Photodynamic Therapy in Dermatology

Fotodinamička terapija je novi oblik fototerapije koji uključuje fotokemijske reakcije nastale međudjelovanjem fotosenzibilizirajuće tvari, vidljivog svjetla i kisika. Fotodinamička terapija provodi se u dvije faze. Prva faza uključuje lokalnu ili sistemsku primjenu fotosenzibilizatora koji se nakuplja u ciljnim stanicama. Druga faza uključuje aktivaciju fotosenzibilizatora vidljivim svjetlom određene valne duljine uz prisutnost kisika te uništenje ciljnih stanica. U dermatologiji se rabi pretežno za onkološke indikacije: višestruke aktiničke keratoze, površinske bazocelularne karcinome i Bowenovu bolest. Prednosti ovog načina liječenja kod gore navedenih indikacija su: podjednaka učinkovitost kao kod klasičnih metoda liječenja, mogućnost liječenja više promjena odjednom, neinvazivnost, dobra podnošljivost, mogućnost ponavljanja bez kumulativnih toksičnih učinaka i dobri estetski rezultati.Photodynamic therapy is a new form of phototherapy which involves the use of photochemical reactions mediated through the interaction of photosensitizing agents, light and oxygen. Photodynamic therapy is a two step procedure. In the fi rst step, the photosensitizer is administered topically or systemically, and it accumulates in the target cells. The second step involves the activation of the photosensitizer in the presence of oxygen with a specifi c wavelength of visible light, and destruction of target cells. In dermatology, it is used mainly for oncological indications: multiple actinic keratoses, superfi cial basal cell carcinomas, and Bowen’s disease. The advantages of this treatment modality are: effi cacy comparable to that of standard treatment modalities; ability to treat multiple lesions simultaneously; it is noninvasive; good tolerance; repeated application will not result in cumulative toxicity, and good cosmetic results

Fototerapija (UVB) i fotokemoterapija (PUVA) u liječenju psorijaze

The review covers the current practice of phototherapy with ultraviolet (UV) radiation without sensitizers and of psoralen photochemotherapy (PUVA) in the treatment of psoriasis. There are several types of UVB radiation in clinical use: traditional or broad band UVB (280 ∑ 320 nm); selective UVB (305 ∑ 325 nm); and narrow band UVB (311 nm). Forms of PUVA therapy are: systemic photochemotherapy (PUVA therapy with oral administration of psoralen); PUVA bath therapy; and PUVA therapy with topical psoralen application. PUVA therapy is more effective than UVB therapy in clearing psoriasis in most patients, but since UVB is easier to administer and does not involve an oral photosensitizing medication, it is often selected before PUVA. UVB and PUVA have been administered alone or in combination with topical corticosteroids, salicylic acid, anthralin, calcipotriol and tazarotene, and with systemic therapies such as retinoids. The most important potential long-term side effects of UVB and PUVA are accelerated skin aging and an increased risk of cutaneous cancer.Ovaj pregledni članak obuhvaća suvremenu primjenu fototerapije s UV zračenjem bez senzibilizatora i psoralensku fotokemoterapiju (PUVA) u liječenju psorijaze. U kliničkoj je primjeni nekoliko vrsta UVB zračenja: klasično ili UVB zračenje širokog spektra (280 - 320 nm); selektivno UVB zračenje (305 - 325 nm); UVB zračenje uskog spektra (311 nm). Oblici PUVA terapije su: sistemska fotokemoterapija (PUVA terapija s peroralnim uzimanjem psoralena); liječenje PUVA kupkama (PUVA bath); PUVA terapija s lokalnom primjenom psoralena. Iako je u većine bolesnika PUVA terapija učinkovitija od UVB terapije, UVB terapija se obično odabire prije PUVA terapije zbog lakše primjene, kao i stoga što ne uključuje uzimanje oralnog fotosenzibilizatora. UVB i PUVA rabe se samostalno ili u kombinaciji s lokalnom primjenom kortikosteroida, salicilnom kiselinom, antralinom, kalcipotriolom, te sa sistemskom primjenom lijekova kao što su retinoidi. Najznačajniji potencijalni dugoročno štetni učinci UVB i PUVA terapije su ubrzano starenje kože i povećani rizik od raka kože

Mycobacterium marinum infection of the hand in an immunocompromised aquarium hobbyist

M. marinum, a nontuberculous mycobacterium, is a rare human pathogen widely distributed in the aquatic environment. In the previous century, epidemics took place due to inadequately chlorinated swimming pool water. Nowadays the majority of infections are acquired through contact of previously damaged skin with contaminated fish tank water. We present a case of M. marinum infection of the hand in an aquarium hobbyist which stayed unrecognized for 2 years. After confirming the correct diagnosis, the patient was successfully treated with a regiment containing clarithromycin and rifampicin. The aim of this paper is to raise the awareness of the possibility of M. marinum infection when encountered with non-healing nodular/verrucous/ulcerative lesions of the extremities. ly: MyriadPro-Bold;color:black;mso-ansi-language:EN-US;mso-fareast-language:HR; mso-bidi-language:TA\u27&gt;   </p

Antiproliferative, Antiangiogenic and Apoptotic Effect of Photochemotherapy (PUVA) in Psoriasis Patients

The aim of the study was to investigate the antiproliferative, antiangiogenic and apoptotic effect of photochemotherapy (PUVA) in psoriatic patients, and to compare it with a control group of psoriatics treated with local corticosteroid therapy. The study included 60 psoriasis patients, 30 of them allocated to PUVA therapy and local corticosteroid each. Immunohistochemical methods of staining with Ki-67, F-8 and bcl-2 antibodies were used to determine proliferative keratinocyte count, to visualize the number of blood vessels in the dermis, and to determine the number of cells exhibiting expression of the antiapoptotic oncoprotein bcl-2, respectively. In all study patients, the values of Ki-67, F-8, bcl-2 and PUVA score were recorded pre- and at six weeks post-therapeutically. Study results showed a statistically significant decrease in the epidermal proliferative keratinocyte count and dermal number of blood vessels after both therapeutic modalities (p<0.001 both). The value of bcl-2 showed a statistically significant increase in the group of patients treated with PUVA therapy (p=0.001) and an increase in the control group, demonstrating enhanced keratinocyte apoptosis after treatment. Accordingly, study results demonstrated the antiproliferative, antiangiogenic and apoptotic effect of both PUVA and local corticosteroids. These very mechanisms appear to play a key role in the action of most antipsoriatic therapies

Advanced Pyoderma Gangrenosum Previously Treated as Squamous Cell Carcinoma

Pyoderma gangrenosum is a rare, neutrophilic ulcerative skin disease of unknown etiology often associated with an underlying systemic disease. We present a case of a pyoderma gangrenosum that was initially misdiagnosed and treated as squamous cell carcinoma in another hospital. Multiple surgical treatments triggered postoperative exacerbations and further rapid progression of the lesions. History of pathergy, clinical findings, and histopathological features examined at our Department indicated pyoderma gangrenosum. The diagnosis was confirmed by excluding other diseases that could cause similar-appearing cutaneous lesions. No associated underlying disease was determined. After the diagnosis was confirmed, corticosteroid therapy was initiated until complete remission of ulcerations.</p

Ultraljubičasto zračenje i imuni odgovor kože

At present, ultraviolet radiation (UVR) represents one of the most important environmental factors affecting mankind. Besides the beneficial effects of UVR such as vitamin D production, it is known that UVR can lead to adverse effects on human health. The best known harmful effects are sunburns, tumors of the skin and ocular damage. It is noteworthy that UVR effects are not restricted to skin-associated infections, as there is strong evidence for their association with systemic (non-skin-associated) infections as well. Alterations in immune functions that are induced by UVR are initiated by the absorption off light energy by chromophores and their transformation into photoproducts. Some of them are removed by repair mechanisms; others induce signal transduction pathways, whereas some exhibit cytotoxicity. The observable skin response may occur within minutes of light exposure (e.g. urticaria) or may take days (e.g. inhibition of contact hypersensitivity), or much longer periods to be expressed (e.g. tumors). Today, artificial UVR (phototherapy) is used in dermatology for induction of immunomodulation in many forms of autoimmune and/or hyperimmune responses in the skin.Ultraljubičasto zračenje (UVZ) danas predstavlja jedan od najvažnijih čimbenika okoliša koji utječu na ljude. Uz korisne učinke UVZ, kao što je stvaranje vitamina D, poznato je da UVZ može imati i neželjene učinke na ljudsko zdravlje. Najprepoznatljiviji štetni učinci su opekline od sunca, tumori kože i oštećenje očiju. Valja napomenuti kako učinci UVZ nisu ograničeni na infekcije povezane s kožom, nego su isto tako udruženi sa sistemskim infekcijama (koje nisu povezane s kožom), i za to postoje jaki dokazi. Promjene imunosnih funkcija što ih izaziva UVZ započinju apsorpcijom svjetlosne energije od strane kromofora i njihovom pretvorbom u fotoproizvode. Neki se od njih uklanjanju popravnim mehanizmima, drugi izazivaju putanje signalne transdukcije, dok su pak treći citotoksieni. Primjetljiva reakcija na koži može se pojaviti u roku od jedne minute izloženosti svjetlu (tj. urtikarija) ili mogu proći dani (tj. suzbijanje kontaktne preosjetljivosti) ili znatno duže vremensko razdoblje (tj. tumori) do njezine pojave. Danas se umjetno UVZ (fototerapija) rabi u dermatologiji za izazivanje imunomodulacije u mnogim oblicima autoimunog i/ili hiperimunog odgovora u koži