Jasna Lipozenčić

Suzana Ljubojević

English

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49 Brest implants made of materials such as ivory, rubber, or ox cartilage have been used since the 19th century. After the 1940s, direct subcutaneous silicone injections were introduced, which caused serious complications (infections and migration to distant tissues). In the 1960s, a solid silicone en-velope filled with silicone gel or saline was used. Escape of silicone from the envelope of these im-plants could be either intracapsular or extracapsu-lar, penetrating though the fibrous capsule formed around the implant. In 1992, the US Food and Drug Administration decided that silicone gel-filled implants could only be used in women in clinical studies, for revision after unsatisfactory saline im-plantation, or after mastectomy for breast cancer. In contrast, these implants have been regularly used for cosmetic purpose in Europe. Autoim-mune disorders in women with silicone implants were reported in the 1970s and 1980s, includ-ing systemic lupus erythematosus, scleroderma, rheumatoid arthritis and some rheumatologic conditions (1). Several studies examined the as-sociation between implants and the development of connective tissue disease (CTD), with a relative risk of 1.24 for CTD in women silicone breast im-plants (1-5). In Tel Aviv, five women with CTD who had silicone implants were treated for 18 months (1). These five cases covered a wide spectrum of CTDs in women who had silicone implants for peri-ods of up to 25 years. Two of these five cases had other possible causes of their CTD, i.e. metastatic breast cancer in patients with dermatomyositis, or drug induction (high doses of paracetamol, met-amizole, ibuprofen). The diagnoses were: mor-phea, dermatomyositis, systemic sclerosis, chil-blain lupus/vasculitis, and eosinophilic fasciitis. In patients with fibromyalgia it has been suggested Acta Dermatovenerol Croat     2007;15(1):49 NEWS AND COMMENTSWHAT SHOULD BE USED AS TOOLS IN WOMEN AT RISK OF AUTIMMUNE DISEASE?to be related to silicone implants (1). None of the patients wanted explanation. Because of the multifactorial nature of most autoimmune disorders, women seeking breast implants should be screened for the known trig-gers for developing CTD. Until we have better di-agnostic tools, the women at risk of autoimmune diseases should not be considered for implanta-tion of silicone devices for cosmetic purpose.Prof. Jasna Lipozenčić, MD, PhDAssist. Prof. Branka Marinović, MD, PhDReferences1.   Rishpon A, Wohl Y, Barnea Y, Ehrenfeld M, Weiss J, Klaz I, Brenner S. Silicone implants and connective tissue disease: 5 cases. Skin-med 2007;6:30-4.2.   Winkler E, Bar-Meir E,  Regev E, Haik J, Tamir J, Orenstein. Silicone breast implants with sili-cone gel and autoimmune disease – are they related? Harefuah 2003;142:536-49.3.   Hannekens CH, Lee I-M, Cook NR,Herbert PR, Karlson EW, La Motte F et al. Self-repor-ted breast implants and connective tissue di-seases in female health professionals. JAMA 1996;275:616-21.4.   Janowsky EC, Kupper LL, Hulka B. Meta-ana-lyses of the relation between silicone breast implants and the risk of connective-tissue di-seases. N Engl J Med 2000;342:781-90.5.   Lipworth L, Tarone RE, McLaughlin JK. Breast implants and fibromyalgia: a review of the epidemiologic evidence. Ann Plast Surg 2004;52:284-7.ACTA DERMATOVENEROLOGICA CROATICA50 ACTA DERMATOVENEROLOGICA CROATICA The treatment of chronic idiopathic urticaria (CIU) is very difficult. According Vena GA et al., cyclosporine (CsA) at a dosage of 5 mg/kg per day progressively reduced to 3 mg/kg per day in addition to background therapy with cetirizine during 8 weeks may be useful in the manage-ment of CIU. This multicenter study included 99 population recruited subjects in 18 Italian outpa-tient clinics, all of them adult patients suffering from several relapsing CIU episodes. Exclusion criteria were other concomitant forms of urticaria, any contraindication to cetirizine and CsA (San-dimum Neoral) and relevant systemic disorders. A a 1-week run-in period with cetirizine, 10 mg/day, the patients entered a 16-week double-blind period of randomized treatment in addition to the background cetirizine therapy and were randomly allocated to one of three treatments: CsA for 16 weeks; CsA for 8 weeks followed by placebo for 8 weeks (8-week CsA), or placebo for 16 weeks. Sixty (60%) patients reported adverse events with fever in the placebo group (elevated serum creati-nine increased in six patients receiving CsA). The Subject’s Global Assessment of relief of symptoms and Dermatology Life Quality Index (DLQI) over 24-week post-randomization period proved the ef-ficacy and point change in total score at 16 and 24 weeks. After 8 weeks, the severity score was significantly improved by CsA with relief of symp-toms and improvement in DLQI scores with CsA compared with placebo (1). This study confirmed the clinical outcome in CIU with CsA as efficient therapy at 8 weeks, as also reported by Grattan et al. (2), Cassano et al. (3), Poon et al. (4), Thomp-son et al. (5), and Lennox and Leahy (6).Prof. Jasna Lipozenčić, MD, PhDSuzana Ljubojević, MD, PhDReferences1.   Vena GA, Cassano N, Colombo D, Peruzzi E, Pigatto P, NEO-I-30 Study Group. Cyclospo-rine in chronic idiopathic urticaria: a double-blind, randomized, placebo-controlled trial. J Am Acad Dermatol 2006;55:705-9.2.   Grattan CE, O’Donnell BF, Francis DM, Niimi N, Bralow RJ, Seed PT, et al. Randomized dou-ble-blind study of cyclosporine in chronic “idio-pathic” urticaria. Br J Dermatol 2000;143:365-72.3.   Cassano N, D’Argento V, Vena GA. Cyclospo-rin A in chronic idiopathic urticaria: an update. Int J Immunopathol Pharmacol 2002;15:13-8.4.   Poon E, Seed PT, Greaves MW, Kobza-Black A. The extent and nature of disability in dif-ferent urticarial conditions. Br J Dermatol 1999;140: 667-71.5.   Thompson AK, Finn AF, Schoenwette WF. Effect of 60 mg twice-daily fexofenadine HCl on quality of life, work and classroom produc-tivity, and regular activity in patients with ch-ronic idiopathic urticaria. J Am Acad Dermatol 2000;43:24-30.6.   Lennox RD, Leahy MJ. Validation of the Der-matology Life Quality Index as an outcome measure for urticaria-related quality of life. Ann Allergy Asthma Immunol 2004;93:142-6.CYCLOSPORINE IN CHRONIC IDIOPATHIC URTICARIAActa Dermatovenerol Croat     2007;15(1):50 NEWS AND COMMENTS51ACTA DERMATOVENEROLOGICA CROATICA On the proposal of the National Health Coun-cil, the Ministry of Health and Social Welfare of the Republic of Croatia issued a decision effec-tive as of June 30, 2006, appointing the University Department of Dermatology and Venereology, Za-greb University Hospital Center and Zagreb Uni-versity School of Medicine, a Reference Center for Dermatologic Oncology of the Ministry of Health and Social Welfare (Reference Center for Derma-tologic Oncology). In recent years, considerable progress has been made in dermatologic oncology. The inci-dence of malignant skin tumors, melanoma in par-ticular, then basal cell carcinoma and squamous cell carcinoma, has been on a constant increase worldwide, including Croatia. As Croatia is a Medi-terranean country, this increasing trend poses a major public health problem. Thus, the Reference Center for Melanoma has already been estab-lished at University Department of Dermatology and Venereology, Sestre milosrdnice University Hospital. The program of activities of the Reference Cen-ter for Dermatologic Oncology includes numer-ous actions in the field of dermatologic oncology related to non-melanoma malignant tumors and primary skin lymphomas. Exact data on the inci-dence of malignant epidermal tumors in Croatia are lacking; therefore, the Board on Dermatology and Venereology at Ministry of Health and Social Welfare has already established collaboration with the National Cancer Register. This collaboration has now been additionally encouraged and in-cluded in the regular activities of the Reference Center for Dermatologic Oncology. Processing of data on malignant epidermal tumors in Croatia is under way. Data have been collected from reports submitted by dermatologists, ENT specialists, sur-geons and other specialists treating patients with malignant epidermal tumors, with special refer-ence to promotion of team approach in the diagno-sis and treatment of malignant epidermal tumors and primary skin lymphomas. Attention will be especially focused on the ear-ly diagnosis of malignant epidermal tumors as a ESTABLISHMENT OF THE REFERENCE CENTER FOR DERMATOLOGIC ONCOLOGY OF THE MINISTRY OF HEALTH AND SOCIAL WELFAREmajor factor influencing therapeutic outcome and patient’s quality of life. This can be successfully implemented at University Department of Derma-tology and Venereology, Zagreb University Hospi-tal Center, with properly equipped Laboratory of Skin Dermatologic Histopathology and Electron Microscopy Unit. Outpatient Clinic for Dermato-logic Radiotherapy is part of the Reference Cen-ter of Dermatologic Oncology. It is an appropriate therapeutic modality for elderly patients with ma-lignant epidermal tumors, recurrent or inoperable malignant epidermal tumors, and some primary skin lymphomas, mycosis fungoides in particular. Photodynamic therapy as a treatment modality for precancerous lesions and some forms of basal cell carcinoma is also performed at the Center. Current diagnosis and treatment of primary skin lymphomas is an important segment of der-matologic oncology. Clinical and histopathologic diagnosis has been developed at the Department for years, using a variety of modern methods of treatment for primary skin lymphomas. Efforts will be made to upgrade team approach in the field, to the benefit of our patients.  Nowadays, prevention of malignant skin tumors is an important task of every dermatologist/vene-reologist. The program of the Reference Center includes prevention actions, which are focused on the respective education of the population at large, with special reference to young population groups, on the methods of protection from sunlight expo-sure as a major factor in the etiology of malignant epidermal tumors. Special attention will be paid to secondary prevention, including early diagnosis and early therapy, which is closely associated with better prognosis. Another aspect of the Center activities is edu-cation of dermatologists/venereologists in part serving their residency at the Reference Center for Dermatologic Oncology. In addition, mention should be made of the rich professional, scientific and publishing activities of the Center for Derma-tologic Oncology.Head Doctor Aida Pašić, MD, PhDActa Dermatovenerol Croat     2007;15(1):51 NEWS AND COMMENTS52 ACTA DERMATOVENEROLOGICA CROATICA Upon the Ministry of Health and Social Wel-fare of the Republic of Croatia decision effective as of June 30, 2006, University Department of Dermatology and Venereology, Zagreb University Hospital Center and Zagreb University School of Medicine, has been appointed Reference Center for Photodermatology of the Ministry of Health and Social Welfare, thus recognizing our Department as the leading institution in the field of photoder-matology in Croatia. Many new diagnostic and therapeutic modali-ties in the field of photodermatology, e.g., photo-therapy, photochemotherapy, phototesting, photo-dynamic therapy, and laser therapy, with the use of ultraviolet light (300-320 nm, 311±1 nm, 365 nm), visible light (400-700 nm) and laser light of various wavelengths, have been employed at the Department.  Outpatient Clinic for Phototherapy was estab-lished at University Department of Dermatology and Venereology in 1978, when the first unit for UVB and UVA therapy was purchased. Since then, the development of photodermatology and photomedicine at the international level has been closely followed. These activities have been in-tensified in the past decade. Currently, all modern phototherapy and photochemotherapy modalities, i.e. UVB, UVB 311 nm, UVA+UVB, PUVA, PUVA-bath, phototherapy of palmoplantar dermatoses, and phototherapy in children, have been success-fully applied at the Department. In 2003, the Unit for Laser in Corrective Der-matology was established to provide treatment for almost all indications for the use of laser in dermatology/venereology. The most important ESTABLISHMENT OF THE REFERENCE CENTER FOR PHOTODERMATOLOGY OF THE MINISTRY OF HEALTH AND SOCIAL WELFAREadvantages of laser therapy over other methods of treatment include selective removal of skin le-sions, excellent tolerability, short-term treatment and favorable cosmetic effects. In January 2004, local photodynamic therapy (PDT) was introduced at Department. PDT is a novel phototherapeutic modality that includes photochemical reactions with interaction of visible light, photosensitizing substances and oxygen. The aim of PDT is selective destruction of the tar-get, abnormal cells while preserving normal ones.Teaching activities for undergraduate students of the School of Medicine and postgraduate educa-tion for physicians of various specialties have for years been performed at Outpatient Clinic for Pho-totherapy. Work at Outpatient Clinic for Photother-apy is part of residency in dermatology/venereol-ogy. In addition, physicians and nurses working at phototherapy clinics established in Croatia to date have received respective training and education at our Department. Besides work with patients, attention has also been paid to professional and scientific activities in the field of photodermatology. The newly established Reference Center for Photodermatology of the Ministry of Health and Social Welfare will invest all efforts to upgrade therapeutic and diagnostic methods in the field of photodermatology, to continue providing education for professionals in the field of photodermatology, to engage in professional and scientific activities, and to publish the results achieved.Romana Čeović, MD, PhDActa Dermatovenerol Croat     2007;15(1):52 NEWS AND COMMENTS

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