Search Results

You are looking at 1 - 10 of 16 items for

  • Author: Mirjana Paravina x
Clear All Modify Search
Open access

Mirjana Paravina

Abstract

Lichen planus is an immune, infl ammatory reaction with characteristic clinical and histological lesions. It is a benign disorder, often chronic or recurrent, characterized by fl at-topped, pink to purple, shiny pruritic polygonal papules on the skin, or milky white reticular papules on the visible mucous membranes. Hypertrophic lichen planus is a chronic form of lichen planus with marked epidermal hyperplasia and intense pruritus. It is characterized by symmetrical hypertrophic plaques, usually located on the pretibial or perimalleolar regions. Lesions are often resistant to treatment.

This paper presents a patient with a giant form of verrucous lichen planus on the lower extremities, with a chronic course and resistance to various forms of therapy (keratolytics, local and intralesional corticosteroids, radiotherapy, systemic antibiotics, cryotherapy). Significant improvement was seen after 8-month treatment with etretinate (initial dose of 75 mg per day, with progressive reduction to 10 mg per day). Etretinate therapy resulted in a significant regression of the disease.

Open access

Mirjana Paravina

Abstract

Cheilitis is an inflammatory condition of the vermilion border of the lips, which is the junction between the skin and the mucosa. Cheilitis may arise as a primary disorder of the vermilion zone; the inflammation may extend from the nearby skin, or less often from the oral mucosa. Primary cheilitis lesions are either superficial or deep. Deep types include cheilitis glandularis (inflammatory changes and lip gland swelling), and granulomatous cheilitis (chronic swelling of the lip due to granulomatous inflammation mostly of unknown origin). Cheilitis glandularis is a rare condition that mostly affects the lower lip and it is characterized by nodular enlargement, reduced mobility and lip erosion. Based on clinical presentation, cheilitis glandularis may be classified into three subtypes: simplex (described as Puente and Acevedo), superficial suppurative (described by Baelz-Unna), and the most severe type - deep suppurative, also known as cheilitis glandularis apostematosa (Volkmann’s cheilitis) characterized by deep-seated inflammation forming abscesses and fistulous tracts. This is a case report of a female patient with a deep suppurative type of cheilitis affecting both lips. Treatment with systemic antibiotics (using antibiogram tests), corticosteroids and topical therapy resulted in significant improvement.

Open access

Mirjana Paravina and Dragana Ljubisavljević

Abstract

Malignant acanthosis nigricans is a rare obligate paraneoplastic dermatosis which accounts for 20% of all acanthosis nigricans cases. The clinical features of the disease are the same as in the benign forms: symmetrical, hyperpigmented, velvety papillomatous lesions mostly involving the axillae, neck, groins, periumbilical cubital and popliteal areas, mammary areolae and less often mucous membranes. However, unlike other forms, it is characterized by sudden onset and rapid spread, commonly (80%) after the age of 40, which may be a marker of malignancy and a key to early diagnosis, indicating the need for a detailed examination. It is a disorder that has no gender differences. Most cases are detected at the moment of cancer diagnosis (61.3%), in fewer cases (about 20%) prior to cancer diagnosis, and in 21% at a later stage of malignant disease. Acanthosis nigricans is usually associated with one of the three or all three forms of paraneoplastic lesions: florid cutaneous papillomatosis, acanthosis palmaris (tripe palms, pachydermatoglyphia) involving the palms and soles, as well as multiple seborrheic keratosis (sign of Leser-Trélat).

We report on a female patient with clinically established three paraneoplastic syndromes: malignant acanthosis nigricans, florid cutaneous papillomatosis, and acanthosis palmaris, which appeared before the diagnosis of advanced gastric adenocarcinoma, leading to fatal outcome.

Open access

Mirjana Paravina, Milenko Stanojević, Mirjana Veličković, Stanoje Petrović and Mirjana Milosavljević

Abstract

A classical triad of extrathyroidal manifestations of Graves’ disease known as EMO syndrome (exophthalmos, pretibial myxedema and osteoarthropathy) is a rare condition. This paper presents a 39-year old male patient who underwent chemo- and radiation therapy of the supradiaphragmatic area due to Hodgkin’s disease at the age of 35 and 36 leading to remission. Two years later, the patient developed general symptoms of Graves’ disease and ophthalmopathy, with high thyroid stimulating hormone levels. Four months later, the patient presented with pretibial myxedema. Thirteen months after the onset of the disease, higher levels of thyroxine and decreased levels of thyroid stimulating hormone were registered. The diagnosis of EMO syndrome was confirmed by radiologic and histopathological analyses. Thiamazole and intralesional corticosteroid therapy were administered, resulting in euthyreosis and decrease of pretibial myxedema. The question is whether the autoimmune thyroid disease was triggered by the previous disease, or by chemo- and radiation therapy..

Open access

Milica Stepanović, Mirjana Paravina and Danica Janjić Spasić

Abstract

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.

Open access

Mirjana Paravina, Milanka Ljubenović, Ivana Binić, Mirjana Milosavljević, Milenko Stanojević and Ljiljana Nikolić

Abstract

Pityriasis rubra pilaris (PRP) is an idiopathic inflammatory hyperproliferative chronic dermatosis characterized by: perifollicular coalescing papules with central keratotic acuminate plugs gradually submerged in sheets of erythema; perifollicular erythema with islands of unaffected skin; palmoplantar keratoderma; diffuse desquamation which typically spreads from the head down to the feet. The cause of the condition is unknown, but possible etiological factors include: vitamin A deficiency, trauma, infections, autoimmune mechanisms, and malignancies. Taking into account different age of onset, clinical course, morphology and prognosis, there are six different types of the disease: two in adults (classical and atypical); three in children (classical, circumscribed and atypical); one in individuals infected with human immunodeficiency virus.

This paper presents two male patients with clinical symptoms of classical PRP, 53 and 69 years of age at the onset of the disease, with rapid generalized involvement, typical erythematous perifollicular papules, islands of unaffected skin, palmoplantar hyperkeratosis with a waxy appearance and nail changes. The diagnosis was based on clinical findings and histopathologic analysis. Apart from topical therapy with emollients, corticosteroids and keratolytics, they received systemic retinoids and corticosteroids, which resulted in improvement of skin lesions.

It is extremely important to consider the possible triggering factors, establish the diagnosis as soon as possible and begin proper treatment.

Open access

Danijela Popović, Mirjana Paravina, Dragan Jovanović, Vesna Karanikolić and Dragana Ljubisavljević

Abstract

Lichen myxedematosus, also known as papular mucinosis, is a primary diffuse cutaneous mucinosis. It is a rare cutaneous myxedematous condition characterized by formation of numerous lichenoid papules. Scleromyxedema, also known as Arndt–Gottron syndrome, is a rare, confluent, papular and sclerotic variant of lichen myxedematosus, characterized by diffuse thickening of the skin underlying the papules. The condition is associated with systemic, even lethal manifestations, fibroblast proliferation and accumulation of acid mucopolysaccharides of the hyaluronic acid. Serum IgG class paraproteinemia is always present and it can be detected in all patients if appropriate or even repeat testing is used.

Herein, we present a 67-year-old patient with a 2-year history of skin problems. He had no health problems other than hypertension and diabetes, wich were both diagnosed 15 years before. On examination, the patient exhibited sclerodermoid lesions with diffuse pseudo-sclerodermatous thickening of the exposed skin, microstomia and sclerodactyly-like changes; on the face, there were numerous solid, shiny 2 - 4 mm in diameter skin-coloured lichenoid papules, scattered across the forehead, glabellar area, nasolabial folds, perioral region, ear lobes and the neck. Histopathological examination revealed: highly distinctive collagenosis and fibrosis in the middle dermis, increased fibroblasts; collagen bundles with irregular arrangement and fragmentation; alcian blue-positive deposits with appearance consistent with acid mucins. Serum protein electrophoresis detected IgG lambda paraproteinemia. The patient was treated with systematic corticosteroids during 9 months with subsequent introduction of methotrexate and showed satisfactory results.

The etiology of scleromyxedema remains unknown, since the purified IgG paraprotein itself has no direct effects on fibroblast proliferation. In scleromyxedema, numerous therapeutic modalities are proposed, unfortunatelly with limited effects.

In colclusion, we report a case of an adult male with lichenoid papules; after a two-year progression, they evolved into scleromyxedema and exhibited well response to conventional therapy.

Open access

Mirjana Paravina, Ivana Binić, Danijela Popović and Dragana Ljubisavljević

Abstract

Yellow nail syndrome is a rare disease of unknown etiology. It is clinically characterized by a triad of yellow nails, lymphedema at one or more sites, and chronic respiratory disease (bronchitis, bronchiectasis and rhinosinusitis). All nails may be affected, but some may be spared. The nail plates are yellowish green, thickened, occasionally with transverse ridging and onycholysis, with increased longitudinal and transversal over-curvature, with partial or complete separation of the nail plate from the nail bed, without lunula and cuticle and slow nail growth rate. The lymphedema is usually peripheral, affecting the lower limbs, or in the form of pleural effusion.

This is a case report of a 47-year-old female patient who presented with nail changes at the age of 40; two years later the patient developed lymphedema of the lower limbs, and a year later a chronic respiratory disease. The affected nails were yellow to yellow-gray, with thickened nail plates separated from the nail bed, ingrown in the perionychium, without lunula. At the same time, additional examinations revealed the following associated conditions: edema of talocrural joints in both legs, chronic obstructive bronchitis, bronchial asthma, chronic rhinitis with bilateral nasal polyposis, labile arterial hypertension. Apart from the management of chronic respiratory disease, oral vitamin E capsules (200 mg 3 times a day) and topical vitamin E solution were administered over 15 months. The nails began to grow, and the newly grown nails were of normal pigmentation.

In conclusion, we present a case of an adult female patient with yellow nail syndrome, and a recognized association of peripheral edema and chronic pulmonary disease. The patient had a typical clinical picture, all the nails were affected, but showed a favorable response to systemic and topical vitamin E therapy.

Open access

Mirjana Paravina, Milenko Stanojević, Dragan Jovanović and Dragana Ljubisavljević

Abstract

Pachydermodactyly is a rare, benign form of digital fibromatosis, characterized by asymptomatic and progressive, periarticular and usually symmetrical soft tissue finger swelling, specifically on the lateral aspects of the proximal interphalangeal joints mainly of the second, third, and fourth fingers; it mostly affects young adolescents and is probably due to repeated mechanical injury of the skin (such as repeated clasping or rubbing of crossed fingers), sometimes as a result of obsessive-compulsive disorder, which must be distinguished from obsessive “chewing pads”. This paper presents a male patient aged 19, who presented with first symptoms at the age of 12, and was diagnosed with periarticular hypertrophy: localized soft tissue thickening around the proximal interphalangeal joints of all fingers except the thumbs; slight hypertrophy of the skin; absence of subjective complaints; normal joint function. Dermatological status on admission revealed: symmetrical soft tissue swelling of all fingers of both hands except the thumbs at the level of the proximal interphalangeal joints; normal appearance of the distal parts of all fingers; thickening at the level of the proximal interphalangeal joints, bilateral, almost symmetrical hypertrophy (ulnar and radial) of phalanges of the affected fingers except both index fingers, affecting only the ulnar side. The skin lesions were pain-free on palpation, with homogeneous texture and elastic consistency, freely movable over underlying structures. The affected joints showed no functional deficit. The test results, sonography, radiography and histopathology confirmed our clinical diagnosis-pachydermodactyly. The review of the currently available literature, published between 1973 and 2014, including 99 papers and 160 patients, provided important insight into the characteristics and variations of the disease.

Open access

Mirjana Paravina, Milenko Stanojević, Ljiljana Spalević, Dragana Ljubisavljević, Zorana Zlatanović and Danijela Popović

Abstract

Systemic scleroderma (SSc) is a multisystem disease with microvascular abnormalities, autoimmune disorders, excessive collagen production and deposition, and fibrosis of the skin and internal organs. According to the simplest, though incomplete classification, there are two forms of SSc: diffuse and limited (formerly acrosclerosis). CREST syndrome is a subtype of limited SSc, characterized by: calcinosis, Raynaud’s phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia. We present a patient with all the features of the CREST syndrome, which appeared at the age of 43 and lasted for 23 years. The patient presented with a gradual development of symptoms during the first ten years, from Raynaud’s phenomenon, skin sclerosis, calcinosis, telangiectasia, and esophageal dysmotility. The diagnosis was based on clinical findings and relevant diagnostic procedures. The article presents a literature review on the epidemiology, etiology, pathophysiology, clinical manifestations, various attempts at classification, diagnostic criteria, and therapeutic modalities.

When classifying systemic scleroderma into two main types — diffuse and limited, with CREST syndrome as a variant of the latter, it should be pointed out that both types represent clinical forms of systemic sclerosis, share similar visceral involvement, laboratory abnormalities and course which is variable, as was the case in our patient.