Genital warts are one of the most common sexually transmitted infections caused by the human papilloma virus. Persons with genital warts may be infected by several types of human papilloma viruses: various types may have antagonistic or synergistic interactions, causing regression or recurrence of the existing lesions. No specific antiviral therapy is currently available. The treatment includes removal of symptomatic lesions on the skin and mucous surfaces. Apart from classical surgical procedures, local destruction of lesions is performed using various chemical and physical agents, whereas systemic therapy includes administration of agents promoting the immune system. The efficacy of treatment is not identical in all cases, and relapses are still inevitable. Combination therapy is often an alternative to monotherapy, while vaccine has an important role in prevention of genital warts.
Urethritis is a clinical syndrome which is characterized by mucopurulent or purulent urethral discharge with or without dysuria, due to an increased number of polymorphonuclear leukocytes in the anterior urethra. Antimicrobial therapy and preventive measures are essential in the management of bacterial urethritis. However, these drugs may cause antimicrobial resistance, resulting in unsuccessful treatment and complications of urethritis. Resistance of Neisseria gonorrhoeae to antibiotics is well known for decades, and in recent years there are more cases of resistance of Chlamydia trachomatis and Mycoplasma genitalium to different antibiotics. There is a danger that in the future certain strains of N. gonorrhoeae will be resistant to all available antimicrobial agents, unless new antibiotics to which resistance will not develop rapidly or an effective vaccine are developed.
Radiation dermatitis is one of the commonest side effects of ionizing radiation which is applied in radiotherapy of carcinoma of all localizations, most frequently of tumors of breast, head and neck region, lungs and soft tissue sarcomas. It usually occurs as a complication of breast radiotherapy and thus it is more often recorded in female patients on the skin in the region of breast subjected to radiation. Clinical manifestations of radiation dermatitis can be divided into four phases: acute phase (erythema, dry desquamation, moist desquamation, ulceration and necrosis with resulting re-epithelialization, residual post-inflammatory hyperpigmentation, reduction and suppression of sebaceous and sweat glands and epilation); subacute phase (hyperpigmentation and hypopigmentation, telangiectasia, skin atrophy, even ulceration); chronic phase (skin atrophy, dermal fibrosis and permanent skin epilation) and late phase (increased risk of skin cancer). In order to prevent radiation dermatitis, skin care products should be applied throughout radiotherapy that will decrease the frequency of skin reactions or block them and thus improve life quality. Although the therapy includes not only topical corticosteroids but numerous other products with active ingredients such as aloe vera, calendula, hyaluronic acid, sucralfat, sorbolene, mineral and olive oil, honey, vitamin C, zinc, antimicrobials and silver, common therapeutic consensus has not been reached on their application in radiation dermatitis. Therefore, the treatment should be conducted according to the basic guidelines but tailor-made for each individual patient.
Acne keloidalis nuchae (AKN) / folliculitis keloidalis nuchae (FKN) is a chronic inflammatory condition which involves hair follicles localized predominantly in occipital scalp and posterior neck area leading to hypertrophic scarring alopecia. We present a 59-year-old factory worker, Caucasian male with a whitish alopecic oval plaque about 10 cm in diameter in the occipital region. The peripheral part of plaque was mildly inflammated, with groups of tufted terminal hairs, while the central part showed cicatricial alopecia and discrete non-adherent dry scales. Skin changes firstly occurred 6 years earlier, as itchy papules and pustules that sometimes healed with scarring. The applied relevant diagnostic and therapeutical measures are discussed in this report.
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.
Serological tests represent a valuable tool for the diagnosis and monitoring the syphilis treatment. Non-treponemal antibodies are nonspecific to detect the infection, but antibody titers are used to monitor the effects of syphilis treatment. A definitive diagnosis of syphilis is made using treponemal tests, because they detect specific antibodies to the treponemal strains or treponemal fragments, which cause syphilis. These tests may remain reactive for years, sometimes for life, regardless of the therapy outcome. Even after successful treatment, approximately 85% of patients remain positive for treponemal antibodies for the rest of their lives. However, treponemal tests cannot differentiate past infections from a current infection. Therefore, we use a combination of specific and non-specific tests, the two most frequently used diagnostic algorithms. The traditional algorithm begins with a non-treponemal assay, and if it is positive, the treponemal test is done. A positive treponemal test indicates syphilis. The reverse serology algorithm detects early, primary, and treated syphilis that may be missed with traditional screening. However, non-treponemal test is necessary to detect patients with active syphilis.
Introduction: Chronic venous insufficiency (CVI) is a very common chronic disease, yet often overlooked by healthcare providers. Education of physicians may have a positive impact on better recognition and treatment of patients with CVI. Material and Methods: During the one year period (2011), we conducted a series of specialized courses on CVI for physicians in the South Bačka region. Before and after each course, the attendants were asked to complete entry and exit tests. During two three-year periods, before and after the education courses (2008 - 2010, and 2012 - 2014), data on hospital morbidity and number of patients with CVI, examined by physicians in general practice and in dermatological outpatient facilities in South Bačka region, Province of Vojvodina, were gathered and analyzed. Results: In the period 2008 - 2010, a total of 1.128 patients were hospitalized due to CVI with an average length of stay of 6.42 days. In the period 2012 - 2014, 1.296 patients were hospitalized and the average length of stay was 3.76 days. The number of hospitalizations increased in second period by 14.89%, and the average length of stay decreased by 41.43%. In the period 2008 - 2010, the total number of patients with CVI in the general practice was 13.624 and in the second period 14.931 patients. The number of examinations increased by 9.59%. In the period 2008 - 2010, there were 1.094 patients with CVI in dermatological outpatient facilities, and 1.165 patients in the second period,. A slight increase of 6.09% was noticed. After analyzing the entry and exit test results, on average, there were 7.35 correct answers in the entry test, and 8.89 correct answers in the exit test. An increase in knowledge by 20.95% was established. Conclusion: Education of physicians in primary and secondary health care facilities may have a positive impact on early diagnosis and better treatment of patients with CVI.
Inherited epidermolysis bullosa (IEB) is a genodermatosis transmitted in either autosomal dominant or autosomal recessive manner. The disease is characterized by the development of blisters, erosions, scars, nail dystrophy and scalp abnormalities. Our case report has included four members of one family in three generations with manifested disease. Our 25-year-old female patient presented with a few eroded, crusted, nummular lesions localized on the dorsal plate of interphalangeal joints of fingers, elbow and knee skin, while anonychia was found on her digits. Our youngest patient (her 3.5-year-old son) presented with the lesions in the form of blisters filled with serous fluid, erosions, recent scars and atrophy. Some atrophic scars on the elbow and knee skin were found in our patient′s younger brother, aged 16. The 46-year-old mother of our female patient had nail dystrophy on her hands accompanied by the toenails absence. Pediatric geneticist created the pedigree chart which showed autosomal dominant inheritance pattern with complete expressivity and penetrance. Further diagnostics was not done because the family was not interested.
Indolent systemic mastocytosis is a benign form of systemic mastocytosis characterized by an abnormal proliferation of mast cells either in the bone marrow or in numerous tissues. Case Report: A 27-year-old female patient was admitted to our department due to urticaria which started a month ago. Before the skin changes appeared, our patient suffered from a toothache, so she took various painkillers (nimesulide, ibuprofen, acetylsalicylic acid, paracetamol). During skin examination, individual hyperpigmented macules on the trunk and lower limbs were observed as incidental findings. The patient reported having them for the last two years. Darier's sign was positive. Following the examination, she was admitted due to suspected urticaria pigmentosa. Laboratory Findings: erythrocyte sedimentation rate: 9 mm/h; complete blood count, urine, blood glucose, total and direct bilirubin, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, urea, creatinine, and uric acid were within normal ranges. Electrolytes: sodium, potassium, chlorine clearance, total calcium and calcium ionized, osteocalcin, and crosslaps were within normal ranges as well. Fibrinogen: 5.57 g/l; 5-Hydroxyindoleacetic acid: 49.8 umol/dU (10.4 - 31.2). Bone densitometry, chest x-ray and upper abdomen ultrasound findings were normal. The suspected clinical diagnosis of urticaria pigmentosa was confirmed by skin biopsy. Histopathological examination of the bone marrow showed moderately increased cellularity (60 - 70%). All three types of blood cells were slightly multiplied. Focal infiltrations were found in the perivascular area, consisting of elongated, oval cells with abundant eosinophilic granular cytoplasm. The nuclei were regular, oval shaped with finely granular chromatin and inconspicuous nucleoli. No nuclear atypia was found. These cells are highly CD117-positive. This finding strongly indicated bone marrow infiltration in systemic mastocytosis. The diagnosis was based on ‘major’ and ‘minor’ diagnostic criteria. The recommended therapy included H1 and H2 antagonists and topical corticosteroids. Conclusion: Regular follow-up was recommended in order to prevent complications and malignant alterations.
Currently, most authors believe that disseminated superficial actinic porokeratosis (DSAP) is an inherited or acquired dermatologic disorder of keratinization that occurs in genetically predisposed individuals after adequate exposure to ultraviolet (UV) rays, or immunosuppression. Lesions in DSAP start in sun-exposed areas most commonly in the third or fourth decade of life. The lesions are pink to brownish papules and plaques with a raised scaling ridge, histologically seen as a column of parakeratotic keratinocytes, the cornoid lamella. DSAP is not only the most common, but also the most often overlooked form of porokeratosis (P). Here we present a 77-year-old male with DSAP, who sporadically developed initial skin lesions at the age of 67, at the time when his personal and medical history were significantly long for chronic intensive sun exposure and type 1 insulin dependent diabetes mellitus. We established the diagnosis of DSAP based on personal and medical history, clinical presentation, auxiliary methods such as dermoscopy, and confirmed with pathohistological findings. We advised the patient to avoid sun exposure and to apply photo-protective sunscreens, emollients and keratolytics. After five years of monitoring his changes, we continue to control his lesions for any possible alteration. Although mutations in several genes and data on sun exposure may be responsible for the onset of the disease, most cases of DSPA occur sporadically and without involving the facial skin, as in our case. Lesions usually begin in the third or fourth decade of life. In the elderly, an additional trigger may be present, such as e.g. age-related decreased immune competence. Diabetes mellitus may also be associated with immunodeficiency in the elderly. Recently, DSPA has been a special subtype of DSPA in the elderly. Malignant alteration can occur in DSPA, most commonly in lesions that are long lasting, large, in the elderly, or in lesions in immunocompromised individuals. In conclusion, this is the case of a 77-year-old male person, who sporadically developed the so-called subtype DSPA in the elderly. In addition to UV radiation, the relevant suggestive trigger factors were the immunosuppressive effects of diabetes mellitus and chronological aging.