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Uvod: U većine bolesnika s kroničnom spontanom urtikarijom (KSU), veliki problem predstavlja svrbež koji se učestalije javlja u večernjim i noćnim satima što uzrokuje poteškoće sa spavanjem. Za postizanje dobre kvalitete sna (KS) je ključan melatonin, hormon koji sudjeluje u započinjanju i održavanju ciklusa spavanja te je izuzetno bitna njegova adekvatna proizvodnja. Cilj ovog istraživanja je bio ispitati vrijednosti salivarnoga melatonina te povezanost težine bolesti i poremećaja kvalitete života (KŽ) i KS u tih bolesnika. Metodologija: U 38 bolesnika s KSU-om i 38 ispitanika kontrolne skupine određivan je salivarni melatonin (ELISA), KŽ (“Dermatology Quality of Life”) i KS (“Pittsburgh Sleep Quality Index”), a u bolesnika s KSU-om je dodatno određivana težina (“Urticaria Activity Score”) i kontrola bolesti (“Urticaria Control Test”). Rezultati: Sniženi salivarni melatonin je uočen u 34/38 bolesnika s KSU. Teški oblik urtikarije imalo je 12/38 ispitanika, a značajno narušenu KŽ 8/38 bolesnika. Težina urtikarije je linearno proporcionalno povezana s KŽ i KS u tih bolesnika, uz jaku korelaciju s KŽ i slabu korelaciju s KS, dok koncentracija salivarnoga melatonina nije povezana ni s KS ni s KŽ. Zaključak: Ovo su prvi literaturni podaci u svijetu o sniženim vrijednostima melatonina, salivarnog biomarkera poremećaja spavanja, u bolesnika s KSU-om. Introduction: For the majority of patients with chronic spontaneous urticaria (CSU), a big problem is the nocturnal itch, which leads to sleep disturbance. Melatonin regulates promoting and maintaining the sleep cycle and its adequate production is crucial for good sleep quality (SQ). The aim of this study was to examine salivary melatonin and the association between disease severity, quality of life (QoL) and SQ in these patients. Methodology: Salivary melatonin (ELISA), QoL (“Dermatology Quality of Life”) and SQ (“Pittsburgh Sleep Quality Index “) were determined in 38 patients with CSU and 38 healthy subjects. In patients with CSU, the severity of the urticaria (“Urticaria Activity Score”) and the disease control (“Urticaria Control Test”) were additionally determined. Results: Decreased salivary melatonin was observed in 34/38 patients with CSU. Severe form of urticaria was detected in 12/38 patients and QoL was significantly impaired in 8/38 patients. The severity of urticaria was linearly proportional to QoL and SQ in these patients, with a strong correlation with QoL and a weak correlation with SQ, while the salivary melatonin was not related to QoL nor SQ. Conclusion: These are the first literature data in the world indicating decreased levels of the salivary melatonin in patients with CSU.

Cilj istraživanja: Cilj ovog istraživanja je dokazati imaju li pacijenti sa psorijazom povećani rizik od razvijanja opstrukcijske apneje tijekom spavanja u odnosu na kontrolnu skupinu bez psorijaze. Ispitanici i metode: U ovom opservacijskom, presječnom istraživanju uključeno je ukupno 42 ispitanika; 21 s dijagnozom psorijaze, te preostalih 21 ispitanika bez dijagnoze psorijazeodnosno kao zdrava kontrolna skupina. Korištena je anketa za pacijente sa psorijazom i STOP upitnik. Uspoređen je rezultat STOP upitnika između kontrolne skupine i pacijenata koji boluju od psorijaze. Rezultati: Rezultat STOP upitnika u pacijenata sa psorijazom značajno je veći u odnosu na pacijente bez postavljene dijagnoze psorijaze, odnosno skupina ispitanika oboljelih od psorijaze imala je statistički veće vrijednosti STOP upitnik rezultata u odnosu na skupinu zdravih ispitanika (P, Objectives: The aim of our study is to prove whether patients with psoriasis have an increased risk of developing obstructive sleep apnea compared to a control group. Subjects and methods: A total of 42 participants were included in this retrospective and observational study; 21 participants with a diagnosis of psoriasis, and the remaining 21 participants without diagnosis of psoriasis as a control group. A survey for patients with psoriasis and the STOP questionnaire were used. The result of the STOP questionnaire was compared between the control group and patients suffering from psoriasis. Results: The result of the STOP questionnaire in patients with psoriasis is significantly higher compared to patients without a diagnosis of psoriasis , i.e. the group of respondents suffering from psoriasis had statistically higher STOP questionnaire values results compared to the group of healthy subjects (P

Autoimmune bullous diseases (AIBDs) are rare organ-specific diseases characterized by the appearance of blisters and erosions on the skin and mucous membranes. These dermatoses are marked by the development of autoantibodies targeting the autoantigens located in intercellular junctions, i.e., between keratinocytes or in the basement membrane area. Therefore, the fundamental division of AIBDs into the pemphigus and pemphigoid groups exists. Although AIBDs are uncommon in the general population, their overall incidence is somewhat higher in women of all ages, for which a pregnant women can be likely affected too. While the pemphigoid gestationis is exclusive bullous dermatosis of pregnancy, the other AIBDs can also start or worsen during this period. The appearance of AIBDs in childbearing women is a particularly sensitive situation requiring exceptional clinicians’ caution due to the possibility of pregnancy complications with adverse effects and risks to the mother and the child. Also, there are numerous management difficulties in the period of pregnancy and lactation related to the drugs’ choice and safety. This paper aimed to outline the pathophysiologic mechanisms, clinical manifestations, diagnostic approach and therapy of the most commonly recognized AIBDs in pregnancy

Pityriasis rosea (PR) is a benign self-limited rash that presents as multiple erythematous patches on the trunk and limbs. While the exact etiology of PR remains unknown, human herpesviruses 6 and 7 have been implicated in its pathogenesis. PR treatment is centered on relieving symptoms, however, no standardized treatment exists for PR. A 2019 Cochrane review provided a comprehensive analysis of the efficacy and safety of available PR treatments that have been studied in randomized controlled trials (RCTs). This review analyzed 14 parallel RCTs and assessed 2 primary outcomes: good or excellent rash improvement within 2 weeks (participant-rated) and serious adverse events. Secondary outcomes were also measured, including resolution of itch within 2 weeks (participant-rated), and good or excellent rash improvement within 2 weeks (provider-rated). Two RCTs found significant provider-rated rash improvement with acyclovir compared to placebo and vitamins or when used in addition to a topical regimen. However, the trials employed varying doses of acyclovir, and the review was unable to recommend a specific dose for PR treatment.

Cilj: Osvijestiti liječnike o potencijalnom riziku razvoja progresije melanocitnih kožnih lezija i eventualnog nastanka malignog melanoma u pacijenata kronično liječenih adalimumabom (Humirom), antagonistom tumorskog faktora nekroze-alfa (TNF-alfa). Prikaz slučaja: U dermatološku ambulantu javio se tridesetosmogodišnji muškarac jer je unatrag mjesec dana primijetio makroskopski vidljivu promjenu postojeće melanocitne lezije na području kože abdomena, u vidu njezinog povećanja i promjene boje. Pacijent je unazad tri godine počeo osjećati zakočenost toraksa i leđa, jutarnju križobolju te bolove u leđima koji bi se smanjili uzimanjem nesteroidnih antireumatika. Na temelju kliničkih, laboratorijskih i radioloških nalaza, pacijentu je dijagnosticiran aksijalni spondiloartritis zbog kojeg mu je, dva mjeseca kasnije, u kroničnu terapiju uveden adalimumab. Primjena adalimumaba dovela je do izrazitog poboljšanja bolesnikovog stanja te ga je nastavio redovito uzimati. Nakon dvije godine kontinuirane terapije adalimumabom pacijent je uočio promjenu postojećeg nevusa na trbuhu, o čemu je obavijestio dermatologa koji je izvršio eksciziju lezije u cijelosti. Patohistološkom analizom potvrđen je displastični nevus visokog stupnja. Zaključak: Povezanost adalimumaba s razvojem melanoma još nije dovoljno istražena, iako mnogi dokazi govore u prilog tome. Važno je da liječnici budu upoznati s mogućim rizikom progresije postojećih melanocitnih lezija, kao i mogućim razvojem malignog melanoma te educiraju pacijente, savjetuju im redovne kontrole i povećan oprez, a sve u cilju pravovremenog otkrivanja i prevencije potencijalno ozbiljnih nuspojava adalimumaba. Istraživanja koja se bave ovom tematikom malobrojna su i potrebne su daljnje studije koje će u obzir uzeti više rizičnih čimbenika za nastanak melanoma., Aim: To make doctors aware of the potential risk of developing melanocytic skin lesions and the possible development of malignant melanoma in patients chronically treated with adalimumab (Humira), a tumor necrosis factor-alpha (TNF-alpha) antagonist. Case report: A 38-year-old man came to the dermatology clinic because a month ago, he noticed the macroscopically visible change of the previously existing melanocytic lesion on the skin of the abdominal wall, in the form of enlargement and color change. Three years ago, the patient began to feel tightness in the thorax and back, morning low back pain and back pain, which would be reduced by taking non-steroidal anti-rheumatic drugs. Based on clinical, laboratory and radiological findings, the patient was diagnosed with axial spondyloarthritis, for which, two months later, adalimumab was introduced into his chronic therapy. The use of adalimumab led to a marked improvement in the patient’s condition, and he continued to take it regularly. After two years of continuous therapy with adalimumab, the patient noticed a change in the pre-existing nevus on his abdomen. He informed the dermatologist, who performed a total excision of the lesion. The pathohistological analysis confirmed a dysplastic nevus with a high degree of dysplasia. Conclusion: The association of adalimumab with melanoma development has not yet been sufficiently investigated, although much evidence supports this. Physicians must be aware of the possible risk of progression of pre-existing melanocytic lesions and the possible development of malignant melanoma, educate patients, and advise regular monitoring and caution to detect and prevent potentially serious side effects of adalimumab. Research on this topic is not numerous, and further studies are needed to consider several risk factors for melanoma.

Cilj: Predstaviti slučaj potencijalnog malignog alteriranja lezije blue naevus i skrenuti pozornost na važnost istraživanja ove lezije koja, ako se propusti pravilna dijagnostika i terapija, može ostaviti po život opasne posljedice. Prikaz slučaja: Tridesetšestogodišnji muškarac javlja se u ambulantu Klinike za maksilofacijalnu kirurgiju KBC-a Rijeka zbog naglo nastale, bezbolne otekline u preaurikularnoj regiji desno, veličine 3 × 2 cm. Pri pregledu postavljena je sumnja na tumorsku masu u desnoj parotidnoj žlijezdi zbog čega je indicirana citopunkcijska dijagnostika, koja je pokazala kako se radi o metastazi melanoma. Indicirana je, a zatim i učinjena superficijalna parotidektomija zahvaćene žlijezde. Poslijeoperacijski tijek bio je uredan. Patohistološka analiza odstranjene žlijezde potvrdila je dijagnozu metastaze melanoma. Započelo je traganje za primarnim sijelom melanoma, koje nikada nije pronađeno. Iz anamneze se doznalo kako je pacijent ranije iste godine u privatnoj zdravstvenoj ustanovi bio podvrgnut kirurškom zahvatu ekscizije madeža na desnoj strani lica temporalno. Nalaz patohistološke dijagnostike ekscidiranog madeža pokazao je da se radi o benignoj leziji blue naevus. U idućim godinama pacijent je na redovnim kontrolama, pregledima i pretragama raznih specijalista i multidisciplinarnih onkoloških timova. Pacijent je u navedenom razdoblju dobivao učestale metastaze melanoma po cijelom organizmu, zbog čega je podvrgnut više od 20 operativnih zahvata. Posljednji nalazi pokazuju kako su kod pacijenta pronađene dvije metastaze melanoma u mozgu. Zaključci: Iako je lezija blue naevus česta eflorescencija čije je liječenje u većini slučajeva bezazleno, nove spoznaje upućuju na potencijal za malignim alteriranjem ove lezije, na temelju sve većeg i češćeg broja opisanih slučajeva. Potrebno je produbiti istraživanja o ovoj potencijalno opasnoj leziji, sve dok se ne utvrdi kada, na koji način i može li uopće blue naevus maligno alterirati, čime će se dijagnostika i liječenje moći reevalvirati i preciznije izvoditi, što će imati izniman utjecaj na preživljavanje i kvalitetu života pacijenata., Aim: To present a case of a potentially malignant alteration of a blue naevus lesion and draw attention to the importance of researching this lesion, which, if proper diagnosis and therapy are inadequate and apsent, can have life-threatening consequences. Case report: a thirty-six-year-old male presents himself to the Clinic for Maxillofacial Surgery at the Clinical Hospital Center Rijeka due to a sudden, painless swelling in the right preauricular region, measuring 3×2 cm. During the examination, a tumor mass in the right parotid gland was suspected, which is why cytopuncture diagnostics was indicated, showing that it was a metastasis of melanoma. Superficial parotidectomy of the affected gland was indicated and then performed, with an orderly postoperative course. Pathohistological analysis of the removed gland confirmed the diagnosis of melanoma metastasis. A search began for the primary melanoma site, which was never found. From the anamnesis, it was learned that earlier in the same year, the patient underwent surgical excision of a mole on the right side of the temporal region of the face in a private health institution. The pathohistological diagnosis of the excised mole showed that it was a benign blue naevus lesion. In the following years, the patient had regular controls and examinations by various specialists and multidisciplinary oncology teams. In that period, the patient had frequent melanoma metastases throughout his body, for which he underwent more than 20 surgical procedures. The latest findings show that two melanoma metastases were found in the patient’s brain. Conclusions: Although the blue naevus lesion is a frequent efflorescence, the treatment of which is harmless in most cases, new findings point to the potential for malignant alteration of this lesion, based on the increasingly more frequent number of described cases. It is necessary to deepen the research on this potentially dangerous lesion, until it is determined when, in what way and if at all blue naevus can turn malignant, which will allow diagnostics and treatment to be reevaluated and performed more precisely, which will have an exceptional impact on the survival and quality of patients’ lives.

Introduction: The broad and sustained efficacy of apremilast for psoriasis has been demonstrated in randomized and real-world observational studies. Data from Central and Eastern Europe (CEE) are lacking. Moreover, apremilast use in this region is limited by country-specific reimbursement criteria. This is the first study to report data on the real-world use of apremilast in the region. Methods: APPRECIATE (NCT02740218) was an observational, retrospective, cross-sectional study assessing psoriasis patients 6 (± 1) months after apremilast treatment initiation. The study aimed to describe the characteristics of patients with psoriasis receiving apremilast, estimate treatment outcomes, including Psoriasis Area Severity Index (PASI), Body Surface Area (BSA), and Dermatology Life Quality Index (DLQI), and assess dermatologists' and patients' perspectives on treatment using questionnaires including the Patient Benefit Index (PBI). Adverse event reports were taken from the medical records. Results: Fifty patients (Croatia: 25; Czech Republic: 20; Slovenia: 5) were enrolled. In patients continuing apremilast at 6 (± 1) months, mean (± SD) PASI score was reduced from 16.2 ± 8.7 points at treatment initiation to 3.1 ± 5.2 at 6 (± 1) months; BSA from 11.9% ± 10.3% to 0.8% ± 0.9%; DLQI from 13.7 ± 7.4 points to 1.6 ± 3.2. PASI 75 was reached by 81% of patients. Physicians reported that the overall treatment success fulfilled their expectations in more than two thirds of patients (68%). At least three-quarters of patients reported apremilast had a quite or very high benefit on the needs they identified as being most important. Apremilast was well tolerated; no serious or fatal adverse events were identified. Conclusion: Apremilast was effective in reducing skin involvement and improving quality of life in CEE patients having severe disease. Treatment satisfaction among physicians and patients was very high. These data add to the growing body of evidence showing consistent effectiveness of apremilast across the continuum of psoriasis disease severity and manifestations.

Uvod: Alergijski kontaktni dermatitis (AKD) negativno utječe na kvalitetu života (KŽ). U razjašnjavanju etiopatogenetskih čimbenika AKD­a, s psihoneuroimunološkog (PNI) aspekta, smatra se da kronični psihički stres (PS) utječe na hipotalamo­hipozifno­adrenalnu (HHA) os i proupalne citokine. Metodologija: U 59 bolesnika s AKD­om šaka i 19 zdravih ispitivani je PS („Perciedved Stress Scale“ upitnikom (PSS)), neuroendokrini (jutarnji kortizol u slini) i imunosni čimbenici (serumski IL­6 i TNF­α), težina (“Hand Eczema Extent Score” (HEES)) i trajanje bolesti, KŽ („Dermatology Life Quality Index“ (DLQI)) te njihove razlike između bolesnika s atopijom i onih bez. Rezultati: Bolesnici s AKD­om šaka imali su niži jutarnji kortizol u slini i viši PSS (p>= 0,001) od zdravih, bez razlike u IL­6 i TNF­α. Viši DLQI bio je povezan s višim HEES­om i PSS­om (p=0,002 i p

Data on various cutaneous adverse events as a result of widespread SARS-CoV-2 vaccination is currently accumulating. However, data on cutaneous reactions following booster dose of COVID-19 vaccines are still limited.1, 2 Herein, we present a case of pityriasis rubra pilaris (PRP) following a booster dose of the BNT163b2 (Pfizer–BioNTech) mRNA COVID-19 vaccine.

Hidradenitis suppurativa je kronična upalna bolest kože koja primarno zahvaća aksile, perineum i submamarnu regiju. Bolest je također poznata pod nazivom acne inversa. Smatra se da je stopa prevalencije do 4%. Etiopatogeneza bolesti nije u potpunosti razjašnjena ali smatra se da je bolest posljedica folikularne okluzije, a ne upalnog ili infektivnog procesa u apokrinim žlijezdama. Klinički se bolest prezentira osjetljivim potkožnim čvorovima koji počinju u razdoblju oko puberteta. Čvorići mogu spontano rupturirati ili se spojiti tvoreći tako duboke bolne dermalne apscese. Posljedično može doći do nastanka fibroze i stvaranja opsežnih sinusnih puteva. Bolest se kasno dijagnosticira i oboljeli se suočavaju sa neuspješnim traženjem liječničke pomoći. Standardna terapija uključuje konzervativno i kirurško liječenje. Današnjim otkrićem novih terapija poput inhibitora čimbenika nekroze tumora alfa liječnici imaju sve više mogućnosti u borbi protiv ove teške bolesti., Hydradenitis suppurativa is a chronic inflammatory skin disease that primarily affects the axilla, perineum and submammary region. The disease is also known as acne inversa. The prevalence rate is considered to be up to 4%. The etiopathogenesis of the disease is not fully elucidated but the disease is thought to be due to follicular occlusion rather than an inflammatory or infectious process in the apocrine glands. Clinically, the disease presents with sensitive subcutaneous nodules that begin around puberty. The nodules may spontaneously rupture or coalesce to form deep painful dermal abscesses. As a result, fibrosis can occur and extensive sinus pathways can form. The disease is diagnosed late and sufferers face unsuccessful seeking medical help. Standard therapy includes conservative and surgical treatment. With today’s discovery of new therapies like tumor necrosis factor alpha inhibitors doctors have more and more options to fight this serious disease.

Crvenilo lica kliničko je obilježje mnogobrojnih dermatoza kao i fizioloških promjena u vaskularnom sustavu tijela i sistemskih bolesti. Eritem je najčešće posljedica upalnih procesa koji se događaju u koži migriranjem upalnih stanica i uzrokovanjem vaskularnih promjena. Dermatovenerolog može već na temelju kliničkog pregleda i anamneze pacijenta u većini slučajeva dijagnosticirati o kojoj se bolesti radi. Diferencijalno dijagnostički postoji širok spektar bolesti koje se očituju eritemom lica, a u najčešće od njih ubrajaju se sljedeće: rozaceja, dermatomikoze, seboroični dermatitis, perioralni dermatitis, fotodermatoze, alergijske reakcije i reakcije uzrokovane lijekovima. Uloga stomatologa nije dijagnosticiranje i liječenje dermatoza koje se očituju eritemom lica, ali je znanje o najčešćim dijagnozama korisno zbog savjetovanja pacijenta i upućivanja na daljnju obradu specijalista. U ovome radu opisane su neke od najčešćih dermatoza koje uzrokuju pojavu eritema lica njihova klinička slika, dijagnostika, diferencijalna dijagnoza i terapijski postupci. Facial redness is a clinical feature of numerous dermatoses as well as physiological changes in the body's vascular system and systemic diseases. Erythema is often the result of inflammatory processes that manifest in the skin as a migration of inflammatory cells and by causing vascular changes. In most cases, a dermatovenerologist can give a diagnosis of the disease based on a clinical examination and the patient's anamnesis. In differential diagnosis, there is a wide range of diseases manifested by facial erythema, the most common of which are rosacea, dermatomycoses, seborrheic dermatitis, perioral dermatitis, photodermatoses, allergic reactions and reactions caused by drugs. The dentist's role is not to diagnose and treat dermatoses manifested by facial erythema, but the knowledge of the most common diagnoses is useful for patient counseling and referral to specialists for further treatment. This thesis describes some of the most common dermatoses that cause facial erythema, their clinical manifestations, diagnosis, differential diagnosis and therapeutic procedures.

Uvod: Kronična spontana urtikarija (CSU) definirana je prisutnošću urtikarije, sa ili bez angioedema, u razdoblju od 6 tjedana ili duže bez određenog uzroka. CSU koja je rezistentna na antihistaminike liječi se omalizumabom, rekombinantnim monoklonskim humaniziranim antitijelom protiv humanog imunoglobulina E (IgE). Cilj: Predstaviti naše iskustvo s primjenom omalizumaba u liječenju bolesnika s CSU-om. Ispitanici i metode: U ovoj retrospektivnoj studiji pregledani su klinički i laboratorijski parametri bolesnika s CSU liječenim omalizumabom u razdoblju od veljače 2019. do lipnja 2022. godine u Kliničkom bolničkom centru Rijeka. Aktivnost bolesti procijenjena je pomoću sedmodnevne ocjene aktivnosti urtikarije (weekly urticaria activity score, UAS7). Potpuni odgovor (complete response, CR) definirali smo kao smanjenje početnog UAS7 za ≥90 % ili postizanje UAS7≤6, a djelomični odgovor (engl. partial response, PR) kao smanjenje od 30 do 89 % u odnosu na početne vrijednosti UAS7. Rezultati: U procijenjenom razdoblju ukupno je 18 pacijenata primilo najmanje jednu dozu omalizumaba. Bilo je 14 žena i 4 muškarca, srednje dobi od 57 godina (raspon 27 - 75 godina). Median vrijednosti UAS7 bio je 31. U 56% pacijenata, urtikarija je bila popraćena ponavljajućim epizodama angioedema. Ukupna razina serumskog IgE bila je povišena u 61% bolesnika, dok je 50% pacijenata imalo barem jedan atopijski komorbiditet, uključujući rinokonjunktivitis, astmu ili anamnezu alergije na lijekove. Pronađeni su dokazi o autoimunom tiroiditisu u 44% bolesnika. U prvom šestomjesečnom ciklusu terapiju je završilo ukupno 14 pacijenata. Do kraja 1. ciklusa terapije, 13 pacijenata postiglo je CR, a 1 pacijent je postigao PR. Od 13 pacijenata koji su imali potpuni odgovor, 5 pacijenta postiglo je CR već nakon prve primijenjene doze lijeka, tj. unutar 4 tjedna od početka liječenja. Većina bolesnika također je ušla u relaps bolesti u prosjeku 7 tjedana od aplikacije zadnje doze. Ipak, postigli su CR odmah nakon ponovnog uvođenja terapije. Četiri pacijenta postiglo je dugotrajnu remisiju bolesti nakon samo jednog ciklusa terapije. Nije bilo povezanosti između odgovora na liječenje i ispitivanih laboratorijskih parametara. Zaključak: Prema našem iskustvu, omalizumab je učinkovit lijek u liječenju CSU s neadekvatnim odgovorom na četverostruku dozu antihistaminika, kao i u ponovnoj primjeni kod relapsa nastalom po prekidu terapije., Introduction: Chronic spontaneous urticaria (CSU) is defined by the presence of urticaria, with or without angioedema, for a period of 6 weeks or longer without a specific cause. CSU that is refractory to antihistamines is treated with omalizumab, a recombinant monoclonal humanized antibody against human immunoglobulin E (IgE). Objective: To present our experience with the use of omalizumab in the treatment of CSU patients. Material and methods: In this retrospective study, clinical and laboratory parameters of patients with CSU treated with omalizumab at the Clinical Hospital Center (CHC) Rijeka in the period from February 2019 until June 2022 were reviewed. Disease severity was assessed using the 7-day Urticaria Activity Score (UAS7). We defined complete response (CR) as a reduction of ≥90% in baseline UAS7 or achievement of UAS7≤6 and partial response (PR) as a reduction of 30-89% from baseline UAS7. Results: In the evaluated period, a total of 18 patients received at least a single dose of omalizumab. There were 14 women and 4 men, with a median age of 57 years (range 27 - 75 years). The median baseline UAS7 score was 31. In 56% urticaria was accompanied by recurrent episodes of angioedema. Total serum IgE level was elevated in 61% of patients while 50% of patients had at least one atopic comorbidity, including rhinoconjunctivitis, asthma, or history of drug allergy. There was evidence of autoimmune thyroiditis in 44% of patients. A total of 14 patients completed the first 6-month cycle of therapy. By the end of the 1st cycle of therapy, 14 patients reached CR and 1 patient reached PR. Of the 13 patients who had complete response, 5 patients achieved CR 4 weeks after starting the treatment, but also relapsed in average 7 weeks after the last dose. Nevertheless, they achieved CR immediately upon retreatment. Four patients achieved long-term remission after only one cycle of therapy. There was no association between treatment response and laboratory parameters. Conclusion: In our experience, omalizumab is an effective drug in the treatment of CSU, as well as in the retreatment of the relapsed disease.

Owing to the widespread use of COVID-19 vaccines, the number of cutaneous vaccine-related adverse events has recently increased. We present two cases of lichen planus in elderly women following COVID-19 mRNA vaccination. The first patient presented with new-onset LP, whereas the second patient experienced an extensive LP flare after a 10-year remission.

BACKGROUND: Dermoscopy is a widely used technique, recommended in clinical practice guidelines worldwide for the early diagnosis of skin cancers. Intra-European disparities are reported for early detection and prognosis of skin cancers, however, no information exists about regional variation in patterns of dermoscopy use across Europe. OBJECTIVE: To evaluate the regional differences in patterns of dermoscopy use and training among European dermatologists. MATERIALS & METHODS: An online survey of European-registered dermatologists regarding dermoscopy training, practice and attitudes was established. Answers from Eastern (EE) versus Western European (WE) countries were compared and their correlation with their respective countries' gross domestic product/capita (GDPc) and total and government health expenditure/capita (THEc and GHEc) was analysed. RESULTS: We received 4,049 responses from 14 WE countries and 3,431 from 18 EE countries. A higher proportion of WE respondents reported dermoscopy use (98% vs. 77%, p

Melanomas that have histopathologic features that overlap with those of Spitz nevus are referred to as spitzoid melanomas. However, the diagnostic concept is used inconsistently and genomic analyses suggest it is a heterogeneous category. Spitz tumors, the spectrum of melanocytic neoplasms extending from Spitz nevi to their malignant counterpart Spitz melanoma, are defined in the 2018 WHO classification of skin tumors by the presence of specific genetic alterations, such as kinase fusions or HRAS mutations. It is unclear what fraction of “spitzoid melanomas” defined solely by their histopathologic features belong to the category of Spitz melanoma or to other melanoma subtypes. We assembled a cohort of 25 spitzoid melanomas diagnosed at a single institution over an 8-year period and performed high-coverage DNA sequencing of 480 cancer related genes. Transcriptome wide RNA sequencing was performed for select cases. Only nine cases (36%) had genetic alterations characteristic of Spitz melanoma, including HRAS mutation or fusion involving BRAF, ALK, NTRK1, or MAP3K8. The remaining cases were divided into those with an MAPK activating mutation and those without an MAPK activating mutation. Both Spitz melanoma and spitzoid melanomas in which an MAPK-activating mutation could not be identified tended to occur in younger patients on skin with little solar elastosis, infrequently harbored TERT promoter mutations, and had a lower burden of pathogenic mutations than spitzoid melanomas with non-Spitz MAPK-activating mutations. The MAPK-activating mutations identified affected non- V600 residues of BRAF as well as NRAS, MAP2K1/2, NF1, and KIT, while BRAF V600 mutations, the most common mutations in melanomas of the WHO low-CSD category, were entirely absent. While the “spitzoid melanomas” comprising our cohort were enriched for bona fide Spitz melanomas, the majority of melanomas fell outside of the genetically defined category of Spitz melanomas, indicating that histomorphology is an unreliable predictor of Spitz lineage.

Contains fulltext : 251813.pdf (Publisher’s version ) (Closed access) IMPORTANCE: A clear dosing regimen for methotrexate in psoriasis is lacking, and this might lead to a suboptimal treatment. Because methotrexate is affordable and globally available, a uniform dosing regimen could potentially optimize the treatment of patients with psoriasis worldwide. OBJECTIVE: To reach international consensus among psoriasis experts on a uniform dosing regimen for treatment with methotrexate in adult and pediatric patients with psoriasis and identify potential future research topics. DESIGN, SETTING, AND PARTICIPANTS: Between September 2020 and March 2021, a survey study with a modified eDelphi procedure that was developed and distributed by the Amsterdam University Medical Center and completed by 180 participants worldwide (55 [30.6%] resided in non-Western countries) was conducted in 3 rounds. The proposals on which no consensus was reached were discussed in a conference meeting (June 2021). Participants voted on 21 proposals with a 9-point scale (1-3 disagree, 4-6 neither agree nor disagree, 7-9 agree) and were recruited through the Skin Inflammation and Psoriasis International Network and European Academy of Dermatology and Venereology in June 2020. Apart from being a dermatologist/dermatology resident, there were no specific criteria for participation in the survey. The participants worked mainly at a university hospital (97 [53.9%]) and were experienced in treating patients with psoriasis with methotrexate (163 [91.6%] had more than 10 years of experience). MAIN OUTCOMES AND MEASURES: In a survey with eDelphi procedure, we tried to reach consensus on 21 proposals. Consensus was defined as less than 15% voting disagree (1-3). For the consensus meeting, consensus was defined as less than 30% voting disagree. RESULTS: Of 251 participants, 180 (71.7%) completed all 3 survey rounds, and 58 participants (23.1%) joined the conference meeting. Consensus was achieved on 11 proposals in round 1, 3 proposals in round 2, and 2 proposals in round 3. In the consensus meeting, consensus was achieved on 4 proposals. More research is needed, especially for the proposals on folic acid and the dosing of methotrexate for treating subpopulations such as children and vulnerable patients. CONCLUSIONS AND RELEVANCE: In this eDelphi consensus study, consensus was reached on 20 of 21 proposals involving methotrexate dosing in patients with psoriasis. This consensus may potentially be used to harmonize the treatment with methotrexate in patients with psoriasis.

By definition, the term “collision lesion” refers to two or more tumors coinciding in the same anatomic position or visceral organ. Collision lesions coexisting on the same skin location are defined as collision skin lesions (CSLs). Although this term implies a conflict between the tumors, this is not the case. CSLs appear to be rare, but still pose a significant diagnostic problem in everyday clinical practice and clinicians should be aware of their existence. The aim of this study was to elucidate the problem of CSLs in clinical practice, with an emphasis on classification of CSLs according to position dependence, tumor histogenesis, etiology, and possible lesion combinations in CSLs, as well as diagnostic possibilities. According to our results, accurate clinical diagnosis could be only rarely reached, requiring lesion excision and pathohistological confirmation of CSLs. Considering the fact that tumors in CSLs can be partially or completely overlying or can even be positioned one within the other, the existence of two or more tumors is extremely difficult to detect.

Atopijski dermatitis česta je, kronično recidivirajuća upalna bolest kože karakterizirana složenom etiopatogenezom i raznolikim kliničkim fenotipom. Klinička slika može biti različita, a bolest je obilježena ponavljajućim dermatitisom, izraženim svrbežom i značajnim utjecajem na kvalitetu života oboljele osobe i cijele obitelji. Dijagnoza se postavlja na temelju kliničke slike prema standardiziranim dijagnostičkim kriterijima, a procjena težine bolesti prema standardiziranim instrumentima za procjenu težine bolesti. Liječenje treba prilagoditi svakom bolesniku, a cilj liječenja je smanjiti simptome svrbeža, obnoviti oštećenu kožnu barijeru, spriječiti egzacerbaciju bolesti, spriječiti odnosno liječiti komplikacije i komorbiditete te smanjiti negativni utjecaj bolesti na kvalitetu života. Zahvaljujući napretku u razumijevanju etiopatogeneze, terapijske mogućnosti su zadnjih godina značajno napredovale. Hrvatsko dermatovenerološko društvo Hrvatskoga liječničkog zbora predstavlja smjernice za dijagnostiku i liječenje atopijskog dermatitisa. Smjernice su rezultat konsenzusa hrvatskih stručnjaka za atopijski dermatitis koji su kritički proučili mjerodavnu znanstvenu literaturu, koja se temelji na najboljim dokazima., Atopic dermatitis is a common, chronically recurrent inflammatory skin disease characterized by a complex etiopathogenesis and a variable clinical phenotype. The clinical presentation is heterogeneous, and the disease is characterized by a recurrent dermatitis, intense itching and a significant impact on the quality of life of patients and their family. The diagnosis is based on the clinical presentation according to the standardized diagnostic criteria, while the assessment of disease severity of the disease is based on the standardized tools for disease severity assessment. Treatment should be tailored to each patient profile, and the goal of the treatment is focused on decreasing symptoms and renewing damaged skin barrier, preventing the exacerbation of the disease and preventing or treating the complications and comorbidities, and decreasing the negative influence of the disease on the patient’s quality of life. Due to progress in understanding the etiopathogenesis, treatment options have significantly expanded in the past years. The Croatian Society of Dermatovenerology of the Croatian Medical Association is presenting guidelines for diagnosis and treatment of atopic dermatitis. These guidelines are the result of consensus of Croatian experts based on critical analysis of relevant, evidence-based scientific literature.

Cilj istraživanja: Cilj ovog istraživanja bio je usporediti kvalitetu života u pacijenata na terapiji biološkim lijekom koji boluju od hidradenitis suppurativa ili boluju od teškog oblika psorijaze Ispitanici i metode: U opažajnu, retrospektivnu studiju parova uključeno je ukupno 52 pacijenta na terapiji biološkim lijekom, 26 s dijagnozom hidradenitis suppurativa i 26 s dijagnozom teškog oblika psorijaze. Korištena je anketa i upitnici: Dermatološki indeks kvalitete života (DLQI), Beckov inventar depresije za žene i muškarce (BDI-II) i Upitnik o radnoj učinkovitosti i smetnjama u radu V2.0 (WPAI:GH). Uspoređen je rezultat DLQI između HS i psorijaze te između žena i muškaraca unutar skupina. Skupine su uspoređene s obzirom na broj promjenama zahvaćenih područja, dobi pri pojavi simptoma i postavljanju dijagnoze, prisutnost komorbiditeta, zadovoljstvo biološkom terapijom, kvalitetu života, prisutnost depresije, smetnje u radu i obavljanju svakodnevnih aktivnosti. Rezultati: Rezultat DLQI u pacijenata s dijagnozom hidradenitis suppurativa (7,4 ± 5,8) značajno je lošiji u odnosu na pacijente s dijagnozom teškog oblika psorijaze (1,8 ± 2,5); P, Objectives: The aim of the present study was to compare quality of life among patients treated with a biologic drug who suffer from hidradenitis suppurativa or suffer from a severe form of psoriasis. Subjects and methods: A total of 52 patients treated with biological drug, 26 with diagnosis of hidradenitis suppurativa and 26 with diagnosis of a severe form of psoriasis were included in the observational, retrospective study of couples. A survey and questionnaires: Dermatology Quality of Life Index (DLQI), Beck's Depression Inventory for women and men (BDI-II) and Work Productivity and Acitivity Impairment Questionnaire V2.0 (WPAI:GH) were used. DLQI results were compared between HS and psoriasis and between women and men within the groups. The groups were compared with regard to the number of affected skin areas, age at onset of symptoms and official diagnosis, presence of comorbidities, satisfaction with biological therapy, quality of life, presence of depression, interference with work and performing daily activities. Results: The DLQI score among patients with hidradenitis suppurativa (7.4 ± 5.8) was significantly worse than DLQI score in the psoriasis group (1.8 ± 2.5); P

Recently, several biologics have been associated with thedevelopment of new-onset or exacerbation of prior sar-coidosis.1–5We report a case of new-onset sarcoidosisinduced by secukinumab in a patient with severe plaquepsoriasis.

Vitiligo is an acquired immune-mediated disorder of pigmentation clinically characterized by well-defined depigmented or chalk-white macules and patches on the skin. The prevalence of vitiligo varies by geographical area, affecting 0.5% to 2% of the population. The disease imposes a significant psychological burden due to its major impact on patients’ social and emotional aspects of life. Given its autoimmune background, vitiligo is frequently associated with other autoimmune diseases or immune-mediated diseases. Vitiligo is a multifaceted disorder that involves both genetic predisposition and environmental triggers. In recent years, major predisposing genetic loci for the development of vitiligo have been discovered. The current findings emphasize the critical role of immune cells and their mediators in the immunopathogenesis of vitiligo. Oxidative-stress-mediated activation of innate immunity cells such as dendritic cells, natural killer, and ILC-1 cells is thought to be a key event in the early onset of vitiligo. Innate immunity cells serve as a bridge to adaptive immunity cells including T helper 1 cells, cytotoxic T cells and resident memory T cells. IFN-γ is the primary cytokine mediator that activates the JAK/STAT pathway, causing keratinocytes to produce the key chemokines CXCL9 and CXCL10. Complex interactions between immune and non-immune cells finally result in apoptosis of melanocytes. This paper summarizes current knowledge on the etiological and genetic factors that contribute to vitiligo, with a focus on immunopathogenesis and the key cellular and cytokine players in the disease’s inflammatory pathways.

Lichen planus is a chronic disease affecting the skin, appendages, and mucous membranes. A cutaneous lichen planus is a rare disease occurring in less than 1% of the general population, while oral illness is up to five times more prevalent; still, both forms equally impair the patient’s quality of life. The etiology of lichen planus is not entirely understood. Yet, immune-mediated mechanisms have been recognized since environmental factors such as hepatitis virus infection, mechanical trauma, psychological stress, or microbiome changes can trigger the disease in genetically susceptible individuals. According to current understanding, lichen planus immunopathogenesis is caused by cell-mediated cytotoxicity, particularly cytotoxic T lymphocytes, whose activity is further influenced by Th1 and IL-23/Th-17 axis. However, other immunocytes and inflammatory pathways complement these mechanisms. This paper presents a comprehensive insight into the actual knowledge about lichen planus, with the causal genetic and environmental factors being discussed, the immunopathogenesis described, and the principal effectors of its inflammatory circuits identified.

Background: Because of the important role in regulating the immune system, increasing evidence suggests a possible implication of gut microbiota in Chronic spontaneous urticaria (CSU). Although the oral cavity is the first site of contact between microbiota and the immune system, the association between salivary microbiota and CSU has not yet been reported. Objective: This case-control study aimed to compare differences in salivary microbiota between CSU patients and healthy controls (HC). Twenty-three participants—13 patients with CSU and 10 HC were enrolled; salivary microbiota was determined by molecular approach targeting 16S ribosomal RNA. Terminal restriction fragment length polymorphism (T-RFLP) analysis was performed. Results: Alpha diversity of salivary microbiota in CSU patients was significantly reduced compared to HC, resulting in alteration of the community composition. Species richness determined via the Shannon index was significantly reduced in the CSU group. Conclusion: Dysbiosis of salivary microbiota may contribute to a dysregulated immune system in the development of CSU. To our knowledge, this was the first study that reported an alteration in salivary microbiota composition in CSU patients.

Koža je organski sustav koji upravlja tjelesnom temperaturom, štiti organizam od gubitka tekućine iz tkiva, osjeća bolne i ugodne podražaje, sprječava tvari da uđu u tijelo, pruža zaštitu od štetnog djelovanja sunca i igra važnu ulogu u sintezi vitamina D. Građa kože i izloženost brojnim unutarnjim i vanjskim štetnim čimbenicima čini je podložnom raznim oboljenjima, a budući da su neke promjene na određenim dijelovima kože lako vidljive, kožne bolesti predstavljaju velik zdravstveni problem. Mnoge kožne bolesti dijagnosticiraju se po njihovom karakterističnom izgledu ili morfologiji promjena pa je za postavljanje dijagnoze potrebna anamneza i fizički pregled, no vizualna pretraga okosnica je obrade. Pravovremeno prepoznavanje simptoma i reagiranje, omogućuje postizanje dobrih rezultata u liječenju kožnih bolesti. CILJ RADA: Prikazati simptome i znakove primarnih virusnih kožnih bolesti te njihovu dijagnozu. Na temelju simptoma, znakova i dijagnoze se određuje potrebna terapija, prilagođena pojedincu. The skin is an organic system that manages body temperature, protects the organism from fluid loss from tissues, feels painful and pleasant stimuli, prevents substances from entering the body, provides protection against the harmful effects of the sun and plays an important role in the synthesis of vitamin D. Its structure and exposure to numerous internal and external harmful factors makes it susceptible to various ailments, and since some changes in certain parts of the skin are easily visible, skin diseases pose a major health problem. Many skin diseases are diagnosed by their characteristic appearance or morphology of changes, so a history and physical examination are required to make a diagnosis, but visual examination is the backbone of the processing. Timely symptom recognition and response allows to achieve good results in the treatment of skin disease. OBJECTIVE: To show symptoms and signs of primary virus skin diseases and their diagnosis. Based on the symptoms, signs and diagnosis, the necessary therapy is determined, adapted to the individual.

Psorijaza je kronična multisistemska upalna bolest koja može zahvaćati kožu, ali i druge organe. Karakterizira je brzi rast stanica epidermisa koje stvaraju ograničena eritematoskvamozna žarišta. Zahvaćena mjesta mogu svrbiti. Bolest najčešće zahvaća područje vlasišta, laktova, koljena, a osim kože mogu biti zahvaćeni i nokti. Bolest je kronično-recividirajuća. Jedna je od najčešćih kožnih bolesti u Hrvatskoj, pogađa 2% populacije i predstavlja veliki javnozdravstveni problem. Psorijaza se ne može izliječiti, ali se terapijom bolest može držati pod kontrolom. Cilj rada je prikazati važnost podizanja svijesti o psorijazi kao javnozdravstvenom problemu, prikazati vrste i učinkovitosti metode terapije, istaknuti važnost uloge medicinske sestre u postupku liječenja i davanja podrške oboljelima. Psoriasis is a chronic multisystem inflammatory disease that can affect the skin, but also other organs. It is caused by the rapid growth of epidermal cells that produce limited erythematosquamous foci. Affected areas may itch. The disease most often affects the scalp, elbows, knees and in addition to the skin, nails can also be affected. The disease is chronic-recurrent. It is one of the most common skin diseases in Croatia, affects 2% of the population and is a major public health problem. Psoriasis cannot be cured, but therapy can keep the disease under control. The aim of this paper is to show the importance of raising awareness about Psoriasis as a public health problem, to show the types and effectiveness of the method of therapy, to emphasize the importance of the role of the nurse in the treatment and support of patients.

Koža, najveći organ,se može promijeniti zbog bolesti unutarnjih organa. Danas je učestalost zloćudnih tumora kože u porastu. Incidencija tumora kože u Europi raste. Činjenica je da svaka lezija na koži koja je drugačija i promijenjena predstavlja indikaciju za dermatološki pregled. Većina promjena, bilo makula, nodusa ili papula, je dobroćudna. Najveća je incidencija bazocelularnih karcinoma, rjeđa planocelularnih karcinoma te melanoma, a najrjeđa Merkel cell karcinoma. Ključni čimbenik u pozitivnom ishodu bolesti kod bolesnika s malignim tumorom kože, osim prevencije, je njegovo rano otkrivanje. Tumor kože prepoznat u ranoj fazi može se izliječiti, dok je u uznapredovalom stadiju liječenje otežano, kvaliteta života smanjena, a ishod neizvjestan. Dijagnoza tumora kože postavlja se na sinergiji anamneze, kliničkog i dermatoskopskog pregleda, incizijske ili ekscizijske biopsije uz patohistološku analizu te, prema potrebi, radiološke dijagnostike. Medicinska sestra sudjeluje u timu zdravstvenih djelatnika u prevenciji u edukativnom smislu, dijagnostici i liječenju malignih tumora kože. The incidence of malignant skin tumors is on the rise. The number of new patients doubles every eight to ten years in most European countries, so the growth rate is higher than in any other type of cancer. Therefore, any skin lesion that is different and altered is an indication for dermatological examination. Most skin changes are benign and do not need to be removed. A number of changes are malignant skin tumors and among them, basaliomas have the highest incidens followed by planocellular carinomas and melanomas with the smalles incidences for Merkel cell tumors. Prevention and early detection of skin tumors is essential. A skin tumor recognized at an early stage can be cured, while at an advanced stage treatment is difficult, quality of life is reduced, and outcome is uncertain. Diagnosis is made on the basis of anamnesis, clinical and dermatoscopic examination, incisional or excisional biopsy along with pathohistology examination, and radiological diagnostics. The nurse, as a part of medical team, has an impact in the prevention, diagnosis and treatment of malignant skin tumors.

Platelet-rich plasma (PRP) treatment has emerged in recent years as a valuable, effective, and affordable treatment for androgenetic alopecia. Androgenetic alopecia is the most common type of alopecia, affecting both men and women, and is characterized by diminished hair follicles mainly pronounced in the frontal region and vertex. A considerable variety of PRP treatment regimens have been described so far, but there is no consensus on the standardization of PRP preparation or administration protocol. Our study was conducted on two patients to test the efficacy of a new PRP application protocol of only two treatments by using a combination of a PRP collecting device and a conventional kit. Efficacy of treatment was assessed after a 6-month follow-up by artificial intelligence (AI)-driven software on microscopic images of treated regions. An average number of hairs, cumulative hair thickness, and the number of follicular units increased in the vertex region of both patients by 30/59%, 35/53%, and 14/48%, respectively. The novel treatment regimen showed significant effectiveness in only six months.

Numerous psychoneuroimmune factors participate in complex bodily reactions to psychological stress, and some of them can be easily and non-invasively measured in saliva (cortisol, alpha-amylase, proinflammatory cytokines). Cortisol plays a crucial role in the stress response; thus, stressful events (academic examinations, cardiac surgery, dental procedures) are accompanied by an increase in cortisol levels. (A correlation between cortisol blood levels and salivary values has already been confirmed, particularly during stress). Academic stress is defined as everyday stress among students that has an impact on aspects of their psychological and physiological well-being. For example, exams are considered one of the most acute stressful experiences for students. The strength of the association between academic self-efficacy, psychological stress, and anxiety depends on a variety of factors: the type of academic challenge (e.g., oral exam), the presence of an audience, etc. Higher stress levels were predominantly recorded among younger students, primarily regarding their academic tasks and concerns (grades, exams, competing with peers for grades, fear of failing the academic year, etc.). The measurement of stress levels during academic stress can improve our understanding of the character and influence of stressful events in populations of students, preventing adverse reactions to long-term stress, such as a decreased immune response and increased anxiety.

Reports from various countries have described increasing numbers of scabies cases, especially in the past two decades. The epidemiological data for various world regions showed prevalence estimates ranging from 0.2% to 71%, with the highest prevalence in the Pacific region and Latin America. Therefore, geographically, scabies occurs more commonly in the developing world, tropical climates, and in areas with a lack of access to water. According to results from specific regions of the world, the greatest burdens from scabies were recorded for East Asia, Southeast Asia, Oceania, tropical Latin America, and South Asia. Among countries with the highest rates, the top 10 were Indonesia, China, Timor-Leste, Vanuatu, Fiji, Cambodia, Laos, Myanmar, Vietnam, and the Seychelles. From Europe, available data shows an increasing trend in scabies infestation, particularly evident among populations with associated contributing factors, such as those who travel frequently, refugees, asylum seekers, those who regularly lack drinking water and appropriate hygiene and are of a younger age, etc. This increase in observed cases in the last 10–20 years has been evidenced by research conducted in Germany, France, Norway, and Croatia, among other countries. In addition, increased scabies transmission was also recorded during the COVID-19 pandemic and may have been the result of increased sexual intercourse during that time. Despite all the available treatment options, scabies commonly goes unrecognized and is therefore not treated accordingly. This trend calls for a prompt and synergistic reaction from all healthcare professionals, governmental institutions, and non-governmental organizations, especially in settings where population migration is common and where living standards are low. Furthermore, the proper education of whole populations and accessible healthcare are cornerstones of outbreak prevention. Accurate national data and proper disease reporting should be a goal for every country worldwide when developing strategic plans for preventing and controlling the community spread of scabies.

Uvod. Akne je kronična bolest pilosebecealne jedinice. Spada u jednu od najčešćih bolesti u svijetu. Uglavnom zahvaća populaciju u pubertetskom razdoblju, no često oboljevanju i stariji od dvadesete godine. Uglavnom su to žene. Akne možemo podijeliti na slijedeće kliničke slike: akne comedonica, akne papulosa i papulopustulosa, te akne conglobata. Liječenje se provodi kombinacijom topičke i sistemske terapije. Cilj. Osnovni cilj istraživanja je vidjeti koliki broj oboljelih od akne koji su se javili u ordinaciju imaju dob veću od dvadeset godina. Materijali i metode. U istraživanje je bilo uključeno 182 pacijenata. Ispitanici su pacijenti ordinacije dermatologije i venerologije Dentaderm. U radu se koristi ꭓ2 test kojim se ispituje postojanje razlike u strukturi, dok se ispitivanje razlike u zastupljenosti među promatranim skupinama provodi upotrebom Z testa razlike u proporcijama dva nezavisna skupa. Istraživanje je provedeno uvidom u dokumentaciju pacijenata s dijagnozom akne. Korišteni su podaci iz vremenskog razdoblja od 2015. godine do veljače 2021. godine. Analiza je rađena u statističkom softwareu SPSS 25. Rezultati. Ženske osobe češće oboljevaju od akne od muškaraca u dobi nakon dvadesete godine. Osobe ženskog spola češće oboljevaju u dvadesetim godinama nego u predpubertetskoj dobi prihvaća kao istinita. Rasprava. Prikazana su mišljenja drugih znanstvenika o aknama i njihova istraživanja. Zaključak. Akne su pretežno pubertetska bolest. Istraživanjem smo dobili podatke da ženske osobe češće oboljevaju od muškaraca nakon dvadesete godine, te da ženske osobe češće oboljevaju u dvadesetim godinama nego u pubertetu. Introduction. Acne is a chronic disease of the pilosebeceal unit. It is one of the most common diseases in the world. It mainly affects the population during puberty, but recently it has become more common in people over the age of twenty.Women are mostly affected. Acne can be divided into following clinical presentations: acne comedonica, acne papulosa and papulopustulosa, and acne conglobata. Treatment is carried out with a combination of topical and systemic therapy. Goal. The main goal of the research is to see how many acne patients who have reported to the office are ove twenty years of age. Materials and methods. 182 patients were included in the study. The subjects are patients of the dermatology and venereology practice Dentaderm. The paper uses the ꭓ2 test to examine the existence of a difference in structure, while the examination of the difference in representation between the observed groups is performed using the Z test of the difference in the proportions of two independent sets. The study was conducted by reviewing the documentation of patients diagnosed with acne. Data from the period from 2015 to February 2021 were used. The analysis was performed in the statistical software SPSS 25. Results. Women are more likely to have acne than men over the age of 20. Females are more likely to have acne in their twenties than in pre-adolescence it is accepted as true. Discussion. Opinions of other scientists on acne and their research are presented. Conclusion. Acne mainly affects people in their puberty. The research showed that women get acne more often than men after the age of twenty, and that women get acne more often in their twenties than at puberty.

Acne vulgaris kronična je upalna bolest multifaktorijalne etiologije koja zahvaća pilosebacealnu jedinicu. Karakteristično razdoblje obolijevanja je adolescencija, uz sve češće perzistiranje ili pojavu akne u odrasloj životnoj dobi. Klinička slika može varirati od blage do teške, a karakterizira je raznovrsnost lezija koje uključuju komedone, papule, pustule, nodule, ožiljke te hiperpigmentacije i postupalne eriteme. Etiopatogeneza akne složena je i uključuje interakciju brojnih endogenih i egzogenih čimbenika. Glavni patogenetski mehanizmi odvijaju se u pilosebacealnoj jedinici, a podrazumijevaju pojačanu produkciju i promijenjenu lipidnu kompoziciju sebuma, hiperkeratinizaciju, razmnožavanje Cutibacterium acnes bakterije i upalu. Osim navedenih danas se istražuju i drugi etiološki čimbenici koji mogu pridonijeti nastanku akne, a uključuju prehranu, stres, povezanost crijevne mikroflore, mozga i kože, utjecaj sunca, predmenstrualnu pojavu akne, komedogenu kozmetiku i pušenje. S obzirom na raznovrsnost etioloških čimbenika i složenost patogeneze pronalazak jednog lijeka zadovoljavajućeg učinka i dobre podnošljivosti nije lak. Akne zbog svoje lokalizacije na pogledu izloženim dijelovima tijela te karakteristične kliničke slike koja uključuje nastanak trajnih ožiljaka, mogu dovesti do nepoželjne stigmatizacije bolesnika i negativnih psihosocijalnih posljedica. Stoga je od iznimne važnosti dobro razumjeti i poznavati etiologiju i patogenezu akne kako bi se u budućnosti pronašle još bolje i učinkovitije metode liječenja., Acne vulgaris is a chronic inflammatory disease of multifactorial etiology that affects the pilosebaceal unit. The characteristic period for onset of acne is adolescence with increasing persistence or the appearance of acne in adulthood. The clinical presentation of acne can vary from mild to severe, characterized by a variety of lesions that include comedones, papules, pustules and nodules, scarring and dispigmentation. The etiopathogenesis of acne is complex and involves the interaction of endogenous and exogenous factors. The main pathogenetic mechanisms take place in the pilosebaceal unit and include increased production and altered lipid composition of sebum, hyperkeratinization, reproduction of Cutibacterium acnes bacteria and inflammation. In addition to these factors, today attention is focused on other etiological factors that may contribute to the development of acne, and include diet, stress, the connection of intestinal microflora, brain and skin, sun exposure, premenstrual acne, comedogenic cosmetics and smoking. Given the diversity of etiological factors and the complexity of pathogenesis, finding a single cure with satisfactory effects and good tolerability is not easy. Acne, due to its characteristic clinical features involving the face and causing sometimes permanent scarring, if untreated can lead to negative psychosocial consequences on the individual. Therefore, it is of extreme importance to have a good understanding and knowledge of the etiology and pathogenesis of acne so that these insights can be directed towards the development of effective treatment.

Lichen planus is a chronic inflammatory mucocutaneous disorder commonly affecting the skin, nails, hair, and mucous membranes (1). Although its main cause is still unclear, lichen planus is defined as a T cell- mediated inflammatory disease (2). CD8+ T lymphocytes activate their cytotoxic armamentarium and induce basal keratinocyte apoptosis (2). The susceptibility of basal keratinocytes to CD8+ T lymphocytes is enhanced through MHC class I expression on keratinocytes triggered by interferon (IFN)- gamma (3). The cytotoxic process is mainly mediated by the release of lytic molecules, such as perforin, granzyme B, and granulysin (GNLY) (4–8). The upregulation of perforin and granzyme B has been previously demonstrated in the peripheral blood and lesional skin of patients with lichen planus (4–8). GNLY is a member of the saposin-like lipid-binding protein (SAPLIP) family and has a cytotoxic effect on tumour cells and a variety of microorganisms (9, 10). It is located in the cytotoxic granules of T cells, which are released upon antigen stimulation, and in the cytotoxic granules of natural killer (NK) cells. GNLY presence has only recently been observed in lichen planus lesions, but the expression level of this molecule in peripheral blood and subsequent determination of cells that express this molecule in blood and lesions remains unknown (8). In this study we examined the dynamics of GNLY expression in different cytotoxic subtypes of peripheral blood lymphocytes and in the skin lesions of patients with lichen planus.

Background: Androgenetic alopecia (male pattern and female pattern hair loss) is characterized by thinning of the scalp hair. Intradermal injection of autologous plate‐ let‐rich plasma (PRP) might have an effect on hair regrowth. Aims: The aim was to evaluate efficacy and safety of platelet‐ rich plasma compared to placebo or no treatment in people with pattern hair loss. Patients/Methods: We searched the databases CENTRAL and MEDLINE on December 24, 2018 and included randomized controlled trials (RCTs). Primary out‐ comes were mean change of hair density from baseline and serious treatment‐ related adverse events. Secondary outcome was mean change of hair thickness from base‐ line. Time point of outcome assessment was 6 months after start of treatment. Results: We identified 13 relevant randomized controlled trials with 356 randomized (343 analyzed) people or half‐head areas who received PRP in a simple parallel or half‐head design. The pooled data of seven studies (171 analyzed people or half‐ head areas) were favorable in the PRP group on hair density. We estimated a mean difference from baseline of 30.35 associated with a wide 95% confidence interval (1.77‐ 58.93), a considerable heterogeneity (I2 = 100%), and unclear risk of bias in most of the studies. Regarding hair thickness, data were also favorable in the PRP group, but these data were limited to a single study. We did not identify serious treatment‐ related adverse events. Conclusion: The results of seven RCTs indicated that autologous platelet‐rich plasma was associated with an increase of hair density when compared to placebo.

Venski ulkus je kronična rana. Posljedica je neadekvatnog liječenja kronične venske bolesti. Kroničnim ranama se nazivaju rane koje, uz sve provedene postupke liječenja, ne uspiju zacijeliti, već su ušle u patološko stanje upale. Rezultat tog stanja je odgođeno cijeljenje, loš anatomski i funkcionalni rezultat koji vodi prema većoj invalidnosti, stoga su troškovi takvog liječenja značajni. Pri liječenju vrlo je važno sagledati bolesnika u cijelosti i osim same rane liječiti i uzrok nastanka, u ovom slučaju kroničnu vensku bolest. Najbolji način popravka kronične venske bolesti između ostalog je kompresivna terapija. U ovome radu definirana je kronična venska bolest, objašnjeni su uzroci nastajanja, opisan tijek bolesti i klinička slika, razrađene su metode liječenja kronične venske bolesti, definirane kronične rane te opisana klinička slika. Također su opisane obloge koje se koriste za liječenje venskog ulkusa, te vrste kompresivne terapije. Objašnjene su metode postavljanja i ukazana uloga medicinske sestre u edukaciji i postavljanju kompresivne terapije. Venous ulcer is consequence of inadequate treatment of chronic venous disease. Chronic ulcers are those sores that cannot be healed even after the administered treatment and therefore are in pathological state of chronic inflammation. The results of such inflammation include delayed healing, poor anatomic and functional outcome that leads towards higher of disability. Therefore the cost of such a treatment is substantial. During venous ulcer treatment, extremely important is to treat a patient as a whole; besides treating the wound itself, the cause of wound formation should be treated as well. In this case it is chronic venous disease. The best way to treat chronic venous disease is, among other treatment, an adequate compressive therapy. In this paper, chronic venous disease is defined, the causes are explained, the course of the disease and the clinical picture are described, methods of treatment of chronic venous disease are developed, chronic wounds are defined and the clinical picture is described. Also described are dressings used to treat venous ulcers, and types of compression therapy. The methods of placement and the role of the nurse in the education and placement of compression therapy are explained.

U istraživanju „Izražaj apoptotskih i proliferacijskih čimbenika u želučanoj sluznici oboljelih od sistemske skleroze“ histološki su analizirane razlike u proliferaciji, apoptozi i profibrotičkim čimbenicima u uzorcima želučane sluznice oboljelih od sistemske skleroze (SSc) i kontrolne skupine. U istraživanju je sudjelovao 15 bolesnika sa SSc i 5 kontrolnih ispitanika bez SSc. Bolesnici su sistematizirani s obzirom na oblik i težinu kliničke slike sistemske skleroze. Pet bolesnika je klasificirano u skupinu s ograničenom kožnom SSc (lcSSc) i blagom bolešću, pet s umjerenom difuznom i pet s teškom difuznom kožnom SSc (dcSSc). Uzorci tkiva su imunohistokemijski obojeni protutijelom Ki-67 (proliferacija), kaspazom-3 (apoptoza), sindekanom-1 (epitelni biljeg), CTGF (profibrotički biljeg) i α-SMA (biljeg miofibroblasta). Istovremena prisutnost (kolokalizacija) Ki-67 pozitivnih stanica s biljegom za miofibroblaste (α-SMA) određena je upotrebom dvostruke imunofluorescentne metode. Postotak reaktivnih stanica analiziran je primjenom Kruskal-Wallis testa i Dunn-ovog post hoc testa, a P, In the study "Expression of apoptotic and proliferative factors in the gastric mucosa of patients with systemic sclerosis" differences in proliferation, apoptosis and profibrotic factors were histologically analyzed in samples of gastric mucosa in patients with systemic sclerosis (SSc) and control group. The study included 15 patients with SSc and 5 control subjects without SSc. Patients were systematized with respect to the type and severity of systemic sclerosis. Five patients were classified into the group with limited cutaneous SSc (lcSSc) and mild disease, five with moderate diffuse, and five with severe diffuse cutaneous SSc (dcSSc). Tissue samples were immunohistochemically stained with Ki-67 antibody (proliferation), caspase-3 (apoptosis), syndecan-1 (epithelial marker), CTGF (profibrotic marker), and α-SMA (myofibroblast marker). The simultaneous presence (colocalization) of Ki-67 positive cells with α-SMA was determined using double immunofluorescence method. The percentage of reactive cells was analyzed by a Kruskal-Wallis test and the Dunn post hoc test. P

Psorijaza se definira kao upalna bolest kože obilježena pojavom oštro ograničenih eritematoznih žarišta prekrivenih bjelkastim ljuskama. Uz kožu često zahvaća vlasište i nokte, a u nekim slučajevima može zahvatiti i zglobove što se očituje u obliku psorijatičnog artritisa. Pogađa sveukupno 1-3% svjetskog stanovništva. U Republici Hrvatskoj od psorijaze boluje oko 1,7% stanovništva. Svjetski dan psorijaze obilježava se svake godine 29. listopada. Suvremeno liječenje psorijaze temelji se na dokazima, a uključuje kliničko iskustvo, znanstvene dokaze kao i želje bolesnika prilikom odabira odgovarajuće terapije. Biološka terapija u liječenju psorijaze veliki je napredak u medicini u odnosu prema klasičnoj terapiji psorijaze zbog visoke učinkovitosti i sigurnosti novih lijekova. U ovom radu definirana je psorijaza, objašnjeni su uzroci nastanka bolesti, opisan tijek bolesti te klinička slika. Također su u radu opisane indikacije za uvođenje sustavne terapije, opisani su lijekovi koji se koriste te kako se apliciraju i njihove posebnosti kod liječenja psorijaze. Navedene su i uloge medicinske sestre u edukaciji i praćenju bolesnika na sustavnoj terapiji, te sestrinske dijagnoze. Psoriasis is defined as an inflammatory skin disease characterized by the appearance of sharply demarcated erythematous foci covered with whitish scales. In addition to the skin, it often affects the scalp and nails, and in some cases, it can also affect the joints, which manifests itself in the form of psoriatic arthritis. It affects a total of 1-3% of the world's population. In Croatia, about 1.7% of the population suffers from psoriasis. World Psoriasis Day is celebrated every year on October 29th. Modern treatment of psoriasis is based on evidence and includes clinical experience, scientific evidence as well as the wishes of patients when choosing the appropriate therapy. Biological therapy in the treatment of psoriasis is a major advance in medicine compared to classical psoriasis therapy due to the high efficacy and safety of new drugs. In this paper, psoriasis is defined, the causes of the disease are explained, the course of the disease and the clinical picture are described. The paper also describes the indications for the introduction of systemic therapy, describes the drugs used and how they are applied, and their specifics in the treatment of psoriasis. The roles of the nurse in the education and monitoring of patients on systemic therapy, as well as nursing diagnosis, are also mentioned.

Case report of a patient developing severe bullous hemorrhagic Sweet syndrome following application of the first dose of the SARS- CoV-2 Oxford AstraZeneca vaccine.

Povezanost vitamina D i kože započinje sintezom vitamina D u koži, a neprestano se istražuju i uočavaju novi mehanizmi kojima najistraživaniji vitamin utječe na najveći organ ljudskoga tijela. Cilj je ovoga rada dati pregled dosadašnjih spoznaja o interakciji vitamina D i kože te utjecaju razina vitamina D na kožne bolesti. Po nekim istraživanjima suboptimalne razine vitamina D nalaze se u čak 30 – 90 % stanovništva, a procjenjuje se da postoji manjak vitamina D u oko jedne milijarde ljudi na cijelome svijetu. U 25,6 – 68 % pacijenata sa psorijazom postoji nedostatak vitamina D, a manjak vitamina D nazočan je u čak 97 % pacijenata. Nadalje, niz opservacijskih studija i metaanaliza dokazalo je da su serumske razine kalcidiola niže u djece i odraslih s atopijskim dermatitisom, a pojedina istraživanja dokazala su da u čak 70,5 % pacijenata s vitiligom postoji nedostatak vitamina D. Niske razine vitamina D povezuju se i s progresijom malignog melanoma, no nepoznato je u kojem trenutku izloženosti UV zračenju vitamin D prestaje djelovati protektivno i započinje biti rizični čimbenik za razvoj tumora kože. Unatoč brojnim provedenim istraživanjima, još uvijek nije poznata priroda odnosa vitamina D i pojedinih kožnih bolesti, odnosno je li on uzročnoposljedičan ili slučajan, dok se u drugih dermatoza, poput psorijaze, dokazi o povezanosti s razinom vitamina D primjenjuju u svakodnevnom radu s pacijentima – u dijagnostici i liječenju., The relationship between vitamin D and the skin starts with the synthesis of vitamin D in the skin. New mechanisms on how the most researched vitamin affects the biggest organ in the human body are constantly investigated and observed. The aim is to review the current knowledge on vitamin D and skin interaction, as well as the effect of vitamin D levels on skin diseases. According to some studies, suboptimal vitamin D levels are found in as many as 30 – 90% of the population, with an estimated vitamin D insufficiency in about one billion people worldwide. In 25.6 – 68% of patients with psoriasis, there is a deficiency of vitamin D and insufficiency of vitamin D in as many as 97% of patients. Furthermore, a series of observational studies and meta-analyses have shown that the serum levels of calcidiol are lower in children and adults with atopic dermatitis, and some studies have shown that up to 70.5% of patients with vitiligo have vitamin D deficiency. Low levels of vitamin D are associated with the progression of malignant melanoma, but it is unknown at which point UV exposure ceases to be protective through vitamin D and begins to be a risk factor for the development of skin tumours. Despite many studies that have been conducted, the nature of the relationship between vitamin D and certain skin diseases is still unknown, whether it is causal or accidental, while in others, such as psoriasis, evidence of the correlation with vitamin D levels is used in daily work with patients – in diagnosis and treatment.

Background. Artificial exposure to ultraviolet B light (UVB) while soaking in an indoor salt bath, also called balneophototherapy, could simulate the natural exposure to the sun while bathing in the Dead Sea. We aimed to assess the effects of this intervention on patients with chronic plaque psoriasis. Methods. We searched CENTRAL, MEDLINE, Embase, and LILACS up to June 2019. We included randomized controlled trials. The primary efficacy outcome was PASI-75 to detect people with a 75% or more reduction in the psoriasis area and severity index (PASI) score from baseline. The primary adverse outcome was treatment-related adverse events requiring withdrawal. Results. We included eight RCTs (2105 participants ; 1976 analyzed). With respect to PASI-75, two studies found that salt bath + UVB may improve psoriasis when compared to UVB alone (risk ratio 1.71, 95% confidence interval 1.24 to 2.35 ; 278 participants). With respect to treatment-related adverse events requiring withdrawal, two other studies found little to no difference when compared to UVB alone (risk ratio 0.96, 95% confidence interval 0.35 to 2.64 ; 404 participants). Conclusions. Salt bath + UVB could improve psoriasis when compared to UVB alone, though, results are based on a limited number of studies and provide low- certainty evidence.

Acne vulgaris je kronična upalna bolest multifaktorijalne etilogije koja zahvaća pilosebacealnu jedinicu. Karakteristično razdoblje oboljevanja od akne je adolescencija uz sve češće perzistiranje ili pojavu akne u odrasloj životnoj dobi. Etiopatogenaza akne je kompleksna, uključuje interakciju brojnih endogenih i egzogenih čimbenika, a glavni mehanizmi nastanka podrazumijevaju seboreju, hiperkeratinizaciju, upalu i C. acnes bakteriju. Klinička slika akne može varirati od blage do teške, karakterizira je raznovrsnost lezija koje uključuju komedone, papule, pustule i nodule te ožiljke i dispigmentacije. U terapiji se trenutno najboji učinak postiže izotretinoinom, ali nedostatak su mu ospežne nuspojave. Od 2019. godine u primjeni je novi topički retinoid, trifaroten. Konstantni napori ulažu se u razvoj lijeka visoke učinkovitosti i dobre podnošljivosti. Dugotrajne akne i ožiljci nerijetko imaju negativne psihosocijalne posljedice na osobu te postoji nužda za učinkovitom i pravovremenom terapijom., Acne vulgaris is a chronic, inflammatory disease with a multifactorial etiology which affects the pilosebaceous unit. The characteristic period of the appearance of acne is during adolescence, with the disease persisting and becoming more common in the adult life. Acne have a complex etiopathogenesis which includes interraction of many endogenous and exogenous factors, and the most important mechanisms of acne pathogenesis are seborrhea, hyperkeratinization, inflammation and the C. acnes bacteria. Clinical presentation of acne can vary from a mild to a severe form, and it is characterised by different lesions such as comedones, papules, pustules, nodules, scars and hyperpigmentation. The best effect in the treatment of acne currently has isotretinoine, but its downside are extreme side effects. In 2019 a new topical retinoid, trifarotene, was introduced into the treatment. Constant effort is invested into the research of medication with a high level of effectiveness and good tolerance. Long term acne and scarring often have negative psychosocial consequences for the person experiencing them and an effective treatment is required.

Cilj istraživanja: Glavni su ciljevi istraživanja bili utvrditi izražaje citotoksičnih molekula granulizina (GNLY) i perforina-2 (P2) u subpopulacijama limfocita periferne venske krvi te u promijenjenoj i nepromijenjenoj koži bolesnika sa psorijazom i lihenom planusom. Ispitanici i metode: Izražaje GNLY+ i P2+ stanica u perifernoj krvi istražili smo istovremenim obilježavanjem unutarstaničnih i površinskih biljega u različitim limfocitnim subpopulacijama i monocitima metodom imunofluorescencije, uz očitavanje rezultata protočnim citometrom. Metodom jednostruke imunohistokemije istražili smo izražaje i distribuciju GNLY+ i P2+ stanica, dok smo dvostrukom imunohistokemijom analizirali izražaje i distribuciju CD8+GNLY+ i CD56+GNLY+ stanica u odjeljcima promijenjene i nepromijenjene kože bolesnika sa psorijazom i bolesnika s lihenom planusom u odnosu na zdravu kožu kontrolne skupine. Rezultati: Učestalost GNLY+ stanica je bila statistički značajno veća u svim stanicama, a P2+ stanica u monocitima (CD14+) periferne krvi obaju skupina bolesnika sa psorijazom te bolesnika s lihenom planusom u odnosu na kontrolnu skupinu, dok se postotak GNLY+, CD3+CD8+GNLY+, CD3+CD56+GNLY+ i CD14+P2+ stanica statistički značajno razlikovao i u perifernoj krvi bolesnika s teškom psorijazom u odnosu na bolesnike s blagom psorijazom. Težina psorijaze je statistički značajno korelirala s udjelima GNLY+, CD3+CD8+GNLY+, CD3+CD56+GNLY+ te CD14+P2+ stanica periferne venske krvi bolesnika sa psorijazom. Zaključak: Povećana učestalost GNLY+ i P2+ stanica u perifernoj venskoj krvi te u promijenjenoj koži bolesnika sa psorijazom i bolesnika s lihenom planusom te pozitivna korelacija težine psorijaze s udjelom GNLY+ i P2+ stanica upućuju da citotoksični mehanizmi posredovani GNLY i P2 doprinose patogenezi ovih bolesti na sustavnoj i lokalnoj razini. Stoga bi se, u budućnosti, GNLY i P2 mogli koristiti kao biomarkeri za uspješnu procjenu težine i aktivnosti psorijaze. Objectives: The main objectives of the study were to determine the expressions of the cytotoxic molecules granulysin (GNLY) and perforin-2 (P2) in the lymphocytes' subpopulations of the peripheral venous blood and in the lesional and nonlesional skin of patients with psoriasis and lichen planus. Patients and Methods: The expressions of GNLY+ and P2+ cells in the peripheral blood were investigated by simultaneous labelling of intracellular and surface markers in monocytes and in different lymphocytes' subpopulations by immunofluorescence, with a flow cytometer results reading. By single immunohistochemistry, we investigated the expressions and distribution of GNLY+ and P2+ cells, while by double immunohistochemistry we analyzed the expressions and distribution of CD8+GNLY+ and CD56+GNLY+ cells in both sections of lesional and nonlesional skin of patients with psoriasis and lichen planus in relation to the healthy skin of the control group. Results: The frequency of GNLY+ cells was statistically significantly higher in all cells, and of P2+ cells in monocytes (CD14+) of peripheral blood of both psoriasis patients groups and patients with lichen planus compared to the control group, while the percentage of GNLY+, CD3+CD8+GNLY+, CD3+CD56+GNLY+ and CD14+P2+ cells statistically significantly differed in the peripheral blood of patients with severe and mild psoriasis also. The psoriasis severity statistically significantly correlated with the proportions of GNLY+, CD3+CD8+GNLY+, CD3+CD56+GNLY+ and CD14+P2+ cells in the peripheral venous blood of psoriasis patients. Conclusion: The increased proportion of GNLY+ and P2+ cells in peripheral venous blood and in lesional and nonlesional skin of patients with psoriasis and lichen planus, as well as a positive correlation of psoriasis severity with the frequency of GNLY+ and P2+ cells suggest that cytotoxic mechanisms mediated by GNLY and P2 contribute to the pathogenesis of these diseases at the systemic and the local level. Therefore, GNLY and P2 could be used in the future as biomarkers for the successful assessment of psoriasis severity and activity

Alergijske bolesti smatraju se bolestima modernog doba jer su veliki javnozdravstveni problem u industrijski razvijenim zemljama, ali i u zemljama u razvoju, posebno u djece i mlađih odraslih osoba. Uzroci porasta alergijskih bolesti još nisu dovoljno objašnjeni, no rizičnim čimbenicima smatraju se nasljedna predispozicija, izloženost alergenima, onečišćenje okoliša, smanjena stimulacija imunološkog sustava u ranim razvojnim stadijima i suvremeni način života. Alergijske bolesti treba tretirati kao općeniti poremećaj zdravlja, te se one mogu javiti u bilo koje doba života, u različitim organima istodobno ili u različitom vremenskom periodu, dugotrajne su i zahtjevaju kompleksnu medicinsku skrb. Značajno utječu na kvalitetu života, i smanjenje radne sposobnosti oboljelih te su veliko socioekonomsko opterećenje za pojedinca i društvo. U radu su teorijski obrađeni pojmovi atopijskih (alergijskih) bolesti, te pojam alergijskog rinitisa koji se smatra najčešćom manifestacijom atopije. Zatim su obrazloženi pojmovi alergije, astme i atopijskog dermatitisa. U radu su opisani načini izvođenja dijagnostičkog PRICK testa te ukazane moguće nuspojave prilikom izvođenja. Pretragom rezultata kliničkih testova ukazano je na najčešće inhalacijske alergene u sjevernom dijelu Republike Hrvatske. Objašnjena je uloga medicinske sestre u edukaciji bolesnika u atopijskim bolestima te su navedene sestrinske dijagnoze. Allergic diseases are considered to be diseases of modern time as they are a great public health problem in developed countries, but also in developing countries, especially among children and young adults. Causes of increase of allergic diseases are still not explained in detail. However, the presumption is that the risk factors are hereditary predisposition, allergen exposure, environmental pollution, decreased stimulation of immune system in early stages of development and modern lifestyle. Allergic diseases should be treated as general health problem disord, and they can appear in any period of life, in different organs at the same time or in different time period. Moreover, their duration is prolonged and they require a complex medical care. They also significantly affect the quality of life, and decrease in work ability of the ill, and they are a great socio-economic burden for the individual and the society. This paper atopic (allergic) diseases are being theoretically explained, mostly allergic rhinitis which is considered to be one of the most common manifestation of atopy. Furthermore, the terms allergy, asthma and atopic dermatitis are being explained. In the paper the way of performing the diagnostic PRICK test is pointed out as well and also the possible side effects during test performance. Statistical analysis of the skin PRICK test pointed out the most common inhalation allergens in the north part of Republic of Croatia. The role of medical nurse in education of the ill about atopic diseases is explained, and the nursing diagnoses are adduced as well.

Vitiligo je stečeni poremećaj pigmentacije koji se očituje karakterističnim depigmentacijskim promjenama na koži. Lezije su mliječno bijele boje, a mogu se pojaviti na bilo kojem mjestu na tijelu. Najčešće zahvaćaju ekstenzorne strane udova, prste, lice te područje oko pupka. Osim kože, bolest može zahvatiti i kosu, obrve, trepavice te područje sluznica. Etiopatogeneza vitiliga još uvijek nije u potpunosti razjašnjena, a kao neki od faktora u nastanku bolesti navode se biokemijski, autoimuni, čimbenici živčanog sustava, poremećaj strukture i funkcije melanocita te stres. U nastanku manifestne bolesti veliku ulogu imaju i faktori okoliša. Procjena težine bolesti prema VASI indeksu važna je zbog izbora odgovarajuće metode liječenja kao i praćenja tijeka bolesti. DLQI indeksom procjenjuje se kvaliteta života oboljelih, budući da vitiligo negativno utječe na mentalno zdravlje bolesnika. Cilj terapije je postići repigmentaciju, a terapija obuhvaća lokalno liječenje kortikosteroidnim preparatima, imunomodulatorima i derivatima vitamina D3, fototerapiju, te sustavnu terapiju kortikosteroidima. Kirurškim metodama pristupa se ukoliko prethodne terapije nisu dale zadovoljavajuće rezultate., Vitiligo is an acquired skin disorder manifested by typical depigmentational skin changes. Skin lesions are milky white coloured and can appear anywhere on the human body. Most common places affected by the lesions are the extensor parts of the limbs, fingers, face and the navel area. In addition to the skin, the disease can also affect the hair, eyebrows, eyelashes and the area around the mucous membranes. The ethiopathogenesis has not yet been fully clarified; however, some of the factors responsible for the development of the disease include biochemical, autoimmune and nervous system factors, melanocyte structure disorders and stress. Environmental factors also play an important role in the development of manifested disease. The assessment of the disease according to the VASI index is important for choosing the appropriate treatment method as well as the monitoring of the course of the disease. The quality of life in patients is assessed by the DLQI index, since the manifested disease also affects their mental health. The goal of therapy is to achieve repigmentation and the therapy includes topical treatment with corticosteroid preparations, immunomodulators and vitamin D3 derivatives, phototherapy and systemic corticosteroid therapy. Surgical methods are used if previous therapies have not given satisfactory results.

Atopijski dermatitis je kronična, recidivirajuća, upalna bolest kože u kojoj se izmjenjuju epizode egzacerbacije i remisije. Od patogenetskih mehanizama nastanka spominju se poremećena funkcija epidermalne barijere, imunosnog odgovora, kolonizacija kože mikroorganizmima i pojačana sklonost infekcijama kože. Hanifin i Rajka su 1980. godine odredili velike i male kriterije kliničke slike za postavljanje dijagnoze ove bolesti, a 2014. godine predloženi su njihovi revidirani kriteriji koji su sada dijagnostički standard. Bolest ima tri klinička stadija – dojenački, dječji i odrasli stadij, a kod najvećeg broja pacijenata bolest se prvi put pojavljuje u dojenačkoj dobi. U dojenačkoj dobi lezije zahvaćaju lice i tjeme te ekstenzorne površine ekstremiteta dok je pelensko područje pošteđeno. U dječjoj dobi papule i plakovi prekrivaju zapešća, gležnjeve, te antekubitalne i poplitealne jame, dok se u odrasloj dobi promjene uglavnom nalaze na fleksornim površinama ekstremiteta te na području lica i vrata. Zajedničke osobine svih stadija bolesti neovisno o dobi su svrbež i suha koža. Svrbež može biti prisutan tijekom dana, ali je intenzivniji tijekom večeri i noći što često dovodi do problema sa spavanjem i drugih psihosocijalnih problema. Otprilike 80% svih oboljelih će kasnije u djetinjstvu razviti alergijski rinitis ili astmu, a s razvojem ovih bolesti, veliki broj oboljelih navodi poboljšanje simptoma atopijskog dermatitisa. Sekvencionalna pojava atopijskog dermatitisa, astme i alergijskog rinitisa obilježena je terminom „atopijski marš“. Blagi atopijski dermatitis liječi se primarno lokalnim kortikosteroidima u periodima egzacerbacije, ili ponekad drugim lokalnim pripravcima. U terapiju srednje teškog atopijskog dermatitisa uvodi se i fototerapija uz lokalno liječenje, dok se teški atopijski dermatitis liječi sistemskom imunosupresijom. Dupilumab spada u novu biološku terapiju i za sada je jedini biološki lijek registriran za liječenje teških oblika atopijskog dermatitisa., Atopic dermatitis is a chronic inflammatory skin condition with episodes of egzacerbation and remission. It is characterized by the involvment of skin barrier defects, innate immune response, colonization of the skin with microorganisms and frequent skin infections. In 1980. Hanifin and Rajka suggested diagnostic criteria based on the minor and major features of the clinical presentation which was revisited in 2014. when a simplified version was suggested as the new diagnostic criteria. There are three stages of atopic dermatitis – the infantile stage, the childhood stage and the adult stage, and the condition most often first appears during infancy. In the infantile stage the lesions affect the face and the scalp, extensor surfaces of the extremities while the diaper area is spared. In the childhood stage lesions appear on the wrists, ankles, hands and feet and elbow and knee flexures, while in the adult stage they mostly appear on the flexor surfaces of the extremities, the face and the neck and the distal extremities. Pruritus and xerosis are two characteristics that appear in all three stages. Pruritus can be present during the day but it is more intense during the night which often leads to trouble with sleeping and other problems with psychosocial functioning. About 80% of all patients will develop allergic rhinitis or asthma, and with the development of these conditions, the symptoms of atopic dermatitis sometimes improve. „Atopic march“ is a term developed to describe the progress of atopic dermatitis to allergic rhinitis and asthma. Mild atopic dermatitis is treated primarly with local corticosteroids in the periods of egzacerbation, or sometimes other local medication. Moderate atopic dermatitis is alongside local corticosteroids also treated with phototherapy. Severe forms of atopic dermatitis require systematic imunosupressors. Dupilumab is a new biologic medication which is currently the only one registered for the treatment of severe forms of atopic dermatitis.

Objectives: The aim of this study is to evaluate the epidemiological and clinical features of contact dermatitis. We used the experience of the dermatovenerological clinic of the Clinical Hospital Center Split, from 2013 to July 2019. It is of great significance and importance to collect and analyze Patch Test data over a period of time, in order to recognize epidemics and trends of contact dermatitis. If a specific trend or epidemic is recognized by the analysis, it is important to ask and search for possible causes. This in turn can lead to future disease prevention and health benefits for the whole population. There can be many reasons for a specific trend or epidemic in the population. It could be due to the water supply system, air pollution, specific cosmetics using unrecognized irritants and furthermore. Materials and methods: An epidemiological study was conducted with the data from patch test results of the allergological ambulance from 2013 till July 2019 at the department of Dermatology and Allergology, Clinical Hospital Centre Split. The data collection included 3228 patients in total, whereof 2279 patients were of female gender and 949 were of male gender. As explained above, we included twenty-three allergens in our study, based on the Patch Test model in the Dermatovenerological Department of the Clinical Hospital Centre Split. The results were interpreted from a weak positive reaction (+), strong positive reaction (++) up to an extreme positive reaction (+++/++++). We also included a time-lapse factor, including the reaction after 48 hours and the reaction after 72 hours. Results: There is a high incidence of Cobalt Chloride 1% associated contact dermatitis in our study population. Overall, the allergens revealed a higher incidence of reaction after 48 hours and declining incidence after 72 hours. Nickel Sulfate 5% exhibited a more severe reaction than other allergens. The frequency of combination between the allergens was especially high for Cobalt Chloride 1%, which occurred together with almost all allergens. Conclusion: We can observe a specific trend of contact dermatitis in our study population. There are differences in the results when comparing the female and male population. Furthermore, we studied that there is a difference in the reaction after 48 hours and 72 hours in our study population. There is a difference in the severity of reaction for each allergen. Many combinations are observed between the different allergens. Ciljevi: Cilj ovog rada je evaluirati epidemiološke i kliničke značajke kontaktnog dermatitisa. Korišteni su podaci iz kliničke prakse Klinike za kožne i spolne bolesti Kliničkog bolničkog centra u Splitu, od 2013 do srpnja 2019. Iznimno je važno skupljati i analizirati rezultate patch testova u određenom vremenskom intervalu kako bi se mogli pratiti epidemiološki trendovi. Ako se određeni trend ili epidemiološki čimbenik uoči tijekom analize, u tom slučaju važno je potražiti moguće uzroke. Pomoću ovih zaključaka mogla bi se poboljšati prevencija bolesti za dobrobit cjelokupne populacije. Materijali i metode: Studija je bazirana na rezultatima patch testiranja provođenih od 2013. do srpnja 2019. na Odjelu za alergologiju Kliničkog bolničkog centra u Splitu. Uključeno je 3228 bolesnika, od kojih je 2279 bilo ženskog spola, a 949 muškog. U studiji su proučavani rezultati za 23 alergena prisutna na standardnom setu koji se koristi na Klinici za dermatovenerologiju KBC-a Split. Rezultati su opisani kao slaba pozitivna reakcija (+), jaka pozitivna reakcija (++) i vrlo jaka pozitivna reakcija (+++/++++). Također je u obradu podataka uključen vremenski čimbenik te su obrađeni rezultati testiranja nakon 48 sati i 72 sata. Rezultati: Uočena je visoka incidencija kontaktnog dermatitisa povezanog s 1% kobalt kloridom unutar ispitivane populacije. Generalno se uočava veća incidencija reakcija nakon 48 sati, a manja incidencija reakcija nakon 72 sata. Niklov sulfat u koncentraciji od 5% izaziva jače reakcije od ostalih alergena. Uz reakciju na 1% kobalt klorid najčešće su prisutne kombinirane reakcije s gotovo svim ostalim alergenima. Zakljućci: Može se uočiti specifični trend kontaktnog dermatitisa unutar ispitivane populacije. Postoje razlike u rezultatima testa između ženske i muške populacije. Također je uočeno da postoji razlika u reakcijama nakon 48 i 72 sata. Postoji razlika u jačini reakcije kod svakog alergena. Unutar ispitivane populacije uočene su kombinirane reakcije preosjetljivosti na više različitih alergena.

Psorijaza je autoimuna, multigenetska bolest kože, čiji mehanizam nasljeđivanja nije u potpunosti utvrđen. U svijetu se pojavljuje u 1 do 3% populacije, a u Hrvatskoj u 1,6% populacije. Može započeti u djetinjstvu, potaknuta streptokoknim faringitisom ili u odrasloj životnoj dobi. Psorijaza je kronična bolest, karakterizirana ponavljajućim egzacebracijama praćenim periodima remisije, te je emocionalno i fizički iscrpljujuća. Jako veliki broj ljudi u svijetu ima genetski potencijal za nastanak psorijaze, ali se samo uz odgovarajuću kombinaciju vanjskih i unutarnjih čimbenika bolest može klinički ispoljiti. Najčešći okidači su stres, virusne i bakterijske infekcije te neki lijekovi. Razlikujemo četiri osnovna klinička oblika psorijaze: kronična plak psorijaza, kapljičasta psorijaza, pustulozna psorijaza i eritrodermijska psorijaza. Kronična plak psorijaza najčešći je oblik psorijaze. Karakterizira ga pojava oštro-ograničenih, eritematoznih plakova pokrivenih srebrnkastim ljuskama. Predilekcijska mjesta su vlasište, laktovi, koljena i sakralno područje. Najčešći komorbiditet u psorijazi jest psorijatični artritis koji zahvaća 30 – 40% bolesnika, iako točni epidemiološki podaci nisu poznati. Istraživanja imunopatogeneze psorijaze omogućila su razvoj specifičnih i učinkovitih lijekova, poput biološke terapije, koja je znatan napredak u odnosu na standardnu terapiju zbog visoke učinkovitosti i dobre sigurnosti novih lijekova., Psoriasis is an autoimmune, multigenetic skin disease whose inheritance mechanism is not fully established. In the world it appears in around 1 to 3% of the population, and in Croatia the prevalence is 1.6% of the population. It usually starts in childhood when the first episode is triggered by streptococcal pharyngitis. Psoriasis is a lifetime disease characterized by chronic and recurrent exacerbations followed by remission periods. This disease is both physically and emotionally exhausting. Studies have shown that millions of people in the world have the potential to develop psoriasis, but only with the appropriate combination of external and internal factors the disease can be clinically present. The most common disease triggers are stress , infections and various drugs. Four clinical forms of psoriasis are described: chronic plaque psoriasis, eruptive psoriasis, pustular psoriasis and erythrodermic psoriasis with chronic plaque psoriasis being the most common form of psoriasis. It is characterized by the appearance of sharpbound erythematosus plaques covered with silver scales. The predilection sites are: scalp, elbows, knees and sacral area. The most common comorbidity in psoriasis is psoriatic arthritis that affects 30-40% of patients, although accurate epidemiological data are not known. Psoriasis immunopathogenesis studies have allowed the development of the new specific and effective drugs, such as biologic therapy, which is a significant advance in psoriasis treatment due to the high efficacy and good safety profile.

Kutani eritemski lupus (CLE) obuhvaća širok spektar dermatoloških manifestacija, koje mogu ili ne moraju biti povezane s razvojem sistemne bolesti. Točan uzrok bolesti je nepoznat, ali se smatra da je bolest autoimune prirode te da veliku ulogu igraju genetički čimbenici i okolišni faktori. Danas je prihvaćena „Düsseldorfska klasifikacija“ bolesti . Prema njoj se CLE dijeli na akutni (ACLE), subakutni (SCLE), kronični (CCLE) te intermitentni (ICLE) oblik bolesti. Dijagnoza se postavlja na temelju kliničke slike, patohistološke i direktne imunofluorescentne pretrage bioptata kože, laboratorijskih i seroloških nalaza. Histopatološki, za svaki oblik CLE-a se mogu naći specifične promjene, no promjene poput interface dermatitisa i abnormalnih nakupina dermalnog mucina su vidljive u gotovo svim oblicima CLE-a. Liječenje kožnog lupusa sastoji se od edukacije pacijenata o pravilnoj zaštiti od sunca zajedno s odgovarajućom topičkom i sustavnom terapijom., Cutaneous lupus erythematosus (CLE) encompasses a wide range of dermatologic manifestations, which may or may not be associated with the development of systemic disease. The exact cause of the disease is unknown, but it is thought to be an autoimmune disease, while genetic and environmental factors play a major role. Current CLE classification is the "Düsseldorf Classification", according to which CLE is divided into acute (ACLE), subacutE (SCLE), chronic (CCLE), and a newly defined er intermittent (ICLE) subtype. Diagnosis is based on clinical presentation, histopathological findings of skin biopsy, direct immunofluorescence, laboratory and serological findings. Histopathologically, specific changes may be found for each CLE subtype, but alterations such as interface dermatitis and accumulation of dermal mucin are visible in almost all CLE forms. Treatment of cutaneous lupus consists of patient education on proper sun protection along with appropriate topical and systemic therapy

Melanocitni nevusi (madeži) su dobroćudne pigmentirane promjene koje najčešće predstavljaju samo estetsko obilježje, za razliku od malignog melanoma koji je potencijalno smrtonosan. Zbog moguće maligne alteracije, kao i zbog ponekad teškog razlikovanja dobroćudnog nevusa od zloćudnog melanoma, melanocitni nevusi predstavljaju jedno od najvažnijih područja dermatologije odnosno dermatološke onkologije. Postoji više podjela melanocitnih nevusa, a ona osnovna je na prirođene i stečene. Histološki se, temeljem distribucije melanocitnih nakupina u koži, nevusi dijele na junkcijske, složene i dermalne. Prema morfološkim obilježjima vidljivim dermatoskopom, nevusi mogu biti retikularni, globularni, zvjezdasti, bestrukturni (plavi), nevusi uvjetovani lokalizacijom, nevusi posebnih karakteristika i drugih podtipova. Često je prisutno preklapanje karakteristika između različitih skupina nevusa, prvenstveno zbog njihovog mijenjanja tijekom života, pa je jasne granice ponekad teško definirati. Nevusi su pod utjecajem okolišnih (ultraljubičaste zrake), hormonskih i genetskih čimbenika. Neki od njih podliježu promjenama, stoga ih je potrebno redovito pratiti, osobito jer se, prema podatcima različitih istraživanja, nešto više od 25% melanoma razvija iz melanocitnih nevusa. Poznavanje kliničkih i dermatoskopskih obilježja melanocitnih nevusa izuzetno je važno radi adekvatnog praćenja postojećih nevusa s ciljem što ranije dijagnostike melanoma., Melanocytic nevi are benign pigmented proliferations that most often represent only an aesthetic feature, as opposed to malignant melanoma that is potentially fatal. Because of the possibility of malignant transformation, and due to occasionally difficult differentiation between benign nevi and malignant melanoma, melanocytic nevi represent one of the most important areas of dermatology and dermatological oncology. There are several classification schemes of melanocytic nevi, but they can be basically divided into congenital and acquired. Histologically, based on the distribution of melanocytes within the skin layers, nevi are divided into junctional, compound and intradermal. In accordance with the morphological features visible with dermatoscope, nevi can be divided into reticular, globular, starburst, homogenous (blue) nevi, nevi of special sites, nevi with special characteristics, and other subtypes. There is often a certain amount of overlap between different groups of nevi, primarily due to the alterations occuring within melanocytic lesions in course of a lifetime, so that clear boundaries are oftentimes difficult to define. Nevi are influenced by the environmental (exposure to ultraviolet light), hormonal and genetic factors. Nevi need to be monitored regularly, especially since, according to various studies, slightly more than 25% of melanomas develop from melanocytic lesions. Knowledge of the clinical and dermatoscopic features of melanocytic nevi is extremely important for their adequate monitoring with the aim of early diagnosis of melanoma

Danas se psorijaza smatra upalnom multisustavnom bolešću koja uz kožu može zahvatiti i brojne druge organske sustave u obliku razvoja komorbiditetnih pridruženih bolesti poput hipertenzije, dijabetesa, kardiovaskularnih bolesti, upalnih bolesti crijeva i oka te psihosocijalnih komorbiditeta. Bolesnici sa psorijazom imaju dva puta veći rizik za razvoj pretilosti, hipertenzije i kardiovaskularne insuficijencije, te 1, 5 puta veći rizik za razvoj dijabetesa i infarkta miokarda. Bolesnici s teškom psorijazom imaju povećani kardiovaskularni mortalitet zbog razvoja hipertenzije, srčane insuficijencije i koronarne arterijske bolesti. Stoga, sukladno kliničkim smjernicama, dermatolog treba informirati bolesnika o psorijazi i mogućem povišenom riziku za razvoj komorbiditeta, napose metaboličkih bolesti. Pristup bolesniku sa psorijazom mora biti sveobuhvatan i multidisciplinaran te uključivati liječenje psorijatične bolesti uz prevenciju, rano prepoznavanje i odgovarajuće liječenje komorbiditeta