[Atopic dermatitis in children and adults]. / Atopijski dermatitis u djece i odraslih.

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease characterized by itching and typical clinical features, depending on patient age. It is often associated with other atopic diseases such as asthma or allergic rhinitis, resulting from the complex etiology and pathogenesis. It occurs more frequently in people with genetic predisposition for atopic diseases. The intensity and extent of skin lesions (Scoring of Atopic Dermatitis, SCORAD Index) vary significantly among AD patients, depending on whether it is acute or chronic, and there are variations in laboratory parameters, especially immune. In the future, it will be necessary to reach consensus on the new criteria for defining AD instead of the old ones (brought by Hanifin and Rajka 31 years ago). What is needed is effective and safe treatment, and control of the early stages of AD as well as maintaining AD remission. The new therapeutic approach in AD has greatly improved the quality of life of AD patients. As the prevalence of the disease continues to increase, we emphasize the importance of prevention, prompt recognition and optimal treatment of the many patients with AD.

[Allergologic emergencies in dermatology--diagnostic and therapeutic procedures]. / Hitna stanja u alergologiji i dermatovenerologiji--dijagnosticki i terapijski postupci.

Emergencies in allergology and clinical immunology are quite common and pose a public health problem in Croatia and worldwide. Allergic reactions ranging from mild symptoms such as pruritus to generalized skin eruptions, gastrointestinal and respiratory symptoms to anaphylaxis with cardiovascular emergencies are very common. Reaction develops to inhalant substances, food and food ingredients, various foreign substances (blood, latex, etc.) and many other well known antigens and drugs which are frequent causes of anaphylactic reactions, asthma, generalized urticaria, angioedema. There are 35 different skin reactions induced by drugs through immune complexes, complement mediated reactions and direct histamine liberation (by opiates or dextran) and modulators of arachidonic acid metabolism (such as NSAID). Along with painful infiltrates, insect venom allergy manifests with disseminated exanthema and angioedema. Current diagnostic methods, especially therapeutic procedures for emergencies in concordance with the international consensus of the European Allergy White Paper, require the same procedure in clinical practice. Many patients with different allergic skin diseases are treated inappropriately, some are tested in active phase of the disease, during anti-allergic therapy, and some are administered corticosteroids and antihistamines longer than necessary. Sometimes, the treatment of emergencies requires a person experienced in intensive care medicine. However, any physician might be responsible for the treatment of acute symptoms in his office, and thus has to know the modalities and relevant drugs and treatment essentials. Anaphylactic reactions are rare, but every physician should be prepared for the worst. Due knowledge of the correct management should be a must for all of us. The most common emergencies require emergency treatment and diagnostic procedures upon disease regression.

Immunology of allergic contact dermatitis.

Allergic contact dermatitis (ACD) is a T-cell mediated skin inflammation caused by repeated skin exposure to contact allergens. This review summarizes current knowledge on the immunology of ACD. Different phases in ACD are distinguished, i.e. sensitization, elicitation and resolution phases. We discuss contact allergen presentation and the central role of antigen presenting cells during sensitization phase. There is an extremely complex interaction of different kinds of immune cells, such as antigen presenting cells, T, B, NK lymphocytes, keratinocytes (KCs), endothelium, mast cells (MCs) and platelets, and this complex interaction is guided through orchestration of numerous cytokines and chemokines. The role of adaptive immunity has been recognized in contact hypersensitivity but we also discuss the important role of some parts of innate immunity such as natural killer T lymphocytes (NKT) and complement system. Cooperation of innate and adaptive immunity, in this case NK cells and B cells, initiates elicitation phase by complement cascade activation, vasoactive substance release and endothelial activation. KCs are not only innocent bystanders, on the contrary, they are involved in all phases of ACD, from the early phase of initiation through sending "danger" signals and activation of innate immunity, through their role in Langerhans cells (LCs) migration, T-cell trafficking, through the height of the inflammatory phase with direct interactions with epidermotropic T-cells, and finally through the resolution phase with the production of anti-inflammatory cytokines and tolerogenic presentation to effector T-cells. Th-1 and Th-17 cells are the main effector cells responsible for tissue damage. At the end, we point out several subsets of T regulatory cells, which exert down-regulatory function and regulate the magnitude and duration of inflammatory reaction.

Psoriasis vulgaris - an inflammatory skin disease and/or benign epidermal hyperplasia.

Psoriasis vulgaris (PV) is a systemic inflammatory disease in which immune and genetic factors are involved in the pathogenesis. Some treatment approaches in PV patients have been similar to therapy of some tumors. This fact has led to a new scientific approach to PV not only as an inflammatory disease, but also as a benign epidermal hyperplasia or a benign tumor. In this article, we hypothesize that there has been a parallel between some benign tumors and neoplasms and PV. The aim of this article is to present the approach to PV as an inflammatory disease as well as benign epidermal hyperplasia or tumor, and to introduce a new meaning.