Dermatovenereology

Basal cell carcinoma is a slow-growing, malignant epidermal tumor predominantly affecting sun exposed areas in Caucasians, accounting for up to 80% of all diagnosed skin cancers, with a rising incidence. Chronic UV radiation, in association with constitutional factors, plays the main role in its etiology. Inappropriate activation of the hedgehog signaling pathway seems to be a key pathogenesis mechanism. Basal cell carcinoma metastases are extremely rare, but it is a locally invasive tumor that can cause significant destruction of the surrounding tissues, with their functional and esthetic impairment. There are four main clinical types of basal cell carcinoma, although clinical classification is of poor prognostic significance. Preselection of suspicious lesions and treatment planning include noninvasive diagnostic techniques: dermoscopy, confocal microscopy and ultrasoud imaging, yet histopathology remains the "gold standard" of basal cell carcinoma diagnosis. In terms of the histological growth pattern, which is essential for the prognosis, basal cell carcinoma may be divided into circumscribed or diffuse types. Surgical excision is considered to be a first line treatment option, but there are numerous less invasive treatment modalities for low-risk basal cell carcinoma. Prevention strategies are focused on behavioral modifications, regular follow up and use of chemopreventive agents in high-risk patients.

Topical photodynamic therapy is a therapeutic modality in development, thus arises grate interest among dermatologists worldwide. It is an effective therapy for actinic keratosis, superficial BCC and Bowenos disease. Treatment efficacy, good cosmetics, low risk of skin cancer, low invasiveness, low rate of adverse events, facility for treating multiple or large lesions, especially in poor healing sites and, for penile, digital and facial involvement, low general toxicity and possibility of repeating the treatments with the same efficiency, enable topical photodynamic therapy to become increasingly practiced treatment modality. Researching aimed topical photodynamic therapy to prove as a treatment modality for clinical use in other dermatoses, is in experimental phase. To answer the question when dermatologist should consider using topical photodynamic therapy treatment modatility, we are present available date.

Solitary and multiple reticulohistiocytomas, often referred to as diffuse cutaneous reticulohistiocytosis, that are generally restricted to skin, must be differentiated from multicentric reticulohistiocytosis. Multicentric reticulohistiocytosis is a rare histiocytic proliferative disease affecting joints, skin and mucous membranes, while arthropathy usually precedes skin and mucosal involvement. Other organs may also be involved, and 20% of patients have an associated internal malignancy. Multicentric reticulohistiocytosis has been reported to be associated with autoimmune diseases and malignancies. We present an 88-year-old man, with a sudden eruption of asymptomatic, firm, skin to brown colored papules and nodules, 6 to 17 mm in diameter, localized on forehead, arms, legs, and buttocks. There were no symptoms of joint or other organ involvement. Clinical and dermoscopic characteristics pointed to reticulohystiocytomas. Multiple excision biopsies of different tumors were performed ...

Introduction Presuming that psoriasis is an autoimmune skin disease, the aim of this study was to establish its association with other autoimmune skin diseases. The material was obtained at the Dermatovenereological Clinic Clinical Center Novi Sad. Material and methods This 10-year retrospective study (1990-1999) included 1743 psoriasis patients. The control group consisted of 7492 nonpsoriatic dermatological patients. Results Association of psoriasis with other dermatological diseases of autoimmune nature has been established in 13 (0.74 %) patients. The most frequent association was with lichen ruber planus in five patients, with alopecia areata and vitiligo in three patients, and in one with bullous pemphigoid and herpetiform dermatitis. Using Fisher's test no significant association was established. Discussion and conclusion According to literature data association of psoriasis with other autoimmune diseases is well known, but rare, which is in accordance with our results. T...

Introduction Utilization of 20 MHz ultrasound probes provided application of ultrasound in dermatology - dermatosonography. As a diagnostic tool, ultrasound was first registered in the early fifties of the past century. Great progress of dermatosonography occurred in the mid-nineties with introduction of the first 20 MHz scanner. Methods of ultrasonography in dermatology Several methods of ultrasonography have been developed: method A, method B, scanning C method and Doppler ultrasound. They were based on different acoustic features of various tissues. Ultrasound in diagnostics Today, dermatosonography is used in diagnosing: cutaneous neoplasms, inflammatory skin diseases and skin diseases of unknown etiology. Apart from that, it is used in differentiating benign and malignant tumors and may be helpful in monitoring morphea, dermatomyositis, cutaneous sarcoidosis, erythema nodosum, allergic diseases, postthrombotic syndrome, physiologic aging and aging due to sun exposure. It can be...

Introduction. Hydroxyurea (HU) is a cytostatic agent, frequently used for the treatment of myeloproliferative disorders, sickle cell anemia and severe forms of psoriasis. Cutaneous side effects occur in up to one third of patients taking hydroxyurea, with the most serious side effect being susceptibility to develop non-melanoma skin cancers. Case report. We report 3 patients using HU that have developed multiple skin malignancies on the head and neck region and dorsa of the hands, arranged according to the level of the overall squamous dysplasia expressed. Conclusion. A cumulative dose of hydroxyurea affects skin cancer promotion in concordance with other risk factors determining cumulative ultraviolet exposure (age of the patients, skin phototype, sun habits), but the exact influence of each of them and enrollment of other possible cofactors remains to be elucidated. We point out the importance of adequate skin cancer preventive and therapeutic approach to the patients treated with...

Introduction. Acronym tick-borne lymphoadenoathy (TIBOLA (Dermacentor-borne necrosis erythema and lymphoadenopathy ? DEBONEL, scalp eschar associated with neck lymphoadenopathy ? SENLAT) comprises clinical diagnosis of tick-borne symptoms of cervical or occipital lymphadenopathy with inoculation eschar at the site of tick bite on scalp. Since the first description, it was proved to be associated with several infectious agents, most frequently Rickettsia slovaca, or less often other spotted fever group Rickettsiae (Rickettsia raoulti and Rickettsia rioja), and gained an emerging infectious disease status in Europe. Dermacentor ticks serve as vectors and possible natural reservoir. The course is in most cases benign and infection is limited. Doxicycline is the recommended initial treatment, both for adult and most cases in children. Case report. Two subjects who acquired the desease caused by tick bites in Vojvodina region of Serbia are presented. Both patients are females. A tick was...

In vivo confocal microscopy is an imaging technique that has been applied to the study of the ocular surface. However, confocal microscopes dedicated to eye examination are routinely adopted only in ophthalmology reference centres and do not allow an examination of periocular tissue, nor a fluorescence examination. We applied for the first time the two in vivo confocal microscopes commonly used in dermatology (VivaScope ® 1500 and 3000, CALIBER, distributed in Europe by Mavig GmbH, Munich, Germany) to observe the cornea, the bulbar and tarsal conjunctiva, the eyelid margin, the lacrimal punctum and the palpebral skin of healthy volunteers. Tumoral, inflammatory and infectious diseases of the ocular mucosa and periocular skin from more than 200 patients were observed under the same microscopes. Both microscopes have a reflectance mode. VivaScope ® 1500 allows an additional fluorescent examination and its placement on the ocular surface was made possible by the creation of a special interface between the microscope and the ocular apparatus. Results: Thanks to its compact and flexible configuration, the handheld camera VivaScope ® 3000 allowed to access more easily to the ocular and periocular tissues. Diagnosis of benign and malignant tumors (melanoma, squamous cell carcinoma and basal cell carcinoma), as well as infectious and genetic disease (storage diseases), could be evocated. The detection of parasites (Demodex folliculorum) on eyelids was possible. Confocal images correlated well with conventional histopathology. The fluorescence examination of corneal squamous cell carcinoma by VivaScope 1500 was characterized by extravasation of fluorescein after intravenous injection. Confocal microscopes dedicated to the skin offer new perspectives for the diagnosis, optimization of treatments, and follow-up of the ocular diseases. They will allow dermatologists to examine conjunctival and eyelid tumors, as it is for skin or genital mucosa. In addition, thanks to some adaptations of the dermatological device VivaScope ® 1500, it is possible for the first time to perform a fluorsecnte examination of the ocular and peri-ocular tissue, opening a new era in the clinical imaging of the ocular surface. A new semiology remains to be learned.

Mammary Paget's disease is a rare intraepithelial carcinoma of the nipple/areola complex often associated with ductal breast carcinoma. We report a case of a 55-year-old female patient with a classical form of mammary Paget's disease associated ductal ipsilateral breast carcinoma. Dermoscopy of Paget's disease revealed a whitish-pink area with polymorphous vessels organized in irregular nests separated by pale streak-like structures, with peripheral light brown diffuse pigmentation. Dermoscopic features described in this case are in agreement with rare previous reports and may contribute to better differentiation of mammary Paget's disease from clinically similar lesions.

Introduction: Cutaneous larva migrans (CLM) is a syndrome, defined by clinical appearance of slowly migrating cutaneous eruption caused by inoculation with animal hookworms larvae in the skin. Despite the typical clinical presentation, CLM is frequently misdiagnosed due to its rarity in temperate climate urban communities. Case Report: We report a case of a 42-year old female, admitted to an outpatient clinic with eruption of multiple intense pruritic, erythematous, exudative papules and oval plaques, located predominately on the back. The patient claimed that skin lesions started three weeks before the examination, during her vacation in Thailand, and at first, was taught to be caused by a contact with jelly fish. Lesions were treated unsuccessfully with oral antihistamines and various topical corticosteroids, which lead to more questions regarding the differential diagnosis. Dermoscopical and histopathological findings were indicative of parasitic infection, most likely CLM. A thr...

Introduction. Localized unilateral hyperhidrosis (LUH) is a rare disorder of unknown origin, with multiple possible triggering factors and unknown pathogenesis. Although there are cases of LUH of the face reported, this is the first to report isolated ipsilateral hyperhidrosis of the face after blunt force trauma. Case outline. A 54-year old Caucasian woman presented with facial LUH of five years? duration. Ipsilateral blunt trauma of the temple that preceded the condition for three months was identified as the most probable cause. For sharp demarcation, the Minor?s or starch?iodine test was performed, which revealed the presence and extent of the facial sweating on the left side of the face. Treatment with 20% aluminium chloride hexahydrate sol. (Retrargin sol.) was conducted with partial response. Conclusion. After ruling out underlying diseases as a cause of LUH, a prior trauma should be considered as a potential cause. The possible mechanism could be the lesion of sympathetic ch...

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.