History of Psoriasis

Psoriasis is probably as old as mankind. Today, it is a well defined skin disease, in which genetic, environmental and immunologic factors participate in etiopathogenesis. However, despite its frequency, chronicity and visibility, it is quite hard to find a description of psoriasis in the works of the ancient physicians. Dermatology developed slowly, first with appearance of the protodermatologists at the end of the 18th century, and continued with the arrival of the first dermatologists. From those times psoriasis became a distinct entity. However, until the last century, the descriptions of disease considered «morbi in pulchredine», were rather vague, the denomination not standardized and the translation from one language to others discrepant. Different authors called the disease with various names, while diverse diseases had the same names. The confusion in terminology and description of psoriasis lasted for centuries

CURRENT CONCEPTS IN THE PATHOGENESIS AND TREATMENT OF ACNE

Acne su bolest pilosebacealne jedinice kože s raznovrsnom kliničkom slikom. Bolest nastaje pod utjecajem više čimbenika, pri čemu najveću važnost ima pojačana produkcija loja, poremećaj orožnjavanja folikula, naseljavanje bakterija u pilosebacealni kanal te spremnost folikula na upalnu reakciju. Liječenje uključuje lokalne protuupalne pripravke, antibiotike i sredstva za ljuštenje kože, sistemske antibiotike, lokalne i sistemske retinoide, te hormonske agoniste i antagoniste. Svrha je članka pregled patogeneze i terapije, uz posebni osvrt na nove mogućnosti liječenjaAcne vulgaris is a disease of the pilosebaceous unit of the skin and may present in a wide variety of clinical forms depending on the type, number and severity of the predominant lesion. The driving forces for the development of acne are an increased sebum production, ductal cornification, bacterial colonisation of the pilosebaceous duct and inflammation. Various effective treatments include topical anti-inflammatory, antibiotic and peeling agents, oral antibiotics, topical and oral retinoids, and hormonal agonists and antagonists. The purpose of this paper is to provide a review of the pathogenesis and treatment of acne with special emphasis on the new concepts of therapy

CURRENT CONCEPTS IN THE PATHOGENESIS AND TREATMENT OF ACNE

Acne su bolest pilosebacealne jedinice kože s raznovrsnom kliničkom slikom. Bolest nastaje pod utjecajem više čimbenika, pri čemu najveću važnost ima pojačana produkcija loja, poremećaj orožnjavanja folikula, naseljavanje bakterija u pilosebacealni kanal te spremnost folikula na upalnu reakciju. Liječenje uključuje lokalne protuupalne pripravke, antibiotike i sredstva za ljuštenje kože, sistemske antibiotike, lokalne i sistemske retinoide, te hormonske agoniste i antagoniste. Svrha je članka pregled patogeneze i terapije, uz posebni osvrt na nove mogućnosti liječenjaAcne vulgaris is a disease of the pilosebaceous unit of the skin and may present in a wide variety of clinical forms depending on the type, number and severity of the predominant lesion. The driving forces for the development of acne are an increased sebum production, ductal cornification, bacterial colonisation of the pilosebaceous duct and inflammation. Various effective treatments include topical anti-inflammatory, antibiotic and peeling agents, oral antibiotics, topical and oral retinoids, and hormonal agonists and antagonists. The purpose of this paper is to provide a review of the pathogenesis and treatment of acne with special emphasis on the new concepts of therapy

Tinea Incognito Due to Trichophyton Rubrum – A Case Report

Tinea incognito is a dermatophyte infection modified by inappropriate and often prolonged use of topical steroids. We present a case of tinea incognito in a 72-year-old woman, referred by her family physician who had unsuccessfully treated the lesions for 3 weeks with topical steroid cream. Physical examination revealed multiple nummular scaly papules and plaques which spread over her arms and trunk. The lesions were circular, erythematous, sharply demarcated with raised scaly edge some coalescing to form moderately infiltrated areas. Direct microscopy was positive for fungal hyphae. Fungal culture on Sabouraud’s agar grew Trichophyton rubrum. The patient was successfully treated with oral terbinafine 250mg daily and 1% clotrimazole cream twice daily. The present case highlights the importance of considering a dermatophytosis when clinical presentation of dermatosis is atypical. Disseminated scaly infiltrate lesions should be investigated for fungal infection in patients previously treated with steroids, as to avoid misdiagnosis and spread of infection

Giovanni Battista Cambieri and the Beginning of Venereology in Rijeka Region

In 1790, an infectious disease appeared in the village of Škrljevo near Rijeka, and spread to the nearby villages and then to Istria, Slovenia and other parts of Croatia. In 1800, the nature of the disease was first investigated by the protomedicus Massich, who believed it was a combination of syphilis and scabies. After him, the protomedicus of the region G. B. Cambieri, who graduated in Pavia and came to Rijeka in 1797, studied the illness, gave a description of the disease and believed it was a morbus sui generis, and termed it morbus of Scherlievo. He was a gifted physician, used all his knowledge, skills and organization capabilities to arrest the disease, and published his works in Italian journals (in 1812 and 1819). Cambieri studied the disease in thousands of patients in local hospitals, and took the initiative to open a new Civic Hospital with a department of syphilidology. He divided the disease into four stages and with permission of the authorities he tried different therapies. With time, he found the disease to be a form of syphilis and treated it with mercury compounds. After his death in 1838, he left his money to the Hospital of Holy Spirit in Rijeka (Cambieri Foundation), which permitted its developmen

Occupational Skin Diseases Caused by UV Radiation

This overview highlights the risk of skin diseases arising in workers exposed to ultraviolet radiation (UVR) at their workplace. There is a plethora of skin manifestations in outdoor workers such as seamen, fishermen, farmers after acute intense or long-term exposure to solar UVR, but some cutaneous diseases may also develop in indoor workers exposed to artificial sources. In recent years, investigations of the biological effects and damage caused by UVB and UVA on the skin have improved our understanding of the cellular and molecular mechanisms of photoaging, skin cancer and other skin diseases caused by UVR exposure. The necessity of primary prevention in workers exposed to UVR is emphasize

Probiotic use in the prevention and therapy of atopic dermatitis

Pojavnost atopijskog dermatitisa (AD) tijekom posljednjih desetljeća u porastu je, što je osobito izraženo u zemljama zapada. Smatra se da je uzrok smanjena izloženost mikroorganizmima tijekom najranijeg djetinjstva i posljedično smanjena stimulacija imunološkog sustava. Budući da crijevna mikroflora predstavlja prvi i najveći izvor mikrobnog opterećenja, promjene u njezinu sastavu i raznovrsnosti smatraju se čimbenikom nastanka AD-a. To je razlog zašto se probiotici, zahvaljujući svojoj sposobnosti manipulacije sastavom mikroflore i imunomodulatornim učincima, smatraju mjerom prevencije i liječenja atopijskog dermatitisa. Dosadašnje studije ukazuju na njihov preventivni potencijal, no kao terapijska intervencija nisu pokazali pozitivne učinke. Ipak, primjena probiotika u AD-a za sada je ostala predmetom istraživanja, a buduće studije trebale bi razjasniti zaslužuju li oni mjesto među ostalim preventivnim i terapijskim mjerama te razriješiti nedoumice glede njihove primjene.The prevalence of atopic dermatitis (AD) has risen over the past decades, and this is especially expressed in western countries. Reduced microbial exposure during infancy and therefore reduced stimulation of immune system is considered to be the cause for this rising prevalence. Intestinal microbiota represents the first and major source of microbial exposure and therefore the changes in its composition and diversity are considered to be responsible for development of AD. That is why probiotics are, owing to their ability to manipulate the composition of microbiota and their immunomodulatory effects, considered to be a promising prevention and therapeutic intervention of atopic dermatitis. Former studies indicate that they have a preventing potential, but their therapeutic effects have not been proven. However, probiotic use in AD is a subject of reasearches at the moment, and future studies should clearify if they deserve a place among the other preventive and therapeutical measures and resolve uncertanities regarding their administration

Tumor necrosis factor antagonists in the treatment of pyoderma gangrenosum, acne and suppurative hidradenitis (PASH) syndrome

The clinical triad of pyoderma gangrenosum (PG), acne and suppurative hidradenitis (HS) has been described under the acronym PASH syndrome and is considered to represent a distinct entity in the group of autoinflammatory diseases. It is a fairly new, only recently recognized disorder with a limited number of reported cases and without defined treatment recommendations. We aimed to summarize currently available data on the use of tumor necrosis factor (TNF) antagonists in the management of PASH syndrome and report on our own experience with the use of adalimumab in a patient presenting with this specific constellation of clinical signs and symptoms. Among the 11 cases identified in the literature, infliximab and adalimumab were the most commonly used agents, both exhibiting favorable effects in the majority of, but not all, patients. This was particularly evident in terms of relatively rapid remission of PG whereas HS lesions seemed to be more resistant to treatment. In our patient, adalimumab monotherapy resulted in a remarkable and sustained remission, although significant improvement of HS lesions was observed only from week 16 of therapy onwards. In summary, TNF antagonists are a promising treatment for PASH; however, conclusions regarding the choice of a specific agent, optimal dosing or use in combination with other treatment modalities cannot yet be drawn. </p

Dermatophyte infections in Primorsko-goranska County, Croatia: a 21-year survey

This study examined the frequency of dermatophytoses in the Primorsko-Goranska County, a north-western part of Croatia, over a period of 21 years (1988-2008). All fungal samples were microscopically examined with 20% potassium hydroxide (KOH) solution. Fungal infections were confirmed in 26.9% cases. Out of these, dermatophytes were isolated in 38.3%, Candida spp. infection in 55.1% cases, while non-dermatophyte molds were identified in 6.6% isolates. The most frequently isolated dermatophyte was Trichophyton (T.) mentagrophytes var. interdigitalis (55.4%), followed by Mycrosporum (M.) canis (36.9%), T. violaceum (3.2%), M. gypseum (2.2%), and T. verrucosum (1.3%). Epidermophyton (E.) floccosum (0.9%) and T. rubrum (0.1%) were identified only sporadically. The most common dermatophytosis diagnosed in the 21-year period was tinea pedis (26.2%) followed by tinea capitis (21.8%) and tinea corporis (20.1%). Toenail onychomycosis (14.5%) was more common than fingernail onychomycosis (2.0%). T. mentagrophytes var. interdigitalis was the major pathogen causing tinea pedis (86.6%) as well as toenail onychomycosis (93.9%), while M. canis was most frequently isolated in tinea capitis (98.6%), tinea corporis (62.1%), and tinea faciei (40.2%). With regard to age and sex, T. mentagrophytes var. interdigitalis infections were predominant in middle-aged men. M. canis affected mostly children up to 9 years with a slight predominance in girls. Data from epidemiological trend analysis such as presented in our study are important for evidence-based public health measures for the prevention and control of dermatophytoses.</p