Praha, 20.–24. 5. 2009
Postery českých a slovenských účastníků
10. světového dermatologického kongresu
a přidružených akcí
TYPE OF ICHTYOSIS IN CHILD – A CASE REPORT
Faculty of University PJ Safarik, Dpt of Dermatovenerology, Košice,
Department of Dermatovenerology, Rožňava, Slovak Republic
Faculty University of PJ Safarik, Department of Pathology, Košice ,
Gipsy boy was reffered for evaluation of multiple lesions on his
neck, lateral sites of the trunck and flexural parts of the limbs.
The lesion appeared at age 3 months as hyperpigmentated
hyperkeratotic plaques, but the skin disease started on the second
day after delivery as several vesicles on the body. Except positive
antibodies against cow milk and eosinophilia there were no other
laboratory or clinical findings.
skin biopsy specimen showed epidermolytic keratosis. Epidermolytic
hyperkeratosis is an unusual type of ichthyosis. This inherited
keratinization disorder is characterized clinically by erythema,
blistering, and peeling shortly after birth. It may resolve and be
replaced with thick scaling. It can lead to life-threatening
complications, such as sepsis. Histologically, there is
and vacuolar degeneration. Genetically, this is an autosomal dominant
disease with complete penetrance; however, 50% are spontaneous
mutations. The clinical phenotype is a result
of alterations in the gene(s) for keratin 1 and/or 10.
child is treated with topical keratolytic agents. His condition is
YAG LASER TREATMENT OF PENILE PEARLY PAPULES
Paracelsi, Dept. of Laserotherapy, Bratislava, Slovak Republic
Pearly penile papules (PPP) are
angiofibromas, occurring circumferentially over the corona and sulcus
of the penis. They occur most frequently in the second and third
decades. This condition is benign, noninfectious and asymptomatic.
PPP need to be differentiated from condylomata acuminata, lichen
nitidus, molluscum contagiosum and ectopic sebaceous glands. Removal
of PPP is often requested for cosmetic reasons. Numerous therapeutic
modalities, such as podophyllin, electrodessication, curretage,
cryotherapy and CO2
laser have been utilized.
We treated 45 individuals with 2,94 mm
Erbium:YAG laser in ablation mode (fluence up to 4
J/cm2). 7 of them
have been previously treated as condylomata acuminata. A topical
anesthesia with 5% lidocaine and prilocaine cream was applicated
prior the procedure. If residual lesions persisted, the treatment was
repeated after 1 month. Antimicrobial ointments were used to cover
the postoperatory wounds.
PPP were removed in all patients in 2,4
sessions. The procedure was very well tollerated by all patients. The
process of reepithelization durated from 10 to 14 days. No scarring
occurred after the treatment.
PPP are benign angiofibromas. Its resemblance
to condylomata acuminata may cause anxiety and may lead to hazardous
treatments, frequently associated with post-treatment complications
such as scarring. Even after reassurance, some patients will ask for
the lesions to be removed. Because of high coefficient for absorption
of water, Er:YAG laser ablation is performed with minimal thermal
injury to the treated tissue and enables a scar-free
OF PSORIASIS IN CZECH REPUBLIC
University, Dermatology, Prague, Czech Republic
Phototherapy belongs to standard dermatologic
treatments for psoriasis and it is considered to be a part
of systemic antipsoriatic therapy. With new investigations and
technical development of devices, phototherapy is an effective and
relative safe treatment with a good
cost/benefit ratio. The aim of our survey was to find out the state
of phototherapy in Czech Republic.
We used a structured
questionnaire with cross check answers that was sent to all
dermatologic departments per post, electronic post or personal
delivery. The answers were then evaluated in percentual figures.
At the time of abstract submission the survey
is still ongoing. The exact data will be presented at the time of ICD
congress 2009 in Prague. Preliminary results show that all
dermatologic in-patient departments carry out phototherapy also for
out-patients, there is also a sufficient
number of dermatologic offices offering phototherapy only for
out-patients. The equipment with UV devices is satisfactory and
up-to-date, with narrow band UVB and photochemotherapy PUVA been
mostly used. The capacity for further patients is still available.
The average frequency of phototherapy is 4 sessions a week,
the average number of procedures is 30 and the duration of session
(incl. necessities before and after irradiation) takes in average
less than 20 minutes. Some drawbacks are the personal, space and
technical requirements with their financial consequences for the
dermatologists and the required time and sometimes complicated
accessibility for patients.
Phototherapy of psoriasis in Czech Republic
represents an available and frequently used therapy for psoriasis
that enables further utilization. Although relative time consuming,
phototherapy is comfortable for patients and that correlates with
their good compliance. Even in the era of biologics, phototherapy is
an important therapeutical modality.
HYPERSENSITIVITY TO ADJUVANT SUBSTANCES OF PHARMACEUTICAL AND
E., Nečas M.
University, Fac. of Medicine, and St. Anne’s Faculty Hospital, 1st
Dept.of Dermatovenereology, Brno, Czech Republic
The study was aimed at determining the
frequency of sensitisation to 29 selected adjuvant substances
(preservatives, antioxidants and emulsifiers) of pharmaceutical and
cosmetic preparations in cohorts of men and women with chronic
eczemas and at determining statistically significant differences in
sensitisation among the cohorts using a binomial test.
The cohort consisted of 687 men (Ø age 44.5)
and 1531 women (Ø age 44.3) examined during the years 2001-2007.
Contact allergens of Chemotechnique Diagnostic AB company and
Curatest patch strips of Lohmann&Rauscher company were used for
the testing. The period of patch test application was 48 hours;
reactions were evaluated in 48, 72 and 96 hours according to ICDRG
The per cent values of sensitisation
frequencies for individual allergens in men/women cohorts were as
follows: Parabenes-mix 1.2/1.1, Formaldehyde 3.2/2.0, Bronopol
1.5/1.9, Imidazolidinylurea 0.3/0.8, Diazolidinylurea 0.7/0.9,
DMDM-hydantoin 0.4/0.4, Quaternium-15 0.7/0.7, Kathon CG 0.7/1.9,
Thiomersal 10.0/11.5, Phenyl mercury acetate 2.3/2.8, Benzalkonium
chloride 0.7/1.0, Chlorhexidine digluconate 1.6/1.2, Phenoxyethanol
0.1/0.3, Dibromodicyanobutane/Phenoxyethanol (1:4) 0.7/1.8,
Chloracetamide 1.9/1.2, Chlorocresol 0.0/0.3, Sorbic acid 0.3/0.2,
Triclosan 0.6/0.4, Glutaraldehyde 0.3/0.5, Dichlorophen 0.4/0.3,
Chloroquinaldol 0.1/0.3, Dodecyl gallate 2.9/1.2, Butylated
hydroxyanisole 0.0/0.7, Propyl gallate 0.1/0.4, Butylated
hydroxytoluene 0.3/0.0, Alcoholes adipis lanae 3.5/3.7,
Cocamidopropyl betaine 0.4/0.3, Triethanolamine 0.9/0.3, Propylene
glycol 0.3/0.1. No statistically significant difference was found
between the men and women cohorts when comparing the percentage
ratios of sensitisation to adjuvants.
Sensitisation to adjuvant substances may
result in chronic progress of eczemas.
by a grant project IGA MZ ČR NR 9203-3/2007.
Hospital, Dermatovenerology, Brno, Czech Republic
Faculty of Masaryk University, Dermatovenerology, Brno, Czech
Dermatitis 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.
diagnosis of DH is based on the clinical features and on the
immunofluorescence findings in the skin biopsy.
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.
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
Antibodies against 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
CHANGES IN THE PSORIATIC LESIONS
Faculty of University PJ Safarik, Dpt of Dermatovenerology, Košice,
Svidnik, Department of Dermatovenerology, Svidnik, Slovak Republic
Immunological changes 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
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 autoantigens.
CYTOKINE GENE POLYMORPHISMS IN PEMPHIGUS VULGARIS PATIENTS IN THE
Buc M.1, Svecova D.2
University, Immunology, Bratislava, Slovak Republic
University, Dermatovenerology, Bratislava, Slovak Republic
Klinikum, Immunologie, Essen, Germany
Cytokines participate 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 to PV.
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-1β, IL-1R, IL-1RA, IL-4Rα, IL-12,
IFN-γ, TGF-β1, TNF-α, 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-αα
-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 testing.
Our results suggest that variations in the
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-αα
allele and haplotype among PV patients seems to be in conflict with
the role of TNF-αα
in the induction of acantholysis. We explain this discrepancy by the
existence of strong linkage disequilibrium between high-producer TNF
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.
BRACKETS DEBONDING USING INFRARED LASER RADIATIONS
Technical University in Prague, Faculty of Nuclear Sciences and
Physical Engineering, Physical Electronics, Prague, Czech Republic
University, 2nd Medical School, Department of Paediatric
Stomatology, Prague, Czech Republic
In some last years the esthetics is an
important factor for patients seeking an orthodontic treatment. Our
study demonstrates the possibility of using laser radiation for
ceramic bracket removing. Three laser radiations were examined for
this effect, and the removing possibility and velocity together with
enamel and pulp damage were investigated.
As radiation sources, three continuously
running laser systems were used: diode pumped Tm:YAP microchip laser
generating wavelength of 1.99 mm, diode pumped Nd:YAG laser with
1.44 mm wavelength, and GaAs diode with 0.808 mm.
human premolars of adolescent patients (age 11 to 15), extracted for
orthodontic reasons, were used in the study. To identify the
temperature rise by a thermocouple, a hole was prepared
inside the tooth opposite the bracket. The bracket with the tooth
sample was heated by the laser light and after the chosen time
interval the bracket was removed mechanically from the tooth surface.
measurement of transmission and absorption of the basic element –
bracket, adhesive resin, and enamel – was also made with the goal
to explain the source of heat and bracket debonding.
The irradiation by the GaAs diode (0.808 mm)
does not help for brackets removing. When Tm:YAP radiation was used,
the heat was concentrated inside the bracket and adhesive resin, and
after 60 s the bracket could be removed. Similar results have
been obtained for the Nd:YAG laser (1.44 μm), only the increase of
temperature without and with cooling was more significant.
The ceramic brackets debonding by the three
various laser radiations were investigated. From the experiments
performed it follows that continuously running lasers – the 1.99 μm
Tm:YAP and 1.44 mm Nd:YAG with the power 1W acting for 60
s providing a reasonable dose for brackets tear off. From
the SEM measurement results, the minimum damage of enamel for this
case was found.
ALLERGIC CONTACT DERMATITIS FROM EPOXY RESINS
of Medicine and Dentistry, Palacky University and University
Hospital, Department of Dermatology and Venereology, Olomouc, Czech
Epoxy resins ( ERs) are used widely in
manufacturing electrical equipment for enclosing transformers,
condensers, in paints for surface coating and in other industries for
adhesive purposes. Most of the health hazards from ERs (epoxy
monomer, hardener, reactive diluent and other additives) occur in the
occupational setting during the production of ERs or during the
manipulation of the finished epoxy product. Approximately 60–80% of
patients with allergic contact dermatitis to ERs are sensitized to
diglycidyl ether of bisfenol A, which is in standard patch test
Between October 2007 to October 2008 patients
with suspicion on contact allergic dermatitis were investigated.
Patch tests were carried out on 338 patients (109 males, 229 females)
with The European Baseline Series in which bisphenol A 1% in
petrolatum was contained. The first test reading was done 30 min
after the patch test strips were removed and further reading at day 3
and day 4.
Positive patch test reactions to bisphenol
A were obtained by 15 ( 4,4%) of patch-tested patients, by 2
females (1%) and by 13 males (11,9%). All of 15 cases of contact
allergic dermatitis to epoxy resins were occupational source. The
location of the epoxy resin dermatitis were exposed sites, including
hands, forearms, face, neck and lower legs.
Epoxy resins are one of the most frequent
causes of occupational allergic contact dermatitis. Approximately
60–80% of patients with allergic contact dermatitis to ERs are
sensitized to diglycidyl ether of bisfenol A, but negative reaction
to bisphenol A does not rule out epoxy resin dermatitis, because
it could be due to hardener, reactive diluent and other additives
FIBROBLASTS FROM BENIGN FIBROUS HISTIOCYTOMA INFLUENCE NORMAL HUMAN
KERATINOCYTES IN VITRO
Faculty of Medicine, Department of Haematology, Prague, Czech
Faculty of Medicine, Institute of Anatomy, Prague, Czech Republic
Faculty of Medicine, Department of Dermatology, Prague, Czech
Maximilians University, Institute of Physiological Chemistry, Munich,
Faculty of Medicine, Center for Cell Therapy and Tissue Repair,
Prague, Czech Republic
Evaluation of influence of benign and
malignant fibrous histiocytoma stromal fibroblasts on the phenotype
of normal human keratinocytes in vitro.
Isolation of stromal fibroblasts from both
tumour types, their FACS and immunocytochemical analysis and their
co-cultivation with normal human keratinocytes was performed.
Phenotype of these keratinocytes was analysed with special regard on
their proliferation and differentiation status and signs of
epithelial mesenchymal transition (CK 8, 19, vimentin, nucleostemin,
Ki-67 and galectin-1).
Keratinocytes co-cultivated with benign
fibrous histiocytoma fibroblasts exhibit significant CK 19 expression
in contrast to fibroblasts prepared from malignant tumor. No
epithelial-mesenchymal transition was observed when both types of
fibroblasts were employed.
Epithelial hyperplasia characteristic for
benign fibrous histiocytoma might be triggered by stromal
IN PRAGUE AT THE BEGINNING OF THE 21ST
Faculty Hospital and 1st Faculty od Medicine, Chareles University,
Dep. of Dermatovenereology, Prague, Czech Republic
Faculty of Medicine, Charles University, Dep. of
Dermatovenereology, Prague, Czech Republic
To evaluate the clinical, epidemiological,
socioeconomic and behavioral characteristics of syphilis patients
between 1999 and 2005 at the two Departments of Dermatovenereology of
the Charles University in Prague.
Syphilis cases were diagnosed based on
clinical features, the serological picture, and dark-field
microscopy. The anonymous questionnaires focused on HIV risk were
During the 7-year period, a total
of 675 syphilis patients were diagnosed and treated. Symptomatic
syphilis was diagnosed in 117 men (17,3%) and in 50 women (11.9%). 70
patients (10.4%) presented with genital chancre, 4 (0.6%) with
extragenital chancre, 63 (9.4%) with macular or papular rash and 20
(3.0%) with condylomata lata. Of the 421 women, 205 (48.7%) were
pregnant. 67(16.0%) were pregnant at the time of syphilis diagnoses
and 138 (32.8%) underwent repeated protective treatment during
pregnancy. Foreigners accounted for 24.1% of all patients; 13.7% came
from the countries of the former Soviet Union.
The number od reported syphilis cases was
increasing from 1989 to 2001, after 2001 it decreases gradually.
Syphilis incidence in Czech Republic is lower than in the states of
the former USSR, but higher than in western countries in Europe. The
migration of foreigners from Eastern Europe and Asia is likely to
continue influencing the incidence of syphilis in the Czech Republic.
According to our data symptomatic syphilis was seen more often in
man, due to the fact, that about half of women were protectively
treated during pregnancy. Public health strategies aimed at syphilis
prevention including an early identification of infected individuals,
adequate treatment, partner notification and treatment of infected
partners, elimination of high risk behaviour, and promotion of
accessibility and use of health care services with testing other STI
STATE MID-INFRARED LASERS FOR LITHOTRIPSY
in Prague, FNSPE, Physical Electronics, Prague, Czech Republic
Military Hospital, Clinic of Urology, Prague, Czech Republic
National College of Technology, Ayashi Chuo, Aoba-ku, Sendai, Japan
University, Department of Electrical Communications, Sendai, Japan
The contemporary medicine leads towards the
minimally-invasive diagnosis and treatment methods. Laser-assisted
lithotripsy is a minimally-invasive method for destroying or
disruption of human urinary stones. The aim of the presented study
was to compare in vitro
the ablation or perforation effect of Ho:YAG and Er:YAG laser
radiations tested on the artificial samples made from compressed
plaster which serve as human urinary stones model.
The interaction samples were stored in water
at room temperature (25°C) and the laser radiation was delivered to
the interaction place by the COP/Ag hollow glass waveguide terminated
with cap (in case of laboratory Ho:YAG laser and laboratory Er:YAG
laser) or by the fibre (in case of clinical Ho:YAG laser). The
interaction was carried out in contact regime. We have evaluated the
ablation effect for various laser pulse energy and various number of
pulses. From the obtained experimental data we have analyzed the
perforation rates for both investigated laser radiations.
Experimental evaluation of laser radiation (Ho:YAG or Er:YAG)
interaction with artificial samples (compressed plaster) used as
simulator of the real human urinary stones was performed in
For clinical Ho:YAG laser, laboratory Ho:YAG
laser and laboratory Er:YAG laser the perforation rates of compressed
plaster were evaluated and compared. All lasers operated in different
energy or power levels.
From the results it can be evaluated that
Er:YAG laser radiation is comparable with Ho:YAG laser in artificial
stone samples perforation efficiency. Er:YAG laser radiation is
preferable for precise tissue cutting and ablation due to its
absorption efficiency in tissue with high content of water. Therefore
the Er:YAG laser is a good candidate for urology treatments
(including laser-assisted lithotripsy) in comparison with Ho:YAG
laser, which is now “gold standard” in clinical urology.
PREVALENCE OF NON-MELANOMA SKIN CANCER IN RENAL TRANSPLANT RECIPIENTS
OBSERVED IN TRANSPLANT CENTER
Hospital, Dermatology, Banska Bystrica, Slovak Republic
Hospital, Internal Medicine, Banska Bystrica, Slovak Republic
In the last 20 years it has significantly
increased the number of patients after solid organ transplantation.
Patient survival have increased as a result
of better immunosuppressive regimens, currently the half life for
kidney grafts has nearly doubled. The dark side of a long-term
immunosuppressive therapy is an increase prevalence of skin cancer,
mainly non-melanoma skin cancer, which is 100-250 more frequent
compared with general population. The aim of our study was to find
out the prevalence of non-melanoma skin cancer in renal transplant
recipient and following the sun-protective attitudes.
160 patients after kidney transplantation
from 21-72 years were examined prospectively by cutaneus examination,
dermoscopy and by questionnary about sun protective behaviours (sun
protective clothing, using suncreens and avoiding the sun exposure).
In 14% examined patients (23/160)
non-melanoma skin cancer has been present. From those, 15/23 were
solitary (6 patients) or multiple (9 patients) actinic keratoses
(AK). In 2/23 patients basal cell carcinoma (BCC) in combination with
actinic keratoses, 2/23 solitary basal cell carcinoma has been
detected and 4/23 squamous cell carcinoma (SCC) combinated with
multiple AK has been detected. In positive group for presence of NMSC
11/23 patients were treated by combination consisting of ciclosporine
A, mycophenolate mofetil and prednisolone, 6/23 by tacrolimus,
mycophenolate mofetil and prednisolone, 3/23 by ciclosporine A and
prednisolone and 3/23 azathioprine, ciclosporine A and
prednisolone. Despite of the fact, that nearly 90%(143/160) have been
informed about sun protection, only 5/160 used strictly
Immunosuppressive regimen in kidney
transplant recipient significantly increase the rates of nonmelanoma
skin cancer. Intensive education, strict prevention, follow-up
strategy and early diagnosis with suitable therapy can decrease
morbidity and mortality of organ transplant recipients.
OF ERYTHEMA MIGRANS – EARLY SKIN FORM OF LYME BORRELIOSIS BY
University, 2nd Medical School , 1st Clinic for Infectious Diseases,
Prague, Czech Republic
University, 2nd Medical School, Clinic of Dermatology, Prague,
Due to the frequent lack of serologic
positivity, the diagnostic of erythema migrans (EM) is predominately
based on the clinical findings. The proof of specific DNA can provide
better results under some circumstances. A sensitivity and
specificity of the newly-designed targets were tested in nested PCR.
48 patients with EM diagnosed by
a dermatologist were tested for the presence of the specific DNA
in plasma and urine. The samples were taken before and after
antibiotic treatment and late after 3 and 6 months. Nested PCR was
performed by five sets of primers in parallel – targeted at 16S
rDNA, flagellin, p66 protein, OspA and OspC proteins.
Before treatment the DNA positivity was found
in 26 patients (54,2%): 8 times in plasma, 12 times in urine and 6 in
both of the media. At the end of treatment the overall positivity 6%
was made up (6 positive patients in plasma, 8 in urine, 2 in both of
the fluids). Specific antibodies were ascertained in in 9 patients
(18,3%). After 3 moths 7 samples remained positive, after 6 months
all of them were negative. Target sequences with the highest
sensitivity were following: OspA (plasma 31,6%; urine 36,4%), 16SrDNA
(plasma 36,8; 45,5%), flagellin (plasma 15,8%; urine 13,6%), OspC
(plasma 15,8%, urine 4,5%).
Laboratory diagnostic of EM made on the DNA
positivity had substantially higher sensitivity comparing with the
proof of the specific antibodies. PCR was capable to detect DNA in
plasma and in urine too whereas the sensitivity in urine was slightly
higher in all of the tested primers. In spite of the fact that
examination of DNA in urine in borreliosis is doubted in some
experiences these results show that a good balanced method is
able to provide deserving results. The arrangement of PCR being used
in our study is too expensive to use it in a clinical practice,
but picking up the two best reactive systems can provide the
practically utilizable results too.
was supported by grants IGA NR/8293 and MSM 0021620812.
CAPITIS IN 22-MONTH-OLD BOY (CASE
Hospital and Faculty of Medicine, Masaryk University, Paediatrics
Dermatology,1st Dept. of Paediatrics, Brno, Czech Republic
capitis is an uncommon disease in small children especially in
infants and toddlers. The authors present a family
case, in which the mother and her two children were affected. The
mother and the sister of our patient had tinea corporis form and they
were treated successfully with local antimycotics. Microsporum
canis was found as the etiological agent.
otherwise healthy boy had the manifestation only in his scalp. Local
therapy was ineffective, the systemic treatment with terbinafin was
started (blood account and basic biochemistry were normal). After six
weeks of this therapy local improvement was observed and the therapy
was terminated. Mycology showed Microsporum
canis again. The following therapy was
consulted with specialists (Mycology diseases specialist and Centre
for treatment of infectious diseases). The treatment with itraconazol
was started. After another 6 weeks of systemic therapy the local
finding and the mycology normalized.
aim of this presentation is to point out the importance of repeated
mycological examinations during the treatment.
OF POSTTHROMBOTIC VENOUS LEG ULCERS
Dermatology, Vrútky, Slovak Republic
The early diagnosis of the inherited
thrombophilic status resulting in repeated thromboses, repeated leg
ulcers reduces the costs of treatment.
86 patients with leg ulcers were examined –
37 men and 49 women. DNA analysis by polymerase chain reaction /PCR/
confirmed the inherited thrombophilic status – mutation of Leiden,
prothrombin gene mutation and mutation of methylenetetrahydrofolate
reductase gene in heterozygous and also in homozygous form.
Mutation of Leiden was confirmed in 12,8% of
patients, p=0,127, prothrombin gene mutation was confirmed in 7% of
patients, p=0,069, mutation of methylenetetrahydrofolate reductase
gene was detected in 58,2% of patients, p=0,58. DNA analysis for all
these mutations costs about 2304 crowns for one patient. The
inherited thrombophilic status resulting in leg ulcers is treated by
anticoagulants. Leg ulcers with decelerated healing are treated
according to phases of healing by enzymes, by means of autolytic
debridement, chemical debridement, by means of wet healing of wounds.
The prices of these means of healing of leg ulcers are high.
This study confirmed that the early diagnosis
of the inherited thrombophilic status resulting in leg ulcers reduces
the costs of treatment.
OF THE PENIS (CASE
University in Pilsen, Faculty of Medicine, Department of
Dermatovenereology, Pilsen, Czech Republic
University in Pilsen, Faculty of Medicine, Department of Urology,
Pilsen, Czech Republic
cell carcinoma (SCC) of the skin is the second commonest cutaneous
malignancy. The etiology of SCC is multifactorial; the most important
factor is UVB radiation on sun-exposed surfaces of the body. One of
the important sites of cutaneous SCC include the external genitalia
and perianal region. Anogenital SCC appears to be HPV associated,
especially with oncogenic strains such as 16 or 18. Most commonly
cutaneous SCC presents as an indurated, slow growing tumour, which is
often painless and may be nodular, ulcerated, plaque-like or
verrucous. SCC of the penis, scrotum and anus are associated with
high risk of metastases. The differential diagnosis includes
infectious and noninfectious inflammatory diseases and other tumours
as basalioma, melanoma, lymphoma and metastases. We present four
patients who had been treated as balanitis and non-specific ulcer of
penis before the diagnosis of SCC was established. One 33 year old
patient died of the symptoms of generalization. Other three patients
submitted to partial or total penis amputation followed by regional
lymphadenectomy and do not suffer from major health problems. In
conclusion, anogenital SCC is a tumour with serious prognosis.
Carcinoma of the penis should be taken into account especially in
patients with a long-lasting history of penile lesions of
different clinical appearance.
LIPOSOMAL PRODUCT CONTAINING PHTHALOCYANINE FOR TOPICAL APPLICATION
OF MALIGNANT TUMOUR PDT
University, Surgery, Prague, Czech Republic
Basic preclinical 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;
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
In most mice, the tumour completely
disappeared, which was supported by histology on the 40th day after
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.
AND FUNCTIONAL INVESTIGATIONS OF LOWER LIMBS VENOUS SYSTEM DISEASE
AND THEIR CORRELATION
S., Pospíšilová A.
Faculty of Masaryk University, Dpt. of Dermatovenereology, Brno,
In the group of 50 patients with CVD symptoms
at both lower limbs, who visited the ambulance of phlebology in the
years 2004-2006, a clinical
finding evaluation according to CEAP classification was performed and
there was carried out the investigation of the lower limbs venous
system via digital photoplethysmography and ultrasound detection.
Results comparison was performed according to CEAP at 100 lower limbs
with clinical symptoms C1-C6.
- CEAP classification
- D-PPG investigation
- Doppler ultrasonography
Resultant kappa coefficient value 0.344
corresponds with low conformity measure when comparing CVD symptoms
classification results in the class C and D-PPG results. It might be
said that D-PPG investigation results do not depend on CVD changes
clinical picture and does not practically correlate with CEAP
classification. Kappa coefficient value 0.522 corresponds with and
average conformity when comparing investigation results according to
C class of CEAP classification and ultrasound examination results.
Comparison of D-PPG investigation results and the ultrasound
examination results with kappa coefficient value 0.552 also
corresponds with the average conformity measure. Kappa coefficient
value is already significantly higher in these comparisons, however,
it is necessary to be aware that there are still cases, in which
D-PPG and ultrasound examinations do not conform in venous system
As well, the determination of reliability,
sensitivity and specificity intervals and the overall accuracy of
D-PPG and CEAP classification investigation results in relation to
DUS, did not proved sufficient reliability of these investigations,
which can not be recommended as first choice examinations at the
diagnosis of lower limbs venous system diseases and they can serve as
supplementary examinations only.
THERAPY OF HUMAN COLORECTAL CARCINOMA CELL LINE
Faculty of Medicine, Clinic of Surgery, Prague, Czech Republic
Faculty of Medicine, Department of Biophysics, Prague, Czech Republic
Photodynamic therapy has been developed in
recent years as a new modality for the treatment of various
pathologies. The method is based on the phenomenon involving the
combination of photosensitizer and light. The antitumour effects
result from direct cell damage, destruction of tumor vasculature and
activation of a nonspecific immune response. The more accepted
use of PDT is still restricted for ophthalmology, dermatology and
some form of cancer. In our experiment, the effect of phototherapy
with disulfonated hydroxyaluminium phthalocyanine and photofrin
(control group) on the growth of colorectal carcinoma was studied. We
chose colorectal carcinoma, because the Czech population has the
highest incidence and it is still increasing. We try to offer a new
possibility of treatment for patients with this severe disease.
In our study, we decided to demonstrate
efficacy of PDT with phthalocyanine for treatment of colorectal
carcinoma. Athymic mice with a human colorectal carcinoma
subcutaneously implanted to the abdominal flank were divided into 4
groups. The first group received disulfonated hydroxyaluminium
phthalocyanine, the second group received photofrin and the other two
groups were control ones. The first group with phthalocyanine and the
second group with photofrin were illuminated by xenon lamp (600-700
nm). The third group was only irradiated and the last one did not
receive any photosensitizer or irradiation.
In our study, we have shown that PDT with
phthalocyanine resulted in tumor remission after a single cycle
of therapy in 87%. Administration of photofrin led to tumor remission
in 62%. In control groups no necroses were observed and rapid spread
of tumor was confirmed. Conclusions: There
is still an increasing interest and research effort focusing on
developing new photosensitizers, exploring PDT mechanisms, and
evaluating potential clinical indications. We proved efficacy of PDT
with phthalocyanine for treatment of colorectal carcinoma. The main
advantages of PDT are: no need of anesthesia, no blood loss and
minimal postoperative pain.
MANAGEMENT OF THE RESISTANT FORM OF PEMPHIGUS VULGARIS (CASE
Ditrichová D., Urbánek J.
of Medicine and Dentistry, Palacky University and University
Hospital, Department of Dermatology and Venereology, Olomouc, Czech
vulgaris (PV) is a severe
autoimmune disease. In its etiopathogenesis play a key
role IgG antibodies which bind to desmosomal proteins. The pemfigus
antibodies reduce intercellular adherence and cause intraepidermal
blistering. Clinical picture is characterized by large flaccid
blisters and non-healing erosions on the skin and mucous membranes.
Before the introduction of corticosteroids the mortality of PV was
75% on average. Systemic corticosteroids are the best established
therapy for the management of PV. In the treatment of a resistant
cases a number of
adjuvant drugs and alternative therapeutics regimens are used.
describe a 51-year
old women with severe form of PV resistant to standard therapy.
Initially, the high doses of systemic corticosteroids were
administered and a complete
remission of the disease occurred. Daily maintenance dose of
corticosteroids (prednisolone 5-10mg) were effective in next six
months. Then relaps of PV occurred with generalized involvement of
the skin and mucous membranes. The administration of prednisolone in
daily dose 120mg was uneffective, therefore we chose combination of
prednisolone and azathioprine (200mg/day). A mild
improvement followed this therapeutic regimen and we slowly reduced
dose of systemic corticosteroids due to developement of side effects
of steroid therapy. A rapid
worsening of the disease with weight loss, weakness and developement
of a new painful
skin and mucous membrane lesions occurred two weeks later. We
recommended a pulsed
intravenous cyclophosphamide with methylprednisolone (three daily
doses of methyprednisolone 1000 mg, single dose of cyclophosphamide
500mg) with very good effect. Another pulse (three daily doses of
methylprednisolone 500mg, single dose of cyclophosphamide 500mg) we
administered one months later, between pulses we recommended oral
methylprednisolone 16mg daily. A complete
remission of the disease followed second pulse and persists for
another six months up to now.
Bata’s Regional Hospital, Department of Dermatology, Zlín, Czech
Bata’s Regional Hospital, Oncology Centre, Zlín, Czech Republic
Novel antineoplastic 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 a series 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 a combination therapy
with radiotherapy and experienced more severe radiation dermatitis
accompanied by skin xerosis. Anaphylactic reaction was observed in
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.
SYNDROME AS IDIOPATHIC AND PARANEOPLASTIC DISORDER. SLOVAK EXPERIENCE
Hospital, Dermatology, Banska Bystrica, Slovak Republic
Hospital, Dermatology, Martin, Slovak Republic
Roosevelt Hospital, Pathology, Banska Bystrica, Slovak Republic
Sweet’s syndrome (SS) or acute febrile
neutrophilic dermatosis is a rare
disorder of unknown origin chracterized by sudden onset of fever and
malaise accompanied by erythematous, sometimes bullous tender plaques
and nodules. Neutrophilia is typical laboratory finding. Histological
picture show a dense
perivascular neutrophilic dermal infiltrate and infrequently bullae
with no evidence of vasculitis. Associated conditions include
infections, malignancies, especially acute myelogenous leukemia,
inflammatory bowel diseases, autoimmune disorders, drugs and
Retrospective analysis od 11 patients with SS
2000 – 2008.
Authors present retrospective analysis of
eleven cases of SS six of them idiopatic and five paraneoplastic.
5/11 demonstrate EEM-like vesiculobullous pattern, 5/11 had the
character of papules or plaques and 1/11 was ulcerated. Associated
malignancies were 2x chronic lymphoid leukemia, 1x myelodysplastic
syndrome, 1x squamous cell carcinoma and 1x colorectal carcinoma. 3/6
idiopathic cases had signes of pharyngitis, no specific
bacterial/viral agent have been detected. Chronic form of
salmonelosis has been diagnosed in one patient. Most frequent
laboratory finding were leukocytosis (11/11), elevated ESR (11/11)
and CRP (10/11). 4/11 patients had arthralgia. All patients respond
well to intravenous pulse glucocorticoids with subsequent switch to
consequently decreasing oral intake. No recurrence has occurred.
Possible pathogenetic relations are
discussed. SS is rare, sometimes misdiagnosed disease. Searching for
malignancies seems to be important with respect to relatively high
proportion oncology disorders in this group of patients. Authors
propose the examination panel as follows: Blood count, ESR, CRP,
biopsy, anti-nuclear factor, systemic autoantibodies, bacterial
examination (salmonela, yersinia, toxoplasma, mycobacteria), virology
(HIV, CMV, HBsAg, HCV), focal infections and oncomarkers.