Kvaliteta života i psihijatrijski komorbiditet u dermatoveneroloških bolesnika

Skin diseases are mostly chronic and lifelong with recurrences. The special thing about skin diseases is their psychosocial burden. Pruritus and in fewer instances pain are common physical symptoms of skin diseases. All of these facts influence patient's life, social network and psychological status. Objectives: This study assessed different dimensions of quality of life and psychiatric comorbidities: depression and anxiety were evaluated among patients with dermtovenereological diseases. Methods: This study was approved by the Ethics Committee of the University Center Hospital „Sestre milosrdnice“, in Zagreb, where the study was conducted. Two hundred and ninety female and male patients suffering from different dermatoses and venereological diseases participated in the study. All participants were treated in an inpatient and outpatient treatment at the Department of Dermatovenereology. Participants were divided into three groups. The first group of patients were those with symptomatic dermatoses like psoriasis, atopic dermatitis and venous ulcer. The second group were asymptomatic dermatoses like vitiligo, alopecia and acne. The third group involved venereological patients with diagnoses of anogenital warts, genital Herpes simplex infection and Balanopostitis. Consenting participants completed the following standardized psychological questionnaires: Dermatology Specific Quality of Life Index, Beck's Index of Depression and State and Trait Anxiety Inventory. Results: Participants with symptomatic skin diseases had the highest influence of the disease on their quality of life. There was a statistically significant difference between different dimensions of quality of life, except for the psychological dimension. Depression and anxiety symptoms were mild but 4,1 % of the participants had high depression scores and 13-15 % had very high anxiety scores. Different dimensions of quality of life were in correlation with the intensity of the disease, with the exception of the psychological dimension. Patients with high intensity of the skin lesions were more depressed, but patients with always exposed lesions were more anxious as a state and trait. Conclusion: Patients with pruritic and painful dermatoses have the highest influence of skin disease on their quality of life. The Psycholgical aspect of quality of life is probably mostly affected by the patient's personality traits, and not by a skin or venereological disease in itself. Localisation and intensity of the dermatovenereological disease influence symptoms of depression and anxiety

The Mechanisms of Action of Phototherapy in the Treatment of the most Common Dermatoses

Phototherapy denotes the use of ultraviolet (UV) light in the management of several dermatoses. Most phototherapy regimens utilize ultraviolet radiation of different wavelenghts. Currently, irradiations with broadband UVB (290–320 nm), narrowband UVB (311–313 nm), 308 nm excimer laser, UVA 1 (340–400 nm), UVA with psoralen (PUVA), and extracorporeal photochemotherapy (photopheresis) are being used. The interplay of the various photobiologic pathways is far from being completely understood. Disordes that may benefit from such approach are numerous, with psoriasis, atopic dermatitis, cutaneous T-cell lymphomas, morphea, and vitiligo as main indications. The immunomodulatory effects of UVB radiation primarily affect the epidermis and superficial dermis, while UVA radiation affects mid and deep dermal components, especially blood vessels. UVB radiation is absorbed by endogenous chromophores, such as nuclear DNA, which initiates a cascade of events. Absorption of UV light by nucleotides causes the formation of DNA photoproducts and supresses DNA synthesis. In addition UV light stimulates synthesis of prostaglandins and cytokines that play important roles in immune suppression. It may reduce the number of Langerhans cells, cutaneous T lymphocytes and mast cells in the dermis. UV radiation can also affect extranuclear molecular targets located in the cytoplasm and cell membrane. Immune suppression, alteration in cytokine expression, and cell cycle arrest may all contribute to the suppression of disease activity. PUVA is a form of chemophototherapy which uses UVA light to activate chemicals known as psoralens, hence psoralen ultraviolet A. The conjunction of psoralens with epidermal DNA inhibits DNA replication and causes cell cycle arrest. Psoralen photosensitization also causes an alteration in the expression of cytokines and cytokine receptors. Psoralens interact with RNA, proteins and other cellular components and indirectly modify proteins and lipids via singlet oxygen-mediated reactions or by generating of free radicals. Infiltrating lymphocytes are strongly suppressed by PUVA, with variable effects on different T-cell subsets. Psoralens and UV radiation also stimulate melanogenesis. Extracorporeal photopheresis is technique used in treatment of erythrodermic cutaneous lymphomas. It is very potent in induction of lymphocyte apoptosis. Despite the introduction of numerous effective systemic medications and biologic agents in dermatology, phototherapy remains a reliable, and often preferred option for several dermatoses

STUDY ON THE IMPACT OF PSORIASIS ON QUALITY OF LIFE: PSYCHOLOGICAL, SOCIAL AND FINANCIAL IMPLICATIONS

Background: Psoriasis is a chronic and stigmatising disease with significant and hard to meet clinical needs in patient management. Psoriasis is a relatively common disease, affecting up to 2% of the population. The impact of psoriasis on quality of life is significant given its chronicity and visibility. Psychological stress is a well-established systemic triggering factor in psoriasis. It has been associated with initial presentation of the disease as well as exacerbations of pre-existing psoriasis. The purpose of this study is to assess the psychological, social and financial implications of psoriasis. Subjects and methods: 51 patients participated in this study. After dermatological examination and determination of Psoriasis Area and Severity Index score, patients were referred to a psychological consult. Assessment was done through questionnaires concerning quality of life, depression, anxiety, illness perception, financial domain and personal data. Results: Results of our study indicate that psoriasis has a strong impact on patients’ life. It influences working habits, poses a significant financial burden, but most of all, significantly impairs their quality of life and psychological status. Conclusion: Psoriasis poses a substantial threat to several dimensions in patient’s quality of life. Patients feel that the current treatment, although often effective, does not provide a satisfactory long-term solution. Thus, long-term psychologic support for patients with psoriasis is desirable

STUDY ON THE IMPACT OF PSORIASIS ON QUALITY OF LIFE: PSYCHOLOGICAL, SOCIAL AND FINANCIAL IMPLICATIONS

Background: Psoriasis is a chronic and stigmatising disease with significant and hard to meet clinical needs in patient management. Psoriasis is a relatively common disease, affecting up to 2% of the population. The impact of psoriasis on quality of life is significant given its chronicity and visibility. Psychological stress is a well-established systemic triggering factor in psoriasis. It has been associated with initial presentation of the disease as well as exacerbations of pre-existing psoriasis. The purpose of this study is to assess the psychological, social and financial implications of psoriasis. Subjects and methods: 51 patients participated in this study. After dermatological examination and determination of Psoriasis Area and Severity Index score, patients were referred to a psychological consult. Assessment was done through questionnaires concerning quality of life, depression, anxiety, illness perception, financial domain and personal data. Results: Results of our study indicate that psoriasis has a strong impact on patients’ life. It influences working habits, poses a significant financial burden, but most of all, significantly impairs their quality of life and psychological status. Conclusion: Psoriasis poses a substantial threat to several dimensions in patient’s quality of life. Patients feel that the current treatment, although often effective, does not provide a satisfactory long-term solution. Thus, long-term psychologic support for patients with psoriasis is desirable

Knowledge and Attitudes towards Sun Protection in Croatia

Skin cancer is the most common form of cancer; the World Health Organization estimates that more than 2 million cases of skin cancer are being diagnosed each year worldwide. Excessive sun exposure and ultraviolet (UV) radiation are the major avoidable risk factors for skin cancer, including melanoma. Sun protection can be achieved through behavioral modification, social changes and environmental changes: regular use of sunscreen, wearing hats and protective clothes, staying in the shade, creating shade by planting trees or constructing canopies, practicing work and sport activities during the time of the day when the sun is not the strongest and many others. The aim of this paper was to investigate the knowledge and attitudes about sun protection and sun behavior patterns in Croatia, as well as the perception of melanoma among general population. Our results indicate relatively good sun behavior patterns among our participants and their mostly correct perception of melanoma

Dysplastic Nevus – Risk Factor or Disguise for Melanoma

Dysplastic nevus is an acquired or hereditary nevus that clinically seems atypical and pathohistologically dysplastic. The term of dysplastic nevus has chaged through history and even until now the dermatologists and pathologists have not found the same conclusion for name and definition of dysplastic nevus. Epidemiology of dysplastic nevus is different depending on geographic lattitude, being three times higher in Australia than in Great Britain. Genetic factors play a role in etiology of dysplastic nevus but are still not well defined. UV radiation is indisputable main etiological factor in developing dysplastic nevus. Many studies confirm that children who have been using sun protection creams with SPF have less dysplastic nevi than those who did not. Nevus with geographic shape and muddy borders, dominately macular, red to brown colored and has 5 mm or more in diameter is clinically dysplastic nevus. ABCDE rules count for dysplastic nevus as well as for melanoma but prefferable diagnostic criteria for dysplastic nevus would be »ugly duckling sign«. Pathohistologic analysis is the key in confirming the diagnosis of dysplastic nevus. Great experience and knowledge in dermatopathology field is essential for pathologists to make a distinction between dysplastic nevus and melanoma in situ. Likewise great experience in dermatooncology field is essential in differentiating dysplastic nevus from other nevi. Surgical excision is the only therapy that should be done for dysplatic nevus. Regular follow up is highly recommended for patients with dysplatic nevus and syndroma naevi dysplastici. Education about sun protection measures and self-examination techniques is essential for all patients with dysplastic nevi and their family

ASSOCIATION OF PSORIASIS AND ALCOHOLISM: PSYCHODERMATOLOGICAL ISSUE

Psoriasis is a chronic, hereditary disease generally characterized by eruption of erythematous, silvery-scaled plaques, predominantly on the elbows, knees, scalp and trunk, affecting between 1-2% of the population worldwide. Psoriasis is a multifactorial disease of unknown etiology. It has been shown that in some patients alcohol abuse has been associated with psoriasis. Chronic alcohol abuse results in the impairment of health-related, social and occupational functioning. Therefore the association of psoriasis and alcoholism represents one of the major psychodermatological issues where a multidisciplinary approach (including dermatologist, psychiatrist, psychologist and others) is crucial for optimal outcome