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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

Milica Stepanović, Mirjana Paravina, Goran Janković and Danica Janjić Spasić

Abstract

Keratitis, ichthyosis and deafness (KID) syndrome is a rare congenital ectodermal dysplasia characterized by ichthyosiform hyperkeratosis of the skin, neurosensory hearing loss and vascularizing keratitis. It is inherited as an autosomal dominant trait, now known to be due to mutations in the connexin gene.

This paper presents a case of a 20-year-old male patient with erythrokeratodermia and mild scaling since birth. He presented mild hearing impairment at the age of two and often suffered from eye inflammations. On admission, his clinical picture was typical of KID syndrome with erythrokeratodermia, neurosensory deafness, vascularizing keratitis, alopecia, palmoplantar keratosis, and nail dystrophy. The patient also had a history of recurrent infections, especially bacterial and candidal infections of the skin, auditory canals and eyes. Despite extensive skin, ocular, ear and hair manifestations, his physical and psychomotor growth and development were normal.

Adjuvant balneotherapy in Prolom Spa, along with emollient creams, significantly reduced cutaneous manifestations in our patient.

Open access

Mirjana Paravina, Predrag Cvetanović, Miloš Kostov, Slađana Živković, Ivana Dimovski and Marina Jovanović

Abstract

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.

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, Milanka Ljubenović, Milenko Stanojević, Milica Stepanović and Dragica Marković

Abstract

Sarcoidosis is an acquired idiopathic granulomatous disease, which is characterized by noncaseating epithelioid granulomas in organs and tissues. Most frequently it affects the lungs, liver, lymph nodes, skin, eyes and other organs. The cutaneous lesions appear in 20 - 30% of patients with systemic manifestations, and in 25% of them they appear without systemic manifestations. Based on the histopathological characteristics, cutaneous lesions are divided into specific, characterized by cutaneous granuloma, and non-specific, which are not granulomatous. Moreover, they can be classified as typical and atypical. We are presenting a female patient with unilateral hilar calcification of the lungs, who exhibited plaque skin lesions typical for sarcoidosis, with a specific granulomatous histology and a favorable response to corticosteroid and antimalarial therapy.