Psychosocial factors in female patient with psoriasis and psoriatic arthritis

Cilj: Danas važeća teorija svrstava psorijazu u psihokutane psihofiziološke bolesti. Traumatska iskustva u djetinjstvu povezuju se s pojavom artritisa i nekih kožnih bolesti te se smatra da u kombinaciji s genetskim faktorima predstavljaju rizične faktore za pojavu psorijaze i psorijatičnog artritisa. Prikaz slučaja: Psorijaza i psorijatični artritis su imunološki posredovane bolesti, a rana traumatska iskustva uzrok su poremećene kompetencije imunološkog sustava s regulatornim problemima u sustavima koji reguliraju odgovor na psihički stres. U radu je prikazana bolesnica sa psorijazom i psorijatičnim artritisom koja je od najranijeg djetinjstva bila izložena mnogobrojnim negativnim traumama u djetinjstvu. Rasprava: Emocionalno zanemarivanje, alkoholizam oca, izostanak osjećaja sigurnosti i kompetentnosti tijekom djetinjstva doveli su do negativnih i bolnih emocija sa stvaranjem obrasca za rasterećenje koji ide putem kože, odnosno zglobova. Dinamika obiteljskih odnosa diktirala je uvelike i tijek njene bolesti i načine nošenja s teškoćama koje je bolest donosila. Uobičajene ili standardne metode liječenja nisu dale zadovoljavajuće rezultate, no interdisciplinarnim pristupom i dugotrajnim psihoterapijskim liječenjem postignuti su značajni i dugoročni terapijskih rezultati. Tijekom psihoterapijskog liječenja razmatrani su njeni disfunkcionalni obrasci ponašanja i razlozi za njih. Bolesnica je u grupi dobila emocionalnu podršku, proradila dio svojih ranijih iskustava i uspjela ojačati ego snage za nošenje sa svakodnevnim obavezama i relacijama. Njen promijenjen odnos prema sebi i okolini omogućio joj je da gratifikaciju nađe u svojoj okolini i relaciji s bliskim osobama iz svog okruženja. Zaključak: Samo kombinirana i individualno prilagođena terapija, uz psihoterapijski pristup, može dovesti do dugotrajnijeg uspjeha u liječenju ovih bolestiAim: According to the new classification of psycho-dermatological disorders, psoriasis is classified as a psychophysiological disease. Recent studies have associated childhood exposure to trauma to same skin and joint diseases. Traumatic experiences in childhood combined with genetic predisposition are considered to be important risk factors in the development of psoriasis and psoriatic arthritis. Case report: Psoriasis and psoriatic arthritis are immunologically triggered diseases and early traumatic experiences are the reason of altered competence of the immune system with the regulatory problems in systems that control the response to psychologic stress. We showed a female patient with psoriasis and psoriatic arthritis with increased childhood negative traumatic experiences. Discussion: Emotional neglect, alcoholism of the father, the lack of sense of security and competence during childhood led to negative and painful emotions with creating a pattern of discharge that leads through the skin and joints. The dinamics of family relations formed in an important manner the ongoing of the disease and the ways of dealing with the difficulties that the desease caused.The common or standardized methods for treating of psoriasis and psoriatic arthritis that have been used since the beginning of the treatment, did not show satisfactory results. However, interdisciplinary approach and longterm pshichotherapy resulted in significant and lasting positve treatment results. During a psychotherapy the disfunctional patterns of behaviour and their reasons were analysed. The patient received emotional support of the group, she worked through a part of her former experiences and succeded in improving her ego for the strength for coping with the everyday dutys and relations. The changed relationship for herself and the surrounding enabled her to find thankfulness in her milieu and the relationship with close people from her surroundings. Conclusion: Thus, only a combined and individually adjusted therapy, together with a psychoterapic approach can lead to a long lasting success in treating this deseases

Molecular and Genetic Mechanisms in Melanoma

Recent studies have indicated an increasing incidence of melanoma worldwide. Although UV signature mutations are found rarely in melanoma cells, there is some evidence that intense intermittent exposure to sunlight can induce melanocyte tumorigenesis, and this is also observed after UV irradiation in some animals. The purpose of this paper is to review some of the most important mechanisms involved in the pathogenesis of this tumor. Genetic studies showed the familiar melanoma is linked to the mutation or deletion of the suppressor gene CDKN2A, and perhaps to CDK4. Studies showed that BRAF mutation is frequent in primary and metastatic melanoma cells but also in naevocytic nevi. This mutation activates the RAF/MEK pathway. Exposure to UV radiation induces immunosuppression. Recent investigations showed that chemokines, angiogenesis, metalloproteinases can play a role in the mechanism of metastasis. In spite of these advances the initiating events are still not completely understood. In conclusion, the pathogenesis of melanoma is very complex because numerous genetic and epigenetic factors are implicated in its development and progression, but some of the showed mechanisms can be targets for new therapies

Molecular and Genetic Mechanisms in Melanoma

Recent studies have indicated an increasing incidence of melanoma worldwide. Although UV signature mutations are found rarely in melanoma cells, there is some evidence that intense intermittent exposure to sunlight can induce melanocyte tumorigenesis, and this is also observed after UV irradiation in some animals. The purpose of this paper is to review some of the most important mechanisms involved in the pathogenesis of this tumor. Genetic studies showed the familiar melanoma is linked to the mutation or deletion of the suppressor gene CDKN2A, and perhaps to CDK4. Studies showed that BRAF mutation is frequent in primary and metastatic melanoma cells but also in naevocytic nevi. This mutation activates the RAF/MEK pathway. Exposure to UV radiation induces immunosuppression. Recent investigations showed that chemokines, angiogenesis, metalloproteinases can play a role in the mechanism of metastasis. In spite of these advances the initiating events are still not completely understood. In conclusion, the pathogenesis of melanoma is very complex because numerous genetic and epigenetic factors are implicated in its development and progression, but some of the showed mechanisms can be targets for new therapies

TREATMENT OF ALOPECIA AREATA: MODERN PRINCIPLES AND PERSPECTIVES

Alopecija areata (AA) česta je bolest koja se očituje neožiljnim gubitkom dlake na vlasištu i/ili tijelu. Folikul dlake u alopeciji areati nije nepovratno uništen, stoga potencijal za ponovni rast kose ostaje. Budući da je etiopatogeneza nepoznata, liječenje AA je simptomatsko i usmjereno na zaustavljanje aktivnosti bolesti. Limfociti oko dlačnog folikula, povišena razina autoprotutijela, poremećaj citokina te udruženost s drugim autoimunosnim bolestima, podupiru hipotezu da je AA organ-specifična autoimunosna bolest. Nova su istraživanja stoga usmjerena na razvoj lijekova koji bi imunomodulatornim ili imunosupresivnim djelovanjem potaknuli rast dlake. Proučavanje utjecaja novih bioloških lijekova na rast kose, kao i razvoj genske terapije u tijeku su. U radu će biti raspravljeni suvremeni principi i dostupne metode liječenja alopecije areate.Alopecia areata (AA) is a frequent disease with nonscarring hair loss on the scalp and/or body. Hair follicle in alopecia areata is not irreversibly destroyed, so potential for hair regrowth remains. Considering unknown etiopathogenesis, treatment of AA is symptomatic and directed toward halting disease activity. Lymphocytic inflammatory infiltrate around hair follicle, increased levels of autoantibodies, cytokine abnormalities and increased prevalence of autoimmune comorbidities, support the hypothesis of AA as an organ-specific autoimmune disorder. Therefore, investigations are directed toward new immunomodulatory or immunosupresive drugs with induction effect on hair growth. New biologic drugs and their influence on hair growth as well as genetic therapy for alopecia areata are currently under investigation. Contemporary principles in therapy of alopecia areata and treatments available will be discussed in this article

Alopecia areata – clinical spectrum, histology and treatment

Alopecija areata neožiljni je upalni gubitak dlake na vlasištu i/ili tijelu, nepoznate etiopatogeneze. Najčešće zahvaćeno mjesto je vlasište. Histopatologija se očituje povećanim brojem katagenih i telogenih folikula te nazočnošću upalnog limfocitnog infiltrata u peribulbarnoj regiji. U liječenju alopecije areate najčešće se primjenjuju kortikosteroidi. U radu je opisana klinička i patohistološka slika uz suvremene metode liječenja alopecije areate.Alopecia areata is a nonscarring, inflammatory hair loss on the scalp, and/or body. Etiology and pathogenesis are still unknown. The most common affected site is the scalp. Histopathology is characterized by an increased number of the catagen and telogen follicles along with the presence of inflammatory lymphocytic infiltrate in the peribulbar region. Corticosteroids are the most popular drugs for the treatment of this disease. Clinical features, histological data as well as modern treatment options will be discussed in this article

TREATMENT OF ALOPECIA AREATA: MODERN PRINCIPLES AND PERSPECTIVES

Alopecija areata (AA) česta je bolest koja se očituje neožiljnim gubitkom dlake na vlasištu i/ili tijelu. Folikul dlake u alopeciji areati nije nepovratno uništen, stoga potencijal za ponovni rast kose ostaje. Budući da je etiopatogeneza nepoznata, liječenje AA je simptomatsko i usmjereno na zaustavljanje aktivnosti bolesti. Limfociti oko dlačnog folikula, povišena razina autoprotutijela, poremećaj citokina te udruženost s drugim autoimunosnim bolestima, podupiru hipotezu da je AA organ-specifična autoimunosna bolest. Nova su istraživanja stoga usmjerena na razvoj lijekova koji bi imunomodulatornim ili imunosupresivnim djelovanjem potaknuli rast dlake. Proučavanje utjecaja novih bioloških lijekova na rast kose, kao i razvoj genske terapije u tijeku su. U radu će biti raspravljeni suvremeni principi i dostupne metode liječenja alopecije areate.Alopecia areata (AA) is a frequent disease with nonscarring hair loss on the scalp and/or body. Hair follicle in alopecia areata is not irreversibly destroyed, so potential for hair regrowth remains. Considering unknown etiopathogenesis, treatment of AA is symptomatic and directed toward halting disease activity. Lymphocytic inflammatory infiltrate around hair follicle, increased levels of autoantibodies, cytokine abnormalities and increased prevalence of autoimmune comorbidities, support the hypothesis of AA as an organ-specific autoimmune disorder. Therefore, investigations are directed toward new immunomodulatory or immunosupresive drugs with induction effect on hair growth. New biologic drugs and their influence on hair growth as well as genetic therapy for alopecia areata are currently under investigation. Contemporary principles in therapy of alopecia areata and treatments available will be discussed in this article

GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF PSORIASIS

Hrvatsko dermatovenerološko društvo Hrvatskoga liječničkog zbora ustrojilo je radnu skupinu vodećih hrvatskih stručnjaka koji se bave psorijazom. Radna je skupina kritički proučila mjerodavnu znanstvenu literaturu te donijela smjernice za dijagnostiku i liječenje psorijaze.Croatian dermatovenerological society of the Croatian Medical Association formed the working group which consists of leading experts for psoriasis in Croatia. After a critical analysis of relevant scientific papers, the working group has developed guidelines for the diagnosis and treatment of psoriasi

Psychosocial characteristics of psoriatic patients and psoriatic arthritis

Uvod: Etiopatogeneza psorijaze i psorijatičnog artritisa nije u cijelosti poznata. Pretpostavlja se da psorijaza i psorijatični artritis nastaju međudjelovanjem genetskih i okolišnih čimbenika. U suvremenom poimanju etiologije i klasifikacije bolesti psorijaza se ubraja u psihosomatske psihokutane bolesti. Psihosocijalni čimbenici u kombinaciji s genetskom predispozicijom imaju ključnu ulogu u razvoju psorijaze i psorijatičnog artritisa. Cilj istraživanja bio je ispitati pozitivna i negativna životna iskustva, različite stresne događaje koji su prethodili pojavi psorijaze i psorijatičnom artritisu te životne stilove, odnosno mehanizme obrane i vrste agresivnosti u bolesnika sa psorijazom i psorijatičnim artritisom. Također je ispitana njihova moguća povezanost s težinom kliničke slike psorijaze. Ispitanici i postupci: U studiji je sudjelovalo 100 bolesnika sa psorijazom i 45 bolesnika koji osim psorijaze imaju psorijatični artritis. U kontrolnoj skupini bio je 101 ispitanik liječen zbog dermatoza koje nemaju nikakav utjecaj na tjelesno ili duševno zdravlje. Svi ispitanici ispunili su upitnik sa sociodemografskim podatcima te psihologijske upitnike: trauma antecedentni upitnik, ljestvicu životnih događaja, upitnik životnog stila te upitnik za mjerenje agresivnosti. U svih bolesnika sa psorijazom kliničkim je pregledom određena težina kliničke slike bolesti izražena ljestvicom PASI. Rezultati: Bolesnici sa psorijazom i psorijatičnim artritisom su značajno češće izloženi mnogobrojnim negativnim životnim iskustvima uz istovremeno smanjenje pozitivnih životnih iskustava napose tijekom školske (p=0.02) i adolescentne dobi (p=0.01). Nadalje, bolesnici sa psorijazom pokazuju značajno češće indirektnu prenesenu agresiju (p=0.026), verbalnu latentnu agresiju (p=0.018) i ukupnu agresiju (p=0.039). Oboljeli od psorijaze i psorijatičnog artritisa ne doživljavaju intenzivnije stresove prije početka bolesti, međutim, značajno su više uznemireni nego kontrolna skupina ispitanika (p=0.0001). Bolesnici sa psorijatičnim artritisom značajno češće koriste negaciju (p=0.005), projekciju (p=0.025) i intelektualizaciju (p=0.0001) dok psorijatičari uz ove mehanizme obrane češće koriste i mehanizme reaktivne formacije (p=0.051) i regresije (p=0.029) u usporedbi s kontrolom. Težina kliničke slike psorijaze značajno korelira s obrambenim mehanizmom premještanja. Premještanje značajno korelira sa svim oblicima agresije i jedino značajno predviđa težinu kliničke slike psorijaze ( Beta = 0.366; p=0.007). Zaključci: Rezultati istraživanja povezanosti pozitivnih i negatinih životnih iskustava, stresa, agresivnosti i mehanizama obrane u bolesnika sa psorijazom i psorijatičnim artritisom ukazuju na važnu ulogu psihosocijalnih čimbenika u multifaktorijalnoj etiopatogenezi tih bolesti. Stoga je u liječenju ovih bolesnika potreban interdisciplinaran pristup koji uz dermatologa uključuje sudjelovanje psihijatra i psihoterapeuta.Introduction: The etiopathogenesis of psoriasis and psoriatic arthritis is not entirely acknowledged. It is assumed that the development of psoriasis and psoriatic arthritis is influenced by interaction of genetic and environmental factors. According to the new data psoriasis is classified as a psychosomatic skin disease. Psychosocial factors in combination with genetic background play a key role in the development of psoriasis and psoriatic arthritis. For their treatment it is neccessary to use an interdisciplinary approach. The aim of the research was to explore both positive and negative life experiences, different stress situations that happened before the appearance of psoriasis and psoriatic arthritis, defense mechanisms and types of aggression in patients with psoriasis and psoriatic arthritis. It has also been investigated their possible correlation with the disease severity. Patients and methods: The study includes 100 psoriatic patients and 45 psoriatic patients with psoriatic arthritis. The control group consisted of 101 patients that suffered from dermatosis which had no influence on their psychological and physical wellbeing. All participants were asked to fill out a questionnaire with sociodemografic data and several psychological questionnaires: a trauma antecedent questionnaire, a life experience scale, a life style questionnaire and a questionnaire for the evaluation of aggression. In all psoriatic patients the severity of psoriasis has been estimated according to the Psoriasis Area and Severity Index (PASI scale). Results: Patients with psoriasis and psoriatic arthritis were exposed more frequently to multiple negative life experiences with the lack of positive life experience, especially during school (p=0.02) and adolescent age (p=0.01). Patients with psoriasis showed more frequently indirect or transposed aggression (p=0.026), verbal latent aggression (p=0.018) and total aggression (p=0.039). Patients with psoriasis and psoriatic arthritis do not experience more intense stress before the beginning of the disease, but they are more upset than the controls (p=0.0001). Patients with psoriatic arthritis significantly often use negation (p=0.005), projection (p=0.025) and intellectualization (p=0.0001) while psoriatic patients with these defense mechanism more often use reactive formation (p=0.0051) and regression (p=0.029) in comparison to the control group. The severity of psoriasis is in significant correlation with the defense mechanism of transponding. The transposition significantly correlates with all forms of aggression and is an important predictor of the severity of the clinical picture of psoriasis (Beta =0.366; p= 0.007). Conclusions: The study results of the association of positive and negative life experience, stress, aggression and defense mechanisms in psoriatic patients and patients with psoriatic arthritis show the important role of psychosocial factors in the multifactor etiopathogenesis of these diseases. Thus for the treatment of these patients interdisciplinary approach is needed which includes the participation of a dermatologist and a psychiatrist-psychotherapist

Psychosocial characteristics of psoriatic patients and psoriatic arthritis

Uvod: Etiopatogeneza psorijaze i psorijatičnog artritisa nije u cijelosti poznata. Pretpostavlja se da psorijaza i psorijatični artritis nastaju međudjelovanjem genetskih i okolišnih čimbenika. U suvremenom poimanju etiologije i klasifikacije bolesti psorijaza se ubraja u psihosomatske psihokutane bolesti. Psihosocijalni čimbenici u kombinaciji s genetskom predispozicijom imaju ključnu ulogu u razvoju psorijaze i psorijatičnog artritisa. Cilj istraživanja bio je ispitati pozitivna i negativna životna iskustva, različite stresne događaje koji su prethodili pojavi psorijaze i psorijatičnom artritisu te životne stilove, odnosno mehanizme obrane i vrste agresivnosti u bolesnika sa psorijazom i psorijatičnim artritisom. Također je ispitana njihova moguća povezanost s težinom kliničke slike psorijaze. Ispitanici i postupci: U studiji je sudjelovalo 100 bolesnika sa psorijazom i 45 bolesnika koji osim psorijaze imaju psorijatični artritis. U kontrolnoj skupini bio je 101 ispitanik liječen zbog dermatoza koje nemaju nikakav utjecaj na tjelesno ili duševno zdravlje. Svi ispitanici ispunili su upitnik sa sociodemografskim podatcima te psihologijske upitnike: trauma antecedentni upitnik, ljestvicu životnih događaja, upitnik životnog stila te upitnik za mjerenje agresivnosti. U svih bolesnika sa psorijazom kliničkim je pregledom određena težina kliničke slike bolesti izražena ljestvicom PASI. Rezultati: Bolesnici sa psorijazom i psorijatičnim artritisom su značajno češće izloženi mnogobrojnim negativnim životnim iskustvima uz istovremeno smanjenje pozitivnih životnih iskustava napose tijekom školske (p=0.02) i adolescentne dobi (p=0.01). Nadalje, bolesnici sa psorijazom pokazuju značajno češće indirektnu prenesenu agresiju (p=0.026), verbalnu latentnu agresiju (p=0.018) i ukupnu agresiju (p=0.039). Oboljeli od psorijaze i psorijatičnog artritisa ne doživljavaju intenzivnije stresove prije početka bolesti, međutim, značajno su više uznemireni nego kontrolna skupina ispitanika (p=0.0001). Bolesnici sa psorijatičnim artritisom značajno češće koriste negaciju (p=0.005), projekciju (p=0.025) i intelektualizaciju (p=0.0001) dok psorijatičari uz ove mehanizme obrane češće koriste i mehanizme reaktivne formacije (p=0.051) i regresije (p=0.029) u usporedbi s kontrolom. Težina kliničke slike psorijaze značajno korelira s obrambenim mehanizmom premještanja. Premještanje značajno korelira sa svim oblicima agresije i jedino značajno predviđa težinu kliničke slike psorijaze ( Beta = 0.366; p=0.007). Zaključci: Rezultati istraživanja povezanosti pozitivnih i negatinih životnih iskustava, stresa, agresivnosti i mehanizama obrane u bolesnika sa psorijazom i psorijatičnim artritisom ukazuju na važnu ulogu psihosocijalnih čimbenika u multifaktorijalnoj etiopatogenezi tih bolesti. Stoga je u liječenju ovih bolesnika potreban interdisciplinaran pristup koji uz dermatologa uključuje sudjelovanje psihijatra i psihoterapeuta.Introduction: The etiopathogenesis of psoriasis and psoriatic arthritis is not entirely acknowledged. It is assumed that the development of psoriasis and psoriatic arthritis is influenced by interaction of genetic and environmental factors. According to the new data psoriasis is classified as a psychosomatic skin disease. Psychosocial factors in combination with genetic background play a key role in the development of psoriasis and psoriatic arthritis. For their treatment it is neccessary to use an interdisciplinary approach. The aim of the research was to explore both positive and negative life experiences, different stress situations that happened before the appearance of psoriasis and psoriatic arthritis, defense mechanisms and types of aggression in patients with psoriasis and psoriatic arthritis. It has also been investigated their possible correlation with the disease severity. Patients and methods: The study includes 100 psoriatic patients and 45 psoriatic patients with psoriatic arthritis. The control group consisted of 101 patients that suffered from dermatosis which had no influence on their psychological and physical wellbeing. All participants were asked to fill out a questionnaire with sociodemografic data and several psychological questionnaires: a trauma antecedent questionnaire, a life experience scale, a life style questionnaire and a questionnaire for the evaluation of aggression. In all psoriatic patients the severity of psoriasis has been estimated according to the Psoriasis Area and Severity Index (PASI scale). Results: Patients with psoriasis and psoriatic arthritis were exposed more frequently to multiple negative life experiences with the lack of positive life experience, especially during school (p=0.02) and adolescent age (p=0.01). Patients with psoriasis showed more frequently indirect or transposed aggression (p=0.026), verbal latent aggression (p=0.018) and total aggression (p=0.039). Patients with psoriasis and psoriatic arthritis do not experience more intense stress before the beginning of the disease, but they are more upset than the controls (p=0.0001). Patients with psoriatic arthritis significantly often use negation (p=0.005), projection (p=0.025) and intellectualization (p=0.0001) while psoriatic patients with these defense mechanism more often use reactive formation (p=0.0051) and regression (p=0.029) in comparison to the control group. The severity of psoriasis is in significant correlation with the defense mechanism of transponding. The transposition significantly correlates with all forms of aggression and is an important predictor of the severity of the clinical picture of psoriasis (Beta =0.366; p= 0.007). Conclusions: The study results of the association of positive and negative life experience, stress, aggression and defense mechanisms in psoriatic patients and patients with psoriatic arthritis show the important role of psychosocial factors in the multifactor etiopathogenesis of these diseases. Thus for the treatment of these patients interdisciplinary approach is needed which includes the participation of a dermatologist and a psychiatrist-psychotherapist

Collision Lesions: Genuine Collision (Conflict) or not?

ABSTRACT By definition, the term “collision lesion” refers to two or more tumors coinciding in the same anatomic position or visceral organ. Collision lesions coexisting on the same skin location are defined as collision skin lesions (CSLs). Although this term implies a conflict between the tumors, this is not the case. CSLs appear to be rare, but still pose a significant diagnostic problem in everyday clinical practice and clinicians should be aware of their existence. The aim of this study was to elucidate the problem of CSLs in clinical practice, with an emphasis on classification of CSLs according to position dependence, tumor histogenesis, etiology, and possible lesion combinations in CSLs, as well as diagnostic possibilities. According to our results, accurate clinical diagnosis could be only rarely reached, requiring lesion excision and pathohistological confirmation of CSLs. Considering the fact that tumors in CSLs can be partially or completely overlying or can even be positioned one within the other, the existence of two or more tumors is extremely difficult to detect