[Lichen sclerosus et atrophicus--a diagnostic problem]. / Skleroticni atroficni lihen--dijagnosticki problem.

INTRODUCTION: Lichen sclerosus et atrophicus (LSA) is a rare disease with etiology that has not been clearly defined up to now. This disease appears up to 10 times more frequently among women, than among men. It occurs at the age of 40-60. Anogenital site is the most common, but in 20% of cases it is extragenital. CASE REPORT: We report a case of a 78-year-old woman with skin lesions on the hand and face, that appeared 7-8 years ago after intensive sun exposure. When admitted to hospital, she had a butterfly-shaped livid erythema on cheeks and nose hypopigmentation on its edges. Atrophic plaques were formed in some areas of lesions. On the dorsal side of hand clear atrophic plaques were noticed. Pathohistological analysis of skin lesions revealed epidermal hyperkeratosis and atrophy with follicular hyperkeratosis, dermal edema, with subepidermal blistering and edematous hyalinized connective tissue. Direct immunofluorescence of the face lesion has shown presence of IgA, IgG and IgM deposits along the epidermo-dermal interface. Based on all findings the following diagnosis was made: Lichen sclerosus et atrophicus bullosus. DISCUSSION: Differentiation between chronic discoid lupus erythematosus and LSA presents a diagnostic challenge. Both diseases have some common pathohistological changes, but a single mixed inflammatory dermal infiltrate as well as edema and hyalinized connective tissue were the most important facts in making diagnosis. CONCLUSION: Lack of knowledge in regard to etiology of this disease has caused some problems in differential diagnosis. This disease hasn't always been a separate entity, but we expect that many things regarding the etiology and pathogenesis to be explained in the future.

[Characteristics of the Koebner phenomenon in patients with psoriasis vulgaris]. / Neke karakteristike Koebnerovog fenomena u obolelih od vulgarne psorijaze.

INTRODUCTION: Koebner phenomenon in psoriasis presents development of psoriatic lesions, after injury of uninvolved skin, which are identical in morphology with the previous trauma. The aim of this study was to establish the correlation of Koebner phenomenon with sex and age distribution, clinical variants of psoriasis vulgaris, age of onset and incidence in psoriasis among relatives of affected patients. MATERIAL AND METHODS: Sixty patients, with severe clinical picture, participated in this study: 38 patients in acute flare of a chronic form; 10 with acute exanthematic form; 8 with a chronic stable form; 3 with psoriatic changes on palms and soles and one patient with psoriatic erythroderma. According to the presence of Koebner phenomenon they were divided in two groups, one with positive and the other with negative Koebner phenomenon which presented the control group at the same time. RESULTS AND DISCUSSION: The Koebner reaction is often thought to be more frequent in actively spreading, severe psoriasis. Although this may be true, it has to be established by prospective studies. According to our investigation, Koebner phenomenon did not depend on clinical picture of psoriasis vulgaris. This reaction also appears to be a marker for a subgroup of patients with a tendency to early onset, but that was not confirmed by our study. In available literature we did not find any data about relations of Koebner phenomenon to sex and age or familiar incidence of psoriasis vulgaris. Our results demonstrated no connection of Koebner phenomenon with sex and age structure. At the same time its presence did not depend on familiar incidence of psoriasis vulgaris. CONCLUSIONS: There is no relationship between Koebner phenomenon and sex and age distribution. It does not depend on clinical picture and also does not predict the age of onset and familiar incidence of psoriasis vulgaris.

[Persistent dyschromic erythema]. / Perzistentni dishromicni eritem.

INTRODUCTION: Erythema dyschromicum perstans (ashy dermatosis) is a very rare skin disease included in the group of acquired, idiopathic hypermelanosis, with development of blue-gray macules. This disease appears more frequently in dark coloured persons, especially women in the first and second life decade. CASE REPORT: A male patient, 42 years of age, was admitted to Clinic of Dermatovenereology in Novi Sad due to appearance of slightly pruriginous, brown-reddish macules on the trunk, upper and lower extremities, without affecting the skin of the face, scalp, palm soles and visible mucous membranes. Later, the color of the macules changed into blue-gray and new lesions appeared in axilla and flexor side of the big joints, with active, erythematous and thin raised borders. Laboratory findings showed no abnormalities; antinuclear antibodies were negative. Histopathological examination of the skin specimens (which were taken from two different places) showed vacuolar degeneration of the basal cell layer, numerous pigmentophages in papillary dermis and presence of lymphohistiocytic infiltrate in dermis. No history of drug intake or exposure to UV light was established. DISCUSSION: Ashy dermatosis is included in the group of hypermelanosis of unknown origin. As possible etiological factors we can mention ingestion of ammonium nitrate, environmental pollution, hypersensitivity to cobalt chloride and postinflammatory pigmentation. Clinical characteristics: occurrence of blue-gray and gray macules on the trunk, face, neck and extremities (absence on the palms, soles, visible mucous membranes, scalp and nails). In the active phase of the disease, these macules are surrounded by erythematous and thin, raised borders. The lesions are mostly permanent. Due to clinical, histopathological, immunofluorescent and electron microscopy established similarities with lichen planus, it is considered that ashy dermatosis is a variant of lichen planus. Absence of previous drug intake, exposure to UV light, absence of the antinuclear antibodies, clinical picture and histological findings confirm the diagnosis of erythema dyschromicum perstans. CONCLUSION: This case of ashy dermatosis shows that there is a need for differential diagnosis of acquired skin pigmentations, because this dermatosis must also be taken into consideration.

[The Koebner phenomenon, a prognostic sign of PUVA therapy effectiveness in patients with psoriasis vulgaris--yes or no?]. / Koebnerov fenomen, prognosticki znak efikasnosti PUVA terapije u bolesnika sa vulgarnom psorijazom--da ili ne?

INTRODUCTION: Former investigations of Koebner phenomenon had demonstrated its higher incidence in patients with severe generalized and/or unstable forms of psoriasis which expressed increased resistance to various treatment modalities. The aim of this study was to establish the correlation between the presence of Koebner phenomenon and the PUVA therapy effects, total number of PUVA treatments, total dose of UVA radiation and the duration of remission after PUVA therapy discontinuation. MATERIAL AND METHODS: Sixty patients with severe clinical picture of psoriasis vulgaris, treated with PUVA therapy, were included in this research. According to the presence of Koebner phenomenon they were divided into two groups, 20 patients with positive and 40 patients with negative Koebner reaction, who were the control group at the same time. RESULTS AND DISCUSSION: 95% of patients treated with PUVA, were cleared of psoriatic changes in the Koebner positive, as well as in the Koebner negative group. There were also no differences between the Koebner positive and Koebner negative group in the mean number of PUVA treatments, mean total dose and the last dose of UVA radiation, which led up to the clinical remission of psoriasis. Our results of investigation have demonstrated increased relapse of psoriasis, during the first 6 months after cessation of PUVA therapy, in the Koebner positive group, with a high statistical significance (p < 0.001), comparing with Koebner negative group in the same period. Furthermore, the tendency of relapse of Koebner positive and Koebner negative psoriatic patients was higher in Koebner positive group even in the first 3 months after PUVA therapy. CONCLUSIONS: PUVA therapy effects, total number of PUVA treatments, total dose of UVA radiation didn't depend on presence of Koebner phenomenon. However, Koebner phenomenon was a mark of high relapsing tendency of psoriasis in the first 6 months after PUVA therapy cessation.

[Isotretinoin in dermatologic practice]. / Izotretinoin u dermatoloskoj praksi.

In dermatology Isotretinoin has been used for 16 years in cases of serious clinical forms of acne resistant to common therapy. This paper presents actual knowledge on pharmacokinetics of isotretinoin, mechanisms of its action, side effects, the newest clinical indications for its application in acne therapy and other possible indications in the contemporary dermatology.

[Chronic urticaria caused by penicillin. Results of monitoring cases of acute penicillin urticaria which developed into chronic urticaria]. / Hronicna urtikarija izazvana penicilinom. Rezultati pracenja slucajeva akutne urtikarije na penicilin koji su se razvili u hronicnu urtikariju.

Penicillin is known to cause allergic reactions with different clinical manifestations and possible immunologic mechanisms. The purpose of this study was to follow cases of established hypersensitivity to penicillin and its possible development into chronic urticaria. 35 patients with a clinical picture of acute urticaria and with or without angioedema were examined. Three kinds of tests to penicillin were performed: patch test, scarification test and PPL test. Hypersensitivity to penicillin was confirmed in 12 (34.27%) patients with positive PPL test. Seven (58.33%) out of these 12 developed the clinical picture of chronic urticaria. As food was assumed to be the hidden source of penicillin, eliminatory diet was included. In 4 (57.14%) patients there was a complete remission of the disease during the course of diet without milk and milk products (intradermal test to milk and specific IgE antibodies were negative). The gathered results show that acute urticaria caused by penicillin can get a chronic character. It is the consequence of prolonged penicillin's activity in some so called "hidden sources of penicillin".

[Chemotaxis activity of neutrophils and monocytes in patients with psoriasis vulgaris in relation to PUVA therapy]. / Hemotaksicna aktivnost neutrofila i monocita u bolesnika s vulgarnom psorijazom u odnosu na primenjenu PUVA-terapiju.

With regard to the existing possibility favored by many immunologists that study on neutrophil (N) and monocyte (Mo) may throw light on the pathogenetic mechanism of clinical conditions such as psoriasis, the effect of PUVA therapy on human N and Mo chemotaxis in psoriasis vulgaris (PV) was investigated. One hundred psoriatic patients with severe clinical picture participated in this study: 20 with acute exanthematic form, 16 with chronic stable form and 64 patients in acute flare of the chronic course. Eitzman's modified method introduced originally by Rebuck was employed prior to and after PUVA, to assess N and Mo chemotaxis. The obtained results have shown pronounced and significant enhancement of N and Mo migration prior to and after PUVA in all investigated groups of patients. Significant difference due to PUVA therapy was seen only in the third phase of the inflammatory response regarding all assessed patients and group A. In this phase, these patients showed significant decrease in N and Mo mobility rate after PUVA treatment in comparison to the chemotactic activity prior to PUVA. These findings suggest the study on N and Mo chemotaxis to be justified only during the third phase of the inflammatory response, when the assessment of PUVA effect is concerned.

[Modern psychosomatic aspects of dermatology]. / Savremeni psihosomatski aspekti u dermatologiji.

Concerning their origin most diseases are multifactorial and that goes for skin diseases too. Emphasizing just one must not exclude further research and other aspects of etiopathogenetic mechanisms. It has been known for along time that psychological factors have a certain influence on the start, aggravation and maintenance on skin changes and that cosmetic defects of this kind disturb the psychological peace of the sick person and his capacity of establishing satisfactory social relations. Psychosomatic approach in dermatology cannot be reduced to investigation of specific etiology in the field of psyche without physical or social spheres. It unites all of them and in that way the old question what cause and what the consequence is has no importance, because there is no time or distance limit among them. They act simultaneously, holistically.

[Chaemotaxic activity of neutrophils and monocytes in patients with vulgar psoriasis]. / Hemotaksicka aktivnost neutrofilnih leukocita i monocita kod bolesnika s psorijazom vulgaris.

In consideration of confirmed disturbances of some functional activities of neutrophils and monocytes in patients with psoriasis vulgaris, this work had a purpose to investigate chaemotactic activity of neutrophils and monocytes in patients with psoriasis vulgaris. Totaly were examined 100 patients with psoriasis vulgaris, which were devidede in three hroups: acute exanthematic (A) forme of disease (20 patients), chronic stable (H) form of disease (16 patients) and acute phase of chronic (AH) form of disease (64 patients). Controle group were composed of 50 healthy persons, chaemotactic activity of neutrophils and monocytes were examined by the "skin windows test", method by Eitzman. Results indicate that cellular migration is significant higher in all groups of patients, significantly disturbances of procentual amount of neutrophils and monosytes in compose of cellular infiltrate, were not confirm in neither group of examinees. Significant differens were not confirm in comparasion of the obtaind results. On the base of results, we can conclude that chaemotactic activity of neutrophils and monocytes in higher in patients of psoriasis vulgaris independent from the exudation, infiltration, duration and course of disease.

[Phagocytic activity of polymorphonuclear cells in patients with psoriasis vulgaris from the aspect of PUVA therapy]. / Fagocitna aktivnost polimorfonukleara u bolesnika s vulgarnom psorijazom s aspekta primenjene PUVA terapije.

The authors present results of examining phagocytotic activity of polymorphonuclear (PMN) granulocytes in patients with psoriasis vulgaris from the aspect of applied PUVA-therapy. 100 patients with psoriasis vulgaris were examined and divided into three groups, 20 patients with acute exanthematous form of the disease, 16 patients with chronic stationary form of the disease, and 64 patients with acute phase of the chronic form of the disease. 50 healthy persons made up the control group. Phagocytotic activity of neutrophils was examined by opsonization test, a modified method by Brandt. Phagocytotic index was expressed as a number of ingested particles of yeast germs in 100 PMN. Polymorphonuclears of patients were examined in the autologous and control serum of healthy people. Values of immunoglobulin IgM and IgG as well as values of complement C3 were examined in all patients using the method of laser nephelometry (Behring). All mentioned parameters were determined prior to and after PUVA therapy which was conducted by apparatus: PUVA 4000 and 6001. Results of examination show that the phagocytotic activity of PMN in patients with psoriasis vulgaris is normal and that it does not depend on how skin disorders are spread, on the strength of infiltration, exudation, the length of duration and course of the disease, as well as on applied PUVA-therapy. Reduced phagocytotic activity of PMN was determined only in individual cases, that is in 5 patients not depending on the applied therapy. In one patient hypoimmunoglobulinemia IgM as a probable cause of disturbed phagocytosis was established while in the remaining 4 patients causes of reduced phagocytosis remained unknown.

[Contact allergic dermatitis caused by plants]. / Kontaktni alergijski dermatitis izazvan biljkama.

In order to contribute to the setting of an accurate diagnosis and prophylaxis of phytodermatitis (PD) and to better understand eczematogenic characteristics of some plants, we present results of an allergologic analysis and review the plants which most commonly cause FD in our material. A total of 15 patients presenting with FD was examined. In all the cases we used a standard technique, patch test (PT); in cases supsective of contact urticaria syndrome (CUS) we used open PT, while photo PT was used for cases suspective of photo PD. We used fresh parts of the plants and standard allergen battery for epicutaneous testing (Department of Immunology, Zagreb). Depending on the profession of the subjects, tests with the material from working places with specific batteries of tests for specific professions were applied according to the recommendations of ICDRG. Tests with parts of the plants were carried out in 8 cases and in 5 controls. A total of 38 plants was examined. Positive PT was found for sisal, willow, parsnip, carrot, celery, spinach, green tomato, broomcorn, lemon skin, pyracantha, arborvitae, yucca, ficus, juniper tree, plane tree and greenhouse grass. In cases of positive PT for willow, carrot, celery, green tomato and grass, positive PT for Peru balsam (PB) was also detected, while in positive PT for lemon skin, a positive PT on turpentine was found as well. Negative results of PT for willow, carrot, celery, parsnip, green tomato, lemon and juniper tree and positive photo PT on greenhouse grass in controls, indicate that we have detected allergic PD on the above mentioned plants.