Different therapeutic modalities in a patient with multiple spontaneously developed keloids: a case report

Keloids are benign tumors that usually develop as an excessive healing response to injury. They remain a challenging therapeutic problem to this day. Numerous treatment approaches are available, yet therapeutic results are often not satisfactory. A female patient with multiple spontaneously developed keloids on her trunk is presented. In this patient, four different therapeutic options were employed at different sites, with variable responses. The first option included cryotherapy, with poor effect. Slight flattening was observed after intralesional corticosteroid therapy. Treatment with excision followed by radiotherapy resulted in recurrence after 3 months. The best effect was noticed when excision and injection of corticosteroids into surgical margins were followed by radiotherapy. To the authors' knowledge, this is the first report of three-modal therapy in the management of keloids, which resulted in no recurrences over a 3-year follow-up

Korektivna dermatologija danas

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.U posljednja dva desetljeća zabilježen je znatan razvoj u području korektivne dermatologije. Nova vrhunska postignuća u tehnikama i sve veće zanimanje za postupke podmlađivanja doveli su porasta broja korektivnih zahvata širom svijeta. U radu se prikazuju korektivni postupci koji se danas najčešće primjenjuju u dermatologiji, a to su laseri, intenzivno pulsno svjetlo, fileri, botulinski toksin, kemijski piling, radiofrekvencija i dermabrazija. Danas se prednost daje onim zahvatima kod kojih se razultati najbrže vide, koji imaju kratko vrijeme zastoja i minimalan rizik od neželjenih učinaka. Stoga je ablativno “presvlačenje” (resurfacing) uglavnom zamijenjeno neablativnim i frakcijskim “presvlačenjem”, dok se fileri i botulinski toksin rabe sve više. Najbolji kozmetski rezultati postižu se kombinacijom različitih korektivnih postupaka

Maskne: A New Entity in the COVID-19 Pandemic

The term “maskne” has been coined during the ongoing COVID-19 pandemic, designating acne associated with prolonged protective mask-wearing. Maskne is a variant of acne mechanica caused by mask-induced mechanical injury (pressure, friction, and rubbing) and occlusion. The additional factors influencing the onset of maskne include genetics, environmental factors, duration of maskwearing, the type of mask, and previous facial skin disease. The prevalence of maskne is increasing since masks are the most commonly used personal protective equipment in the general population. Furthermore, wearing masks in public tends to become the “new normal” even in the post-pandemic period. Hence, the problem of maskne could become even more significant. This review aims to provide a comprehensive view of current knowledge on prevalence, pathogenesis, prevention, and treatment of maskne

Laser Therapy in Dermatology

Laserska je terapija metoda prvog izbora u liječenju brojnih prirođenih i stečenih promjena kože, koje uključuju vaskularne i pigmentne promjene, dobroćudne tumorske tvorbe, tetovaže, bore i ožiljke. Najvažnija prednost lasera u odnosu na druge metode liječenja jest selektivnost (uklanjanje ciljane promjene kože bez značajnog oštećenja okolnih struktura), odlična podnošljivost i kratko trajanje tretmana. Prikazani su principi rada lasera s osvrtom na indikacije za primjenu lasera u dermatologiji te su navedene mjere opreza kojih se valja pridržavati pri rukovanju laserskim uređajima. Zaključuje se da je u rukama iskusnog stručnjaka, pri ispravno odabranim indikacijama, dobroj pripremi bolesnika te kvalitetnom poslijeoperacijskom tretmanu, laserska terapija u velikom broju indikacija nadmoćna tradicionalnim metodama.Laser therapy is a therapeutic method of the fi rst choice in the treatment of various congenital and acquired skin lesions, including vascular and pigmented lesions, benign tumors, tattoos, wrinkles and scars. The most important advantage of laser comparing to other therapeutic modalities is the selectivity (removal of target structures with minimal damage to the adjacent tissues), excellent tolerability, and short duration of the therapeutic session. This article explains basic laser principles and provides an overview of indications for laser treatment in dermatology, including laser safety measures. It is concluded that the laser therapy is superior to conventional therapeutic methods if used by skilled experts, and subject to a proper choice of indications, good preoperative preparation of the patient, and adequate postoperative care

Maskne: A New Entity in the COVID-19 Pandemic

The term “maskne” has been coined during the ongoing COVID-19 pandemic, designating acne associated with prolonged protective mask-wearing. Maskne is a variant of acne mechanica caused by mask-induced mechanical injury (pressure, friction, and rubbing) and occlusion. The additional factors influencing the onset of maskne include genetics, environmental factors, duration of maskwearing, the type of mask, and previous facial skin disease. The prevalence of maskne is increasing since masks are the most commonly used personal protective equipment in the general population. Furthermore, wearing masks in public tends to become the “new normal” even in the post-pandemic period. Hence, the problem of maskne could become even more significant. This review aims to provide a comprehensive view of current knowledge on prevalence, pathogenesis, prevention, and treatment of maskne

Skin Changes in Primary Psychiatric Disorders

ABSTRACT Primary psychiatric disorders where skin changes appear most frequently include: delusions of parasitosis, body dysmorphic disorder, neurotic excoriations, dermatitis artefacta, and trichotillomania. In all these diseases the primary pathologic condition is of psychiatric nature, and the skin changes are secondary and self-induced. In this review we wanted to present the epidemiology, clinical pictures, and treatment options for these disorders. These patients are more frequently seen in dermatology clinics, as they may be unwilling to acknowledge a psychiatric basis for their psychical symptoms. If we want the treatment to be effective and timely, it is important for the dermatologist to understand the underlying psychopathology of these conditions. Treatment should be gradual. An initially supportive, nonconfrontational, empathic approach to the patient is indicated. Immediate confrontation regarding the suspicion that the patient’s lesions are self-induced can be counterproductive in that the patient will often refuse treatment. Frequent visits and symptomatic topical treatments are useful in the beginning. The goal is to establish a trusting and supportive enough relationship with the patient so that he or she will accept a psychiatric referral to explore the complex personality and behavioral issues that often underlie these conditions. KEY WORDS: delusions of parasitosis; body dysmorphic disorder; neurotic excoriations; dermatitis artefacta; trichotillomania</p

Skin Changes in Primary Psychiatric Disorders

ABSTRACT Primary psychiatric disorders where skin changes appear most frequently include: delusions of parasitosis, body dysmorphic disorder, neurotic excoriations, dermatitis artefacta, and trichotillomania. In all these diseases the primary pathologic condition is of psychiatric nature, and the skin changes are secondary and self-induced. In this review we wanted to present the epidemiology, clinical pictures, and treatment options for these disorders. These patients are more frequently seen in dermatology clinics, as they may be unwilling to acknowledge a psychiatric basis for their psychical symptoms. If we want the treatment to be effective and timely, it is important for the dermatologist to understand the underlying psychopathology of these conditions. Treatment should be gradual. An initially supportive, nonconfrontational, empathic approach to the patient is indicated. Immediate confrontation regarding the suspicion that the patient’s lesions are self-induced can be counterproductive in that the patient will often refuse treatment. Frequent visits and symptomatic topical treatments are useful in the beginning. The goal is to establish a trusting and supportive enough relationship with the patient so that he or she will accept a psychiatric referral to explore the complex personality and behavioral issues that often underlie these conditions. KEY WORDS: delusions of parasitosis; body dysmorphic disorder; neurotic excoriations; dermatitis artefacta; trichotillomania</p

Drug-Induced Rosacea-like Dermatitis

Rosacea is a common, chronic cutaneous disorder with a prevalence of 0.5-10%, predominantly affecting women. The disease presents with a heterogeneous clinical picture characterized by transient flushing, persistent facial redness, telangiectasias, and, in more severe clinical forms, the presence of inflammatory papules and pustules in the central third of the face. Although its pathophysiology is complex and still remains unknown, factors that exacerbate the disease are well defined. They include genetic predisposition as well as external factors such as exposure to UV light, high temperature, and diet. Besides these well-known factors, recent studies suggest that drugs and vitamins could also be possible factors inducing rosacea-like dermatitis or aggravating pre-existing rosacea. Although these are less common possible triggering factors, the aim of this article is to present the current knowledge on the association between use of certain drugs or vitamins and rosacea. </p

Post-COVID Telogen Effluvium

Recently, the number of patients with acute telogen efflu- vium (ATE), among other forms of hair loss, has increased in comparison with previous years. The COVID-19 pandemic, taking place during this period, may be the cause of this phenomenon. The exact mechanisms by which this virus causes hair loss are not entirely understood; still, the most likely cause is an excessive release of proinflammatory cytokines during SARS-CoV-2 infection. This process can trigger the development of telogen effluvium (TE) by damaging hair matrix cells. Additionally, the psychosocial condition of patients recovering from COVID-19 will have deteriorated, contributing to hair loss. Based on data collected un- til now, post-COVID TE is expected to improve without any treatment. Although there is no specific treatment for post-COVID TE, eliminating psychophysical stress, managing systemic complications, and explain- ing the course of the condition to the patient will potentially improve and speed up the hair recovery process

PHOTOALLERGIC DRUG REACTIONS

Reakcije na lijekove posredovane svjetlom mogu biti fototoksične i fotoalergijske. U ovom preglednom članku prikazane su fotoalergijske reakcije na lijekove koje nastaju interakcijom lijeka i ultraljubičastog svjetla uz sudjelovanje imunosnih mehanizama. Uz osvrt na fotobiologiju te najčešće lijekove koji sudjeluju u nastanku fotoalergijskih reakcija, prikazana je imunološkapodloga tih dermatoza, klinička slika, te dijagnostički i terapijski postupak. Poznavanje potencijalnih fotoalergena i pridržavanje mjera fotoprotekcije mogu u velikoj mjeri smanjiti učestalost fotoalergijskih reakcija na lijekove.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