<abstract><title style='display:none'>Abstract</title> Visual perception of human skin is determined by the light that reflects off the skin surface to retina and interpretation of these information by visual centers in the brain cortex. Skin has a partly translucent and turbid structure and visual perceptions depend on interactions between the light and structures of the skin surface and below it, through absorption, reflection and scattering. Light absorption by the skin depends on the composition, absorption spectra and amount (volume fraction) of chromophores. Subsurface scattering occurs within the skin layers: Rayleigh scattering (subcellular structures sized up to 1/10 of incident wavelength) and Mie scattering (collagen, melanosomes). Due to fluctuations of the refractive index within tissue components and intense scattering, the spatial distribution of light within the skin is diffuse. Skin images are created by the light that reflects off the skin after being color-modified by absorption and being scattered on the skin surface and internal skin structures.</abstract>

Institute of Child and Youth Health Care of Vojvodina, Novi Sad, Serbia

Clinic of Dermatovenereology Diseases, Clinical Center of Vojvodina, Novi Sad, Serbia

Optical properties of the human skin / Optičke osobine ljudske kože

<abstract><title style='display:none'>Abstract</title>Neurofibromatosis-1 (NF1) is one of the most common hereditary multisystemic disorders. The disease manifests a variety of characteristic features that include: hyperpigmentary abnormalities of the skin (café-au-lait macules, freckles in the axillae, and iris Lisch nodules) and growth of benign peripheral nerve sheath tumors (neurofibromas) in the skin. Associated extracutaneous clinical features include: skeletal abnormalities, neurological, cardiovascular, endocrine and other malformations. NF1 is caused by mutation in the neurofibromatosis-1 gene, which codes for the protein neurofibromin. The inheritance of NF1 follows an autosomal dominant trait, although about 50% of patients present with new („de novo“) mutations, and represent the first member of their family. No difference in the severity of the disease can be found in patients with familial mutations versus those with new mutations. We present a 78-year-old female patient with an extreme cutaneous form of neurofibromatosis who reported no affected family member. Apart from skin problems, she had no major health issues in childhood and adolescence, but in recent decades she had frequent headaches, occasional abdominal pain, and vision and hearing impairment. About 10 to 14 days before admission, she developed a severe cough, shortness of breath, and chest and abdominal pain. On examination, the patient of short stature (hight: 152 cm, weight: 49 kg) presented with thousands of soft nodules dispersed over the whole body, except on extensor sides of thighs and lower legs; the nodules varied in color from skin-colored, livid erythematous, to brown-grey; the nodules on the abdomen were moist, partly bleeding from the base, and accompanied by an unpleasant odor. Her feet were also densely covered by dark purple lumps, with dystrophic changes of the toe nails that were thickened, frayed, and yellowish. The skeletal abnormalities included: short stature, severe osteoporosis and osteosclerosis of the head bone structure; degenerative arthropathc-spondylotic changes of the thoracolumbar spine segment with signs of diffuse skeletal hyperostosis; pronounced degenerative changes of the lumbar spine. CT scans of the head, chest and abdomen showed the following abnormalities: flattening of the paraventricular gyri and reduction of brain parenchyma with hypodensity of the white matter in terms of cortical atrophy; periventricular bilateral small post-ischemic microvascular brain lesions of varying chronicity; in the parenchyma of the upper left lung lobe the apical presence of small areas of pleural effusion with consequent subatelectic region; distended stomach and a small inner wall herniation; hypotrophic right kidney; atherosclerotic lesions of the abdominal aorta; low grade infrarenal kinking of the abdominal aorta. Pathohistological analysis of biopsy specimen taken from the nodule corresponded with cutaneous neurofibroma. Consultative examinations of various specialists pointed to the existence of the following comorbidities: obstructive respiratory syndrome and right lobe pneumonia that were treated by antibiotics, aminophylline and dexamethasone infusions; psycho-organic syndrome without focal neurological deficit; Lisch nodules in each eye, and senile cataract. Considering the age and medical presentation of the patient, no other treatment was considered. In conclusion, this is a sporadic case of cutaneous neurofibromatosis 1 in a 78-year-old female patient who presented with extremely severe cutaneous neurofibromas, making this case at least rather peculiar.</abstract>

Clinic of Skin and Venereal Diseases, University Clinical Centre of the Republic of Srpska, B&H

Department of Pathology, University Clinical Centre of the Republic of Srpska, B&H

Extensive Peculiar Cutaneous Form of Neurofibromatosis Type I as a New Mutation - a Case Report

<abstract><title style='display:none'>Abstract</title><bold>Introduction.</bold> Superficial infantile hemangiomas (IH) are rarely localized in the genital region.<bold>Case Report.</bold> We present 8 infants with IHs in the genital region (3 boys and 5 girls). Our patients had only superficial IHs, their internal organs were not affected and there were no associated anomalies. In the boys, IHs were localized on the scrotum and the foreskin in 2 cases and 1 case, respectively. In the girls, IHs were on the labia majora and near the vaginal introitus. None of the IHs showed any IH-related complications. No therapy for IHs was administered in any of the presented infants, either because IHs were small and non-aggressive, or because their parents rejected the proposed therapy.<bold>Conclusion.</bold> Genital IHs have increased tendency for ulceration, so thorough examination and follow-up are of outmost importance. If therapy is indicated, oral propranolol is the treatment of choice for genital IHs.</abstract>

Superficial Genital Infantile Hemangiomas

<abstract><title style='display:none'>Abstract</title>Keratosis lichenoides chronica represents a distinct entity, a rare disease of unknown etiology and pathogenesis, with clinical manifestations which, although typical, require extensive differential diagnosis. The course of the disease is chronic, progressive, and it is resistant to various treatment options, so despite variations in the clinical picture it is really easier to diagnose than to treat. This is a case report of a male patient in whom the diagnosis of keratosis lichenoides chronica was based on typical clinical picture, repeated biopsies and histopathological findings, course of the disease and poor response to any therapy.</abstract>

Faculty of Medicine, University of Niš, Serbia

Clinic of Dermatovenereology Diseases, Clinical Center of Vojvodina, Faculty of Medicine, University of Novi Sad

Keratosis Lichenoides Chronica – a Case Report and Literature Review

<abstract><title style='display:none'>Abstract</title>Disseminated superficial actinic porokeratosis is the most common form of porokeratosis in adults, which develops in the third or fourth decade of life, but may also occur later or earlier, more frequently in females, particularly in countries with high sun exposure. Lesions are numerous, uniform, superficial with central atrophy, demarcated by a distinct peripheral ridge, and usually found on sun exposed areas or elsewhere. The disease is inherited as an autosomal dominant condition. We present a 57-year-old retired woman. Her initial skin changes, affecting the face, developed in her thirties, and they have not changed their features since. In the following years, changes developed on the extensor surface of her arms and legs, with more prominent erythema, and then also on other parts of the body, including palms and soles, presenting as dark brown pigmented patches. Her mother had similar changes, and her daughter, who lives abroad, also has them. On examination, the patient presented with facial lesions, patches 2-3 mm wide, with peripheral hyperpigmentation and a pale center. There were multiple, 2-3 mm wide, dark brown lesions on the extremities and trunk. The lesions were either flat or with atrophic center with darker filiform corneal rim. Pathohistolgical examination revealed a "cornoid lamella", which is pathognomonic for the diagnosis of porokeratosis. Auxiliary diagnostic methods were also used - dermoscopy and Gentian violet staining. The patient was advised to avoid sun exposure and to apply photoprotective sunscreens. In conclusion, this is a case report of a disseminated superficial actinic porokeratosis that affected three generations of a family. Our patient developed lesions on palms and soles as well. A review of available world literature shows that this is the second case report of disseminated superficial actinic porokeratosis with palmoplantar involvement.</abstract>

Special Hospital for Rehabilitation Prolom Spa, AD Planinka Kuršumlija, Serbia

Prokuplje Primary Health Care Center, Serbia

Progressive Disseminated Superficial Actinic Porokeratosis: a Case Report with a Family History in Three Generations

<abstract><title style='display:none'>Abstract</title> Basal cell carcinoma (BCC) is the most common cancer among Caucasians. It generally occurs on sun-exposed areas of the body, mostly on the head and neck (80%), trunk (15%), rarely on arms and legs. Basal cell carcinoma is a good example of a disease caused by a combination of genetic and environmental factors. Ultraviolet (UV) radiation plays a dual role in the development of BCC: it causes DNA damage and immunosuppression. UVA and UVB rays damage the DNA via various mechanisms. UVB radiation directly damages DNA within skin cells, causing cytosine → thymine mutations at dipyrimidine sites, whereas UVA radiation is 10.000 times less mutagenic, but it is significantly more present in the natural UV radiation. Also, UVA photons have lower energy than UVB photons and do not induce mutations. UV radiation exerts immune suppression by decreasing the antigen presenting cells ability and by producing immunosuppressive cytokines, such as interleukin-10 (IL-10) and tumor necrosis factor alpha (TNF-α). Mediators of UV-induced immunosuppression are DNA and cis-urocanic acid. Several studies showed a significant association between the development of BCC and sun-exposure during childhood and adolescence, and a strong relation with family history of skin cancer. Exposure to ionizing radiation increases the risk of nonmelanoma skin cancers by three times, while the risk is proportional to the radiation dose. Chemical carcinogens, such as arsenic, tar, psoralen, and pesticides, increase risks for nonmelanoma skin cancers, predominantly for squamous cell carcinoma (SCC). Regarding genetic predisposition, there is glutathione S-transferase (GST) as an important part of cellular defense against endogenous and exogenous chemicals. Several polymorphisms in GST family members have been associated with impaired detoxification, thus influencing the risk for some cancers, including nonmelanoma skin cancers. Cytochrome P450 enzymes are involved in detoxification of photosensitizing agents, and thus involved in BCC carcinogenesis. PTCH is a tumor suppressor gene first identified in patients with Gorlin syndrome. Abnormal activation of this gene and its pathways result in various types of tumorigenesis. BCC is associated with homozygous PTCH gene deletion. With regard to acquired genetic mutations, it was found that aggressive BCCs are significantly associated with increased p53 protein expression, probably representing the mutated form, although that assertion could not be established with certainty. Considering the apparently limited contribution of DNA damage and chromosome instability to the expression of BCC phenotype, the relevance of p53 mutations for BCC growth remains to be demonstrated. Data on the role of Bcl-2 gene family in the development of BCC are scarce. It is unclear whether Bcl-2 has a functional role in the development of BCC, or it only indicates the level of gene expression in tumor stem cells. Activation of Ras gene may play an important role during early stages in the development of nonmelanoma skin cancers, and it is often found on UV-exposed skin in BCC, actinic keratosis and SCC. Concerning immunologic factors, studies have shown that tumor necrosis factor-α (TNF-α) is the critical mast cell product involved in ultraviolet-induced immunosuppression: mast cells contain high quantities of TNF-α which is released after activation; the level of TNF-α is increased in the skin exposed to UV radiation disrupting the morphology and function of Langerhans cells, the principal antigen-presenting cells of the skin. An animal study suggests that the degree of susceptibility to ultraviolet-B-induced local immunosuppression depends on TNF-α level within the epidermis after UVB. It has been established that mast cell-derived histamine stimulates prostaglandin E2 (PGE2) production from keratinocytes. PGE2 alters the cytokine balance in favor of the immunosuppressive interleukin-10 (IL-10) against the immunostimulatory IL-12; histamine also increases suppressor T-cell function by binding to the H2 receptors, which in turn release higher levels of immune suppressive cytokines including IL-10 and induce apoptosis of antigen-presenting cells. All this results in a shift of the immune response from T helper 1 (Th1) cytokine profile to T helper 2 (Th2) cytokine profile, inhibiting antigen-presenting cells to induce antitumor activity.</abstract>

Etiology and pathogenesis of basal cell carcinoma

<abstract><title style='display:none'>Abstract</title>Blistering beetle dermatitis is an important dermatological disease of tropical countries. Although the clinical features are classical, little awareness amongst medical practitioners may cause difficulties in the diagnosis of this condition. Further, it may sometimes mimic an unrelated disease which can lead to delay in treatment causing prolonged suffering of the patient. We present a case of blistering beetle dermatitis that was initially misdiagnosed as a case of herpeszoster ophthalmicus. The case is presented to reinforce awareness on this dermatologicaldis-ease and discuss its atypical presentation and its management.</abstract>

Blistering Beetle Dermatitis Mimicking Herpes Zoster Ophthalmicus: a Case Report

<abstract><title style='display:none'>Abstract</title>Necrotizing fasciitis is a soft tissue, life-threatening infection with a fulminant and often fatal course. Early diagnosis is usually delayed as the onset of the disease is often masked in the form of erysipelas or cellulite. The condition is characterized by necrosis of the skin, subcutaneous tissue and underlying fascia. We describe a case of a 42-year-old man with a complaint of erythema, fever and severe pain in his right leg 4 days before hospitalization. The patient was admitted and treated with a diagnosis of erysipelas. A few hours after admission, in connection with a drastic deterioration in the general condition and dermatological status, he was transferred to a purulentseptic ward with a fulminant picture of necrotizing fasciitis. Debridement and fasciotomy were performed successfully and timely. Good prognosis and survival in patients with NF correlate directly with the complex of measures. Appropriate antibiotics and intensive general support avoid massive systemic diffusion. Early and adequate surgical debridement and fasciotomy are associated with improved survival.</abstract>

Necrotizing Fasciitis: a Clinical Case and a Review of the Literature

<abstract><title style='display:none'>Abstract</title><bold>Introduction.</bold> Piloleiomyoma is a rare benign tumor which is caused by erector pili muscle and makes up 5% of all leiomyomas. They can be solitary and multiple. Multiple lesions still pose challenges for clinicians since their treatment option is very limited.<bold>Case report.</bold> We report a case of a 25-year-old male patient who had painful papules and nodules on the neck and chest for three years. Multiple red-brown papules and nodules in the skin of regio mammaria dextra and regio submandibularis on the left were seen on physical examination. Histopathological examination of punch bi-were seen on physical examination. Histopathological examination of punch biopsy sample revealed well-circumscribed nodule composed of spindle cells. The case was reported as cutaneous leiomyoma (piloleiomyoma). The patient was given 5 mg/day amlodipin and kept under control.<bold>Conclusion.</bold> The ideal treatment option for piloleiomyoma is surgical excision, but the problem with that treatment is that the lesions have tendency to recur. Medicamentous therapy plays a limited role; however, calcium-channel blockers and <italic>α</italic>-adrenergic blockers may help in palliating or eliminating associated pain through inhibition of smooth muscle contraction.</abstract>

Piloleiomyoma Presented by Multiple Cutaneous Nodules: a Case Report

<abstract><title style='display:none'>Abstract</title><bold>Introduction.</bold> Nevus sebaceous is a rare congenital hamartoma, composed of epidermis, sebaceous glands, sweat glands and hair follicles. It is possible to develop secondary tumors in the area of nevus sebaceous during the lifetime, most often after puberty. Secondary lesions are most often benign, while malignant lesions may occur but significantly less frequently.<bold>Case report.</bold> We present the case of a 21-year-old patient who came for an examination due to the appearance of a nodule in the area of a yellowish lesion on the head. The yellowish lesion was present since birth, and the nodule appeared about a year before. The dermoscopic examination of the lesion was nonspecific. The final diagnosis of eccrine poroma as a secondary lesion in nevus sebaceous was made by pathohisto-logical analysis.<bold>Conclusion.</bold> Every secondary tumor in nevus sebaceous deserves full attention, with either close follow up, or excision with pathohistological analysis.</abstract>

Secondary Tumor Arising in a Nevus Sebaceous

<abstract><title style='display:none'>Abstract</title><bold>Introduction.</bold> Warts are benign epithelial lesions that involve skin and mucosa. Successful management depends on the patient’s immunity, site and type of wart. In spite of huge therapeutic armory available, no treatment has been found to be effective so far.<bold>Objective.</bold> To evaluate the effectiveness of autoimplantation in the management of multiple warts.<bold>Material and Methods.</bold> This is a hospital based prospective study of forty patients with multiple warts. A prospective, hospital-based study included forty cases of multiple warts for autoimplantation. Resolution of warts within three months was taken as complete clearance; the follow up of any recurrence lasted six months.<bold>Results.</bold> The majority of patients were males (69.7%), belonging to 21–30 years age group (57.6%). Complete resolution was observed in 25 patients, partial response was achieved in 5 patients and there was no response in 3 patients. The majority of patients did not have any complication or recurrence<bold>Conclusion.</bold> Autoimplantation is a simple, daycare, effective procedure. It provides resistance by inducing cell mediated immunity and also prevents recurrence to a great extent.</abstract>

Autoimplantation – An Immunological Treatment For Multiple Warts

<abstract><title style='display:none'>Abstract</title>Hand-foot-mouth Disease (HFMD) is an acute, self-limited, and highly contagious disease caused by a virus and generally affects children under 10 years old. The etiology of this disease is enterovirus 71 or coxsackievirus A16 which usually causes symptomatic infection or mild disease. Immunocompetent adults are rarely affected. However, recently the incidence of HFMD in immunocompetent adults has increased. We report a 41-year-old woman with severe oral lesions and painful papulovesicular eruption on the palms of her hands and feet.</abstract>

Hand, Foot and Mouth Disease in Immunocompetent Adult with Severe Oral Manifestation

<abstract><title style='display:none'>Abstract</title>Application of different kinds of mineral waters and peloids on the skin exerts mechanical, thermal and chemical effects. Significant reduction of inflammation and increased differentiation of keratinocytes may explain why balneotherapy has positive clinical effects in psoriatic patients. In vitro models have shown that thermal water stimulates interleukin-2 production after cell stimulation by staphylococcal enterotoxin B, and reduces interleukin-4 secretion. After balneotherapy, a significant decrease in Psoriasis Area Severity Index (PASI), associated with a significant reduction of interleukin-8, Staphylococcus aureus colonization and enterotoxin N, have been reported in patients with psoriasis. Mineral water was found to have inhibitory in vitro effects on substance P, TNF-α release and antigen-induced cell degranulation. Immunomodulatory effects of water depend on its content. Sulfur waters have beneficial anti-inflammatory, keratolytic, and antipruriginous effects and also possess antibacterial and antifungal properties. The effectiveness of balneotherapy in the treatment of psoriasis has been reported in many studies conducted all over the world. The majority of studies were conducted at the Dead Sea coast. Investigations showed that balneotherapy factors are important therapeutic factors in the treatment of psoriatic patients. The first and only comparable study of this kind in Serbia, was conducted in Prolom Spa with satisfactory therapeutic results.</abstract>

Faculty of Medicine, University of Novi Sad, Serbia

General Hospital Kikinda, Department of Dermatovenereology, Kikinda, Serbia

Balneotherapy of Psoriasis

<abstract><title style='display:none'>Abstract</title> Melasma is a common cosmetic problem and its severity ranges from minor pigmentation during pregnancy that resolves spontaneously, to a chronic, troublesome, disfiguring condition. Today, there are various treatment modalities for melasma, providing a different success rate. The need for an effective treatment for melasma is becoming more and more significant probably due to the current lifestyles with increased UV exposure, broad use of hormones for contraception and hormone replacement therapy, as well as increasing esthetic demands. The mainstay of treatment is regular use of sunscreens along with topical medications suppressing melanogenesis. This review summarizes recent progress in understanding the pathophysiology of melasma and implications for new treatment strategies.</abstract>

New Aspects of Melasma/Novi aspekti melazme

<abstract><title style='display:none'>Abstract</title> Histopathological analysis is not a routine procedure for diagnosing fungal skin infections. In the histopathological specimens, fungi are visible only when using special stain such as periodic acid-Schiff (PAS). However, histopathological analysis may not be performed in small laboratories. Histopathological characteristics of fungal skin infections are not specific. In all skin biopsy cases, obtained without clinical suspicion of fungal infection, the knowledge of certain, most frequent histopathological reaction patterns, as well as specific histopathological indicators (a diagnostic histopathological “clue”), of certain superficial mycoses e.g., dermatophytoses, may raise a suspicion of fungal infection and warrant a fungal-specific staining. A retrospective analysis of all PAS-stained sections was carried out. All PAS-positive biopsy specimens were assessed for clinical features, histopathological patterns of skin reactions, and presence of histopathological indicators. Our results have shown that out of the total of 361 PAS-stained sections, fungal hyphae were identified in 12 (3.3%) specimens. In 5 (1.4%) cases, the diagnosis of fungal infection was suspected on clinical grounds, while in 7 (1.9%) cases detection of fungi was an unexpected finding. The most frequent type of histopathological pattern was spongiotic, and the most frequent histopathological indicator was the presence of neutrophils within the epidermis. Our results confirm that dermatophytoses may present with clinical and histological non-specific findings. PAS staining represents a relatively cheap and simple fungal-specific staining. It has been suggested that it not only confirms that the selected material is actually invaded, but also reduces the number of false-negative direct reports, where fungi are cultured from a microscopically negative specimen. Apart from a small percentage of positive findings, our results justify the need for routine PAS staining of all clinically and histologically non-specific inflammatory skin conditions<italic>.</italic></abstract>

The role of histopathology in the diagnosis of dermatophytoses / Značaj patohistološkog nalaza u dijagnostici dermatofitoza

<abstract><title style='display:none'>Abstract</title> The purpose of this study was to analyze the characteristics of an outbreak of early syphilis registered at the City Institute for Skin and Venereal Diseases in Belgrade, during the period from 2010 to 2012. The study was designed as a case-note review. In a three-year-long period, a total of 86 patients with early syphilis were registered: 33 cases of primary, 31 of secondary and 22 cases of early latent syphilis. Sixty-five (76.5%) of all patients were men who have sex with men, 15 were heterosexual men and 6 were women. The majority of patients were infected in Belgrade, and in 51/86 cases oral sex was the only risk factor. There were 13 HIV-positive patients, all men who have sex with men. Thus, 20% of men who had sex with men in this study were co-infected with HIV. In conclusion, this outbreak of early syphilis in Belgrade, in which more than two thirds of all patients were men who have sex with men, of whom 20% were HIV-infected, shows the need for: 1) enhanced prevention efforts targeting this group more important than ever, with education and condom use for oral sex as an important part of patient counseling; 2) coordinated and expeditious surveillance, partner services, screening among population at-risk, as well as early diagnosis and treatment.</abstract>

City Institute for Skin and Venereal Diseases, Belgrade, Serbia

Institute of Epidemiology, School of Medicine, University of Belgrade, Serbia

An Outbreak of Early Syphilis in Patients Registered at the City Institute for Skin and Venereal Diseases in Belgrade from 2010 to 2012: a Case Series of 86 Patients

<abstract><title style='display:none'>Abstract</title>Localized bullous pemphigoid is a rare variant of bullous pemphigoid, and its exact etiopathogenesis is yet to be elucidated. We present a case of a 74-year-old Caucasian male with a 3-month history of skin lesions that appeared 9 months after he underwent a knee arthroplasty. Dermatological examination showed several pruritic tense bullae on the right knee, localized around the surgical scar, as well as erosions covered with crusts. The diagnosis of localized bullous pemphigoid was confirmed by direct immunofluorescence test (conventional and split-skin). The patient was treated with potent topical steroids, which led to complete resolution of cutaneous lesions.We suppose that the occurrence of localized bullous pemphigoid in our patient may be explained by the concept of “immunocompromised district” in which one disease (surgery) caused an immunological alteration which is a predisposing factor for the development of secondary disease such as localized bullous pemphigoid.</abstract>

Localized Bullous Pemphigoid on the Site of Knee Arthroplasty: A Case Report

Serbian Journal of Dermatology and Venereology

The Journal of Serbian Association of Dermatovenereologists (SAD)

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