Acta dermatovenerologica Croatica : ADC最新文献

A 38-year-old Hispanic man without comorbidities presented to our dermatology clinic for the evaluation of an asymptomatic dark macule on his left hand, which had gradually grown since he was a child. The hyperpigmentation involved the dorsum and palm (Figure 1). The patient was right-handed and denied previous trauma, inflammation, occupational exposure to chemicals, or using any medications. During physical examination, no other similar pigmentation was found on the rest of his body. An incisional biopsy of the left palm was performed (Figure 2). The histopathology revealed the presence of spindle-shaped cells with melanin granules in the superficial and middle dermis, surrounding the blood vessels, and between collagen bundles, which are findings compatible with acquired dermal melanocytosis (1,2). On dermoscopy, we found a pattern of regular pigment with a gray-brown tone and whitish spots within. We discussed the benignity of this rare entity with the patient, and he decided not to pursue treatment. Acquired dermal melanocytosis (ADM) is a rare condition, with isolated presentation on the hand and with less than 10 cases reported (1). Dermal melanocytosis includes several benign pigmented lesions histologically characterized by the presence of melanocytes in the dermis, which are spindle-shaped dendritic cells containing brown melanin pigment. Melanocytes can also be identified with immunoperoxidase staining for S100 and Fontana-Masson melanin stain (2). The physiopathology of ADM remains unclear, but it has been proposed that it involves reactivation of latent dermal melanocytes due to external factors such as trauma, inflammation, chemical exposure, sunlight, drugs, and hormonal treatment with estrogen and/or progesterone (3). ADM with hand involvement usually appears in the Asian population without sex predilection. The lesions develop in adolescence or young adulthood and tend to affect both hands and other body areas such as the face or the legs; there have also been two reported cases in the Hispanic population (both by Fitzpatrick III) (3,4). ADM must be differentiated from ectopic Mongolian spots, plaque-type blue nevi, tinea nigra, or other pigmented neoplasms. A biopsy is mandatory to establish a proper diagnosis. Ectopic Mongolian spots and plaque-type blue nevi are both congenital dermal melanocytoses that may present as bluish macules on the hand. However, these lesions show deep and more widely scattered distribution of melanocytes (1). There have also been some reports of malignant melanoma and acquired dermal melanocytosis that appeared on congenital nevus spilus (5). ADM is a benign condition, and reassurance should be offered to these patients.

Dear Editor, Ticks carry many diseases, bacteria, and viruses and represent a very important healthcare issue both in Croatia and globally. Although most ticks are not infected with pathogens dangerous to humans, some ticks can transmit infectious diseases with significant morbidity and mortality. This is caused by the increasing incidence of many tick-borne diseases over a growing geographical area. Many factors influence which species of ticks are present in a given geographical area, as well as the density of their population and the risk of human exposure to infected ticks. The average morbidity from Lyme borreliosis in the Republic of Croatia is 6.51 infected per 100,000 inhabitants. There can be no Lyme borreliosis without ticks infected by Borrelia burgdorferi (1,2). In Europe, Lyme borreliosis (LB) is caused by the Borrelia burgdorferi sensu lato complex genotype. There are three skin manifestations of LB: erythema migrans (EM), borrelial lymphocytoma (BL), and acrodermatitis chronica atrophicans (ACA) (3,4). Herein we describe a female patient with a diagnosis of Lyme disease based on the non-specific clinical picture and laboratory diagnostics, in whom successful treatment led to complete regression of all skin manifestations. The patient was a 58-year-old woman with no previous history of severe illness. Notably, the patient history showed that, eight months prior to presenting for the dermatological exam, the patient had observed the appearance of edema and demarcated macular exanthema around both ankles and subsequently on the dorsum of the right hand, which spread to the left hand and with gradual spread to both lower legs and the lower extremities, with more pronounced changes on the left leg. The initial dermatological examination found pronounced skin changes on both legs, especially the left leg, with erythematous changes in the form of figurate erythema forming confluences up to the size of a smaller palm; the skin of the left leg was partially mottled with normal turgor and elasticity (Figure 1a and Figure 1b). Inguinal lymph nodes were enlarged and painless on palpation. Changes were minimal and discrete on the right leg and were absent on the torso, upper extremities, and skin. Subjectively, there was no itching, burning, or tingling sensation in the affected areas of the skin. The patient subjectively reported feeling well. Family history showed that the patient's father had died from prostate cancer and that the mother had died from melanoma. Laboratory findings were as follows: hematological, biochemical, and immunological parameters were normal. Venous and arterial ultrasound of both legs was normal, with the presence of reactively enlarged left inguinal lymph nodes. Lyme disease was suspected based on the clinical picture, with a differential diagnosis of possible livedo reticularis. A biopsy of the skin changes was also performed, with the results showing that the histological picture in the examined material cou

In 1980, Hanifin and Rajka (1) proposed major and minor diagnostic criteria for atopic dermatitis (AD). Major associations included pruritus, dry skin, and history of atopy. One minor feature included Dennie-Morgan Folds (DMFs), which manifest as secondary creases in the skin underneath the inferior eyelid, usually found in infants (2). In an attempt to refine these criteria, a study evaluating 210 patients with an existing AD diagnosis observed DMF in 84% of AD cases. A pediatric study in Bijapur, India on 174 children under 16 years of age with AD identified DMF to be the most prevalent minor criterion. DMFs were found in 71.8% of the study's population and was followed by palmar hyperlinearity and xerosis in prevalence (2). Although DMF pathophysiology remains unclear, we suggest a theory stemming from nocturnal pruritus (NP). The two leading causes of NP are AD and psoriasis, both of which interfere with the patient's sleep quality. Children with increased NP have greater sleep fragmentation and difficulty waking up in the morning (3). A lack of melatonin rhythmic secretions resulting in circadian misalignment may serve as an intermediary for DMF onset. As more blood perfuses the skin under the eyes, edematous fluid enhances dysregulation of the collagen fibers under the eyelids. NP also manifests as facial touching and rubbing or scratching the eyelids during sleep, which can aggravate tissue surrounding the eye (3). AD affects 15-20% of the pediatric population, whereas food allergies, some life-threatening, are found in up to 30% of children with AD, compared with 0.1-0.6% of children in the general population (2). Identifying DMF in children can facilitate the diagnosis of AD and thus lead to the necessary tests to determine whether conditions associated with AD exist, such as food allergy. DMFs are indicative of an AD diagnosis and can be especially critical for children who have life-threatening food allergies associated with their AD (3). One challenge in using DMF as a marker for AD are its different manifestations across ethnic and racial groups. In a study of 160 children aged 3-11 years in London, England, DMFs were present in 34/69 children classified as "black", regardless of whether the child presented with AD. In children classified as "white", only 11/44 had DMFs regardless of AD diagnosis. When cases of AD were excluded, 25% of the white children and 49% of black children had DMFs (4). In a separate study evaluating the differences in prevalence of AD minor characteristics between African Americans and European Americans, African Americans were more likely to have extensor involvement along with diffuse xerosis, palmar hyperlinearity, and DMFs (5). Furthermore, in individuals with darker skin tones, DMFs may be of greater importance, as other characteristics such as erythema may be harder to recognize (5). Life-threatening food allergies are rare, but represent serious sequelae associated with AD. DMFs can serve as a cr

Mycosis fugnoides (MF) is an indolent cutaneous T-cell lymphoma (CTLC) and is the most common of all cutaneous lymphomas. An increased risk for developing a second primary malignancy in patients with CTCL has been described in several studies, with a range from 1.04 to 2.4 (1-4). Caucasian males are at higher risk for MF development. MF is often diagnosed at ages between 55 and 67 years, and second malignancy usually occurs 5 or 6 years after the diagnosis of MF was established (5). The most common second primary malignancies include non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), lung carcinoma, bladder carcinoma, and melanoma. Even though a higher incidence rate of all NHL was described in patients with MF (15/1000) in comparison with the general population (0.32/1000), there are still only a few cases of B-cell NHL following MF described in the literature (6,7). We describe a rare case of a patient with MF and simultaneous large cell transformation (LCT) and a small B-cell lymphocytic lymphoma/chronic lymphocytic leukemia (B-CLL). In 2017, an 82-year-old man previously treated for MF presented with two fast growing tumorous lesions with ulceration on the right tight (Figure 1). A biopsy was performed, and a diagnosis of MF with LCT was established (Figure 2). During hospitalization, mild leukocytosis (12.2 x109 L-1), lymphocytosis (64%, total count of 7.81 x109 L-1), and anemia were found. Bone marrow biopsy was not performed due to low pain threshold. Bone marrow aspirate showed 70% of atypical lymphocytes and few "smudged" cells. Immunophenotyping by flow cytometry detected 49% monoclonal kappa+ B-cells with phenotypic features typical for B-CLL (CD5+, CD23+, kappa +). Of overall bone marrow cells, the ratio of monoclonal kappa + B-cells with the B-CLL phenotype was 21%. Immunophenotyping of peripheral blood showed up to 50% monoclonal kappa+ B-cells with phenotypic features typical for B-CLL (CD5+, CD23+, kappa +). Of overall peripheral blood cells, the ratio of monoclonal kappa+ B-cells with the B-CLL phenotype was 28%. Multi-sliced computed tomography was within normal ranges. A flow cytometry showed lymphocytes with phenotypic findings for CD20+ B-CLL. A diagnosis of MF with LCT (CD30+) clinical grade IIB (T3, N0, M0) and B-CLL was established. The patient was treated with fractionated superficial irradiation that resulted in applanation and regression of the tumorous lesions. No hematologic treatment was indicated other than regular follow-up. On dermatologic follow up for 2 years, the patient was stable, with no active skin lesions and no progression of MF. The patient was subsequently lost to follow-up. This is a rare case of MF with LCT and B-CLL occurring simultaneously. Large cell transformation in patients with MF can occur in 20-55% of advanced MF, as in our case, and this something physicians must be aware of, so repeated biopsies are advised (8). We also should keep in mind that patients with MF are at higher risk of d

Background: Pemphigus diseases are a subgroup of autoimmune bullous diseases characterized by autoantibodies against desmogleins and occasionally desmocollins. Desmocollin 3 is the main desmocollin isoform that contributes to cell adhesion in the epidermis.

Objective: To evaluate the presence and level of anti-desmocollin 3 antibodies in pemphigus diseases, and to investigate whether their presence is associated with a specific type, presentation, or clinical pattern.

Methods: Forty patients with pemphigus diseases and forty healthy controls were enrolled. Medical history, clinical examination, and pemphigus disease area index (PDAI) scoring were recorded for all patients. Serum samples were collected from both groups for assessment of anti-desmocollin 3 antibody reactivity by ELISA.

Results: The presence of anti-desmocollin 3 antibodies was significant among patients with pemphigus compared with controls (P=0.003). The level of anti-desmocollin 3 antibodies was also significantly higher in patients with pemphigus compared with controls (P=0.01). There was no significant relationship between the presence of anti-desmocollin 3 antibodies and any of the clinical presentations of pemphigus (type, severity, duration, activity, presence of annular pattern, or site of affection - mucosal, cutaneous, on the scalp, palmoplantar, or flexural).

Conclusion: Anti-desmocollin 3 antibodies are upregulated in pemphigus diseases and can contribute to the pathogenesis of pemphigus. No specific clinical type, presentation, or pattern was found to be associated with the presence of anti-desmocollin 3 antibodies.

Introduction: Cutaneous T-cell lymphomas (CTCLs) are rare diseases characterized by infiltration of malignant T-cells into the skin. We evaluated the prevalence, epidemiology, and therapy of CTCLs, focusing on its most well-known subtypes, namely mycosis fungoides (MF) and Sézary syndrome (SS).

Patients and methods: We retrospectively analyzed the medical data of patients with a histologically confirmed diagnosis of CTCL presenting to our outpatient department during a 5-year period from January 2015 to December 2019.

Results: We evaluated the files of 102 patients, of whom 67% were men and 33% women. The overall mean age was 59.1±14.1 (24-86) years. Ninety-two patients (90%) were diagnosed with MF and ten patients (10%) with SS. According to ISCL/EORTC, the majority of patients initially classified as stage IA (34%) and IB (45%). Disease frequency decreased at advanced stages (II: 4%; III: 7%; IV: 10%). Forty-five patients (44.1%) received only skin-directed therapy (SDT). Twenty patients (19.6%) progressed from SDT to systemic therapy (ST). Thirty-seven patients (36.3%) received ST combined with SDT (TS) from the start of treatment. Overall, fifty different therapeutic approaches of TS were initiated due to lack of response to therapy or disease progression.

Conclusion: Management of CTCLs aims to maintain patient quality of life while minimizing side-effects. As CTCLs are usually incurable diseases, the focus of treatment is on symptom control and prevention of disease progression. Due to the large patient group and the long observation period, our study allows for a valid evaluation of the frequency and therapy of MF and SS in a university outpatient clinic in Germany. We favor topical therapies in early stages with more invasive therapies in advanced stages.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by painful inflammatory lesions, predominantly affecting areas of the skin rich in apocrine glands, such as inguinal, axillary, submammary, and anogenital regions, with an estimated global prevalence between 1%-4%. The treatment of HS is challenging with various treatment modalities employed to control the disease. Since the condition is chronic and life-impairing, many patients have looked for ways to complement their conventional treatment procedures with non-medical interventions, among which dietary interventions have been of particular interest. Researchers have looked for ways to connect the gastrointestinal system with the skin through the ˝skin-gut axis concept˝ introducing a strong association between the microbiome of the gastrointestinal system and the skin. In addition, diet stimulation of insulin and IGF-1 (insulin-like growth factor 1) may impact signaling pathways playing a role in HS pathogenesis. Patients have tried various dietary interventions to alleviate their symptoms of inflammation and suppuration. Among the different dietary approaches that have been described are paleo, autoimmune, Mediterranean, and elimination diet regimes. Dietary supplements have become the mainstay of lifestyle factors aimed at improving the clinical signs and symptoms of HS. This review aims to synthesize and present the current findings on diet as a modifiable factor in HS, helping the patients to navigate through the data and helping them make informed choices on their healthy lifestyles.

Platelet-rich plasma (PRP) is used in medicine as a source of autologous growth factors in different indications. At present, PRP is applied increasingly frequently in aesthetic medicine with the aim of skin revitalization. Until now, the mechanisms of PRP effects in healthy human skin treated with aesthetic goals have not been identified in detail. This study aimed to examine PRP effects on the synthesis of procollagen type I in human skin. This study was a prospective, single-center, single-dose, open-label, non-randomized controlled clinical study. The study was conducted on a group of 10 volunteers in whom forearm skin was injected with PRP, while the placebo control group received injections of 0.9% NaCl. Expression of procollagen type I was examined after 21 days using immunohistochemistry. The study demonstrated that skin fragments subjected therapy using PRP demonstrated a significantly higher expression of procollagen than that which was observed in placebo controls. The study demonstrated that PRP stimulated collagen expression in healthy human skin.

Academician Franjo Kogoj graduated medicine in 1920 in Prague, where he then pursued training in dermatovenerology. During later years, he also visited other dermatology clinics in Europe, where he collaborated with renowned dermatologists of the time, such as in Breslau (present day Wroclaw in Poland) with Josef Jadassohn and in Strasbourg with Lucien-Marie Pautrier. He was also active in the famous Saint-Louis hospital in Paris. Academician Kogoj's scientific interests were especially focused on allergies, exanthemas, skin tuberculosis, and keratodermas. Kogoj was very active in defining a precise and useful terminology for various dermatological conditions, where the terminology was in many ways confusing and often overlapping, such as in cases of eczema and dermatitis. Kogoj performed experimental studies of allergic reactions in eczema and atopic dermatitis and introduced the term pruridermatitis (Pruridermatitis allergica chronica) into dermatological terminology instead of the name neurodermitis and other synonyms essentially describing atopic dermatitis (endogenous eczema, prurigo-asthma, prurigo Besnier). Academician Kogoj managed to define Mal de Meleda as a separate form of hereditary keratoderma and was engaged in the clinical symptomatology, serology, and therapy of syphilis, whereby he emphasized the so-called "critical moment" in the treatment of syphilis. Academician Kogoj's most famous scientific achievement was his histological definition of the spongiform pustule in the pathomorphology of psoriasis, which became a groundbreaking histological novelty in the classification of psoriasis, thus bearing Kogoj's name in the medical literature to this date. Academician Kogoj published many scientific and professional articles, books, monographs and contributions to manuals and textbooks. He was honored nationally as well as internationally as a leading expert in the field of medicine and dermatology, receiving many eminent awards and recognitions throughout his scientific career.

Vogt-Koyanagi-Harada (VKH) disease is a multisystem disorder characterized by bilateral granulomatous panuveitis resulting in serous retinal detachments, disk edema, and a sunset glow fundus development. Furthermore, it is associated with various extraocular findings, such as tinnitus, hearing loss, vertigo, poliosis, and vitiligo (1). VKH is considered to be an autoimmune disease mediated by T-cells targeting melanocyte antigen tyrosinase peptide (2). Moreover, VKH more often occurs in individuals with a genetic predisposition to the disease, including those of Asian and Hispanic heritage (3). Three disease categories have been recognized, including complete, incomplete, and probable VKH. Each category has different clinical features, varying from neurological and auditory manifestations to ophthalmologic and dermatologic findings (1). Herein, we present a case of chronic complete Vogt-Koyanagi-Harada disease, which started with vitiligo. CASE REPORT A forty-year-old female patient presented to the Department of Ophthalmology with photophobia, dull eye pain, and a gradual decrease in visual acuity over two months. In addition, at clinical examination, vitiligo spots were observed on the patient's hands and the periocular area. The patient's medical history revealed she had vitiligo from a young age. Additionally, she developed generalized epilepsy and headaches in adolescence. The neurologic symptoms had been treated, whereas dermatologic workup and treatment were never performed. It was also found that our patient was of Hispanic heritage, which later helped establish a diagnosis. Ophthalmologic examination revealed eye redness, hypotony, keratic precipitates, anterior chamber cells, and posterior synechiaes. Fundoscopy showed mild vitreous haze, optic disc and macular edema, chorioretinal thickening (also seen on eye ultrasound), and disturbance of retinal pigment epithelium (Figure 1). A standard diagnostic protocol for uveitis was performed. Serology for infectious causes was performed, and IgG for CMV and HSV 1 were positive. Tuberculosis testing was negative. HLA testing showed positive HLA-DR1, HLA B13/18, and HLA DQ-1 antigens. There were no cells in the intraocular fluid, and PCR of the fluid was negative for CMV and HSV 1 and 2. Considering the noninfectious uveitis, a history of neurological and dermatological disorders, and the Hispanic heritage of our patient, the diagnosis of Vogt-Koyanagi-Harada disease was established. Systemic methylprednisone in a 1.5 mg/kg dose was introduced during the first hospitalization. After slow tapering of the corticosteroid therapy, cyclosporine A in a 175 mg/day dose and azathioprine in a 100 mg/day dose were introduced for prolonged therapy. Although signs of eye inflammation were reduced, poor prognostic signs such as hypotony and optic disc edema were persistent. Therefore, the TNF-α inhibitor adalimumab was introduced. After the introduction of adalimumab, the disease was considered stable