TREATMENT OF VERRUCA VULGARIS IN TRADITIONAL MEDICINE.

Common warts (verrucae vulgares) are the most common complaint in routine dermatological practice. Warts can be painful on pressure and are often an aesthetic problem, but they are not a major threat to the person's general health. Treatment options are symptomatic and do not eradicate the causative agent. Dermatological surgery procedures such as cryotherapy, electrocauterization and excochleation can be painful, with common recurrences. These are the most important reasons for revival of the treatment procedures and remedies based on traditional medicine. Traditional medicine is still commonly practiced as a form of self-healing. This paper presents the most commonly used wart remedies of plant, animal and mineral origin, along with various magic practices. We emphasize that this paper is written from the viewpoint of physicians, practitioners of dermatology, not as a study in the history or culture. The main objective of the study was to explore various substances and methods people use as home remedies for warts. We performed a case study survey among the general population by interviewing 147 adult participants using a simple preliminary questionnaire inquiring about preferred treatment and knowledge about common warts.

[Wounds and dermatoses]. / Rane kod dermatoloskih bolesti.

Wounds are a hallmark of various skin diseases. Most patients with wounds suffer from chronic venous insufficiency or other vascular diseases. Autoimmune, infective, metabolic, malignant, some psychiatric and diseases caused by environmental factors like radiation, present with skin and mucosal erosions and ulcerations. Lichen planus, lichen sclerosus, toxic epidermal necrolysis, Kaposi sarcoma, genodermatoses like Hailey-Hailey and Darier's disease belong to different dermatological entities, they have different etiology, pathogenesis and clinical presentation, but at some stage ulcerations and erosions dominate through the disease course as a result of complications of untreated disease or as part of a complex clinical presentation. Wounds demand a different multidisciplinary therapeutic approach, sometimes even in intensive care unit, where special care is available. Most patients are followed-up to avoid fatal complications like sepsis, as well as a potential malignant transformation of cells in the environment of chronic inflammation. Wounds are found in female genital lichen planus and lichen sclerosus. Oral lichen planus has a potential for malignant transformation and is considered a precancerous disease. Toxic epidermal necrolysis is a life threatening disease similar to burns. Wounds cover most of the body surface as well as mucosa. The high mortality rate is due to complications like sepsis, loss of thermoregulation, electrolyte and fluid disbalance and shock. Chronic wounds are also a hallmark of skin tumors and other skin malignancies like Kaposi sarcoma and lymphoma. The primary treatment goal in genodermatoses like epidermolysis bullosa is wound care, and to a less extent in other inherited skin diseases like Hailey-Hailey and Darier's disease wound healing is important for sustaining a good quality of life in affected individuals.

A multivariate analysis of clinical severity, psychological distress and psychopathological traits in psoriatic patients.

Psoriasis is a chronic skin disease associated with problems in body image and self-esteem and feelings of stigma and shame. The aim of this study was to analyse the clinical extent of psoriasis and its association with psychological distress, and to compare the psychopathological traits in early-onset (type I: age of onset < 40 years) vs. late-onset (type II: age of onset > 40 years) psoriasis. A total of 140 patients participated in the study; 70 patients with confirmed diagnosis of psoriasis vulgaris and 70 patients as a comparative group. A battery of psychological instruments was used together with an Inventory of life stress events. The severity of psoriasis was assessed by standardized Psoriasis Area and Severity Index measure. The Psoriasis Life Stress Inventory showed the significant correlation with clinical extent of psoriasis and other measures of psychological distress. Patients with late-onset psoriasis had more prominent symptoms of depression compared with the group with early-onset psoriasis and the comparative group. The results of the Minnesota Multiphasic Personality Inventory-201 for the patient group with late-onset psoriasis showed a specific configuration of neurotic triad.

New option in photoprotection.

All the people are exposed to solar ultraviolet radiation. Exposure to sun with living in an oxygen-rich atmosphere causes unwanted photodemage. Sunburned skin is a leading risk factor for melanoma and non-melanoma cancers. UV exposure causes immunosuppression via multiple mechanisms in the skin. In this review the main topic is to mention new or alternative ways of photoprotection. Sunscreens are commonly used as protection against sun damage. They reduce the penetration of damaging solar UV wavelengths in skin by reflecting or absorbing them. Sunscreens are very valuable, but they have limitations. They have to be used properly to gain the full effect (application a little while before UV exposure, at frequent time points and in adequate amounts). Also, they have the problem of photoinactivation, which is the degeneration of the UV-filter due to exposure to UV rays resulting in the loss of absorbing capacity. Products with immune protection factor contain DNA-repair enzymes and antioxidants that may reduce mutations and enable the immune system to combat photodamage. The use of antioxidants and polyphenols may exert an anti-aging effect by preventing and even reversing sun damage. Adequate photoprotection is essential to control photocarcinogenesis and photoaging.

Photosensitivity skin disorders in childhood.

Photosensitivity in childhood is caused by a diverse group of diseases. A specific sensitivity of a child's skin to ultraviolet light is often the first manifestation or a clinical symptom of photodermatosis. It might indicate a serious underlying systemic disease such as lupus erythematosus or dermatomyositis, or a rare group of genetic skin disorders like Xeroderma pigmentosum, Cockayne syndrome, Trichothyodystrophy, Bloom syndrome, Rothmund-Thomson and Kindler syndrome as well as metabolic disorders and cutaneous porphyria. Photosensitivity secondary to topical or systemic agents may also cause photosensitivity in children. Early recognition and prompt diagnosis may prevent complications associated with unprotected exposure to sunlight and avoid actinic injuries that can lead to malignant skin changes.

Evolutionary medicine perspective on coping style and health outcomes: an exploratory study.

One of the issues within the framework of Darwinian medicine is why individuals develop the specific disease they do. Ethologists have long known that within any given population, there are organisms with the tendency towards higher (Hawks) or lower (Doves) aggressiveness, and since the physiological responses to stressful events are different in Hawks and Doves, it has been suggested that these strategies might be related to health outcomes. The aims of this exploratory study were to determine whether an analogues of Hawks and Doves as basic coping strategies could be defined among chronically ill patients and healthy controls and whether the proportion of Hawks and Doves differs among different groups of patients. Patients from several clinical departments (dermatology, gastroenterology and psychiatry) and a comparable group of healthy participants were recruited (N = 288). Based on their coping style and anxiety trait, they were categorized as either Hawks (low anxiety trait and problem-oriented coping style) or Doves (high anxiety trait and avoidant coping style). We found a significantly larger proportion of Hawks among patients with gastroenterological and dermatologic symptoms, and significantly more Doves among psychiatric patients. The proportion of Hawks and Doves in healthy controls was close to 50:50. This is in accordance with the notion that Hawks and Doves have different allostatic load management, and that the onset of certain diseases might be related to these strategies. However, prospective longitudinal studies are necessary to reach definite conclusions regarding the susceptibility to certain diseases among people with different stress-related behavioral and emotional strategies.

Differential diagnosis of neonatal and infantile erythroderma.

Neonatal and infantile erythroderma is a diagnostic and therapeutic challenge. Numerous underlying causes have been reported. Etiologic diagnosis of erythroderma is frequently difficult to establish, and is usually delayed, due to the poor specificity of clinical and histopathologic signs. Differential diagnosis of erythroderma is a multi-step procedure that involves clinical assessment, knowledge of any relevant family history and certain laboratory investigations. Immunodeficiency must be inspected in cases of severe erythroderma with alopecia, failure to thrive, infectious complications, or evocative histologic findings. The prognosis is poor with a high mortality rate in immunodeficiency disorders and severe chronic diseases such as Netherton's syndrome.

A dose-finding study of azithromycin in the treatment of acne vulgaris.

This open, multicenter, comparative, randomized study included 120 subjects with papulopustular stage of acne vulgaris. Subjects were randomized to one of the three treatment groups (A, total dose 4.5 g of azithromycin in 7 weeks; B, total dose 6.0 g in 10 weeks; and C, total dose 7.5 g in 13 weeks). The aim was to identify the optimum azithromycin dose in the treatment of acne vulgaris through monitoring the efficacy and safety of three dosage regimens. Clinical efficacy was assessed upon completion of study therapy and six months of therapy initiation. Post-therapeutic efficacy assessment was available in 104 subjects. The difference between three treatment groups was most pronounced in the "cure" category (36.11% in group A, 58.82% in group B and 55.88% in group C) and "failure" category (8.33% in group A, and no failures in groups B and C). Follow up efficacy assessment was available in 87 subjects. The group percentage of "cure" was lower and group percentage of "treatment failure" higher in group A than in groups B and C. Azithromycin in a total dose of 6.0 g in 10 weeks seems to be a promising agent in the treatment of papulopustular acne vulgaris with few side effects and good patient compliance.

IMPORTANCE OF EDUCATIONAL INTERVENTION AND PARENTAL KNOWLEDGE ON ATOPIC DERMATITIS IN CHILDREN.

Atopic dermatitis (AD) is a chronic relapsing, inflammatory skin disease. Failure to treat AD successfully can often be directly linked to poor treatment adherence as a result of the lack of information about the disease and basic principles of treatment. Several studies have found that making patients active participants in their care through information and education is a successful treatment strategy in AD. The aim of this study was to evaluate parental knowledge on AD and to stress the importance of therapeutic educational program in long-term management and control of the disease. We carried out a short questionnaire-based study among 238 parents of children with AD regarding their knowledge on the etiology and treatment of AD. Our results showed that 21% of the participants reported corticophobia and were concerned about systemic absorption affecting the child's growth and development even after short application. In children with AD who have food hypersensitivity, 14% of parents thought that a small amount of food allergen could be beneficial in achieving tolerability. The role of interdisciplinary educational program is to explain the epidemiology and pathogenesis of AD, as well as concomitant atopy related diseases and to teach parents about the importance of appropriate skin care.

Skin photodamage and lifetime photoprotection.

Ultraviolet (UV) radiation is a very small part of the electromagnetic radiation spectrum, released and transported from the source in the form of photons. Disposal of these photons within the skin causes cutaneous photodamage, which leads to clinical, histologic, and biochemical changes. Aging is a complex process characterized by cellular attrition, decreased cellular reserve capacity, and compromised ability to perform normal cellular function. Intrinsic aging, which steadily develops with time, is linked to chronologic age; it is the result of a genetic program. Photoaging, on the other hand, develops as a consequence of UV radiation-induced degenerative changes in the skin. Intrinsic aging is a universal, inevitable process, whereas photoaging is neither universal nor inevitable and can be prevented. UV radiation can also suppress the immune system in both local and systemic way and lead to simultaneous and sequential biochemical events that ultimately cause photocarcinogenesis. Therefore, everyday use of products that protect against UV radiation is necessary to prevent acute and long-term photodamage (clinical and cellular changes) leading to photoaging, photoimmunosuppression, and photocarcinogenesis.

The use of emollients as sophisticated therapy in dermatology.

Emollients are agents designed to make the stratum corneum softer and more plant by increasing its hydration. A large number of preparations are available today, many of which are marketed as cosmetic and therapeutic moisturizers. They are the most prescribed products in dermatology. Their structure and function are surprisingly complex and sophisticated, and many are equidistant between cosmetics and drugs. The use of the emollients corrects the problems in scaling disorders. It is well known that the electrical properties of the stratum corneum change after application of an emollient. It is also possible that they have suppressive effects on epidermal thickening. Emollients have an anti-inflammatory activity and also give some transient relief from irritation. In clinical use emollients are employed as treatments for ichthyoses, xeroderma and disorders of keratinization, atopic dermatitis, psoriasis, and photodamaged skin. Emollients of the new millennium include agents that mimic natural ingredients and function as botanicals, including vitamins, hydroxy acids, and retinoids. Emollients can cause a few side effects, such as irritant dermatitis, allergic contact dermatitis, fragrance allergy or allergy to other constituents (preservatives or additives), stinging, cosmetic acne, and pigmentary disorders. We can conclude that emollients, continuously evolving to ever more sophisticated products, are very important in the treatment of different dermatoses.