual cases
– the detection of antibodies against gliadin, reticulin,
endomysium and tissue transglutaminase.
EXPERIENCE WITH PHOTODYNAMIC THERAPY
P., Vašků V.
Ann’s Faculty Hospital in Brno, 1st Department of Dermatology,
Brno, Czech Republic
is an efficient treatment method for some skin cancers and
premalignant conditions. Its mechanism is based on applicating the
photosensitizer, which is a chemical compound concentrating in
the most quickly proliferating tumour or inflammatory cells, and
exposure of the patient to the visible light of certain spectrum. The
subsequent reaction of the two elements causes death of corresponding
There were 52 patients
treated and 84 procedures carried out at the I. Department of
Dermatovenereology between October 2006 and October 2008.
The most frequent PDT
indications were basocellular carcinoma (41), keratosis actinica (24)
and m.Bowen (9). Other indications were spinocellular carcinoma (4)
and mycosis fungoides (2), extramammal m.Paget (2), verucae
vulgares (1) and condyloma accuminatum (1).
We accept PDT as
a modern, non-surgical technique with very good cosmetic
effects. With our patients the results of PDT treatments were
cosmetically outstanding and the method is highly appropriate for
multiple lesions – i.e. actinic keratoses. PDT treatment of
our patients with mycosis fungoides proved very hopeful results, too.
We have not met any serious adverse effects during or after the
POSSIBILITIES OF THE ANTIOXIDANT PROTECTION OF THE ORGANISM AFTER
of South Bohemia, Radiology and Toxicology, Ceske Budejovice, Czech
Technical University in Prague, Medicine and Humanities, Kladno,
Cell damage is induced
by reactive oxygen species (ROS). ROS are either free radicals,
reactive anions containing oxygen atoms, or molecules containing
oxygen atoms that can either produce free radicals or are chemically
activated by them. Under normal conditions, ROS are cleared from the
cell by the action of superoxide dismutase (SOD), catalase, or
glutathione (GSH) peroxidase. Superoxide Dismutase (SOD) catalyzes
the reduction of superoxide anions to hydrogen peroxide. It plays
a critical role in the defense of cells against the toxic
effects of oxygen radicals .
We used female mice of
the strain CD1 with a weight of 26 - 28 grams. The mice were
exposed in the abdomen region to laser light (830 nm, 300 mW) with an
energy density 20 J/mice (5 J/cm2).
After 30 min. the mice were narcotized by surgery anesthesia and
blood samples were taken from the vena cava inferior. Erythrocytes
were used to assess the activity of the Superoxide dismutase (SOD)
and Reduced Glutathione (GSH).
The purpose of our
work was the assessment of changes in the activities in erythrocytes
of selected antioxidants after in vivo laser irradiations. The
results of our present work are not in contrast to the findings
discussed above; however, they suggest that laser radiation induces
a complex process in the organism, persisting for a rather
long time period. These studies certainly need to be continued.
Karu in his paper 
demonstrated enhanced superoxide dismutase (SOD) levels after LLLT
exposure. Interaction between SOD and Reactive Oxygen Species (ROS)
production seems to balance free radical activity and to allow for
the beneficial effects of ROS while inhibiting detrimental action.
Cho  described an LLLT induced increase in the activity of
Superoxide dismutase (SOD) by about 40% in osteoarthropathic rabbits
as compared to controls.
EXPERIENCE WITH APPLICATION OF ISO 9001 QUALITY MANAGEMENT SYSTEM
IN PRIVATE LASER CLINIC (CASE REPORT)
Medical Laser Association, Chief Executive Officer, Praha, Czech
Esthetic Clinic, Director, Praha, Czech Republic
medicine, laser is a phenomenon of last few decades. Modern
surgical laser deliver enormous energy to the tissue in a fraction
of a second. Different wavelengths produce different
interactions. In therapy, devices emitting a couple of miliwatts
are history. Pocket size lasers bring specific penetration
characteristics. Prices of IPL`s and LED`s decrease, but their energy
is on the rise. What do all these technological miracles have in
common? High-tech require high safety! Specific operating procedures,
hygienic standards, safety measures must be observed. And, high-tech
require high quality. Specific processes regarding quality,
organization, documentation must be aplied. Quality accreditation and
certification systems can help you a lot. This presentation
brings current experience with introducing Quality Management System
in one of the leading laser centers in Prague. The Clinic should
obtain its ISO 9001 International Quality Certificate in August 2009.
OF ESTROGENS AND SELECTIVE ESTROGEN RECEPTOR MODULATORS IN THE
TREATMENT OF HAIR LOSS
Faculty of Medicine, Faculty Hospital Kralovské Vinohrady,
Dermatology, Prague, Czech Republic
a profound influence on skin and hair. It has been known that
estrogens alter hair follicle growth and cycling by binding to
locally expressed high-affinity estrogen receptors (ERs). Our aim was
to dissect the effect of the estrogen and ERs agonists and
antagonists on the hair follicle growth and cycling in order to
identify possible new treatment targets for androgenetic alopecia,
telogen effluvium and chemotherapy-induced alopecia.
In our studies we
first investigated the expression of ERs in the different regions of
male and female hair follicle, the effect of estrogen and ERs
modulators on the hair growth and the role of estrogen on the hair
protection during chemotherapy. Emphasizing the complexity and
species-, gender, and site dependence of E2-induced biological
effects on the hair follicle, we explored potential targets for
pharmacological intervention in clinically relevant hair cycle
While the pre-clinical
results often show that estrogen or ERs modulators might be highly
effective in the hair loss modulation, the treatment sucess in the
clinical experience is dependent on the drug profile and route of
University, Bulovka University Hospital, Dermatology Department,
Prague, Czech Republic
of Dermatology, Saint-Louis University Hospital, Paris, France
Virginia Medical School, Department of Dermatology, Virginia, USA
University Hospital, Dermatology Department, Rouen, France
Wyeth-sponsored satellite symposium will communicate the serious and
debilitating consequences of moderate-to-severe psoriatic disease for
both adult and paediatric patients, and review the biologic treatment
options currently available to the clinician. To begin the symposium,
Professor Hervé Bachelez will describe the prevalence and impact of
childhood psoriasis, and review strategies currently available for
the management of this patient group. Dr David Pariser will then
discuss recently published data on nail psoriasis to educate the
audience on the impact of this disease on the patient, and discuss
the importance of effective management with a focus on biologics.
Non-skin-related symptoms of moderate-to-severe psoriasis are
important considerations in patient management. Professor Pascal Joly
will highlight the significant physical and psychological
comorbidities associated with psoriatic disease, and their impact
upon the patient. A discussion will also take place on the
on-going challenges in the effective and patient-focused management
of psoriatic arthritis.
IN PALIATIVE TREATMENT OF COLORECTAL CANCER
Štukavec J, Denemark L
medical school Charles Univerity, Surgery, Prague, Czech Republic
their more than 20 years experiences with laser treatment of
In the first period of
our clinical practice, from 1988 to 1991, all the laser treatments
were held under short-term anaesthesia. Our patients were
hospitalized for 2 or 3 days. For the actual treatment we used the
rigid and also the flexible endoscopic technique. We preferred the
flexible technique definitely. Since January 1991 we have practiced
almost all treatments in the out patient department without general
anaesthesia. Only in the cases where treatment reaches under linea
dentata we choose local or short-term general anaesthesia. The
patients are hospitalized for one day. In the actual treatment we
take advantages of diode laser. We try to evaporize the most of the
tumour tissue. The haemostasis is defined by the zone of coagulation.
The indication against the palliative treatment is incontinence
caused by the growth of tumour into the sphincter muscle.
In the first period of
our clinical practice, from 1988 to 1991, all the laser From 1988 to
20099 we performed 1478 operations for 483 patients with inoperable
carcinoma of rectum. The average age of our patients was 72 years. In
92% of the cases we were primarily successful. In 8% of the cases we
had to establish colostomy because of unsuccessful recanalization.
The average time of surviving in these cases was 8 months (1–61),
we had to repeat the recanalization every 3 months. Among our
complications we met with the perforation into abdominal cavity in 4
cases and serious bleeding in 2 cases.
Laser recanalizaton is
effective method of palliation. The necessity to repeat laser
recanalizations every three months is a great disadvantage of
CHANGES IN THE PSORIATIC LESIONS
Faculty of University PJ Safarik, Dpt of Dermatovenerology, Košice,
Svidnik, Department of Dermatovenerology, Svidnik, Slovak Republic
include an increase of T-lymphocytes, positive reaction to rheumatic
factor and C-reactive protein, change in number of B-lymphocytes,
production of immunoglobulins and immune complexes. Immunological
changes found in psoriatic lesions – hyperproliferation of
keratinocytes activity of polymorphonuclear leukocytes in acute phase
and infilration of T-lymphocytes in chronic phase. These reactions
may be accompanied with humoral immunological changes.
We indicated an
immunohistological examination in 56 patients aged 2 to 74 years with
a histologically confirmed psoriasis.
We found in the
stratum corneum a focal deposits of immunocomplexes (IC), more
often with IgG, less with IgA antibodies and C3 component of
complement. We found out IC with IgM and IgG antibodies and fibrin in
the vessel walls.
In our opinion the
detection of IC in psoriatic lesions together with changes of
immunity in peripheral blood enables to place psoriasis to autoimmune
diseases and it will be valuable after the identification of
CYTOKINE GENE POLYMORPHISMS IN PEMPHIGUS VULGARIS PATIENTS IN THE
University, Immunology, Bratislava, Slovak Republic
University, Dermatovenerology, Bratislava, Slovak Republic
Klinikum, Immunologie, Essen, Germany
in the induction of antibody production as well as maintenance and
regulation of immune responses to pemphigus vulgaris-related
autoantigens. The functional polymorphisms in cytokine genes are
therefore among potential candidates participating in susceptibility
The study comprised 33
PV cases and 140 unrelated healthy subjects. Cytokine genotyping was
carried out by polymerase chain reaction with sequence-specific
primers using a commercial kit. Polymorphisms in following 13
cytokine genes were investigated: IL-1α,
IL-1R, IL-1RA, IL-4Rα,
IL-2, IL-4, IL-6 and IL-10. Their association with the disease was
assesed with Fisher’s exact test.
A weak disease
association was found with TNF-α
-308 G/A and IL-10 -1082 G/A, -819 T/C and -592 A/C gene
polymorphisms only. The analyses revealed slightly increased
frequencies of TNF-α
-308 G allele (95.45% vs. 86.79%; P = 0.053), -308 G/-238 G
haplotype (93.94% vs. 82.86%; P = 0.022) and IL-10 -1082 A/-819
C/-592 C haplotype (45.45% vs. 30.00%, P = 0.019) in PV patients;
however, the significance dissapeared after correction for multiple
Our results suggest
that variations in the TNF-α
and IL-10 promoter regions could contribute to the development of PV
but their overall impact would be rather limited. Our finding of
increased frequency of low-producer TNF-α allele and haplotype among
PV patients seems to be in conflict with the role of TNF-α
in the induction of acantholysis. We explain this discrepancy by the
existence of strong linkage disequilibrium between high-producer TNF
-308 A allele and protective HLADRB1* 0301 allele, which is rare
in patients with PV. The observation of increased frequency of
lowproducer IL-10 ACC haplotype in PV patients is in line with
believed protective role of IL-10 in acantholytic process and
indicates a role of IL-10 gene promoter polymorphisms in the
susceptibility to PV.
INVOLVEMENT IN HUMAN HERPES VIRUS INFECTIONS – KAPOSI SARCOMA
University, St. Anna Hospital, I.Dept.Dermatovenereology, Brno, Czech
are at least eight herpes virus types causing mucocutaneous disease
in human. Herpes simplex virus 1,2, Epstein Barr virus,
cytomegalovirus, varicella zoster virus, human herpes virus (HHV) 6,
7 and 8 cause acute, recurrent or chronic lesions on the skin and
mucous membranes. Typical for these infections is latency. HHV 6 is
a cause of exanthema subitum in children and is probably
associated with pityriasis rosea in young adults. HHV 8 is associated
with Kaposi sarcoma (KS), classic and HIV related as well as KS
in immunocompromised patients. Classic KS is not rare in the
region of central Europe , typically affecting elder men. It usually
takes an indolent course with favorable survival rates. The authors
present their experience with the course and treatment of classic
University, St. Anna Hospital, I.Dept.Dermatovenereology, Brno, Czech
Autoimmune reaction in
subepidermal bullous diseases can be targeted against several
antigens in the dermo-epidermal junction zone. Scarring with skin
and/or mucosal involvement occurs in cicatricial pemphigoid,
epidermolysis bullosa acquisita and IgA linear dermatosis. Sometimes
the autoantibodies against bullous pemphigoid antigens can be
detected as a result of epitope spreading. Clinical picture
depends on the involved antigens. Diagnostic methods as classical
biopsy, direct and indirect immunofluorescence have been complemented
by ELISA, immunoprecipitation and immunoblot studies during the last
years. These tests improve considerably diagnostic possibilities in
bullous dermatoses and enable to study the course of the diseases and
detect rare variants. The experience with the clinical picture,
laboratory diagnostics and therapy of patients with cicatrizing
bullous dermatoses in the Centre of bullous dermatoses in Brno ,
Czech Republic is given.
STATE LASERS IN MEDICAL DISCIPLINES
H., Šulc J., Němec M., Koranda P., Fibrich M., Kubeček
V., Čech M.
in Prague, FNSPE, Physical Electronics, Prague, Czech Republic
Lasers have become
powerful and indispensable tools, used in many aspects of medicine.
The requirements needed when laser radiation is used in medicine are:
minimal injury of surrounding tissues (thermal and mechanical),
minimal bleeding, and precision of surgical procedure. For
understanding of the laser radiation influence on life tissue, the
factors entering into the interaction of radiation and tissue must be
The solid state lasers
in infrared spectral region were used for application in
ophthalmology, urology and dentistry. As radiation sources, solid
state laser systems from near- up to the mid-infared region were
used. The interaction with eye and urology tissue was investigated
for the understanding of possibility to use appropriate wavelength
and intensities for specify treatments. Also the possible wavelength
for utilization in dentistry – for drilling and for bracket
debonding is discussed.
The laser applications
in medicine are summarized on the basis of the radiation interaction
with the tissues.
The description of the
physical background of the interaction mechanism between laser
radiation and biological tissue is shown. Laser applications in
urology and dentistry are also mentioned.
OF LIFE IN CHILDREN WITH ATOPIC DERMATITIS
A., Vojáčková N., Schmiedbergerová R., Slavíková Š., Hercogová
Medical Faculty, Charles University, Dermatology Department, Prague,
dermatitis (AD) is the commonest chronic relapsing childhood
worldwide incidence of atopic dermatitis is estimated at 3 %
to 5 % in children 5 years of age or less. About 49 % to 75 %
of children with atopic dermatitis develop the disease by 6 months of
age and the percentage increases to 80 %, 90% by 5 years of age. The
lifetime prevalence has been increasing in most countries with
a ‘Western style’ of environment over the last few decades.
The most recent studies in the Czech Republic reports the prevalence
rate of AD in children up to 1 year of age 16 %, in a pediatric
group up to 15 years of age 12 % and in adolescents over 16 years old
3 %. There are significant difficulties of living with AD which have
a profoundly negative effect on the healthrelated quality of
life of children and their family unit in many cases. The aim of this
study was to evaluate the level and the structure of the quality of
life of pediatric patients with AD. Similar study has not been
conducted in the Czech Republic so far. We enrolled a group of
patients: children (from newborns up to 18 years) suffering from AD.
During check-ups, each child with the help of his parent/carer filled
proper quality of life questionnaires (with permission of
Prof. Finlay). For the children from newborns up to 7 years of
age, ’Infants’ Dermatitis Quality of Life Index’, then for the
older group: from 8 up to 13 years, ‘Children’s Dermatology Life
Quality Index’ the cartoon version. For the children from 14 up to
18 years of age ‘Children’s Dermatology Life Quality Index’ the
text version. The first results of this study will be presented at
the 6th EADV Spring Symposium in Bucharest, Romania.
COMPLICATIONS OF BIOLOGICAL THERAPY
A., Hercogová J.
Medical School, University Hospital Bulovka, Department of
Dermatovenereology, Prague, Czech Republic
The implication of an
immunologic phenomena in the pathogenesis and development of many
cancers as well as many chronic inflammatory diseases, (e.g.
psoriasis), has led to research for the new treatment options over
the past few years. The result has been the birth of biologic
therapies. Biological therapy has been designed to repair, stimulate
or enhance the immune system’s responses in the fight with the
chronic inflammatory processes or cancer cells. There has been
defined 4 strategies that clarify the mechanism of action for the
various biologic agents used in dermatology: (1) reduction of
pathogenic T-cells (alefacept), (2) inhibition of T-cell activation
(efalizumab), (3) immune deviation and (4) blocking the activity of
inflammatory cytokines (infliximab, etanercept, adalimumab). Many of
them cause mild, local sensitivity reactions such as: urticaria,
angioedema, allergic drug eruption, pruritus. According to the March
18 US Food and Drug Administration Drug Safety Newsletter, there also
have been reported serious skin reactions such as: Erythema
multiforme, Stevens-Johnson syndrome and Toxic epidermal necrolysis.
Biologic agents group, which is used to a large degree in the
treatment of cancers, is epidermal growth factor receptor (EGFR)
inhibitors (erlotinib, cetuximab, gefitinib). Although these targeted
therapies are devoid of hematopoetic and nonspecific toxicities
common with conventional chemotherapy, they are characterized by the
development of dermatologic reactions, which occur in the majority of
patients. These reactions include: papulopustular rash (45 % - 100 %
of patients), xerosis ( 7 % - 35 % of patients), pruritus ( 8%-35% of
patients), periungual inflammation ( 12 % -16 % of patients ) and
alopecia (14 % - 21 % of patients ). The importance of these
reactions is underscored by the psychologic and physical distress to
the patient, by data suggesting that the severity of the rash may
predict clinical outcome and by the need in certain cases for
EGFR-inhibitors dose decrease or discontinuation due to the
intolerance. There are no established guidelines in the dermatologic
literature for the treatment of these reactions. We present a case
of a patient who developed a rash due to the treatment of
non-small cell lung cancer with EGFR-inhibitor erlotinib. This
patient has been treated with the wide range of possible methods at
our department in years 2007/2008. The fully underwent treatment led
first of all to the significant regression of the skin lesions but
also to the improvement of the quality of life and continuation of
the anticancer therapy by our patient. Many trials confirm a clear
and consistent association between the development of the
papulopustular rash and better outcome of the patient. We do believe
that also our case report will confirm and reinforce this thesis.
ON CUTANEOUS SEBACEOUS NEOPLASMS AND RELATED LESIONS
University Medical Faculty Hospital, Dept of Pathology, Pilsen,
The presentation is
focused on cutaneous adnexal lesions with sebaceous differentiation.
The following issues are discussed: histological and embryological
aspects of sebaceous glands: common denominators of sebaceous
differentiation in cutaneous adnexal tumors; main entities (sebaceous
carcinoma, sebaceous adenoma, and sebaceoma) and their
clinicopathological variations; concept of mantle and lesions with
mantle differentiation, including those occurring in Birt-Hogg-Dube
syndrome; sebaceous differentiation in other cutaneous adnexal
tumors; pitfalls in microscopic diagnosis of sebaceous neoplasms;
ectopic sebaceous glands and sebaceous lesions; Muir-Torre syndrome;
role of immunohistochemistry in identification of sebaceous
OF SYPHILIS PATIENTS IN PRAGUE – RESULTS OF A QUESTIONNAIRE
I., Velčevský P., Kojanová M.
Faculty of Medicine, Charles University, Dermatology, Prague, Czech
survey, indicators of risk sexual behaviour of patients hospitalized
with acquired syphilis between January 2007 and June 2008 have been
identified and compared with the results obtained in 1998–2000.
These characteristics has been assessed in relation to gender, age,
sexual orientation, level of education, prostitution, attitude to the
use of contraception and drug use.
Data were analyzed
using SPSS 16.0 (Command Syntax Reference) with chi-squared test and
Fisher exact test.
Out of 224
hospitalized syphilis patients 106 completed the anonymous
questionnaire.There were 87 (82,1 %) men and 19 (17,9 %) women. Among
the 87 men, 21 (19,8 %) had diagnosed primary syphilis, 15 (14,3 %)
secondary syphilis, 64 (73,6 %) were homosexual or bisexual, three
(3,6%) admitted practicing sex for money, 54 (62,1 %) reported anal
intercourse, 12 (14.5 %) reported a history
of more than 10 sexual contacts in the preceding 12 months, 47 (54,7
%) gave a history
of casual first coitus, 29 (34,7%) reported inconsistent condom use,
only two (2,3 %) were an injecting drug users, 8 (9,2%) had diagnosed
gonorrhoea coinfection, 6 (6,9%) were HIV positive, 17(19,5 %) had
of gonorrhoea. Among the 19 women, 10 (52,6 %) of women were
pregnant, one had diagnosed secondary syphilis, 12 (63,1 %) early
latent syphilis and 6 (31,6 %) late latent syphilis.Three (16,7%)
identified themselves as prostitutes, two (10,5 %) reported a history
of more than 10 sexual contacts in the preceding 12 months, two (10,5
%) gave a history
of casual first coitus, 17 (89,5 %) reported inconsistent condom use,
only one was injecting drug user and 13 (72,2%) had been tested for
HIV previously with negative results, one (5,3%) had diagnosed
gonorrhoea, two (10,5 %) had gonorrhoea in their history.
Compared to the
previous data from the period 1998-2000 the number of homosexual (p
<0,001), single (p=0,045) and HIV positive men and men using
condom (p=0,007) has increased. In women no significant changes have
DOPPLER LINE SCANNER – AN USEFUL, SIMPLE AND NON-INVASIVE TOOL FOR
EVALUATION PERIPHERAL SKIN
Hospital and Medical Faculty, Department of gerontology and
metabolism, Hradec Kralové, Czech Republic
Medical Laser Association, Chief Executive Officer, Prague, Czech
Non-healing wounds are
frequent problem in patients on chronic HD. Malnutrition is main part
of MIAC syndrome (malnutrition, inflammation, atherosclerosis,
calcification), which can lead to peripheral ischemic skin defects.
The aim of present study was to estimate skin blood flow changes
during hemodialysis and their possible relationship to signs of
malnutrition and inflammation.
10 different areas in
each hand of 36 patients (14 f and 22 m, 36-79 y) were measured using
Laser Doppler Line Scanner (LDLS) before and during HD with
ultrafiltration (UF) (1147 ± 745 mL). 714 areas of interest (AIs)
were evaluated (10 on each hand of each patient). The relationships
were evaluated using Pearson/ Spearman coefficients according to
Decreased blood flow
was apparent in 61% of evaluated areas. The decrease was more
pronounced on dorsum of the hand (74% of AIs) compared to fingers
(50%). We found a significant
correlation between S-Alb (0.5, p=0.002), TIBC (0.3, p=0.05), Ca x P
(-0.4, p=0.04) and change in blood flow, respectively.
LDLS was found to be
an useful simple and non-invasive tool for evaluation of skin blood
flow in HD patients. Malnutrition and inflammation negatively
influences peripheral blood flow during HD with UF. Supported by
research projects MSM 0021620820, MSM 0021620819
ROLE OF ALA – PDT IN THE TREATMENT OF BROAD BASED RECTOSIGMOIDEAL
ADENOMAS – A PILOT STUDY
Elisabeth Cancer Hospital, Department of Laser Medicine, Bratislava,
Laser Cantre, Department of Biophysics, Bratislava, Slovak Republic
rectosigmoideal adenomas with various degrees of dysplasia after
previous piece meal or en bloc incomplete polypectomy were treated
additionally either with photodynamic therapy (PDT) or with argon
plasma coagulation(APC) or with combination of both with the aim to
destroy residual remnants in the period from 2004 to 2006.
36 patients (mean age
59 years) with broad based adenomas located in rectum (24) and
sigmoid colon (12) were treated after incomplete piece meal or en
bloc polypectomy either with APC (23 patients using E: 50 – 60 W)
or with PDT (13 patients with ALA 60 mg/ kg orally with
treatment followed 5 hours later), or in combination of both
modalities (5). Endobioptic controls were performed l week, 1
and 3 months after treatment.
Broad based polypoid
lesions with size from 20 to 35 mm were found in rectum (24) and
sigmoid colon (12). All were adenomas (8 tubular, 9 with LGD, 7 with
HGD, 4 tubulovillous and 8 villous adenomas).Only incomplete( piece
meal or en bloc) polypectomy was performed because of the size (29)
or difficult localisation (7) of the lesion. The remnants present on
the base from flat (13) up to the 5 mm of endoluminal protrusion
(23). APC was added as additional treatment in 23 patients with more
elevated lesions (E: 50 –60 W). 18 patient were treated in one and
5 in two session procedure. PDT with ALA sensitization (60 mg
/kg bodyweight orally) was performed in flat lesions in 13 patients.
In 5 patients PDT was perfomed additionally after APC, because of
persisting residual lesion. Endobioptic controls were performed l
week , 1 and 3 month after the treatment. In 33 patients (92%)
complete healing was observed. 3 patients (8%) with persistence of
dysplasia (1 HGD) and suspected cancer in the base of lesion (2)
underwent surgery. All procedures were performed on outpatients
basis. In PDT group skin photosensitivity for 2 days in 7 patients
(55%) and one-day nausea (4 patients-33%) were observed. Transient
uncomfort because of bowel inflation after the procedure was present
in 12 patients (53%) in APC group. No serious complications were
observed during both procedures.
PDT with ALA is
efective as additional treatment for flat broad based remnants of
rectosigmoideal adenomas after incomplete polypectomy. Combination
with APC procedure seems to be promising.
PHLEBOLYMPHEDEMA – DIFFERENTIAL DIAGNOSIS AND THERAPY
practice, Dermatology and lymphology, Brno, Czech Republic
Lower limbs swelling
are one of the most current compliants that we encounter in general
practice. It is a very unpleasant symptom with a negative
influence on the quality of our patientsˇ lives.
Edema provoked by
chronic venous disease is the most common cause of lower limbs
swelligs. The most frequent clinical sign of chronic venous disease
is edema, which can accompany all its stages. Ambulatory venous
hypertension, which causes capillary hypertension, is the reason of
increased net ultrafiltration and compensatory increase of lymphatic
water load. When transport capacity of suprafascial lymphatic system
fails, edema due to veno-lymphodynamic insufficiency (phlebedema) is
developed. This is a low protein edema, the transport capacity
of lymphatic system is not affected. Edema is usually localized
around the ankles and on the distal part of the leg, the fibrotic
changes are not developed, edema recedes after a night rets. The
cascade of pathophysiologic changes during the progression of chronic
venous disease is the reason of the lymphatic system failure, the
venolymphostatic insufficiency (phlebolymphedema) is developed. It is
localized not only at the perimaleolar area and on the leg, but
dorsum of the foot is swallen too, Stemmer ´s sign is positive,
fibrotic changes and lipodermatosklerosis are developed, and skin
changes due to chronic venous disease are ussually present.
The identification of
different edema stages is essential for the establishment of an
accurate therapeutic plan. The compression therapy, application of
phlebotrophic drugs and life style changes are crucial for the
therapy of veno-lymphodynamic insufficiency. When veno-lymphostatic
insufficiency is developed, the complex decongestive therapy (i.e.
manual lymphdrainage, multilayer compressive bandages and special
excercises) is the treatment of choice.
IN ATOPIC DERMATITIS
Anna Faculty Hospital, Ist. Dept. of Dermatovenereology, Brno, Czech
Atopic dermatitis is
a complex multifactorial disease resulting from the interactions
between genes and nongenetic - environmental factors. One of these
environmental factors which can trigger atopic dermatitis - at least
in a subgroup of atopic patients - are aeroallergens.
The most important
aeroallergens in atopic dematitis are the house dust mite allergens,
grass and tree pollen, animal dander and molds. Revealing the role of
aeroallergens in the flares of atopic dermatitis consists of careful
history taking, clinical picture evaluation and other diagnostic
procedures like prick tests, specific IgE and recently also atopy
patch tests (APT).
Also in our department
we are very interested in this field. Between November 2004 and April
2006 a cohort of 100 patients (26 males and 74 females) with atopic
dermatitis with the average age of 32, 4 years was investigated with
atopy patch tests in the dermatoallergological office of the Ist.
dept. of dermatovenereology of the St. Anna Faculty Hospital in Brno,
Czech Republic. The most common allergens were the house dust mite
allergens (13 %), the second were grass and plant pollen (12 %) and
the dog allergens were on the third place (10 %). Also our results
support the fact that the atopy patch tests have higher specificity
in comparison with prick tests and specific IgE and they are
therefore able to supplement and precise the possibilities of the
identification of aeroallergens.
The identification of
aeroallergens as triggering factors of atopic dermatitis is important
in respect of the preventive measures as well as the possible
OF CONTACT SENSITIZATION IN PATIENTS WITH LOWER EXTREMITY ECZEMA
Faculty Hospital, Ist Dept. of Dermatovenereology, Brno, Czech
The aim of this work
was to determine the frequency of contact sensitization in patients
with lower extremity eczema/dermatitis.
Between the years 2001
and 2007 the authors investigated 462 patients (mean age 49,1 years,
196 males and 266 females) with eczema/dermatitis localised on lower
extremities, including feet. The patients have been investigated with
epicutaneous tests of the European standard series and also with
other special patch tests.
The most frequent
allergens were: balsam of Peru 44/462 (9,5%), wool alcohols 41/462 (
8,9%), nickel sulphate 39/462 (8,4%), propolis 35/462 (7,6%),
fragrance mix 34 (7,4%), and colophony 29/462 (6,3%).
In patients with lower
extremity eczema/dermatitis the frequency of contact sensitization is
still high and therefore the investigation with epicutaneous tests
should belong to the routine dermatological diagnostic procedure in
these patients. The
work was supported by the grant NR 9203-3/2007.
WITH RECURRENT ERYSIPELAS TREATED BY INJECTION ENZYME THERAPY -
D., Mateřanková A.
Office of Dermatology Hlučín Ltd., Hlučín, Czech Republic
Thanks to significant
progress in surgery, traumatology and orthopedics, but also for
consequences of serious polytraumas, recurring erysipelas is still
a serious medical, social and psychological problem. Applying
causal original Czech method (known since 1970s), our medical office
manages to treat recurring erysipelas in the field of secondary
lymphoedema (post traumatic, post surgery and post radiations),
where, understandably, it is not possible to rely on manual lymphatic
draining and compressive therapies not even with continual
prophylactic antibiotic therapy. Serious acute and chronic recurring
streptococcus infections in affected tissue (the areas of secondary
lymphoedema) need to be handled quickly and causal using injections
of hyaluronidasis enzyme: deliberately from central collective
lymphonodes gradually towards periphery affected by erysipelas every
second day. We present case report of one of our most complicated
cases – 70 years old female patient, 4 years after gynecological
surgery of vulvar cancer following actinotherapy with development of
secondary abdominal lymphoedema, glutei, vulva and lower extremities
with numerous erysipelas, with the risk of potential elephantiasis,
where the frequency of recurring didn’t allow us to interrupt
usage of antibiotics, nor apply manual and instrumental lymphatic
draining. In 5 weeks of the treatment her condition significantly
improved to that extend, that within the course of one year she had
no recurrences. Our medical office had the possibility to enlarge the
strategy of applying therapy by hyaluronidasis on next anatomical
areas where these had not been used (face, auricle, axilla and arm,
lower trunk and gluteal regions), which helps to significantly lower
the cost of complicated treatment.
FOLLOW-UP OF PATIENTS WITH ACNE VULGARIS TREATED WITH ORAL
Hospital, Dermatovenerological Department, Jihlava, Czech Republic
Severe forms of acne
frequently fail to respond to conventional acne therapy. Isotretinoin
is a systemic drug that really heals these forms of acne. The aim of
th follow-up was to evaluate some important parameters of peroral
isotretinoin treatment, especially the safety and the possibility to
treat patients with concomitant diseases or laboratory abnormalities.
A treatment with
peroral isotretinoin of patients with severe forms of acne was
followed and some important parameters were analyzed. Before
treatment sex and age of the patients, type and localization of acne,
sport activities, concominat diseases including atopic ones,
laboratory abnormalities and signs of depression were documented. All
side effects, signs of depression and stabilization of other diseases
during the treatment were recorded.
Total number of
treated patients was 100 (71% males and 29% females). The average age
of the patients was 18,1 years. 3% of the patients suffered from acne
papulopustulosa III, 11% from acne papulopustulosa IV, 67% from acne
nodulocystica and 19% from acne conglobata. The presence of severe
acne in the family was at 44% of the patients. Intensive sport
activities were mentioned by 51% males and by 10% females.
Concomitant diseases or laboratory abnormalities were very frequent
(at 51%), 33% of the patients suffered from some atopic disease. Only
common and not severe side effects were recorded. No depression was
We mentioned a great
number of concomitant diseases and laboratory abnormalities at the
treated patients. The treatment of all these patients was possible,
successful and no significant worsening of any disease or laboratory
abnormalitiy was recorded. No severe side effects during the
treatment were seen, dryness of skin and mucous membranes was more
frequent at the patients suffering from some atopic disease. Adequate
sport activities during the treatment were possible. No depression
caused with peroral isotretinoin was observed.
WITH SUBCORNEAL PUSTULAR DERMATOSIS, DIVERICULOSIS AND HYPER IgA
GAMAGLOBULINEMIA – A CASE REPORT
Hospital, Dept. of Dermatology, Jihlava, Czech Republic
Dermatohistopathology, Prague, Czech Republic
with a rare diagnostic trias, subcorneal pustular dermatosis,
diverticulosis and hyper IgA gamaglobulinemia, is reported. A woman
with several internal diseases was hospitalized because of worsening
of a dermatological state. In several days many slightly
infiltrated, red plaques with many small pustules, not disturbing the
patient arised on the trunk (especially on the breast), upper and
lower extremities. A biopsy was taken and a diagnosis of
subcorneal pustular dermatosis was established. A treatment with
peroral acitretin was started, no new lesions arised any more and
present plaques healed. At the same time another problems started -
the patient became feverish and suffered from abdomen pains. She was
transferred to a surgery department and an intensive antibiotics
therapy was started. A suspected diagnosis of diverticulitis
(resp. diverticulosis) was later confirmed by colonoscopy. Hyper IgA
gamaglobulinemia was founded by laboratory investigation.
DISORDER IN ONYCHODYSTOPHIA ARTEFACTA – A CASE REPORT
University, Department of Dermatology, Prague, Czech Republic
woman with a 5–year history of onychodystrophy of hand
fingers-like lesions in the context of vasculitis allergica, was
recomended at dermatology.This woman was treated at imunology and
alergology departments. Comorbidity and pathophysiology –
autoimmune thyreoiditis, allergic bronchial astma (atopy ), diabetes
mellitus type II, hypertension, hypertriglyceridemia, reduced high
density lipoprotein (HD), abdominal obesity, ulcerous colitis.
Clinical and laboratory findings – white dermatographism, dryness
of the skin, onychodystrophy and onycholysis only on the hands,
complement components C34, C4, and immunoglobulins IgG increased,
auto-antibodies ANA IgG and ANCA proteinase 3 positive, eosinophil
cationic protein (ECP) increased. Differential diagnosis is inclusive
of lichen planus, psoriasis, eczema atopicum, onychomycosis, alopecia
areata, acrodermatitis continua, genodermatoses, onychotillomanie,
onychodystrophy artefacta. Histopathology – hyperkeratosis with
thickening of the stratum granulosum and light dilation of the
superficial dermal vascular plexus – non-pathognomic
histopathological finding. Psychosomatic conclousion: the painfull
skin changes of the hand fingers and of the nails occurred six months
after chronic family stress-situation (divorce), patient`s retirement
and moving to the country. The patient reported anxiety, frustration,
social impairment. She was awareness of daily obsessive-compulsive
behaviour, nail picking with scissors (sharp-tipped). This
„treatment“ caused permanent destruction of cuticles, paronychia,
erosion and erythema on the skin of hand fingers, and step by step
nails dystrophy. Dermatologist suggestion of pharmacotherapy or
cognitive-behavioral psychotherapy has not accepted. The patient
follows on psychosomatic therapeutic interviews. Clinical course is
fluctuating. Her grand-daughter`s birth has strong impact on
OF SPECIFIC DNA IN DIFFERENT FORMS OF LYME BORRELIOSIS
University, 2nd Medical School , 1st Clinic for Infectious Diseases,
Prague, Czech Republic
University, 2nd Medical School, Clinic of Dermatology, Prague, Czech
University, 3rd Medical School, Medical Department, Prague, Czech
Specific DNA was
examined in a group of 124 patients with different forms of Lyme
borreliosis. Sensitivity and specifity of PCR and comparison with
clinical status were tested.
DNA was proved by the
in-house nested PCR using five parallel amplifications: three were
targeted to chromosomal genes (16S rDNA, flagellin, p66) and two
specific for OspA and OspC protein. Specific DNA was examined at the
beginning and end of the treatment in plasma, urine, CSF and synovial
fluid. Plasma and urine were tested in 3 and 6 month controls.
78 patients (62,9%)
out of 124 were found DNA positive before treatment. 41 patients
(77,4%) were found positive in the group of neuroborreliosis, in skin
involvement were positive 26 patients (54,2%) and 11 (47,8%) in
arthritis. After treatment the positivity in neuroborreliosis was
41,5% (22 patients), in skin form were 16 positive patients (38,1%)
and in arthritis 10 patients (47,6%). During controls after 3 moths
were 29 patients positive (29,0%) in generally and after 6 months it
was 7 (9,2%) patients. Before treatment specific antibodies were
proved in all patients with neuroborreliosis, only in nine patients
with skin form and in five Lyme arthritis.
The above described
technique was capable to detect specific borrelial DNA in all of the
tested clinical forms of borreliosis and in all examined body fluids.
There were found no substantial differences in the reactivity of
primers that could be used in clinical practice. The mentionable fact
was, that sensivity of PCR in urine was comparable with the
examination in CSF and synovial fluid – in relative discrepancy
with some literary experiences. Some recommendations for the clinical
practice could be drawn. It is necessary: a) to use methods with
clearly declared sensitivity; b) to use two target sequences
minimally; c) PCR is not suitable diagnostic method for the first
was supported by grants: IGA NR/8293 and MSM 0021620812.
DISORDERS WITH DISTINCTIVE HISTOPATHOLOGICAL PATTERNS
Medical Faculty, Charles University, Dermatology Dept., Prague 8,
disorders there are only few with distinctive histopathological
patterns – focal acantholytic dyskeratosis, epidermolytic
hyperkeratosis, granular parakeratosis and pagetoid dyskeratosis.
Except for pagetoid dyskeratosis all the others have been found both,
in clinicopathological entities and incidentally in biopsy specimens
with many different dermatoses. The aim of the lecture is to show
these keratinization disorders in entities and incidental findings
and to answer the question if their number is final.
evaluation of our skin biopsies with the above mentioned
keratinization disorders was performed. Moreover, a new type of
dyskeratosis is demonstrated in two men with a generalized
dyskeratosis is presented in Darier’s, Grover’s and
Hailey-Hailey‘s diseases and in warty dyskeratoma. Epidermolytic
hyperkeratosis is demonstrated in epidermolytic keratosis palmaris et
plantaris, solitary and disseminated epidermolytic acanthoma.
Granular parakeratosis is presented as an entity and in many
incidental findings in association with different dermatoses.
Pagetoid dyskeratosis is found only incidentally. The specific type
of dyskeratosis in the two above mentioned patients has an appearance
of focally arranged narrow columns of dyskeratotic cells throughout
the epidermis. The term “columnar dyskeratosis“ has been used for
There are four
keratinization disorders with distinctive histopathological patterns.
In addition to them skin is able to develop other original
keratinization disorders as is demonstrated by columnar dyskeratosis
in a new entity. One can speculate that this type of
dyskeratosis could be found as an incidental finding in the future
similarly to previously identified keratinization disorders.
SIDE-EFFECTS OF ERLOTINIB TREATMENT IN PATIENTS WITH NSCLC
J., Krejčí J., Cetkovská P.
University, Medical School and Teaching Hospital, Department of
Dermatology and Venereology, Pilsen, Czech Republic
is a tyrosine-kinase inhibitor affecting an intracellular domain
of the EGFR receptor. The treatment is associated with various
cutaneous side-effects. Erlotinib has been approved for the treatment
of locally advanced or metastatic non-small cell lung cancer (NSCLC)
after failure of at least one prior chemotherapy regimen. The study
aimed to evaluate the incidence and characteristics of skin changes
in patients with NSCLC treated with erlotinib.
Since 2006 we have
been collecting data about patients with NSCLC treated with
erlotinib. We have clinically examined the presence, severity and
onset of skin side-effects and response to dermatological treatment.
Furthermore, we have been assessing the influence of EGFR and K-RAS
gene mutations on an oncological treatment response and observed skin
changes in a relevant subgroup of patients.
In the first weeks of
treatment, most patients developed papulopustular eruptions. We also
noticed other cutaneous changes as pruritus, xerosis and painful
paronychia. In severe cases the cutaneous reaction led to
dose-reduction or temporary discontinuation of the erlotinib therapy.
Preliminary results show that a presence of the EGFR mutation in
patient’s genome is a positive sign for both oncological
treatment response and prognosis whereas the presence of the K-RAS
mutation’s effect is exactly opposite. The association between skin
changes and gene mutations is under further investigation.
side-effects of the EGFR tyrosine-kinase inhibitors are very common,
with great impact on the patient quality of life, sometimes
necessitating an interruption of the oncological therapy. The early
dermatological examination and adequate therapy enables to continue
in the anti-cancer treatment regimen. Further research is needed to
clarify the association among the gene mutations, the oncological
treatment response and the cutaneous side effects.
EXPERIENCE WITH CHILDREN ATOPIC DERMATITIS THERAPY IN MULTI-SECTIONAL
Dept. of Dermatology, Nový Jičín, Czech Republic
Authors are describing
group of 87 children patients with atopic dermatitis (AD).
These patients were
examined and treated in the multi-sectional outpatient department.
There is cooperation of different specialists from dermatology,
allergology, immunology or psychology is used to enhance the
treatment in this department. Essential part of this program is to
evaluate quality of children patients life with AD.
This study intensely
emphasizes cooperation between specialists from different areas.
OF LIFE IN PATIENTS WITH CHRONIC LEG ULCERS
V., Vašků V.
University Hospital, Dept.of Dermatovenereology, Brno, Czech Republic
Leg ulcers represent
an important health problem. In last years, many studies evaluated
quality of life of leg ulcer patients which is significantly
decreased. The aim of this preliminary study was to collect data
about quality of life of the patients with chronic leg ulcers in the
questionnaire focused on quality of life of patients with chronic leg
ulcers was developed in our department of dermatology.
A questionnaire is divided in 6 parts, the questions are aimed
at pain, physical, social and psychological impact, at daily
activities and at aspects of treatment.
Pain is the most
dominant negative experience of leg ulcer patients. Localization of
the pain, types of the pain and mean pain intensity score (using
numerical rating scale) will be described. Most patients reported
sleep disturbances every night or very often. They also experienced
moderate restrictions in leisure activities and in household duties.
Half of the patients reported partial or complete change in their
clothing style (especially women). Many patients had to change their
shoes completely or partially. Most patients reported certain social
isolation caused by problems connected with their leg ulcer.
Psychological aspects are very important, our patients often
complained about bad mood and feelings, they described depression and
Leg ulcers can
influence nearly ever aspect of the patient´s life. Therefore the
care must be more intensively focused on quality of life.
OF GASTROINTESTINAL SUPERFICIAL POLYPS WITH AMINOLAEVULINIC ACID: A
CLINICAL AND SPECTROSCOPIC PILOT STUDY
Laser Center, Department of Biophysics, Bratislava, Slovak Republic
Elisabeth Cancer Hospital, Department of Laser Medicine, Bratislava,
In ten patients with
polypoid esophageal, gastric and colororectal lesions 4 hours after
oral sensitisation with ALA fluorescence spectroscopic studies of
healthy and pathological tissues were performed before PDT and
compared with frozen bioptic cryoslits tissue samples measured by
scanning confocal microscope. Clinical PDT effects were evaluated as
10 patients (7 M, 3 W,
mean age : 56 y) with small adenomas and early cancers in esophagus,
stomach and rectosigmoideum after sensitisation with ALA 60 mg
/kg/ bodyweight orally, underwent fibre fluorescence spectroscopic
studies with He-Ne laser (LESA 10 BIOSPEC) before PDT.Four hours
lates PDT using He Ne diode fibre laser with 630 nm wavelenght and
with average TD 481 J was performed. Fluorescence of frozen bioptis
cryoslits samples were scanned with LSM 510 Meta (Zeiss) confocal
microscope in response to excitation of 488 nm Acrion laser line and
633 nm He-Ne laser line (Lasos Lasertechnik) respectivelly.
In all cryoslits
scanned with confocal microscope with C – Apochromat 40x1.2 water
immersion objective was observed higher accumulation of PP IX
fluorescence in adenomatous and early cancer lesions compared to
normal tissue with ratio 2.5–3 : 1. PP IX fluorescence was
predominantelly present in mucosa with 8–9 : 1 ratio of
fluorescence compared to submucosa and muscularis mucosae
respectivelly. In fluorescent spectra the new emission band with the
maximum at around 675 nm was observed, which is a typical
wavelength of photoproduct of PPIX – photoprotoporphyrin – PPp/ .
This was probably caused by light source of endoscope during biopsy
sampling. Each patient had a response to PDT. In four patients
total response was observed and in 6 more than 60 % of polypoid
adenomatous lesion was destroyed.Two patients with histologically
unfavourable cancers (epidermoid and sigillocelular) later underwent
surgery. Sunburn in 2 patients on exposed skin lasting 3 days and two
days nausea in 2 patients was observed. No other side effects or
serious complications during and after the treatment were observed.
fibre spectrometry and bioptic cryolists scanned with confocal
microscope as well have confirmed significant higher accumulation of
PPIX in superficial mucosal GI adenomas and proved ALA- PDT to be
appropriate modality for these lesions.
Fac. Med., Charles University, Dermatology, Prague, Czech Republic
old woman with an overlap syndrome of systemic lupus erythematosus
(SLE)/rheumatoid arthritis (RA). Because of the increased activity of
the disease and the development of nephrotic syndrome she was
admitted to rheumatology department. She developed on upper
extremities, less on thighs, concentric purpuric lesions starting as
flat centrifugally spreading papules. Biopsy of the flat papule
revealed vacuolisation along epidermal basement membrane, diffuse
sparse neutrophilic infiltration of the dermis with slight
leucocytoclasia, dermal oedema (flat papule) and some extravasated
erythrocytes (purpura). Direct immunofluorescence examintation (DIF)
of the lesion (arm)revealed fine granular linear positivity of IgG,
A, M and C3 complement along epidermal basement membrane, DIF of
the non lesional unexposed skin (buttocks) showed the same pattern of
positivity in IgG, M.Differential diagnosis of dermal
neutrophilic infiltrates is very broad. Clinicopathological
correlation of figurate erythemas with neutrophilic dermal
infiltration include idiopathic cases and cases associated with RA,
SLE. Recently, two similar cases were published as neutrophilic
dermatosis and leucocytoclastic vasculitis with erythema gyratum
repens-like pattern in association with SLE. Because the neutrophilic
infiltration is observed in both RA and SLE the diagnosis of
neutrophilic figurate erythema in connective tissue disease was
established. Considering dermal neutrophilic infiltration,
considering interface changes on histology, DIF findings and close
resemblance to described cases of erythema gyratum repens-like
eruption associated with SLE we suppose that skin lesions in our case
were manifestation of SLE. Neutrophilic figurate erythema (erythema
gyratum repens-like) form a part of the spectrum of skin
manifestation of SLE and relevant clinical data are necessary to make
LIPOSOMAL PRODUCT CONTAINING PHTHALOCYANINE FOR TOPICAL APPLICATION
OF MALIGNANT TUMOUR PDT
Vinohrady University Hospital, Third Faculty of Medicine, Charles
University, Clinic of Surgery, Prague, Czech Republic
of Biophysics and Informatics, First Faculty of Medicine, Charles
University, Biophysics and Informatics, Prague, Czech Republic
of Membrane Transport Biophysics, Institute of Physiology, Academy of
Sciences, Department of Membrane Transport Transport, Prague, Czech
Institute of Organic Syntheses, a.s. (VUOS), Pardubice, Rybitví,
Hospital, Department of Surgery, Rakovník, Czech Republic
studies were carried out with a newly
prepared liposomal product comprising hydrophobic phthalocyanine as
its active ingredient. The newly prepared liposomal product for the
photosensitizer topical application needs the time interval („drug-to
light time interval”) of 10 min only in contrast to the commercial
product METVIX, in which the drug-to-light time interval takes 2 hrs.
The product anti-cancer effect was tested in nude mice with growing
human tumours as follows: mammary carcinoma (line MDA-MB-231),
PE/CA-PJ34 basaloma (clone C12), HCT-116 colon carcinoma and
amelanotic melanoma (line C-32). The new product containing
phthalocyanine was locally spread onto the surface of the tumour
region (area of about 2 cm2;
4mg phthalocyanine per 1 g
of the product; 0.2 g
of the product applied onto the area of 2 cm2).
Ten min after that, the area was exposed to radiation from a xenon
lamp (lamp type ONL 051, wave length 600-700 nm, total energy 80 J/
In most mice, the tumour completely disappeared, which was supported
by histology on the 40th day after the PDT. We conclude that the
hydrophobic photosensitizer with hydroxyl-aluminum phthalocyanine and
its liposomal gel formulation offer optimum characteristics enabling
wide ranging use of topical PDT for numerous cancer indications.
work was supported by grant MPO č. 2A-1TP1/026, grant IGA
č. NR/7778-6, MSM0021620808 and grant League against Cancer-
Bata’s Regional Hospital, Department of Dermatology, Zlín, Czech
Bata’s Regional Hospital, Oncology Centre, Zlín, Czech Republic
therapies are being increasingly utilized by oncologists for the
treatment of tumours in which standard chemotherapy cannot be
tolerated or has failed. They target specific molecular pathways
affecting cancer development. These signal transduction pathways may
not only be overexpressed in tumours, but are also expressed in the
skin which leads to cutaneous adverse reactions frequently observed
in treated individuals. Epidermal growth factor receptor (EGFR)
inhibitors belong to agents that are recently used in advanced cases
of certain malignancies.
The authors report
of 24 patients (12 patients with head and neck cancer and 12 patients
with colorectal cancer) treated with cetuximab.
The most frequent side
effect reported in this series was pustular or maculopapular
follicular eruption, often referred to as acneiform rash, which
developed in 22 patients. Patients with head and neck cancer had
therapy with radiotherapy and experienced more severe radiation
dermatitis accompanied by skin xerosis. Anaphylactic reaction was
observed in three patients.
The spectrum of
cutaneous side effects in EGFR inhibitor-treated patients is
discussed with a focus
on their etiopathogenesis, management as well as the relation to
patients´ response to antitumour therapy.
BIOLOGICS WITH NON-BIOLOGICS IN DERMATOLOGY
Hospital, Dermatology, Banska Bystrica, Slovak Republic
Combination therapy is
remedy in the treatment moderate to severe psoriasis. Despite this
fact, there is lack of informations about combination biologics
systemics in dermatology practice, majority of publications had
manner. With the addition of biologics, combination therapy can
attain a synergistic
therapeutic effect between lower doses of multiple agents, thereby
minimizing the adverse effects of higher dose monotherapy, such as
nephrotoxicity and hepatotoxicity associated with the most commonly
used systemic therapies like cyclosporine (CsA) acitretine (Act) and
methotrexate (MTX). Author present review of the literature of
combinations biologics with traditional systemic drugs with the
addition of his own experiences in the group of partial responders to
monotherapy of biologics. Combination of biologics with MTX seems to
be (acording to the previous studies in psoriatic arthritis) most
attractive approach with respect to improved efficacy, good
tolerabilty and pharmacoeconomy. Addition of acitretin to biologics
present also the alternative tretament combinig immunsuppresive,
antiproliferative and the canceroprotective effect. Combination
biologics with ciclosporine A is
controversial because of high level of immunosuppresion. The role of
combination therapy need to be comfirm by clinical studies over the
next few years to determine optimal combination, efficacy, mode of
regimens and side effects.
FIRST RESULTS IN STUDYING OF LABORATORY PARAMETRES IN PATIENS WITH
EPIDERMOLYSIS BULLOSA CONGENITA
hospital Brno, Dep. of pediatric dermatology, Brno, Czech Republic
hospital Brno, 1st Dep. of pediatrics, Brno, Czech Republic
congenita (EBC) is a rare
hereditary congenital skin disease, which leads to the formation of
blisters on the skin and mucous membrane caused by slight pressure or
friction. Patients’ hair, teeth and nails are usually affected to
differing extents. EBC is caused by the mutation of thirteen genes.
Four types of EBC are distinguished at this time (simplex /EBS/,
junctional /EBJ/, dystrophic /EBD/ and Kindler syndrome). Autosomal
recessive forms are more severe, leading to serious malnutrition,
invalidity and even death in childhood.
In our study we
focused on the investigation of several laboratory parameters
including the immune system in children with EBC.
We compared laboratory
parameters in patients with EBS, EBD and healthy children. We focused
on comparison of the differences of certain laboratory parameters in
patients in better and worse clinical states, separately for simplex
and dystrophic forms. We tried to discover if there were any
differences in laboratory findings in the same patient in a better
and worse clinical state.
Elevated levels of
acute phase proteins are more often observed in patients with EBD.
Patients with EBD also suffer more often from malnutrition and
anaemia. Markers of inflammation are higher and anaemia is more
severe for those in a worse
clinical state. There were higher levels of antibodies against cows
milk, gliadin, anti EMA and anti TTG in patients with EBD.
Patients with EBC do
not show signs of immunodeficiency. Patients with EBD also have an
altered intestinal mucous membrane, which becomes more permeable.
Therefore, in these patiens, higher levels of antibodies against cows
milk, gliadin, anti EMA and anti TTG were observed without any
characteristic clinical signs of intolerance of cows´ milk and
gliadin. Supportet by IGA MH NR9346-3
AND MEDICINE: REALITY AND FUTURE
University, Faculty of Medicine , Department of
Dermatovenerology, Brno, Czech Republic
The genome of each
individual can be considered a dynamic
system, whose main characteristics are fatally determined at the
moment of conception. However, this characteristic of the genome is
not definite, as it can be modulated by a wide
variety of factors, both epigenetic and genetic.
The progress in
molecular biological methods made it possible to analyse the
underlying genetic background of many mendelistic disorders. In this
sort of diseases, the certain genetic background plays the role of
However, in complex
(multifactorial, multigenic) diseases there are certain gene pattern
combinations together with environmental factors that are
corresponding to what we call a general
predisposition. But, the basic principles of genetics of complex
disorders still remain to be elucidated. What is definitely certain,
with familiar aggregation should be always suspicious from genetic
aetiology even in case that understanding of this genetic background
is rather poor or the so-far knowledge is not convincing.
The use of developed
molecular biology methodology, especially direct sequencing and DNA
microarray technology in biomedical research has dramatically
increased during the past years. Recently, a series
of gene expression studies have been performed for various
dermatological diseases, such as malignant melanoma, psoriasis and
lupus erythematosus. These analyses have identified interesting
target genes as well as putative disease susceptibility loci.
However, further functional studies will be needed for a more
complete understanding of the pathogenesis of these diseases. In
future, interference with genes or regulatory pathways may open
interesting therapeutic perspectives, especially more individualized
treatment approaches of cutaneous diseases.
ASPECTS OF MOLECULAR BIOLOGICAL BACKGROUND OF PSORIASIS
Ann’s Faculty Hospital, Masaryk University, Faculty of Medicine,
1st Department of Dermatovenereology, Brno, Czech Republic
inflammatory, immune-mediated skin disease affecting 2% of the
European population. The complex disease usually occurs in
individuals with genetic susceptibility in conjunction with
environmental stimuli (trauma, infections) and may involve an immune
response to autoantigens. Evidence supports a central
role for dendritic cells and T
cells in establishing and maintaining the “vicious cycle” of
psoriatic plaque development.
Up to 50% of genetic
susceptibility for psoriasis is associated with PSORS1. But, other
single nucleotide polymorphisms were observed to be more common in
subjects with psoriasis.
From these point of
view polymorphic variants in retinoid X receptors, RAGE (advanced
glycation end products), angiogenetic and cytokine genes can be
supposed to participate in etiopathogenesis of psoriasis at least as
As a result,
individual gene characteristics of patients with psoriasis could
improve the possibilities of pharmacotherapy using pharmacogenomic
approach which could be further stratified according to the subtypes
of psoriasis in future.
OF SYPHILIS PATIENTS IN PRAGUE – RESULTS OF A QUESTIONNAIRE
Faculty of Medicine, Charles University, Department of
Dermatovenereology, Prague, Czech Republic
of Biophysics and Informatics, 1st Faculty of Medicine, Charles
University, Department of Biomedical Statistics, Prague, Czech
syphilis patients in Prague - results of a questionnaire
inquiry, 2007-2008 compared to 1998-2000.
a questionnaire survey, indicators of risk sexual behaviour of
patients hospitalized with acquired syphilis between January 2007 and
June 2008 have been identified and compared with the results obtained
in 1998–2000. These characteristics has been assessed in relation
to gender, age, sexual orientation, level of education, prostitution,
attitude to the use of contraception and drug use.
Out of 224
hospitalized syphilis patients 106 completed the anonymous
questionnaire. There were 87 (82,1%) men and 19 (17,9%) women. Among
the 87 men, 21 (19,8 %) had diagnosed primary syphilis, 15 (14,3%)
had secondary syphilis, 64 (73,6%) were homosexual or bisexual, 3
(3,6%) admitted practicing sex for money, 54 (62,1%) reported anal
intercourse, 12 (14.5%) reported a history of more than 10
sexual contacts in the preceding 12 months, 47 (54,7%) gave a history
of casual first coitus, 29 (34,7%) reported inconsistent condom use,
only two (2,3 %) were an injecting drug users, 8 (9,2%) had diagnosed
gonorrhoea coinfection, 6 (6,9%) were HIV positive 17 (19,5%) had
a history of gonorrhoea. Among the 19 women 10 (52,6%) of women
were pregnant, one had diagnosed secondary syphilis, 12 (63,1%) early
latent syphilis and 6 (31,6%) late latent syphilis. Three (16,7%)
identified themselves as prostitutes, two (10,5%) reported a history
of more than 10 sexual contacts in the preceding 12 months, two
(10,5%) gave a history of casual first coitus, 17 (89,5%)
reported inconsistent condom use, only one was injecting drug user, 9
(47,4%), 13 (72,2%) had been tested for HIV previously with negative
results, one (5,3%) had diagnosed gonorrhoea, two (10,5%) had
gonorrhoea in their history.
Compared to the
previous data from the period 1998-2000 the number of homosexual,
single and HIV positive men and men using condom has increased. In
women no changes have been observed.
TREATMENT OF PENOSCROTAL LYMPHEDEMA
Jarolím L., Adámek J., Hyklová L., Váchová H.
Medical Faculty of Charles University, Department of Surgery,
Prague, Czech Republic
The incidence of
lymphedema of the scrotum and penis is much lower than lymphedema of
extremities. In Europe we can usually see it as a result of
lymphadenectomy and /or radiotherapy of inguinal or pelvic lymphatics
whereas primary lymphedema of the scrotum and penis is very rare. Its
progression is passed through the same stadiums as the lymphedema of
the upper or lower extremities. In many cases lymphedema progresses
to the lipohypertrophy and elephantiasis in despite of very well done
The authors in their
paper call the attention to indications for surgery, particular steps
by the surgery and post-operative care.
At present, patient
feedback from these surgeries has been unanimously positive from the
aspect of: assisting with their personal hygiene, solving this social
handicap, and from the perspective of improved sexual function;
however, it is necessary to reach a better cosmetic effect,
especially in the case of young individuals.
DERMATITIS AND CORTICOSTEROIDS – LATEST KNOWLEDGE
Private Dept. of Dermatovenerology, Svidník, Slovak Republic
Hospital, University of P.J. Šafárik, Dept. of Dermatology,
Košice, Slovak Republic
topical therapy may be without exaggeration divided into therapy
prior to and after the introduction of steroids into medical
a revolutionary break in the therapy of many dermatoses. Not
only do they foster the improvement of the condition of the skin of
the patients treated, but improve the appearance and the mental state
of the patient in general. Of course, it is necessary to add that
nowadays we are also acquainted with the adverse effects of steroids,
especially following the application of halogenated glucocorticoids
to rather extensive areas over a long period of time.
The most common and
frequently seen adverse effects of inadequate topical application of
steroid-containing crèmes, ointments, and lotions are observed
especially in cases of perioral dermatitis or other face dermatoses.
We would also like to
demonstrate the possibility of adverse effects development following
the treatment with aerosols containing corticoids.
EVALUATION OF HYPERSENSITIVITY TO TRIBENOSIDE (GLYVENOL)
Ann’s Faculty Hospital Med. Fac. Masaryk University, I. Department
of Dermatovenereology, Brno, Czech Republic
Ann’s Faculty Hospital Med. Fac. Masaryk Univ., Department of
Clinical Immunology and Allergology, Brno, Czech Republic
a semisynthetic sugar derivative which is indicated to treatment
of chronic venous insufficiency. Up to 10 % patients treated by
tribenoside can suffer from skin side-effects. They usually occur as
anaphylaxis, angiooedema, urticaria and exanthemas maculo-papular
We evaluated 27
patients treated in our department for exanthemas induced by
tribenoside – in period Oct. 2005-Aug. 2008. 22 these patients were
subjected to clinic (patch tests) and 8 patients of them to
laboratory (lymphocyte transformation test, basophil activation test)
A positive patch
test reaction to tribenoside was seen in 1 of 22 patients. Basophil
activation test gave a positive reaction in 1 of 8 patients.
Lymphocyte transformation test elicited no clear positive reaction.
The obtained results
proved the possibility of development of immediate and delayed type
of immune reactivity in aetiology of the tribenoside induced