Persistent hepatic venous plexus in a patient with Sturge-Weber syndrome.

A patient with extensive facial and intracranial features of Sturge-Weber syndrome was found to have a persistent primitive hepatic venous plexus, characterized by three additional vessels arising from the inferior vena cava, circulating between liver segments, which formed a common trunk in the supra-hepatic region that flowed into the right atrium. To the best of our knowledge, this hepatic finding has not been previously described in association with Sturge-Weber syndrome.

Results of the clinical examination of an ointment with marigold (Calendula officinalis) extract in the treatment of venous leg ulcers.

The aim of this study was to determine the therapeutic efficacy of marigold (Calendula officinalis) extract on the epithelialization of lower leg venous ulcers. The experiment was carried out in 34 patients with venous leg ulcers. The patients were divided into two groups. In the first (experimental) group, patients were treated with an ointment containing marigold extract, which was prepared in an apparatus devised by Soxleth and was incorporated into a neutral base. Twenty-one patients with 33 venous ulcers were treated. Therapy was applied twice a day for 3 weeks. The second group was a control group that consisted of 13 patients with 22 venous ulcers. In the control group, saline solution dressings were applied to ulcers for 3 weeks. In the experimental group the total surface of all the ulcers at the beginning of the therapy was 67,544 mm2. After the third week the total surface of all the ulcers was 39,373 mm2 (a decrease of 41.71%). In seven patients, complete epithelialization was achieved. In the control group the total surface of all the ulcers at the beginning of the therapy was 69,722 mm2. After the third week the total surface of all the ulcers was 58,743 mm2 (a decrease of 14.52%). In four patients, complete epithelialization was achieved. There was a statistically significant acceleration of wound healing in the experimental group (p < 0.05). The results obtained are preliminary, but they suggest the positive effects of the ointment with marigold extract on venous ulcer epithelialization.

Sesquiterpene lactone mix patch testing supplemented with dandelion extract in patients with allergic contact dermatitis, atopic dermatitis and non-allergic chronic inflammatory skin diseases.

We investigated the value of patch testing with dandelion (Compositae) extract in addition to sesquiterpene lactone (SL) mix in selected patients. After we detected a case of contact erythema multiforme after patch testing with dandelion and common chickweed (Caryophyllaceae), additional testing with common chickweed extract was performed. A total of 235 adults with a mean age of 52.3 years were tested. There were 66 men and 169 women: 53 consecutive patients with allergic contact dermatitis (ACD); 43 with atopic dermatitis (AD); 90 non-atopics suffering from non-allergic chronic inflammatory skin diseases; 49 healthy volunteers. All were tested with SL mix 0.1% petrolatum (pet.) and diethyl ether extracts from Taraxacum officinale (dandelion) 0.1 and 3.0% pet. and from Stellaria media (common chickweed) 0.1 and 3% pet. A total of 14 individuals (5.9%) showed allergic reaction (AR) to at least 1 of the plant allergens, 4 (28.6%) to common chickweed extract, and 11 (78.6%) to Compositae allergens. These 11 persons made the overall prevalence of 4.7%: 8 (3.4%) were SL-positive and 3 (1.3%) reacted to dandelion extract. 5 persons (45.5%) had AD, 2 had ACD, 2 had psoriasis and 2 were healthy controls. The Compositae allergy was relevant in 8 cases (72.7%). The highest frequency of SL mix sensitivity (9.3%) was among those with AD. Half the SL mix-sensitive individuals had AD. ARs to dandelion extract were obtained only among patients with eczema. A total of 9 irritant reactions (IRs) in 9 individuals (3.8%) were recorded, 8 to SL mix and 1 to common chickweed extract 3.0% pet. No IR was recorded to dandelion extract (P = 0.007). Among those with relevant Compositae allergy, 50.0% had AR to fragrance mix and balsam of Peru (Myroxylon pereirae resin) and colophonium. SLs were detected in dandelion but not in common chickweed. Our study confirmed the importance of 1 positive reaction for emerging, not fully established, Compositae allergy. In conclusion, the overall prevalence of 4.7% in our study represents a basal SL mix detection rate of 3.4% reinforced and safely supplemented by testing with the dandelion extract.

Erythema multiforme due to contact with weeds: a recurrence after patch testing.

Erythema multiforme (EM) as a complication of patch testing (PT) is rare. A 52-year-old woman with a 13-year history of episodes of EM, after contact with weeds during home gardening, had had no recent history of herpes simplex, other infection, drug ingestion or vaccination. On examination, EM lesions were distributed on the exposed skin. 5 weeks after complete resolution, PT and photopatch testing (PPT) were done with fresh plants she brought in. She was PT with a standard series and the Hermal-Trolab plants, woods, tars, balsams and flavors series. Intradermal testing, with a 3 + reaction to mixed weed pollens, was done 3 weeks later. Specific IgE to weed pollens class 1 (CAP-Pharmacia) was detected. Eczematous PT reactions were obtained with fresh leaves: common chickweed (Stellaria media Caryophyllaceae), dandelion (Taraxacum officinale Compositae), field-milk thistle (Sonchus arvensis Compositae) and white clover (Trifolium repens Leguminosae). Photoaggravation was seen to common chickweed and dandelion. Positive PT was also seen with alantolactone. By the 4-day reading, a typical EM had commenced, coming up to quite the same extent as seen on admission. There was no photosensitivity (UV skin tester, K. Waldmann). In the essential oil obtained from common chickweed, thin layer chromatography (TLC) revealed the well-known contact allergens borneol, menthol, linalool, 1,8-cineole, and other terpenes such as epoxy-dehydro-caryophyllene, monoterpene alcohol-ester and caryophyllene. Up to now, no data on essential oil in Stellaria media (common chickweed) have been reported. It can be concluded that EM developed due to contact with weeds, and recurred after patch testing. Neither blistering nor eczematous lesions have been seen on her skin, making this case very unusual. As far as the world literature is concerned, this is only the 4th report of EM developing in association with patch testing.

[Etiopathogenesis, clinical picture and diagnosis of onychomycoses]. / Etiopatogeneza, klinicka slika i dijagnostika onihomikoza.

ETIOLOGY OF ONYCHOMYCOSES: Onychomycoses can be caused by dermatophytes, molds and yeasts. However, dermatophytes appear to be the chief organisms capable of a primary attack on the nail. By far the most frequent dermatophytes isolated from nails are Trichophyton rubrum, T. mentagrophytes var. interdigitale and Epidermophyton floccosum. Molds virtually only invade toenails, but their role as a primary pathogen is still debated. Yeasts have been isolated from diseased nails at highly different rates. Nails may be infected by two different dermatophytes, two dermatophytes and a yeast, a dermatophyte, a yeast and a mold, etc. PATHOGENESIS OF ONYCHOMYCOSES: The mode of infection is still under debate. In many cases palmar and/or plantar tinea, exists but can often remain asymptomatic for years. After spreading to the nail, the fungus invades the hyponychium or lateral nail sulcus to finally reach the nail bed where it moves proximally to the matrix. Proximal subungual onychomycosis probably starts with a fungal skin infection, whereas white superficial onychomycosis seems to be a culture of T. mentagrophytes on a softened nail surface. Total dystrophic onychomycosis may result from both distal and proximal subungual onychomycosis or from C. albicans in chronic mucocutaneous candidiasis. Candida infections occur most often due to previous Candida paronychia, but it appears that a number of cases of so called idiopathic onycholysis are also caused by C. albicans with damage to the hyponychium being the portal-of entry. CLINICAL PICTURE OF ONYCHOMYCOSES: Onychomycoses can be divided into four different types. Distal subungual onychomycosis is the most common. The most frequent presenting clinical features are thickening and opaci-fication of the nail plate along the distal and lateral borders. The discoloration ranges from white to brown. The edge of the affected nail is usually uneven and often one or more streaks of dystrophic discoloured nail extend towards the distal border. Proximal subungual onychomycosis is uncommon. A white spot appears beneath the proximal nail fold and may extend distally to involve the deeper layers of the whole nail. Superficial white onychomycosis is also uncommon. The surface is the initial site of invasion. The causative organisms produce small superficial white and powdery patches over the nail. The surface becomes rough and the texture softer than normal. Total dystrophic onychomycosis represents the most advanced from all the previous three types, especially the distal subungual onychomycosis. The nail matrix has become permanently scarred by chronic infection. The nail is thick, elevated, denser and opaque. Candidomycotic onychomycosis shows erythematous and swollen proximal and lateral nail folds. Consequently, the nail plate becomes detached from the eponychium. Mycotic onycholysis is characterized by detachment of the nail plate from the bed, distal nail erosions, and grayish-yellow paste-like material under the nail. DIAGNOSIS OF ONYCHOMYCOSES: The diagnosis of onychomycoses cannot be made on the basis of clinical observation alone. Direct microscopy plays an important role in diagnosing nail fungal infections. However, fungal cultures are the only definitive test that can be used to identify the genus and the species of the infectious organism. Histological examination is a routine technique useful for defining the nature and localization of fungi in the nail plate. Immunohistochemistry applied to onychomycosis is an experimental approach bringing prominent information about identification of fungi. In vivo confocal microscopy represents a technique of the future.

[Epidemiologic characteristics of onychomycosis--results of a retrospective study]. / Neke epidemioloske odlike onihomikoza--rezultati retrospektivnog ispitivanja.

INTRODUCTION: The term onychomycosis is used for fungal infections of the nail unit. Tinea unguium is defined as a dermatophyte nail infection. The aim of this study was to determine the epidemiological characteristics of onychomycoses. MATERIAL AND METHODS: Ambulatory patients of the policlinic department of the Clinic of Dermatovenereology in Novi Sad were included in this study. Every patient with clinically suspected nail changes was examined. Direct microscopy of nail clippings and isolation of fungi on Sabouraud agar were performed. The results were evaluated using standard statistic methods. RESULTS: During a one-year-period (1995-1996) 70 cases of onychomycoses were registered that is 1.07% of the total number of patients examined in this period (N = 6535). The vast majority of observed patients were females (N = 47-67.14%), and male patients were significantly less frequent (N = 23-32.86%, p < 0.01). The most frequent type was dermatophyte onychomycosis (N = 39-55.71%), and the most often isolated agent was Trichophyton mentagrophytes (N = 38-54.29%). Manual workers were most often affected (N = 18-25.71%). Most patients were in the 41-50 year age group (N = 23-32.86%). The mean age of patients was X = 47.64 years (SD = 15.39). Table 4 shows the clinical duration of different types of onychomycoses. The longest clinical course was in the group of dermatophyte onychomycosis (20 years, one case). The mean clinical duration of the whole group was 26.81 months (SD = 40.04). Table 5 shows presence of other dermatomycoses associated with onychomycoses. Tinea pedis was the most frequently observed dermatomycosis (N = 9-60.00%). DISCUSSION: The incidence (1.07%) is something less than usual, and other findings are compatible with standard results. A lower incidence could be the result of the fact that children under 17 years are managed at the Institute of Mother and Child Health Care in Novi Sad. CONCLUSION: This study is a contribution to epidemiological investigations of onychomycoses. This disorder, with its social and medical importance and dubious treatment results, puts onychomycoses on high level of interest in modern dermatovenereology.

[Small-plaque parapsoriasis: case report]. / Parapsorijaza malih plakova: prikaz slucaja.

INTRODUCTION: Small plaque parapsoriasis is a relatively rare, chronic, idiopathic dermatosis, most often seen in middle age people. This disease shows a definite male predominance of approximately 3-4: 1. It is characterized by presence of round or oval erythematous, slightly scaly plaques on the limbs and trunk, which histologically reveal mild eczematous changes. CASE REPORT: A male patient, 61 years of age, was admitted to the Clinic of Dermatovenereology in Novi Sad due to long persisting erythematous patches on his upper and lower limbs. Plaques were of oval and round shape, pretty well marginated. They were of light red colour, covered with fine scales with a slightly wrinkled surface. He complained of itching. Laboratory findings showed no abnormalities. Histopathologic examination of the skin specimen revealed epidermal atrophy, focal parakeratosis, perivascular dermal infiltrate of mononuclear cells with exocytosis in the epidermis. This finding was compatible with the clinical diagnosis. After treatment with topical corticosteroid cream combined with whole body exposure to sunlight irradiation, vast majority of skin lesions regressed. DISCUSSION: The clinical course of small plaque parapsoriasis is very long. The plaques are remarkably stubborn, responding to treatment with steroid creams or to natural or artificial sunlight, but usually reappearing promptly when treatment is discontinued. The patches increase in number for a time, and then remain relatively constant for a long time. A small minority of cases clears entirely. Recent studies provided evidence of monoclonality and immunophenotypic abnormalities. Rearrangement of T-cell receptor genes was demonstrated by using PCR method. Detection of monoclonal T-cell populations in skin lesions, as a characteristic of lymphoproliferative diseases, forced some authors to include this dermatosis into a group of abortive cutaneous T-cell lymphomas. CONCLUSION: This case deserves a long and probably life-long clinical and histological assessment, especially due to new knowledge about the possible nature of this disease.

[Etiopathogenic importance of human herpes viruses type 6, 7 and 8 in manifestations of certain skin diseases]. / Etiopatogenetski znacaj humanih herpes virusa tip 6, 7 i 8 u pojavi nekih oboljenja koze.

INTRODUCTION: In the past few years new human herpes viruses (HHV): HHV-6, -7 and -8 have been discovered. According to the most recent literature, they might have an important role in etiopathogenesis of some dermatological diseases. HUMAN HERPESVIRUS 6: HHV-6 was isolated in 1984 from peripheral blood lymphocytes of AIDS patients and patients with different lymphoproliferative diseases. Up to now, two variants of this virus have been identified, A and B, which differ in genetic, biological and immunological characteristics. The etiological importance of variant A, has not yet been clarified, while variant B is considered to be the major cause of many diseases, such as exanthema subitum in infants. In many cases primary infection is associated with elevated temperature, without rash. HUMAN HERPESVIRUS 7: HHV-7 was isolated in 1990 from activated peripheral blood CD4+ T cells of healthy persons. The virus is ubiquitous and more than 80% of babies and infants are affected. Presence of DNA sequences of this virus in mononuclear cells of peripheral blood, skin and plasma of pityriasis rosea patients, points to possible connection between this illness and HHV-7 infection. HUMAN HERPESVIRUS 8: HHV-8 was first identified in tissue samples of patients with Kaposi's sarcoma associated with AIDS in 1994. DNA virus sequences were also isolated in HIV negative persons with Kaposis's sarcoma. Presence of virus can be established in mononuclear cells of peripheral blood, endothelial cells that cover vascular spaces and spindle cells within skin changes. Modes of transmission are still not clarified. However, HHV-8 was identified in some other dermatological diseases as well.

[Atrophic pilar keratosis of the face: case report]. / Atroficna pilarna keratoza lica: prikaz slucaja.

INTRODUCTION: Keratosis pilaris atrophicans faciei (KPAF), previously called ulerythema ophryogenes, belongs to a group of follicular syndromes with inflammation and atrophy. The disease often starts at birth or during the first months of life with autosomal dominant inheritance. CASE REPORT: We report a case of a 24-year-old woman, who noticed the first lesion two years ago. Skin lesion spread symmetrically on the cheeks, forehead and chin. Keratotic follicular papules were surrounded by erythema. After disappearance of follicular papules, atrophy occurred. Histopathological analysis from skin biopsy specimens confirmed the diagnosis of KPAF. DISCUSSION: Follicular syndrome with inflammation and atrophy starts in early childhood, but first lesions can also appear among teenagers or in adults. The course of the disease is progressive with permanent follicular destruction. The histopathologic changes are dynamic and follow the clinical course of the disease. A topical retinoid: tretinoin therapy was introduced. After one month of treatment good effects were visible, including decrease of erythema and follicular hyperkeratosis.

[Darier's disease--a familial case report]. / Darierova bolest--familijarni slucaj.

INTRODUCTION: Darier's disease is a slowly progressive autosomal dominant disorder characterized by a gene with variable penetrance. However, many cases of this disease are considered to be a new mutation in the genealogic tree. The prevalence of the disease was estimated as 1/55,000 to 1/100,000. CASE REPORT: The authors report a case of a female patient, 66 years of age, with Darier's disease, hospitalized at the Clinic of Dermatovenereology of the Clinical Center Novi Sad. The first changes of the skin occurred at the age of 16 originally on the shins and face, as miniature hard papules confluent in larger areas. Skin changes always exacerbated in the summer. At hospital admission the patient's head and hair were whole covered with white, thick, keratotics layer, resembling a helmet. The skin of the trunk was covered with white-gray, hyperkeratotic, fused papules like verrucous plaques, more expressed on the back. The skin of forearms presented with hyperkeratotic papules, and dorsum of the hands presented with plaques. Lower legs were covered with fused papilokeratotic, rough cauliflower-like layers with macerates and foetor. Buccal mucous was covered with whitish papules on erythematous lesions of cobblestone-like appearance. The nails were thickened with longitudinal furrowing, whereas the left third finger presented with V-shaped onychorrhexis. 4 generations were investigated, and the disease occurred only in the patient's younger daughter. DISCUSSION: Beside the classic "seborrheic" forms of Darier's disease there are a few clinical types: hypertrophied (intertriginous), vesiculo-bullous and linear (zosteriform) type. CONCLUSION: This case is a very severe classic form of Darier's disease, with variable penetrance and severity in the family.

[Occurrence of sexually transmitted diseases in Vojvodina during the last 20 years]. / Prisustvo polno prenosivih bolesti u Vojvodini u poslednjih dvadeset godina.

INTRODUCTION: Sexually transmitted diseases are the most often registered communicable diseases in a great number of countries. The aim of this study was to analyze dynamics and distribution of gonorrhea, syphilis and scabies in Vojvodina region during the last twenty years. MATERIAL AND METHODS: Epidemiological characteristics of gonorrhea, syphilis and scabies were analyzed on the basis of data obtained from the Section of Epidemiology of the Institute of Public Health in Novi Sad. The research included the period between 1980 and 1999, with sex and age distribution of patients. Morbidity rates were given per number of inhabitants of Vojvodina. RESULTS: In the period between 1980-1999 there were 454 registered patients with the diagnosis of syphilis in Vojvodina. The morbidity ratio was highest in 1980 (3.41/100.000), and lowest in 1991 (0.24/100.000). In the twenty-year period there were more patients with gonorrhea, than patients with syphilis. There were 44.621 registered patients with gonorrhea. The maximum morbidity ratio was in 1980 (25.09/100.000), but the minimum was in 1998 (1.68/100.000). Within the examined period scabies was recorded in 56.490 patients. The highest morbidity ratio was in 1984 (232.37/100.000) and the lowest was in 1992 (73.56/100.000). DISCUSSION: The average morbidity ratio of syphilis in USA, between 1992-1994, was 11.8/100.000 and at the same time in Vojvodina it was only 0.42/100.000. In Vojvodina most patients with this disease were 20-39 years old. In the same period in USA the ratio of gonorrhea patients was 309/100.000 and in Vojvodina it was 2/100.000. In this group also, most patients were 20-39 years old. However, scabies mostly appeared at the age of 7-14. CONCLUSION: According to the obtained results, the number of registered patients with these three diseases in Vojvodina stagnates or it decreases. In order to deal with real data, it is necessary to report these diseases regularly.

[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.

[Congenital giant pigmented hairy nevus--case report]. / Kongenitalni gigantski pigmentni dlacni nevus--prikaz slucaja.

INTRODUCTION: Authors present the characteristics of a giant congenital pigmented hairy nevus (GCPN) of the skin. CASE DESCRIPTION: A case of a female patient, 21 years of age, with many changes of the skin, namely: giant congenital pigmented hairy nevi involving the skin of the trunk, the upper and lower extremities and the face is reported. There have not been any changes in regard to the color, size or distribution of the nevi. The family anamnesis is negative. The involvement of the skin is 20% of the total body surface, according to Wallace. Since there was a suspicion of neurocutaneous melanosis, the patient underwent electroencephalography (EEG) and nuclear magnetic resonance (NMR). These examinations could not ratify the pathologic changes of the brain structures, which could affirm the neurocutaneous melanosis. DISCUSSION: The frequency of occurrence of GCPN larger than 20 cm in diameter in pediatric patients is estimated as 1:4,150 of children with female predominance. Data on possible malignant alteration of GCPN into a malignant melanoma vary from 6-12%. Authors have decided to follow-up the patient and to perform a clinical observation of the nevi, mostly due to extent of the skin changes and signs of malignant alterations. CONCLUSION: Authors have presented this case because of the risk of malignant melanoma development in a patient with GCPN and in the aim of pointing to the problem of melanocytic tumor progression.

Frequency estimation of the gene alleles for genodermatoses in the population of Vojvodina.

Genodermatoses are hereditary skin disorders or anomalies. The authors had investigated the frequency of genes, species and clinical forms of hereditary dermatoses in Vojvodina including age and sex distribution. The experimental group was selected by random sampling of the diseased of genodermatosis and/or genetic diseases at the Clinic of Dermatology and Venereology and Institute for Children and Adolescents in Novi Sad. The experimental group included 152 cases, and that made simultaneously the experimental and positive control group in relation to the diseased population with genodermatoses and/or genetic diseases in Vojvodina. In the investigation we applied the following methods: family history taking including genealogy; dermatoglyphic examination; screening tests in medical genetics; cytogenetic analysis of patient's karyotype; histopathological analysis of the material obtained by skin biopsy; dermatovenereological, genetic and dysmorphologic examination of skin diseases by analysis of dysmorphologic signs on the skin using a special computer program--POSSUM (Pictures of Standard Syndromes and Undiagnosed Malformations). Application of non-parametric statistics and Log-linear analysis, revealed that there is no statistically significant difference between the experimental group and the group with genetic diseases in population of Vojvodina. The obtained incidence of genodermatoses and/or genetic diseases was computed by "Hardy-Weinberg's principle". These methods of genetic population investigations give possibilities for valid incidence estimation of the diseases and frequency of the gen allele's for genodermatoses and/or genetic disorders and syndromes in defined population. Our results of investigation of the incidence genodermatoses in our's population showed significantly increased values in relation to literature data for the same hereditary disorders.

[Skin diseases and hepatitis virus C infection]. / Oboljenja koze i infekcija virusom hepatitisa C.

INTRODUCTION: Using a creative molecularbiologic technique in 1989 Choo and co-workers isolated a new virus of hepatitis C, an agent responsible for numerous cases of parenterally transmissible viral hepatitis. Hepatitis C virus is a RNA virus with unique genomic organisation. Six genotypes of hepatitis C virus have been identified, which differ in geographical distribution, tendency towards chronicity and sensitivity to antiviral therapy. Transmission occurs due to apparent and inapparent parenteral procedures (after transfusion, transplantation, transplacentally, during lactation, sexually or after accidental injury of medical staff). Mode of transmission through intact skin or mucosa has not been proved yet. Due to development of laboratory methods for detection of anti-hepatitis C virus antibodies and obligation for routine testing of blood donors for hepatitis C in majority of countries in the world, risk of post-transfusion hepatitis C is minimised to less than 1%. In 70% of patients the infection runs a chronic course, affecting numerous extrahepatic organ systems, including skin. VASCULITIS ASSOCIATED WITH MIXED ESSENTIAL CRYOGLOBULINEMIA: Mixed essential cryoglobulinemia is a disorder with deposition of circulating immune complexes in small and medium blood vessels. Clinical characteristics comprise palpable purpura on lower extremities, arthralgias and weakness. It might occur during autoimmune disorders, liver diseases and viral infections, among which hepatitis C infection has a central part. Mixed cryoglobulins can be detected in 35-54% of patients with hepatitis C and symptomatic vasculitis associated cryoglobulinemia, decreased C4 component of complement, positive rheumatoid factor and elevation of hepatic enzymes occurs in 10-21% of patients. Findings of anti-hepatic C virus antibodies and/or viral RNA in 96% of patients with mixed cryoglobulinemia can be considered as a definitive proof of etiopathogenetic association between hepatitis C infection and mixed cryoglobulinemia. Interferon alpha therapy is a first-choice therapy, although transient responses are frequent. PORPHYRIA CUTANEA TARDA: Hepatitis C infection has recently been recognised as an important precipitating factor of clinical porphyria cutanea tarda sympotomatology. Apart from high level of seropositivity among porphyria cutanea tarda patients (62-100%), association between these two entities hasn't been clearly revealed yet. The question whether hepatitis C infection is enough to be the only precipitating factor, or other hepatotoxic cofactors are necessary, still exits. Interferon therapy has been a meter of several studies, but no definite recommendations had been given about its administration in these cases. LICHEN PLANUS: About possible association between lichen planus and chronic liver diseases, and hepatitis C infection as well, suggest 35% prevalence of hepatic disorders in patients with lichen planus, and 9.8-23% of hepatitis C virus seropositivity. The clinical picture of lichen planus in hepatitis C virus infection is characterised by generalised skin lesions, with erosive involvement of oral mucous membrane, and by chronic course. Therapeutical efficiency of interferon is unpredictable, with possible improvement, cure or deterioration of lichen planus. OTHER DERMATOLOGICAL DISORDERS: Other dermatological disorders (erythema nodosum, erythema multiforme, urticaria) may be direct consequences of hepatitis C infection, of other extrahepaic non-dermatological manifestations, or fortuitous reports. CONCLUSION: Considering big pathogenetic potentials of hepatitis C virus with possible skin involvement, and proved association between cutaneous necrotising vasculitis with mixed essential cryoglobulinemia, porphyria cutanea tarda, lichen planus and chronic hepatitis C infection, all patients with these disorders should be tested for hepatitis C and all cases of hepatitis C should be searched for signs and symptoms of these skin diseases.

[Von Recklinghausen's neurofibromatosis (neurofibromatosis type I)--a familial case report]. / Von Recklinghausenova neurofibromatoza (neurofibromatoza tip I)--familijarni slucaj.

INTRODUCTION: Neurofibromatosis is a term used for two disorders: NF-1 and NF-2. NF-1 is Von Recklinghasusen's neurofibromatosis and comprises characteristic skin lesions (cafe au lait spots, intertriginous freckles, neurofibromatous skin tumors) and other congenital and hamartomatous bone, endocrine glands and central nervous system lesions. Its incidence is one in every 2500 to 3300 births. CASE REPORT: Two female patients, a 20 years old daughter and her mother 46 years of age were admitted to the Clinic of Dermatovenereology in Novi Sad due to appearance of many sessile and pedunculated neurofibromas, cafe au lait spots and freckles on their trunks, axillary and inguinal regions. Laboratory findings showed no abnormalities. Both of them were examined by many specialists. No systemic disturbances were established. The daughter was sent to plastic surgery for operative treatment. DISCUSSION: The clinical presentation of NF-1 is very variegated. Beside characteristic skin lesions, other clinical features include skeletal bony abnormalities, mental deficiency, seizures, neurofibromas of the spinal and cranial nerve roots, iris hamartomas, optic nerve gliomas, endocrine disorders, endocrine tissue tumors, other visceral tumors, etc. Some of these disorders can be life-threatening. Malignant transformations of the NF-1 lesions occur approximately in 5% of patients, most often as neurofibrosarcomas, Wilms' tumors, rhabdomyosarcomas or various forms of leukemias. CONCLUSION: We present familial cases of Von Recklingausen's neurofibromatosis without systemic abnormalities so far. The clinical course of this disease is unpredictable and a multidiscipline clinical assessment is necessary during whole life.

[Microcirculatory changes in chronic venous insufficiency]. / Mikrocirkulatorne promene u hronicnoj venskoj insuficijenciji.

INTRODUCTION: The venous system of lower leg can be topographically divided into two subsystems: superficial (extrafascial) and profound (subfascial). Functionally, we can divide circulation in to macrocirculation (arteries and veins) and microcirculation (arterioles, capillaries, and venules). Blood flow towards heart can be disturbed by different pathological conditions, and than chronic venous insufficiency (CVI) develops. First alterations occurs in macrocirculation, and after some period changes in microcirculation also appear. Those changes are leading to the ultimate stage in CVI--venous ulcer. RESULTS AND DISCUSSION: Previous conceptions that alterations in microcirculation in CVI are consequences of venous stasis, high pressure in capillaries and anoxic tissue are still actual. Observations that partial pressure of oxygen is higher in venous blood of lower limbs with ulceration than in limbs without ulceration lead to hypothesis that blood is passing directly from arterioles to venules over arterio-venous temperature-regulating shunts in dermis. Histological and electron-microscopic examinations certain alterations in the structure of capillaries. Raised pressure in these altered capillaries leads to exudation of plasma and fibrinogen in the interstitial space. Soluble fibrinogen is transformed to insoluble fibrin and forms fibrin cuffs. These cuffs are a barrier for normal diffusion of oxygen. Recently, it was observed that blood cells can adhere to the endothelial cells--Leukocyte trapping hypothesis. It can be explained by slower blood flow velocity and also by expression of certain endothelial and leukocyte adhesion molecules intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1). This causes congestion of white blood cells which leads to tissue damage due to secretion of inflammatory mediators.

[What do we know today about diaminodiphenylsulfone?]. / Sta danas znamo o diaminodifenilsulfonu?

INTRODUCTION: Diaminodiphenylsulfone or dapsone is a chemical analogue of sulfapyridine, synthesized in 1908. Dapsone is a bacteriostatic agent that proved to be efficient in treating leprosy and malaria, but today it is used in treating dermatologic noninfectious inflammatory diseases. PHARMACOLOGY: Dapsone is orally used in a dose of 50-400 mg per day in treatment of dermatologic diseases, and also in a dose of 50-100 mg per day in leprosy treatment. Dapsone is mainly eliminated from the body by urine and smaller part by faeces. Pharmacological interaction was reported when it is used with rifampicin and probenecid. MECHANISM OF ACTION: The bacteriostatic effect of dapsone is well known. It involves inhibition of folic acid synthesis in susceptible organisms. The anti-inflammatory effect of dapsone, which proves to be efficient in treating noninfectious inflammatory diseases, has not been explained completely yet. There are some pieces of evidence that anti-inflammatory action is not connected with its antibacteriological action. CLINICAL USE: Based on previous studies about therapy efficiency of dapsone in treating some diseases, there are two groups of diseases: the group responding well to dapsone (leprosy, malaria, DH, linear IgA-dermatosis, erythema elevatum diutinum, bullous systemic lupus erythematosus) and a group responding with average good response to dapsone (pyoderma gangrenosum, bullous and cicatricial pemphigoid, acne conglobata, discoid cutaneous lupus erythematosus, subcorneal pustulosis dermatosis, granuloma faciale, rheumatoid arthritis, polychondritis, leucocytoclastic vasculitis). ADVERSE EFFECTS: Adverse effects depend on the dose and they rarely occur at doses less than 100 mg per day. They are mainly shown on skin, nervous system, digestive system, hepatobiliary system, and kidney and hematologic system. The most important adverse effects are hemolytic anaemia and methemoglobinemia. Hemolysis usually occurs at doses of 200 mg and more per day. In patients with glucose-6-phosphate dehydrogenase deficiency, hemolysis may be provoked by a dose less than 50 mg per day. For prevention, before using dapsone in therapy, clinical examination with history, blood parameters, liver and renal parameters and determination of glucose-6-phosphate dehydrogenase level are recommended. CONCLUSION: The use of dapsone is absolutely indicated in DH treatment and erythema elevatum diutinum. Because of anti-inflammatory effects, dapsone can also be used in treating other inflammatory noninfectious dermatoses when one should take care about "therapy efficiency/adverse effect" balance using the correct dose, monitoring relevant clinical and laboratory parameters and educating patients.

[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.

[Clinico-epidemiologic characteristics of superficial multiple basal cell carcinoma at the Dermatovenereology Clinic in Novi Sad 1986-1996]. / Klinicko-epidemioloske odlike multiplih bazocelularnih karcinoma superficijalnog tipa na klinici za kozno-venericne bolesti u Novom Sadu za period 1986-1996. godine.

INTRODUCTION: Multiple superficial basal cell carcinomas of the skin (MSBCC) appear as a rare clinical form of basal cell carcinoma (BCC) on the trunk. The aim of this paper was to display the clinical characteristics and frequency of superficial basal cell carcinomas on the trunk. MATERIAL AND METHODS: The examination was done on a 10-years material of the Department of Dermatological Oncology of the Dermatovenererology Clinic in Novi Sad (in the period 1986-1996). The examination included only MSBCC. RESULTS: In the 10-year period the total number of nonmelanotic malignant epithelial tumors of the skin (NMETS) was 2218 with 22 of MSBCC with total incidence of 0.99%. The average annual number of NMETS was 221.8. The average annual number of MSBCC was 2.2. In regard to the incidence of BCC of the skin in the same period, the total number of BCC of the skin was 1220, with the incidence of MSBCC 1.80%. The total number of changes of the superficial types BCC in the examined group was 110, and the average number of changes 5. The localization of MSBCC in the examined group shows the greatest number of tumors on the skin of the back (42--38.18%), hence thorax (29--26.36%), abdomen (25--22.73%) and the least on the presternum (14--12.73%). The average period from discovery of MSBCC in the examined group until the moment of inspection was about 2.5 years. In one case nevocellular syndrome was established, MSBCC was established in 35 patients, while in 80 cases these were different types of BCC of the face, capillitium, neck, trunk and extremitites. In the examined group 22.73% patients with positive familial anamnesis in regard to malignancy. Most were pensioners (11 cases--50.00%) mainly living in towns, while agriculturers are on the second place (7 cases--31.82%) mostly living in the village. In regard to the age, it appears that increasing number of patients are in the seventh decade of life. DISCUSSION: The recent literature data point to the genetic dispositions for MSBCC on the skin of the trunk, probably due to poorphotoexposition of the skin. CONCLUSION: Authors principally point to the genetic pre-disposition as the main etiological factor for MSBCC of the skin of the trunk. Professional or accidental photoexposition to ultraviolet radiation, also have a secondary role. The disease mostly affects the elderly and mostly males.