Acta Dermatovenerologica Croatica最新文献

The US Food and Drug Administration approved a supplemental application for HPV 9-valent vaccine for 27-45-year-old women and men. The Advisory Committee on Immunization Practices did not recommend catch-up vaccination of adults aged 27-45 years, but recognized that some adults who were not previously vaccinated may be at risk for new HPV infection and might benefit from vaccination in this age range. We decided to compare HPV vaccination knowledge, prevalence, risk factors, and history of HPV detection in cohorts with ages of 18-26 and 27-45 years. Men and women aged 18-45 years were asked to complete an anonymous internet survey about HPV infection and vaccination. Valid answers were received from 524 respondents. HPV vaccination rates were low (from 0.00 to 5.56%). All women aged 27-45 years bought the vaccine at their own cost and were vaccinated after sexual debut. Knowledge on existence of the HPV vaccine was better in women (P<0.01). The overall number of sexual partners was significantly higher in men and in persons aged 27-45 (P<0.05). Women aged 27-45 reported higher prevalence of unprotected vaginal and anal sex, a higher number of sexual partners, and lower HPV-related cancer awareness. Our study showed that better knowledge on HPV vaccination and HPV-related cancer awareness did not lead to higher HPV vaccination rates. A substantial number of individuals aged 27-45 years may benefit from HPV vaccination, and information on HPV vaccination should be actively disseminated by physicians and mass media.

During recent decades, the number of patients diagnosed with cancer has been increasing. Conventional treatments, which comprise chemotherapy, radiotherapy, surgery, and hormonal treatment, represent improvements in effectiveness and safety of administration and continue to be the standard model of treating malignancies. Advances in oncology have enabled the development of newer therapies such as immunotherapy and targeted therapy. However, numerous adverse events continue to emerge, including dermatologic adverse events, which significantly impact the course of treatment, treatment outcomes, and patient quality of life. Alopecia occurs most commonly, along with mucositis, xerosis, pruritus, hyperpigmentation, acral erythema, nail changes, and many others. The early detection, monitoring, and adequate treatment of these adverse events could prevent reduction, interruption, or permanent discontinuation of oncologic therapies. Herein we review various dermatologic adverse events that may occur due to the therapy applied, present their possible treatments, and emphasize the need to evaluate their impact on patient quality of life.

Dear Editor,Mammary Paget's disease (MPD) is an adenocarcinoma localized within the epidermis of the nipple and/or the areola of the breast, and it is as a rule associated with a carcinoma of the underlying lactiferous ducts, where it usually starts. MPD is relatively rare, observed in 0.7-4.3% of all breast cancers (1). We present a patient with MPD and atypical clinical finding as an annular plaque. A 74-year-old Japanese woman with a past medical history of hypothyroidism presented with a 6-month history of an itching plaque on the left areola. The patient had been treated with the application of topical steroids for a duration of approximately 5 months, and showed no clinical improvement. Physical examination showed a pink plaque encircling the nipple on the left areola (Figure 1, a). The right nipple and areola appeared normal (Figure 1, b). No palpable masses were detected within either breast. A 3.5 mm punch biopsy of the skin at the 6 o'clock position of the left areola was performed. Histological examination showed single and small aggregations of atypical cells with large hyperchromatic nuclei and pale-staining, ample cytoplasm throughout the epidermis. There was a lymphocytic infiltration in the dermis (Figure 1, c). Immunohistochemical studies were positive for CK7 and negative for S-100 and HMB45. With the diagnosis of MPD, the patient underwent a partial mastectomy of the left breast center area, consisting of surgical excision of the left nipple, the adjacent surrounding areolar skin, and subcutaneous tissues. Subsequently, radiation therapy for the residual breast was prepared. As has been described in detail by Kanitakis, the skin lesion develops insidiously as a scaly, fissured, or oozing erythema of the nipple and, more rarely, the areola. Advanced lesions present as a well-demarcated, round, ovoid, or polycyclic eczema-like plaque with a pink or red hue. It is occasionally slightly infiltrated and has an erosive, oozing, scaly, or crusted surface. The lesions are almost invariably unilateral, showing centrifugal spread. Retraction or ulceration of the nipple are often noted (1). The present case exhibited a very rare clinical finding of a plaque encircling the nipple, which has not been reported previously. It was initially difficult to establish the diagnosis of MPD, and biopsy was needed to obtain a definitive diagnosis. Differential diagnosis of MPD comprises eczema as atopic dermatitis or contact dermatitis, erosive adenomatosis, and malignant skin condition such as Bowen's disease, superficial basal cell carcinoma, or superficially spreading melanoma. As in the present case, individuals presenting with an annular plaque are often considered to have sebaceous hyperplasia. Sebaceous hyperplasia is a common, benign skin condition involving hypertrophy of the sebaceous glands, common in middle-aged or older adults (2). These lesions can be single or multiple and manifest as yellow, soft, small papules. These papules are

Dowling-Degos disease (DDD) is a benign, rare genodermatosis (reticulate pigmented anomaly) of flexure sites with autosomal dominant inheritance (1,2).The disease is caused by a loss-of-function mutation of keratin 5 (KRT5) present on the chromosome 12q gene (3). It usually affects the younger population, most commonly 20-30 years of age, with some patients being older and with a predominance in the female population (4). The disease is characterized by formation of dark, hyperpigmented macules which are confined to the flexure sites, most commonly over the axillae, groin area, and neck, along with scattered, comedo-like lesions and pitted acneiform scars (3,5).The diagnosis is established based on clinical and histopathological correlation. We report the case of a 39-year-old patient who presented with a dark brown discoloration of the skin in the area of vulva, perineum, and perianal region (Figure 1) with occasional itching sensation that had suddenly appeared a year before presentation at our Department. Additionally, sparce brown macules were found in the left axillary region that had appeared a few months earlier. Histopathology of the skin showed fine and irregular elongation of the interpapillary cones with hyperpigmentation. Based on her clinical presentation and histopathology, the diagnosis of DDD was established. The patient was unsuccessfully treated with adapalene gel and refused the recommended oral retinoid therapy, as well as laser therapy. Dowling-Degos disease can present as an isolated disease or can be linked to other clinical entities. Usually, it presents with flat macules which are 3-5 mm in diameter and can vary in color from light brown to black (6). Furthermore, the disease is almost always asymptomatic, but pruritus has been reported in some cases (6), as observed in our patient. Even though DDD is primary a disease of the flexures, there have been reports of patients that have presented with hyperpigmented macules on the dorsum of the hands and feet (7). The affected areas in our patient were the anogenital region and left axillary region, and even though this combination of areas is rather uncommon, to our knowledge two similar cases have been reported in the literature (6,8). The most notable histopathological findings of DDD are elongation of rete ridges of the epidermis as well as hyperpigmentation, usually found in the lower third of the elongated rete ridges (6); both of those features were present in the skin biopsy specimen of our patient. Both the clinical picture and pathohistological findings are crucial for the diagnosis of DDD, and we can conclude that the findings of our patient were consistent with DDD. There are a number of closely related entities to Dowling-Degos disease: Galli-Galli disease (GGD), reticulate acropigmentation of Kitamura (RAPK), Haber disease, and symmetrical acropigmentation of Dohi. Galli-Galli disease has an almost identical clinical presentation, the only difference between

Perifolliculitis capitis abscedens et suffodiens (PCAS) is a rare, suppurative dermatosis of the scalp, the etiology of which remains unknown. It is characterized by the development of comedones, perifollicular pustules, firm or fluctuant and itchy or painful nodules and abscesses of the scalp, connected by communicating sinuses that may lead to the formation of scarring and irreversible alopecia. Treatment of PCAS is challenging, often leading to unsatisfactory results. We present a case of a 23-year-old Caucasian man with PCAS who was treated successfully with systemic isotretinoin monotherapy and we review the current therapeutic options.

The last two decades have seen a continuing shift from visual and tactile diagnoses in dermatology towards novel, state-of-the-art, and noninvasive instrumental technologies. Against the current tide toward replacing classical physical examinations with sophisticated high-tech ones, the present article will describe an easy-to-use and practical clinical sign to differentiate between metastases of malignant lesions and apparently benign inflamed/infected dermoid cysts. Epidermoid cysts (sometimes erroneously called "sebaceous cysts") are subcutaneous nodules containing keratin and encapsulated by an epidermoid wall. They are mobile nodules, smooth to the touch, variable in size, and most commonly located on the face, neck, and trunk. They may rupture or become infected and inflamed, red, painful, or purulent. Diagnosis is usually clear-cut, and uncomplicated cysts may not require treatment. Patients usually seek advice and request excision for esthetic or medical reasons (inflammation/infection). A 48-year-old otherwise healthy woman presented for a consultation because of a small cyst on her forehead (Figure 1). Two-finger palpation of the cyst revealed that it did not have the gelatinous fluctuant consistency of an ordinary cyst, but rather felt like a packet of granulated sweetener. The histological diagnosis of the cyst was small-to-medium-sized T-cell lymphoma. The diagnostic challenge of this case was to distinguish between metastases and an ordinary innocent-appearing cyst. The impression of a packet containing granular material upon palpitation of a cyst can be the definitive clue to detecting metastases of malignant lesions among what appear to be uncomplicated dermoid cysts. We have seen several such cases of subcutaneous nodules that turned out to be metastases of sarcomas and carcinomas, all of them with the same impression of a packet of granulated material upon palpation. We propose the term "granulated sweetener packet sign" for this diagnostic sign.

Systemic sclerosis (SSc) is a systemic autoimmune disease characterised by generalized microangiopathy and fibrosis of skin and internal organs. The 2013 American College of Rheumatology (ACR) / European League Against Rheumatism (EULAR) criteria have contributed considerably to classifying patients with SSc in earlier stages, but they still lack sensitivity for a very early stage of the disease. Criteria for a very early diagnosis of SSc (VEDOSS) have been proposed by EULAR Scleroderma Trial and Research group (EUSTAR) which include three red flags: Raynaud's phenomenon, puffy fingers and antinuclear antibody positivity, plus SSc specific antibodies positivity and/or abnormal nailfold capillaroscopy. We report a case of a 54-year-old female patient with 6-week history of puffy fingers, Raynaud phenomenon and positive antinuclear antibodies. Further workup revealed early pathologic capillary pattern by nailfold capillaroscopy and positive anticentromere antibodies. Screening for internal organ involvement detected no heart, lung, or upper gastrointestinal tract involvement. The patient was started on pentoxifylline with further follow-up. The aim of the implementation of VEDOSS criteria is to diagnose SSc at the earliest possible stage, so that subclinical internal organ involvement could be detected and appropriate treatment started at a potentially reversible stage.

Recently, the number of patients with acute telogen effluvium (ATE), among other forms of hair loss, has increased in comparison with previous years. The COVID-19 pandemic, taking place during this period, may be the cause of this phenomenon. The exact mechanisms by which this virus causes hair loss are not entirely understood; still, the most likely cause is an excessive release of proinflammatory cytokines during SARS-CoV-2 infection. This process can trigger the development of telogen effluvium (TE) by damaging hair matrix cells. Additionally, the psychosocial condition of patients recovering from COVID-19 will have deteriorated, contributing to hair loss. Based on data collected until now, post-COVID TE is expected to improve without any treatment. Although there is no specific treatment for post-COVID TE, eliminating psychophysical stress, managing systemic complications, and explaining the course of the condition to the patient will potentially improve and speed up the hair recovery process.

Dear Editor, Pityriasis rosea (PR) is a common, self-limited erythematous papulosquamous dermatosis that mainly affects young adults. It is believed to represent a delayed reaction to viral infections and is usually associated with endogenous systemic reactivation of human herpesvirus (HHV) 6 and / or 7 (1). A 46-year-old man presented to our Department with a two-week history of skin rash associated with mild pruritus. He described the appearance of an erythematous centrally scaled lesion at the right part of his abdomen, followed by the spreading of red oval mildly scaling lesions on the trunk, neck, and proximal parts of the upper extremities, which showed in the physical examination (Figure 1, a and b). He was otherwise healthy and taking no medications. Six weeks prior to the appearance of the initial skin lesion, the patient had coronavirus disease 2019 (COVID-19) infection with mild clinical presentation (fever up to 38 °C lasting for four days and mild headache) and with symptoms of post COVID-19 syndrome (excessive tiredness). He denied oropharyngeal lesions. Potassium hydroxide, syphilis, and laboratory tests were within normal limits. Within two weeks of topical betamethasone dipropionate treatment, the lesions disappeared completely. In addition to reactivation of HHV-6 or HHV-7, PR can be triggered by some drugs (like angiotensin-converting enzyme inhibitors alone or in combination with hydrochlorothiazide, sartans plus hydrochlorothiazide, allopurinol, nimesulide, and acetyl salicylic acid (2) and vaccines (such as smallpox, poliomyelitis, influenza, human papillomavirus, diphtheria, tuberculosis, hepatitis B, pneumococcus, and yellow fever vaccines) (3). There is a growing number of published cases that link PR to COVID-19 infection, with PR appearing either in the acute phase of COVID-19 or, as in our patient, in the post COVID-19 period (4-9). Unlike in our patient, oropharyngeal lesions were observed in approximately 16% of patients with typical PR (10). It has been suggested that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces reactivation of other viruses, such as HHV-6, HHV-7, varicella zoster virus, and Epstein-Barr virus (5). PR has also been reported to follow COVID-19 vaccination (11). As our patient did not receive a COVID-19 vaccine, we cannot evaluate the latter based on the present case. We speculate that PR could be a delayed skin manifestation of COVID-19 infection, triggered either by SARS-CoV-2 immediately or indirectly by the reactivation of other viruses such as HHV-6 or HHV-7. However, the etiopathogenetic mechanisms remain largely unknown and further studies are needed in order to clarify the correlation between SARS-CoV-2 and PR.

severe distinctive cutaneous drug reaction, generalized pustular figurate erythema, closely linked with hydroxychloroquine (HCQ), has been documented. It is distinguishable from AGEP by its longer incubation, more varied morphology (initially urticarial and later targetoid, arcuate plaques), recalcitrance to therapy and longer disease course. Aim of the article is to review the recognized entity associated with ingestion of hydroxychloroquine in patients infected with COVID-19. A systematic review using electronic search was performed. Inclusion criteria: n patients with COVID-19 demonstrated by PCR, with typical clinical features of AGEP/GPFE or atypical features associated with typical histopathology. We used the (JBI) Critical Appraisal Checklist for Case Reports for the qualitive assessment. We included 13 publications. Their overall quality was good to moderate. Only 27.3% of the patients had a severe COVID-19 course. The mean lag time between trigger exposure and rash development was 24 days. Only 15.38% of the reported AGEP were clinically typical, while the remaining 69.23 % were suggestive of GPFE. Unfortunately, 2 patients died secondary to massive pulmonary embolism. In COVID-19 infection, we suggest reconsidering treating established COVID-19 empirically with HCQ, as both triggers can augment the subsequent cytokine storm, inducing a severe drug reaction and possibly increasing the risk of thrombo-embolic events.