MINERAL BONE DENSITY AND VITAMIN D LEVELS IN PATIENTS WITH PSORIATIC ARTHRITIS.

The objective of this study was to explore the possible differences in bone mass density (BMD) and markers of bone metabolism between patients with psoriasis with concomitant psoriatic arthritis (PsA) and patients with psoriasis only (PV). A comparable sample of both types of patients were included in analysis. In all patients, vitamin D serum levels along with inflammatory markers and parathyroid hormone (PTH) were measured. BMD was assessed with dual-energy x-ray absorptiometry scan in axial and appendicular skeleton. Patients with PsA tended to have decreased BMD in axial skeleton, while BMD in appendicular skeleton was comparable between the groups. No statistically significant correlation was found of inflammatory markers, vitamin D and PTH levels with BMD in either patient group. A negative correlation was recorded between vitamin D serum concentration and PTH levels.

Merkel cell carcinoma: case report.

Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine carcinoma of the skin. Although it is 40 times less common than malignant melanoma, its mortality is much higher compared to melanoma. From 1986 to 2001 there was rapidly increasing incidence in reported cases of MCC, with a tripling in the rate over this 15-year period. The vast majority of MCC presents on sun-exposed skin. The head and neck area is the most common site of tumor occurrence. We present 70-year old female patient with painless red-colored nodule, size 2 x 2 x 2 cm on the dorsal side of mid left forearm. The surgical excision with negative margins was performed, and pathohistological analysis confirmed Merkel cell carcinoma. Sentinel lymph node biopsy was negative. In conclusion, as MCC is a very aggressive rare skin carcinoma with lethal outcome, it should be mandatory to perform biopsies of any suspected skin lesion.

Psoriasis, mental disorders and stress.

Etiology of psoriasis is still not known and comprises a range of assumptions and very complex etiological and pathogenetic mechanisms. Along with genetical predisposition, mental disorders and stresses might have a key role in the occurrence of this disease. Total number of 70 patients suffering from psoriasis were included in the investigation. Generally accepted structured clinical interview (SCID - The Structured Clinical Interview for DSM-IV) was applied in diagnostics of mental disorders. Various mental disorders were found in as many as 90% of patients suffering from psoriasis. The most frequent mental disorders were depressive disorder (19.2%), the posttraumatic stress disorder (17.8%), alcoholism (16.4%), adaptation disorder (15.1%), anxiety - depressive disorders (13.7%) and generalized anxious disorder (9.6%). The authors have concluded that in patients with psoriasis both various mental disorders and various stress events are frequent. The results have implied that there is a link between psoriasis on the one hand and various mental disorders and various stressors on the other. The investigation implies that there is a need to improve multidisciplinary approach in diagnostics and treatment of psoriasis and multi disciplinary team should consist of dermatologist, psychiatrist and psychologist.

Acute phase proteins in psoriasis.

Psoriasis is a chronic, relapsing, inflammatory and hyperproliferative skin disorder. The levels of acute phase proteins are suggested to be elevated in those patients with acute disease. The expression of selected acute phase proteins as the parameters of humoral immunity has been analyzed in 70 patients with acute psoriasis and 40 healthy controls. The aim was to evaluate the inflammatory response in the exacerbation of psoriasis and to determine the correlation of these objective inflammatory parameters with clinical features of disease activity. Main demographic and epidemiologic features were, as well, analysed. The plasma levels of C-reactive protein (CRP) (chi2 = 23.61; p < 0.005), and alpha1-acid glycoprotein (alpha1-AGP) (chi2 = 7.42; p < 0.01) were significantly increased in those patients with acute phase of the disease compared to healthy controls. Our results suggest that psoriasis is an inflammatory disease and therefore its worsening seemed to be linked to the increase in the inflammatory response. It seems that CRP and al-AGP levels could serve as important prognostic factors for the worsening of psoriasis.

Depression in dermatology: an integrative perspective.

An example which confirmes the adequacy of the integrative perspective in medicine is depression in dermatology because of the sufficient number of arguments linking depression and some chronic skin conditions in depth more than simply comorbidity. In recent literature, the authors found, how depression in dermatology occurs significantly more frequently than in the general population. In dermatological patients the prevalence of depression is around 30% which is more in comparison to patients in general practice where prevalence of depression is 22%. The authors found a considerable similarity in the various characteristics between depression and psoriasis, based upon recent research findings in immunity disorder and elevated concentrations of proinflammatory cytokines as well as acute phase proteins in both disorders, indicating that both disorders can be considered as immunologicaly mediated, inflammatory states with repetitive chronic progress and similar comorbidity. The afore mentioned theoretical settings evoke the integrative aspect and the integrative interdisciplinary approach placing in the center of attention not only the diseased person with his fears, needs, preocupations and expectations during treatment, but the person who is at risk of becoming burdened with these disorders.

Cell apoptosis as assessed by M30 expression in keratoacanthoma and squamous cell carcinoma.

Involution displayed by keratoacanthoma (KA) represents an important difference between KA and squamous cell carcinoma (SCC). It has been suggested that apoptosis plays a part in process of involution of KA. Altogether 150 specimens were included in this study, 30 cases of each; normal skin (NS), proliferative (pKA) and regressing keratoacanthoma (rKA), well differentiated (wdSCC) and poorly differentiated (pdSCC) squamous cell carcinoma. All samples were examined immunohistochemically for expression of M30 protein. A significantly lower number of M30 positive cells has been detected in NS as compared to skin tumors examined (p<0.001), except for rKA (p=0.057). The highest percentage of M30 positive cells was detected in pdSCC (p<0.001) as compared with all other examined groups. Keratinocytes of normal and changed epidermis expressing higher levels of M30 protein were predominately found in sun-exposed areas (chi2=14.93; p=0.060). There was an increasing trend of M30 protein expression with increasing age of the patient in NS and skin tumors examined. Majority of skin tumors with higher percentage of M30 positive cells tended to display higher Ki-67 expression. M30 expression was highly correlated with bak (r=0.811; p=0.048) and granzyme B expression in rKA (r=0.733; p=0.015). Cell apoptosis as assessed by M30 expression is, generally, increased in examined skin tumors and related to cell proliferation. Cell apoptosis mediated by bak and granzyme B expression could contribute to KA regression.

Maculopapular eruption secondary to itraconazole.

Adverse cutaneous reactions to itraconazole are known to be quite rare. We report a case of maculopapular reaction caused by itraconazole. On the 7th day of itraconazole therapy for hand onychomycosis, in a 39-year-old woman pruritus occurred with a subsequent morbiliform, symmetric, maculopapular eruption on the upper torso, neck, trunk and pressure-bearing areas. Eruption progressed, becoming confluent and spreading to extremities. Due to increasing indications for the administration of itraconazole its increased usage as well as the possibility of allergic reactions should be expected even if these are a rare event.

Dermatomycosis, hyperhydrosis, and mechanical injury to skin of the feet in Croatian soldiers during war in Croatia 1991-1992.

During the War in Croatia from 1991 to 1992, we conducted an epidemiological study of the most frequent skin changes on the feet of 1,702 Croatian soldiers stationed in trenches and exposed to direct war activities. We saw significant increases in dermatomycosis, hyperhydrosis, and mechanical injury to the skin of the feet. Soldiers involved in this study did not have any specific medications or powders available as standard gear to prevent any of these foot diseases, but upon physical examination they received treatment. We can conclude that, in war situations, conditions are sufficient to cause an increased number of dermatomycosis, hyperhydrosis and chronic mechanical injuries of the foot. This study suggests the need for planned prevention to avoid these foot diseases in combat situations.

UV damage of the hair.

Hair is a very important for our self-confidence as well as a very important part of appearance and self-concept. It reflects our personality and hair loss or hair damages are considered aesthetic imperfections and social handicap. Outward part of the hair is a "hair shaft" keratin fiber structure sensible to external effects whether they are mechanical, physical or chemical. Excessive sun exposition is the most frequent cause of hair shaft's structural impairment. Photochemical impairment of the hair includes degradation and loss of hair proteins as well as degradation of hair pigment. Hair protein degradation is induced by wavelengths of 254-400 nm. UVB radiation is responsible for hair protein loss and UVA radiation is responsible for color changes. Absorption of radiation in photosensitive amino acids of the hair and their photochemical degradation is producing free radicals. They have adverse impact on hair proteins, especially keratin. Melanin can partially immobilize free radicals and block their entrance in keratin matrix. It also absorbs and filters adverse UV radiations. Therefore melanin is important for direct and indirect protection of hair proteins. Protecting the cuticle is very important for keeping hair shaft's integrity. One can achieve that by avoiding noxious impacts or by implementation of hair care products with UV filters. Nowadays major studies and researches are conducted in order to create hair care products that prevent hair damage.

Epidemiology of dermatomycosis in the eastern Croatia--today and yesterday.

The aim of our investigation was to compare the distribution of dermatomycosis species in Eastern Croatia between two different periods: first period from 1997-2001 year, and second period from 1986-88 year. The outpatients from Department of Dermatovenerology University Hospital "Osijek" with confirmed diagnosis infection. Tinea, were selected on the basis o age, gender, localization and dermatomycosis species. During the first period (1997-2001) among 75,691 outpatients Tinea infection was confirmed in 558 (0.73%), while in the second period among 47,832 outpatients there were 126 (0.26%) cases with Tinea, what showed significant increase of fungal infections among population this region. According the age and gender in both periods predominant population were under of the age 16(40.14%: 41.26%), and female population was predominant (58.60% and 57.14%) in comparison to males (41.39% and 42.85%). The most frequent localization of lesions in period I were cutis glabrae (47.31%), palms and soles (31.36%), capitis (17.38%) and unguis (9.31%) and isolated species were as followed: Trichophyton (39.06%), Microsporum (31.72%) and Candida (28.13%) species. In period II the most frequent localization were palms and soles (40.47%), cutis glabrae (36.50%), capitis (12.69%) and unguis (10.31%). The isolated species in this period were: Trichophyton (80.15%), Candida (12.69%) and Microsporum (4.76%) species. From the data collected during two different periods we can observe 1) increase of fungal infection generally in our region; 2) significant changes in causative species (increase of Microsporum and Candida species infection, but Trichophyton spp still remain the first causative agent); and 3) changes in the localization of lesions.