[ANTIMICROBIAL DRESSINGS FOR INFECTED ULCER AND CLINICAL COMPREHENSION OF BIOFILM]

Current knowledge and proofs of biofilm, interactions between various bacterial species and overall virulence of microbes play a role in delayed healing of wound and development of infection. High quality description of clinical symptoms and current knowledge of microbes provide an excellent guideline for creating the strategy of wound treatment. Owing to better understanding of the role of biofilm in prolongation of healing time and facts about biofilm system and structure, scientists have developed the Ag+ technology. This technology has strong synergistic effects of the general and antimicrobial activity of ionic silver and specific compounds, which have proved efficient in biofilm obstruction and removal.

Differences between keratoacanthoma and squamous cell carcinoma using TGF-alpha

Squamous cell carcinoma (SCC) and keratoacanthoma (KA) are skin neoplasms of epithelial origin. In contrast to clearly malignant skin neoplasm SCC, KA is an unusual cutaneous neoplasm with a tendency to regression. The distinction between these two neoplasms, on histological grounds only, is still a challenge. In order to investigate further and to assess the possible differences in transforming growth factor-alpha (TGF-alpha) expression between SCC and KA, 40 of skin tumor specimens, 20 cases of each SCC and KA were analyzed immunohystochemicaly. We have found a significant difference in staining patterns between KA and SCC. In KAs we have detected TGF-alpha staining mainly diffusely (90% of cases) and without peripheral staining of cells in 1-2 layers (60% of cases). Contrary, there was a mostly patchy staining (55% of cases) with peripheral staining of cells in 1-2 layers (100% of cases) in SCCs. Generally, differentiation between KA and SCC can be based on clinical and histological ground, but the distinction between these two skin tumors could sometimes be difficult. We have shown that these skin neoplasms could be differentiated based on staining patterns of TGF-alpha expression, thus this method could aid in differentiation between these two closely related entities in clinical practice.

Polymorphisms of vitamin D receptor gene in the population of eastern Croatia with psoriasis vulgaris and diabetes mellitus

The aim of this study was to evaluate the possible association between polymorphisms in the Vitamin D receptor gene (VDR gene) and tendency for development of psoriasis vulgaris and diabetes mellitus in the population of Slavonia, which is a region in the Eastern Croatia. In order to conduct the mentioned evaluation the restriction fragment length polymorphisms (ApaI, BsmI and TaqI) in the Vitamin D receptor gene were researched in three groups of patients: patients suffering only from psoriasis vulgaris, patients suffering only from diabetes mellitus, and patients suffering at the same time from both diseases. Four most common genotypes were found in all standardized control patients: triple heterozygotes BbAaTt (in 29.3% of the studied patients), bbAaTT (in 18.6% of the studied patients), bbaaTT (in 12.9% of the studied patients) and BbAATt (in 8.6% of the studied patients). Three most common VDR 3'-RFLP haplotypes determined in this study were: three-component baT, Bat and bAT haplotype. Results of the Hardy-Weinberg equilibrium showed presence of BsmI polymorphism genotype frequencies disequilibrium in the group of patients suffering from psoriasis and ApaI polymorphism in the group of patients suffering from both diseases. According to the same statistical test all conditions for TaqI polymorphism genotype frequency were fulfilled in all groups of studied patients. There was no significant difference in distribution of BsmI, ApaI or TaqI polymorphism genotype frequencies between control patients and any of the subgroup of studied patients. In studied population none of analysed polymorphisms individually was associated with the risk of development of psoriasis, diabetes or combined phenotype.

Descriptive epidemiology of cutaneous squamous cell carcinoma in Croatia

The aim of the study was to investigate the squamous cell carcinoma (SCC) incidence in Croatia in the 2003-2005 period. The cases of SCC were retrospectively studied. Data were collected from University Department of Dermatology and Venereology, Zagreb University Hospital Center and National Cancer Registry. In the study period, there were 1,860 cases of SCC (934 men and 926 women). The crude incidence rate for the Croatian population of 100,000 was 14.6 for men and 13.4 for women. The age-standardized incidence rate (adjusted for the world standard population) was 8.9 for men and 5.2 for women. The head was almost exclusive localization of SCC in both sexes. The highest SCC incidence was recorded in Zadar County. These results will serve for the SCC trend monitoring in Croatia and Europe in the forthcoming years.

Contact allergy caused by fragrance mix and Myroxylon pereirae (balsam of Peru)--a retrospective study

Because of their widespread use, fragrances are among the most common causes of contact allergic dermatitis, second only to nickel. During a five-year period 3,065 patients with contact dermatitis were patch tested using a specific mix of fragrances. 509 (16.6%) patients were allergic to the fragrance mix, while 258 (8.4%) patients exhibited an allergic reaction to Myroxylon pereirae (balsam of Peru). Between those 509 patients, 157 were patch tested with eight individual substances contained in the fragrance mix: cinnamal, cinnamyl alcohol, eugenol, isoeugenol, geraniol, hydroxycitronellal, alpha-amyl cinnamal and Evernia prunastri (oak moss). The most frequent allergens were isoeugenol 57.9% (91/157), eugenol 55.4% (87/157), cinnamyl alcohol 34.4% (54/157) and Evernia prunastri (oak moss) 24.2% (38/157). There were 62 patients (39.5%) who exhibited an allergic reaction to both the fragrance mix and Myroxylon pereirae (balsam of Peru). The results prove the importance of avoiding allergens in daily life, especially in industrial and cosmetic products. In order to prevent ACD, better cooperation between industry and dermatologists is needed.

[Reactions to insect stings and bites]

Reaction to insect sting and bite may be local, such as erythema, edema and pruritus, or systemic, such as anaphylactic reaction. Diagnosis can be made by patient history, clinical picture, skin testing, total and specific IgE level, and provocation test. Local reactions are treated with cold compresses, topical corticosteroids and oral antihistamines. Oral and intramuscular antihistamines and corticosteroids are used for the treatment of mild systemic reactions, and in severe reaction epinephrine injections are added. Hyposensitization is indicated in patients with severe systemic reaction, positive skin tests and high level of specific IgE antibodies.

[Atopy patch test--when is it useful?]

The aim of the article is to introduce the atopy patch test (APT) as a model of cellular immunity reaction. APT is epicutaneous test performed with food and aeroallergens, and represents a good model for T lymphocyte hypersensitivity. It is compared with skin prick test (SPT). Its value is supported by the fact that atopic dermatitis is the result of complex immune interactions and involves both Coombs and Gell reactions type IV and I. In this review, we shortly discuss the etiopathogenesis of atopic dermatitis, distinction of extrinsic and intrinsic issues, and compare the value of APT with SPT and IgE determination. APT includes epicutaneous application of type I allergens known to elicit IgE mediated reactions, followed by evaluation of eczematous skin reaction after 48 and 72 hours. The limitations of ATP include the lack of test standardization, but there also are comparative advantages over SPT and specific IgE determination. We also briefly discuss the most important food and aeroallergens. APT has been recognized as a diagnostic tool in the evaluation of food allergy and aeroallergens such as house dust mite, pollen and animal dander. APT is a useful diagnostic procedure in patients with atopic dermatitis allergic to inhalant allergens and in children with food allergy younger than 2 years. The sensitivity and specificity of the test greatly depend on the allergen tested and patient age.

[Photoallergic drug reactions]

Drug-induced hypersensitivity reactions include phototoxic and photoallergic reactions. Photoallergic reactions, which develop as cell-mediated immune responses to a light-activated compound, are described in this review article. The main topics include photobiology, list of common drugs inducing photoallergic reactions, immune response, clinical features, diagnostic and therapeutic approach. Photoallergic drug reactions can be avoided in most cases if the potential photoallergens are known and appropriate photoprotection is used.

[Atopic dermatitis in children and adults]

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease characterized by itching and typical clinical features, depending on patient age. It is often associated with other atopic diseases such as asthma or allergic rhinitis, resulting from the complex etiology and pathogenesis. It occurs more frequently in people with genetic predisposition for atopic diseases. The intensity and extent of skin lesions (Scoring of Atopic Dermatitis, SCORAD Index) vary significantly among AD patients, depending on whether it is acute or chronic, and there are variations in laboratory parameters, especially immune. In the future, it will be necessary to reach consensus on the new criteria for defining AD instead of the old ones (brought by Hanifin and Rajka 31 years ago). What is needed is effective and safe treatment, and control of the early stages of AD as well as maintaining AD remission. The new therapeutic approach in AD has greatly improved the quality of life of AD patients. As the prevalence of the disease continues to increase, we emphasize the importance of prevention, prompt recognition and optimal treatment of the many patients with AD.

[Chronologic annotation on the development of allergology and clinical immunology in Croatia]

This issue of Acta Medica Croatica is dedicated to historical development and role of allergology and clinical immunology in Croatia. Also listed are the names of experts who have historically marked allergology and contributed to its development. Understanding the origin of allergies as immune phenomena occurred in Croatia simultaneously to many other European countries. The origin and development of institutions established in the early 1920s constituted the backbone of a solid vertical line, crucial for the development of allergology and immunology in Croatia during the past century. Interest of allergology experts from various medical specialties has resulted in the establishment of Allergy Section at the Croatian Medical Association in 1952, now Croatian Society of Allergology and Clinical Immunology of the Croatian Medical Association. It turned out that the work of institutions and physicians, as well as cooperation with the Croatian Immunological Society and other scientific institutions during the second half of the 20th century provided solid foundation for contemporary research, design and development of allergy subspecialty centers and units at various medical institutions all over Croatia. Members of the Croatian Society of Allergology and Clinical Immunology have played an important role in educating new generations of physicians and in the organization of numerous research projects, symposia, congresses and seminars. Continuous, scientific and professional work has resulted in active Society membership in the European Academy of Clinical Immunology and Allergology.

[Management of allergic diseases]

Treatment of allergic diseases is based on the direct impact of the three main target areas: mast cell stabilization, preventing the release of mediators, and specific immune response. It is essential to prevent exposure to the causative allergen. Treatment is applied systemically or topically. Local treatment is preferred in many allergic skin diseases and asthma, when it is effective. Associated inflammatory components must also be treated, especially in the treatment of asthma, and not just with symptomatic agents. There is also anti-inflammatory and symptomatic treatment. Corticosteroids and antihistamines are the most commonly used drugs. Some subchapters list the benefits of individual drugs for organ systems, by their generic names. Mast cell stabilizers, beta-agonists, antihistamines, leukotriene antagonists, quinine antagonists, immunotherapy and omalizumab (anti-IgE antibody) are essential in the treatment of allergy.

[Allergologic emergencies in dermatology--diagnostic and therapeutic procedures]

Emergencies in allergology and clinical immunology are quite common and pose a public health problem in Croatia and worldwide. Allergic reactions ranging from mild symptoms such as pruritus to generalized skin eruptions, gastrointestinal and respiratory symptoms to anaphylaxis with cardiovascular emergencies are very common. Reaction develops to inhalant substances, food and food ingredients, various foreign substances (blood, latex, etc.) and many other well known antigens and drugs which are frequent causes of anaphylactic reactions, asthma, generalized urticaria, angioedema. There are 35 different skin reactions induced by drugs through immune complexes, complement mediated reactions and direct histamine liberation (by opiates or dextran) and modulators of arachidonic acid metabolism (such as NSAID). Along with painful infiltrates, insect venom allergy manifests with disseminated exanthema and angioedema. Current diagnostic methods, especially therapeutic procedures for emergencies in concordance with the international consensus of the European Allergy White Paper, require the same procedure in clinical practice. Many patients with different allergic skin diseases are treated inappropriately, some are tested in active phase of the disease, during anti-allergic therapy, and some are administered corticosteroids and antihistamines longer than necessary. Sometimes, the treatment of emergencies requires a person experienced in intensive care medicine. However, any physician might be responsible for the treatment of acute symptoms in his office, and thus has to know the modalities and relevant drugs and treatment essentials. Anaphylactic reactions are rare, but every physician should be prepared for the worst. Due knowledge of the correct management should be a must for all of us. The most common emergencies require emergency treatment and diagnostic procedures upon disease regression.

Corrective dermatology today

The field of corrective dermatology has gained remarkable development in the past two decades. New heights in techniques and the growing interest in rejuvenation procedures have resulted in an increase in the number of corrective procedures all over the world. Here we present the most frequently performed corrective procedures in dermatology today: lasers, intense pulsed light, fillers, botulinum toxin, chemical peeling, radiofrequency, and dermabrasion. Currently, the most preferable procedures are those with early visible results, short 'down-time' and minimal risk of unwanted effects. Therefore, ablative resurfacing has been mostly replaced by nonablative and fractional resurfacing, while fillers and botulinum toxin have been ever more employed. The best cosmetic results can be achieved with combination of different corrective procedures.

Molecular variants of human papilloma viruses type 16 and 6 in women with different cytological results detected by RFLP analysis

HPV infections are common and the presence of the same high-risk type in cervical specimens can be due to reinfection or persistence. Persistent infection is the most important predictor for development of cervical carcinoma. The aim of this study was to validate PCR-RFLP with two sets of primers: MY09/MY11 that amplify a fragment of L1 and P1/P2 that amplify a fragment of E1 ORF. PCR product of MY09/MY11 was digested with a set of 6 restriction enzymes (RE) and PCR product of P1/P2 with a set of 12 RE. Cervical samples from 110 women patients of the University Gynecologic Clinic CHC Zagreb were analyzed. There were 98 (89.1%) PCR positive samples detected with P1/P2 primers, and 94 (85.5%) PCR positive samples detected with MY09/MY11 primers. Seven HPV types were detected with P1/P2-RFLP technique and 17 with MY09/MY11-RFLP PCR positive samples amplified with both primer pairs agreed with each other in 82 samples; 16 samples were only positive with P1/P2 and 12 samples were only positive by MY09/MY11. HPV 16 was detected in 39 samples with MY09/11-RFLP, out of these two variants (two different patterns) were found with P1/P2 using Dde I, Hae III and Eco I. HPV 6 was detected in 9 samples with MY09/11-RFLP, out of these two variants were found with P1/P2 using HinfI. Combining these two PCR-RFLP methods subtypes of HPV 16 and HPV 6 were detected.

Skin cancers in Croatia, 2003-2005: epidemiological study

This study presents the incidence of major nonmelanoma skin cancers (major NMSCs), other nonmelanoma skin cancers (other NMSCs) and malignant melanoma (MM) in Croatia. The skin cancers recorded between 1 January 2003 and 31 December 2005 were retrospectively analyzed. Until 2003, the incidence of major NMSCs and other NMSCs was not estimated in Croatia. Incident cases of NMSCs were identified by the use of a questionnaire distributed to dermatology departments in Croatia and then collected at the University Department of Dermatology and Venereology, Zagreb University Hospital Center, and from the records kept at the National Cancer Registry. Incident cases of MM were extracted from the National Cancer Registry. During the 3-year period, 9,479 cases of major NMSCs are recorded, 4,622 (49%) in male and 4,857 (51%) in female patients. The crude incidence rate was 72.1/100,000 for males and 70.3/100,000 for females. Basal cell carcinoma (BCC) was the most common major NMSC in both sexes. In the total number of major NMSCs, there were 7,244 cases of BCC. Squamous cell carcinoma (SCC) was the second most common major NMSC. There were 1,860 SCC cases. The crude incidence rate was 54.9/100,000 for BCC in males, 53.9/100,000 in females, and 14.6/100,000 for SCC in male and 13.4/100,000 in female patients. Other NMSCs were registered in 119 cases (53% male and 47% female). The crude incidence rate was 0.9/100,000 for male and 0.8/100,000 for female patients. MM was registered in 1,427 cases (48% male and 52% female.) The crude incidence rate was 10.7/100,000 for males and females. These results will serve as reference for studying the patterns of descriptive epidemiology of major NMSCs, other NMSCs and MM in Croatia and Europe in the forthcoming years.

Role and significance of atopy patch test

Atopic eczema/dermatitis syndrome (AEDS) is a chronic, intermittent, inflammatory, genetically predisposed skin disease characterized by severe pruritus and xerosis. AEDS is a common disorder in children with an increasing prevalence. A number of environmental factors have been implicated in the pathogenesis of AEDS. Atopy patch test (APT) is a patch test using type Iota allergens known to elicit IgE mediated reactions. Results are evaluated after 48 and 72 h. APT has been recognized as a useful diagnostic tool in the diagnosis of delayed type of reaction in AEDS since specific IgE (sIgE) and skin prick test (SPT) can be only correlated with early reactions. Standardized technique has been proposed by the European Task Force on Atopic Dermatitis. It consists of purified allergen preparation in petrolatum, applied in 12 mm diameter Finn chambers mounted on Scanpor tape to non-irritated, non-abraded, or tape-stripped skin on the upper back. Optimal results were obtained with petrolatum, in aeroallergen concentration over 5000 PNU. Food allergy takes place in the first years of life, while the role of aeroallergens becomes more significant in older children and adults. A common scenario is development of allergy to cow's milk early in life, usually accompanied by allergy to hen's egg and wheat. Up to 3 years of age, the child usually becomes tolerant to food and sensitization to one of multiple aeroallergens occurs. The children that will develop clinically relevant reactions to food may benefit from elimination diets. APT has been recognized as a diagnostic tool in food allergy evaluation, but its role remains controversial and double blind placebo controlled food challenge remains the gold standard. It has a role in the detection of gastrointestinal manifestations of allergy and in eosinophilic esophagitis. When the symptoms occur at air-exposed sites, the role of aeroallergens is possible. Today, the most commonly used aeroallergens are house dust mite, pollen and animal dander.

Comparison of diagnostic value of indirect immunofluorescence assay and desmoglein ELISA in the diagnosis of pemphigus

Pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are autoimmune blistering diseases characterized by intraepidermal separation as the result of autoantibodies directed to desmoglein 1 and desmoglein 3, adhesion molecules that have a pathogenic role in blister formation. Both PV and PF are diagnosed according to clinical picture, histopathologic, immunopathologic and molecular biologic features. In the present study, the value of indirect immunofluorescence (IIF) and enzyme linked immunosorbent assay (ELISA) for desmoglein 1 (Dsg 1) and desmoglein 3 (Dsg 3) at baseline visit was compared. The study was performed as a retrospective study that included 22 patients, 19 of them with PV and three with PF. Patient sera were tested with IIF and Dsg 1 and Dsg 3 ELISA. In the group of 19 PV patients, 12 patients had positive IIF, Dsg 3 and Dsg 1 ELISA; two had positive IIF and positive anti Dsg 3 but negative anti Dsg 1; three had negative IIF but positive both Dsg 1 and Dsg 3 antibodies; and two had negative IIF and Dsg 1 but positive Dsg 3 antibodies. In the group of PF patients, all three patients had positive IIF, positive Dsg 1 ELISA and negative Dsg 3 ELISA. Results of our study supported previous reports confirming Dsg 1 and Dsg 3 ELISA to be a sensitive and specific tool for the diagnosis of PV and PF.

Adverse cutaneous reactions to psychopharmaceuticals

Adverse cutaneous reactions to psychoactive drugs are common. They disturb and interrupt therapy often leading to non-compliance. The majority of adverse cutaneous reactions are benign if they are promptly recognized. Withdrawal of suspected drug is the first step for consequent treatment. As some adverse cutaneous reactions are life threatening, the most important action is to discontinue the drug usage promptly, thus minimizing morbidity. It is very important for physicians to be aware of the potentially serious adverse skin reactions to psychoactive drugs. Patients must be provided with simple information on these adverse effects.

The frequency of superficial mycoses according to agents isolated during a ten-year period (1999-2008) in Zagreb area, Croatia

Fungal infections involving the skin, hair and nails represent one of the most common mucocutaneous infections. Significant changes in the epidemiology, etiology and clinical pattern of mycotic infections have been observed during the last years. The aim of this retrospective study was to determine the incidence and the etiologic factors of superficial fungal infections in Zagreb area, Croatia, over a 10-year period (1999-2008). A total of 75828 samples obtained from 67 983 patients were analyzed. Dermatomycosis was verified by culture in 17410 (23%) samples obtained from 16086 patients. Female patients were more commonly affected than male (59% vs. 41%). Dermatophytes were responsible for 63% of all superficial fungal infections, followed by yeasts (36%) and molds (1%). Trichophyton (T.) mentagrophytes (both var. interdigitalis and var. granulosa) was the most frequent dermatophyte isolated in 58% of all samples, followed by Microsporum (M). canis (29%) and T. rubrum (10%). The most common clinical forms of dermatomycosis were onychomycosis (41%), tinea corporis (17%) and tinea pedis (12%). Candida spp. was mainly isolated from fingernail debris.

[What should we know about venous and arterial ulcers?]

Chronic venous insufficiency starts by promoting the case of events. This results in pathologic venous and tissue changes consequential to chronic venous insufficiency. In this article, chronic venous insufficiency is defined as an abnormal function of the venous system due to venous valvular incompetence with or without associated venous outflow obstruction, which may involve the superficial venous system, deep venous system, or both. Long-term venous hypertension may present by a variety of clinical manifestations in terms of the severity and duration of venous circulation damage. Venous leg ulcer occurs in distal part of the shin, mostly around medial malleolus. The base of the ulcer is often covered by a yellowish fibrin layer. The surrounding skin is hyperpigmented, usually irritated by ulcer secretion, and inflamed. Arterial leg ulcer is caused by arterial insufficiency. It is round-shaped with dry basis and involves deeper structures, up to tendons. The skin is dry, atrophic, cool, pale, smooth, and hairless. Therapy of ulcers is demanding and consists of numerous general measures, topical and/or systemic therapy. Topical therapy consists of cleansing, mechanical debridement, disinfection and stimulation of granulations and epithelialization with prevention of secondary infection. Therapy with currently available bio-occlusive wound dressings is most effective. These dressings are hydrocolloids, hydropolymers, transparent films, alginate, and ionic silver. Vascular protectors, venetonics and antiaggregation medications can be used in systemic therapy.

[Diagnostic-therapeutic guidelines for men whose partners have HPV genital infection]

Human papilloma virus infection is the most frequent sexually transmitted disease. HPV infections are connected with different diseases such as benign warts, condylomata acuminata, malignant cervical, vulvar, vaginal, penile and anal carcinoma. Peniscopy with HPV detection is a specific diagnostic method for diagnosis of subclinical HPV genital infection in asymptomatic men. Taking the samples for HPV detection from asymptomatic men with curette is more qualitative way of getting enough samples then taking swab with wooden stick or (tongue) depressor. Early diagnosis and treatment of HPV infections in men is of potential benefit because their eradication can reduce the viral reservoir and as the result of that the incidence of CIN, carcinoma in situ and invasive cervical carcinoma can be reduced. For the correct diagnosis and for choosing the adequate therapeutical technique, we suggest diagnostic-therapeutic guidelines for HPV genital infection in men.

Treatment of chronic urticaria

Urticaria is a disorder characterized by rapid onset of localized swelling of the skin or mucosa, called wheals or urtica. According to frequency and duration, urticaria can be divided into acute and chronic type. Chronic urticaria is any type of urticaria occurring every day or twice per week, lasting longer than 6 weeks. Chronic urticaria is a common disorder and estimated prevalence is 1% of the population. Also, it is not rare in childhood. The pathogenesis of chronic urticaria has not yet been completely understood. Chronic urticaria is a heterogeneous group of disorders, and according to the etiology and cause, several groups of chronic urticaria are distinguished, i.e. autoimmune, pseudoallergic, infection-related, physical urticaria, vasculitis urticaria and idiopathic urticaria. Treatment and management of chronic urticaria can be non-pharmacological and pharmacological, and sometimes it is not possible to control the disease with antihistamines only, which are considered to be the mainstay of treatment. In severe cases of chronic urticaria, especially if autoimmunity has been proven, several authors describe different modules of immunomodulation: cyclosporine, cyclophosphamide, mycophenolate-mofetil, omalizumab, plasmapheresis, systemic corticosteroids, and immunoglobulin therapy. This article primarily addresses the treatment of chronic idiopathic and autoimmune urticaria.

The role of CD4 and CD8 lymphocytes and macrophages in psoriasis vulgaris

Current knowledge of the immunopathogenesis of psoriasis vulgaris is based on the crucial role of CD4 and CD8 lymphocytes. Also, the connection of activated lymphocytes with macrophages, especially dendritic cells and plasmacytoid dendritic cells, is considered to be significant. In the present study, the expression of CD4+ lymphocytes as well as CD8+ lymphocytes (P < 0.001) and macrophages (P < 0.001) was found to be significantly increased in lesional skin epidermis and dermis in psoriasis vulgaris patients as compared with healthy skin. These findings suggested a cascade or chain reaction with cells and cytokines playing an important role to be involved in the immunopathogenesis of psoriasis vulgaris.

Antipruritic effect of natural superoxide dismutase--sensory evaluation

The primary objective of the study was to evaluate the antipruritic effect of natural superoxide dismutase in the cosmetic product Sodermix cream. In this randomized intra-individual study including 15 volunteers, 14 female and one male, mean age 41 +/- 4 (range 18-66) years, the cosmetic product Sodermix cream was evaluated according to the Dermscan Group protocol by recording thermal sensitivity levels using Cutaneous Thermal Sensitivity analyzer before and 30 and 90 minutes after the product application. The study was conducted from April to June 2008. Study results showed a decrease in the lengths of pruritus 30 minutes of the product application onto the treated zone and a significant decrease in pruritus intensity 90 minutes of the product application onto the treated zone. The study allows for evaluation of physical sensation and quantification of heat with cutaneous thermal sensitivity measurements as a psycho-physical method to evaluate variables of thermal sensations in relation to variables by thermal stimuli. The study demonstrated a significant antipruritic effect of Sodermix cream.

The genetics of psoriasis--selected novelties in 2008

The genetic background of psoriasis is clearly demonstrated by the familial occurrence, data from epidemiological studies, twin studies, and results of genome-wide scan investigations. In the last years, molecular genetics analyses have permitted new insights into psoriasis. A number of studies indicate the likely genomic location of psoriasis susceptibility genes and suggest their possible identity and function. According to current concepts, psoriasis is caused by the interplay of multiple genes and different trigger factors, and the disease is classified in the group of genetically "complex" diseases. The first associated locus (PSORS1) resides within the HLA region (6p21.3). Strong association of HLA-Cw6 allele at this locus was first reported in Finnish population over 26 years ago. However, the exact location of PSORS1 gene remains controversial due to extensive linkage disequilibrium across the region. Two genes lying within this interval have been intensively studied with respect to their role in psoriasis susceptibility: HCR and corneodesmosin (CDSN). The precise location of PSORS 1 is under intense screening. Other candidate loci identified by genetic linkage research include PSORS 2 (17q25), PSORS 3 (4q34), PSORS 4 (1q21), PSORS 5 (3q21), PSORS 6 (19p13), PSORS 7 (1p32), PSORS 8 (16q) and PSORS 9 (4q31). Despite a large body of new data, the extent of genetic heterogeneity and the role of environmental triggers and modifier genes have not yet been clarified. The isolation of novel susceptibility genes will provide an insight into the precise pathways that control the disease. Such pathways will also reveal additional candidate genes that can be tested for molecular alterations resulting in the disease.

Neurofibromatosis type 1 associated with dysplastic nevus syndrome

Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder that primarily affects the development and growth of neural cell tissues. It causes tumors to grow on nerves and produces other abnormalities such as skin changes and bone deformities. Dysplastic nevus syndrome (DNS) represents multiple atypical nevi associated with polygenetic inheritance pattern and may rarely occur together with NF-1. DNS type A is a marker of increased melanoma risk, while melanoma has been rarely reported in patients with NF-1. We describe a case of NF-1 type A with DNS presenting with multiple neural tumors, cafe-au-lait spots, hamartomas in globus pallidus and pigmented melanocytic iris hamartomas (Lisch nodules). The importance of close follow up of nevi in such patients with NF-1 and DNS for the development of melanoma as well as other NF-1 associated skin disorders and with multidisciplinary approach to other associated diseases is highlighted.

Allergic contact dermatitis to antibacterial agents

Topical antibiotics are frequently introduced in therapy by various specialists, e.g., dermatologists-venereologists, ENT specialists, proctologists, ophthalmologists, and others. In dermatology, topical antibiotics are used in the treatment of superficial inflammatory skin lesions, acne and rosacea. These agents are also used in the prevention of inflammatory lesions after surgical and corrective procedures. Long-term and uncontrolled application of topical antibiotics, on the skin with impaired protective barrier in particular, implies a risk for the development of hypersensitivity to these agents. Considering the very wide utilization of these agents, hypersensitivity to topical antibiotics poses a major problem worldwide. The groups at a high risk of contact sensitivity to topical antibiotics include patients with chronic venous insufficiency, chronic ulcers and chronic otitis externa, as well as individuals at occupational exposure to antibiotics, e.g., human medicine and veterinary medicine professionals, pharmaceutical industry workers, cattle breeders, etc. When long-term therapy fails to result in improvement in the above mentioned chronic states, the possibility of allergic reactions to topical agents should be taken in consideration. Cross-sensitivity, which is frequently associated with the use of topical aminoglycoside antibiotics, poses a significant problem.

Psoriasis in pregnancy: a review of most important literature data

In women with psoriasis, the course of the disease during conception, pregnancy and delivery generally does not differ from other individuals involved. In psoriasis patients, pre-pregnancy period offers time to learn about the hereditary nature of the disease, the effect of hormonal changes and acceptable treatments during pregnancy. In the majority of patients, psoriasis improved during pregnancy and worsened six weeks after delivery. Women should tell their dermatologist early if they plan to become pregnant and the treatment during pregnancy should be considered carefully. This article provides a short review of the most important literature data on therapeutic options for psoriasis in pregnancy.

Dermatologic medication in pregnancy

In female body, a vast number of skin changes occur during pregnancy. Some of them are quite distressing to many women. Therefore, performing treatment for physiologic skin changes during pregnancy with antiinfective agents, glucocorticosteroids, topical immunomodulators, retinoids, minoxidil, etc., is discussed. Drug administration during pregnancy must be reasonable.

[Significance of atopic diathesis in atopic diseases prediction]

INTRODUCTION

Atopy is a complex disorder characterized by affinity for elevated titre of IgE antibodies against one or more ubiquitous antigens, by the joint respiratory and skin manifestations, that is caused by an individual gene structure. Urticaria is a monomorphous dermatosis meaning a short-lived eruption of urticaria, characterized by circumscript edema of superficial dermis.

AIM

The objective of this study was to establish a participation of atopic genesis in the examined groups, on the basis of the questionnaire results.

PATIENTS AND METHODS

The study involved 184 subjects, 10-60 years old, divided into the group with atopic diseases (70), the group with chronic urticaria (66), and the group with healthy controls (48). The questionnaire contained data on the family and personal history, clinical symptoms (dry skin, sneezing, eye-tearing, heavy breathing, etc.), and total IgE values in periphery blood. Each of these symptoms was qualified by curtain number of points (0.5-2), and the testees were classified into the groups according to the total score: with no atopic diathesis (0-8), unclear atopic diathesis (8-12), probable atopic diathesis (12-16), and clear atopic diathesis (over 16 points).

RESULTS

atopic diathesis (probable and clear) was confirmed in 70% of subjects in the atopic disease group, in 27.3% subjects with chronic urticaria, while in the healthy controls atopic diathesis was not registered (probable and clear).Statistical significance is present between atopic diseases group (15.4 +/- 3.6) and the rest of groups (8.8 +/- 3.9) according to the total score values in the questionnaire (p < 0.0001).

CONCLUSION

Atopic diathesis monitoring used in our study was proved as a good method for atopy recognition, that is confirmed statistically, as well. The score value was tested by the logistic regression, which enabled a possibility of atopic diseases prediction on the basis of the total score value from the questionnaire.

The incidence of basal cell carcinoma in Croatia: an epidemiological study

The aim of the study was to investigate the basal cell carcinoma (BCC) incidence in Croatia in the 2003-2005 period. Data were collected from University Department of Dermatology and Venereology, Zagreb University Hospital Center and National Cancer Registry. The age-specific incidence rate and age-standardized incidence rate were calculated per 100,000 inhabitants according to the latest population census in Croatia from 2001. In the study period, there were 7,244 BCC cases (3,519 men and 3,725 women) in Croatia. The crude incidence rate for the Croatian population of 100,000 was 54.9 for men and 53.9 for women. The age-standardized incidence rate (adjusted for the world standard population) was 33.6 for men and 24.5 for women. The head and neck were almost exclusive localizations of BCC. The highest BCC incidence was recorded in Zadar County. The incidence of BCC was high in both littoral and inland counties of Croatia. Study results will serve as reference figures on studying the trend of BCC incidence in Croatia and Europe in the forthcoming years.

The basis of topical superoxide dismutase antipruritic activity

In humans, as in all mammals and most chordates, three forms of superoxide dismutase (SOD) are present: SOD1 is located in the cytoplasm, SOD2 in the mitochondria, and SOD3 is extracellular. SOD is used in cosmetic products to reduce free radical damage to the skin, for example, to reduce fibrosis following radiation for breast cancer. Pruritus is one of the most common symptoms of skin diseases, but can also be a major symptom of systemic diseases (e.g., malignancy, infection or metabolic disorders). There are various antihistaminics used as antipruritogenic substances. In the genesis of pruritus there are many pruritogens involved, not only histamine and leukotrienes such as acetylcholine, cytokines, kallikreins, proteases, kinins, opioids, etc., which are described. On many occasions, we observed that topical SOD seemed to possess strong antipruritic activity, even in anti-histamine-resistant pruritus. We analyzed literature data on the effect of SOD as an anti-pruritogen on NK-1 receptors and proinflammatory cytokines, its regulatory role in calcitonin gene-related peptide production and expression, down-regulation of TNF- and numerous cytokines, and suppression of nitric oxide production.

Genital contact allergy

Irritant and allergic contact dermatitis is commonly seen in patients complaining of itching, burning and irritation in the genital area. The aim of this retrospective study was to establish the prevalence of allergic contact dermatitis patients with genital complaints. We followed 33 patients with persistent or recurrent genital redness, itching and burning sensation. Diagnosis was made by history, clinical examination and patch testing. Patch tests were carried out according to the International Contact Dermatitis Research Group with a standard series of allergens. We also tested topical pharmaceutical products that individual patients used for treating genital symptoms and patients self intimate hygiene products. There were 11 male and 22 female patients, mean age 38 years. Thirteen (39%) patients had one or more positive allergic reactions, mainly to nickel-sulfate, thimerosal, balsam of Peru, formaldehyde and neomycin sulfate. In seven of 13 patients with positive patch test results, these reactions were considered to be relevant to their clinical condition. Three patients had positive patch test reactions to their intimate hygiene products. One patient had positive patch test reaction to latex condom. Patients with genital symptoms are at a risk of developing contact sensitivity. Patch testing is useful in the management of these patients and many can be helped by allergen avoidance.

Could anti IL12/23 therapy replace anti-TNF biologics?

Biologic therapies improved dramatically the outcome of psoriatic arthritis and moderate to severe chronic plaque psoriasis. Anti-TNF agents were developed approximately one decade ago by rheumatologists and today represent one of the most effective classes of drugs in severe psoriasis resistant to 2 out of 3 "classic" systemic therapies (methotrexate, cyclosporine, and PUVA). Recent studies on psoriasis pathogenesis were focused on early steps of the inflammatory cascade, i.e. activation of T cells with a recently described phenotype Th17 and consequent expression of interleukins (IL) 12 and 23. IL12 and IL23 have a common p40 subunit that is a target of a new therapeutic class, fully human monoclonal antibodies anti IL12/23: ustekinumab and ABT-874. Randomized, placebo-controlled clinical trials in patients with moderate to severe chronic plaque psoriasis using ustekinumab and ABT-874 showed PASI 75 achievements at week 12 in 80% and 93% of patients, respectively. Larger studies are ongoing in order to assess the safety profile of this new therapy. As anti-TNF drugs represent an important and effective treatment of psoriatic arthritis and moderate to severe plaque psoriasis, comparative studies are needed to assess the advantages, the safety and the place of anti-IL12/23 in the era of biologic therapy.

Halo phenomenon with regression of acquired melanocytic nevi: a case report

We report a case of halo-phenomenon in excisional biopsy of junctional nevi in a 19-year-old girl. The diagnosis was established histopathologically because of the lack of clinical halo and unspecific dermoscopic features. Clinicopathologic difficulties in establishing the diagnosis of these pigmented lesions, etiopathogenesis and differential diagnosis of halo nevi are emphasized. Dermatologists should be familiar with the possible changes in benign melanocytic nevi, halo reactions and possible complete regression of melanocytic nevi. Diagnostic difficulties are seen in the ultimate phase of regression when melanocytes are diminished or destroyed with immune reaction.

Immunologic aspects of atopic dermatitis

Atopic dermatitis/eczema is a chronically relapsing, pruritic, and inflammatory skin disease. The term "atopic eczema/dermatitis syndrome" covers the "extrinsic" and "intrinsic" atopic dermatitis. The pathogenesis of atopic dermatitis includes complex interaction between the genetic background, skin barrier defects, abnormalities in innate and adaptive immunity, abnormalities of humoral and cellular immunity, and environmental influences. Understanding the immunopathogenesis of atopic dermatitis leads to new diagnostic and therapeutic approaches. The targets in atopic dermatitis are innate immunity including improvement of skin barrier defects by supplementing lipids or inhibiting proteases, and regulating antimicrobial peptides, adaptive immunity, and induction of regulatory T cells.

Nonallergic hypersensitivity to nonsteroidal antiinflammatory drugs, angiotensin-converting enzyme inhibitors, radiocontrast media, local anesthetics, volume substitutes and medications used in general anesthesia

Urticaria and angioedema are common allergic manifestations and medications are one of common triggering factors. The most severe immediate drug reaction is anaphylaxis. Apart from the well established IgE-mediated immediate type hypersensitivity reactions, the pathogenesis of drug-induced urticaria, angioedema and anaphylaxis often remains obscure. In this article, emphasis is put on nonallergic reactions to the most commonly used drug groups of nonsteroidal antiinflammatory drugs, angiotensin-converting enzyme inhibitors, radiocontrast media, volume expanders and drugs used in general anesthesia. Urticaria is the second most common drug eruption after maculopapular exanthema. The mechanisms of acute urticarial reactions are multiple, mostly IgE mediated, but some drugs can induce immune complex reactions and activate complement cascade, while others can induce direct activation of mast cells and degranulation or activation of complement by non-immune mechanisms. With different types of medications different pathomechanisms are involved. Non-steroid anti-inflammatory drugs are thought to cause reaction due to cyclooxygenase-1 inhibition and overproduction of leukotrienes, blamed for cutaneous and respiratory symptoms. Angiotensin-converting enzyme inhibitors can cause fatal angioedema, which is partially explained with bradykinin excess and impairment of aminopeptidase P and dipeptidyl peptidase IV that are involved in the metabolism of substance P and bradykinin. It remains unknown what additional mechanisms are involved. Radiocontrast media and local anesthetics mostly cause nonallergic hypersensitivity reaction, but in rare cases true allergic reaction can occur. Dextran is known to cause IgG mediated, immune complex anaphylaxis and it is recommended to use human serum albumin as the safest colloid.

Influence of PUVA and UVB radiation on expression of ICAM-1 and VCAM-1 molecules in psoriasis vulgaris

The expression of adhesion molecules Intercellular adhesion molecule-1 (ICAM-1) and Vascular cell adhesion molecule-1 (VCAM-1) is increased in lesional and in non-lesional skin of psoriatic patients, and play role in pathogenesis of the disease. PUVA and UVB therapy are important treatments of psoriasis vulgaris. It has been demonstrated that UVA and UVB therapies reduce expression of these molecules. In this investigation, phototherapy was used to treat psoriatic patients. The expression of these molecules was examined by immunohistochemical method in lesional and non-lesional skin of 10 patients with psoriasis vulgaris before and after treatment. Results showed increased expression of ICAM-1 molecules in keratinocytes, in perivascular infiltrate--lymphocytes, and in endothelial cells. The expression of VCAM-1 molecules was also increased, although with less intensity then ICAM-1. After therapy, the expression of the adhesion molecules decreased together with a marked improvement of the disease. In conclusion, study demonstrated that phototherapy improves psoriasis vulgaris probably through mechanisms acting on the adhesions molecules. Adverse reactions due to intense or long lasting UVA (PUVA) and UVB therapies are immunosuppression and damage of DNA which can lead to development of non-melanocytic skin tumors like basal cell carcinoma and squamous cell carcinoma, as well as melanoma.

Correlation between clinical-dermatoscopic and histopathologic diagnosis of skin tumors in our patients

In this study 103 patients with skin tumors were examined. Among them there were 43 (42%) male patients and 60 (58%) female patients. Working diagnosis was obtained by clinical examination using dermoscope. After excision of lesion, working diagnosis was compared to pathohistological diagnosis. In our study we used dermoscope Heine proper delta 10. The clinical-dermoscopic diagnosis included verrucae seborrhoicae in 26 (25.24%), fibropapilloma in 17(16.5%), naevus pigmentosus in 9 (8.79%), naevus dysplasticus in 4 (3.88%), fibroma molle in 8 (7.76%), Mb. Bowen in 1 (0.97%), basal cell carcinoma in 7 (6.79%), squamous cell carcinoma in 6 (5.82%), haemangiofibroma in 1 (0.97%), haemangioma in 3 (2.91%), keratosis actinica in 5 (4.85%), melanoma malignum in 6 (5.82%), naevus fibromatosus in 2 (1.94%) cases and naevus blue in 1 (0.97%), naevus traumatisatus in 1 (0.97%), verruca vulgaris in 1 (0.97%), lymphocytoma in 1 (0.97%), naevus verrucosus in 1 (0.97%), lentigo solaris in 2 (1.94%) and Reed nevus in 1 (0.97%) case. Dermoscopic diagnosis were conformable with pathohistological diagnosis in 75 cases (72.82%). We presumed that dermatoscoping obtains correct diagnosis of skin tumors.

Human papilloma virus associated with genital infection

Genital human papillomavirus (HPV) infections are among the most common sexually transmitted diseases. HPV is associated with a spectrum of diseases ranging from benign vulgar verrucae and condylomata accuminata to malignant cancers of the cervix, vulva, anus and penis. Genital HPV is in most cases transmitted sexually, but non-sexual routes of transmission, such as perinatal and autoinoculation, are possible. Men can be a reservoir of the virus that lives in latent or subclinical form on genital mucosa. Such an asymptomatic infection may be an oncogenic factor in the development of cervical cancer Colposcopic examination of the genitalia after the application of 3-5% acetic acid is a reliable method for the identification of subclinical HPV infection. Successful therapy of anogenital warts is characterized by their complete clearance, as well as by the lack of recurrence. Current treatments do not reliably eradicate HPV infections. The diagnosis and therapy of HPV infection in men is potentially beneficial because the eradication of penile HPV infection may decrease the reservoir of the virus.