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The purpose of this study was to review currently available literature data concerning pathomechanisms of action, indications, treatment efficacy, as well as side effects of nonsteroidal immunomodulators used in dermatology, primarily for the treatment of allergic dermatoses. MEDLINE search was undertaken using the key words “Topical Immunomodulators, Dermatology and Allergy”. Full articles, and nothing but full articles, were used. [ABSTRACT FROM AUTHOR]

Background/Aim. Treatment of psoriasis is very complex and there are no still universal, nor unique treatment modalities. Apart from conventional treatment, which includes topical calcipotriol (vitamin D3 analogue), balneotherapy is drawing increased attention worldwide. Being part of climatotherapy, balneotherapy is defined as the use of natural environmental factors in the treatment of health conditions, whereas in the treatment of psoriasis it means the use of mineral baths and peloids. The aim of this study was to examine the therapeutic efficacy of mineral waters and peloids of the Rusanda Spa on plaque psoriasis in patients also treated with calcipotriol. Methods. The study included 60 patients divided into two groups. The first group included patients treated with mineral waters, peloids and calcipotriol in the Rusanda Spa, while the second one included those treated only with calcipotriol. The study took 21 days, and each patient was followed up for at least one month after ending the treatment. The treatment efficacy was measured by psoriasis area severity index (PASI) scores on the days 0, 7, 14 and 21 during the treatment and 30 after the end of the therapy. Results. After a 3-week treatment in the Rusanda Spa, the first group showed a decrease in PASI score by 59.45%, whereas in the group of outpatients treated by calcipotriol it was 39.34%. On the day 30 following the treatment, the first group presented with the PASI score reduction of 58.44%, and the second group of 34.78%. The therapeutic efficacy of mineral waters and peloids combined with calcipotriol showed to be significantly higher in regard to monotherapy with calcipotriol (p < 0.05). In regard to clinical symptoms, the best results were obtained in the reduction of desquamation (p < 0.001). Conclusion. The results of our study show that in the treatment of plaque-type psoriasis, topical calcipotriol combined with Spa Rusanda balneotherapy is more effective than topical calcipotriol alone. Randomized controlled trials are needed to confirm the effects of balneotherapy as monotherapy in treatment of this type of psoriasis. [ABSTRACT FROM AUTHOR]

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 FROM AUTHOR]

Introduction. In contact with insects, people present a wide range of reactions, local or systemic, whether caused by insect bites or a venom injections, sucking blood or exposure to insect's body and its secretions. Simulium erythrocephalum is an aggressive anthropophilic species, and following its bite humans may develop purpuric macules, edema and erythema surrounding the bite site. Our case series indicates frequent occurrence of Simulium erythrocephalum bites in Serbia. Case Series. We present a series of 30 cases reviewed between April and July 2006, who developed a local reaction at the site of this insect's bite. In all patients, the skin lesions were located on the extremities, mainly the lower legs. The number of bites varied from two to more than ten. In all patients the bites occurred either during outdoor activities on the riverside or their residence was near the Danube. The therapy with antihistamines, local and/or systemic corticosteroids, as well as symptomatic therapy, with compression and limb elevation was recommended. The skin lesions regressed in one week in most patients, but in few they lasted for several weeks. Conclusion. In addition to its impact on human health, Simulium erythrocephalum also has a role in veterinary medicine. Insect bites in animals can cause significant livestock losses, occasionally resulting in animal mortality. Apart from this, Simulium erythrocephalum may also be a vector in the transmission of the parasite from the genus of Leucocytozoon that infests birds. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about epidemiological features of pemphigus chronicus.

Introduction Sexually transmitted infections (STIs) are major global public health problems. Present strategies for prevention have limitations. Vaccines are an attractive addition to the current prevention armamentarium because they provide durable protection and do not require repetitive adherence to be effective. Challenges for vaccination include induction and long- term maintaince of mucosal immune responses in the female genital tract. Vaccines: a realistic goal? For the time being, US Centers for Disease Control and Prevention have recommended only hepatitis and HPV immunization to be routinely offered. Final, III stage trials are underway on other prophylactic vaccines for human papillomavirus and genital herpes. Though vaccines against Chlamydia trachomatis and Neisseria gonorrhoeae are in early stages of development they do offer the hope of preventing pelvic inflammations. The high incidence of HIV-infection for which a vaccine would not be readily available, "cries out" for an effective vaccine. Vaccines for HPV infections According to a recent meta-analysis of worldwide prevalence data, vaccinating with HPV-16/18 VLP against HPV-16 and HPV-18 could prevent over 70% of invasive cervical cancer worldwide. The latest release of data from the phase III trial of a quadrivalent recombinant non-infectious vaccine HPV-6.H 16/18 LI VLP, including HPV types 6.11.16.18 have given complete protection against HPV-16/18-related cervical intraepithelial neoplasias 1, 2/3. and adenocarcinoma in situ and cancer through 2 years of post-vaccination follow up. Conclusion Despite the fact that the development of vaccines for STI prevention was rather slow in the past, the ideal vaccine would decrease transmission of the infection between partners and would prevent complications of disease. Moreover, in future decades, increasingly successful universal vaccination of new-borns and children will substantially reduce the need for vaccination of persons with specific risk factors, including sexual risk. [ABSTRACT FROM AUTHOR]

Background/Aim. Development of allergic contact dermatitis as a complication of treatment of chronic venous insufficiency (CVI) is well known. The aim of this study was to determine the incidence and risk of eczematous contact sensitization in patients with CVI, as well as the correlation between disease duration and contact sensitization. Methods. The study involved 266 subjects examined during three-year-period who were divided into two groups: the study group included patients with CVI referred for allergy testing due to suspected contact dermatitis, and the control group included the ones without CVI patch tested for suspected contact dermatitis. The severity of CVI was assessed by Clinical Etiology-Anatomy-Pathophysiology (CEAP) classification. Thereafter, each patient underwent patch testing. Results. The incidence of contact sensitization among patients with CVI was 49.3%. In these patients, the incidence of contact sensitization to the European standard battery of allergens was 31.55%; to the battery specific for CVI it was 28.45%. Patients with CVI had a 2.45-fold higher risk for developing contact sensitization to two or more allergens, and a 3.69-fold higher risk for developing contact sensitization to five or more allergens compared to those without CVI. The prevalence of contact sensitization in patients with CVI was not significantly different from those without CVI. There was a positive correlation between the incidence of contact sensitization and the duration of the disease. Conclusion. Patients with CVI had no statistically significantly distinct contact sensitization prevalence and had 2.45 and 3.69 times higher risk to manifest contact sensitization to two and more allergens and five and more allergens, respectively, than patients with no CVI. The positive correlation between frequency of contact sensitization and disease duration was found. [ABSTRACT FROM AUTHOR]

Introduction. Hypertensive ischemic leg ulcer, also known as Martorell ulcer, is not very rare, but an under-recognized type of leg ulcer. It has specific clinical and histopathological characteristics. It occurs almost exclusively in patients with arterial hypertension. It is more common in women and in patients with type 2 diabetes. It is localized particularly in the laterodorsal distal third of the lower leg. This ulcer is extremely painful. Its clinical features may very much resemble pyoderma gangrenosum. Case Report. We are presenting a case of a 40-year-old obese male, who suffered from arterial hypertension during the past 26 years. His ulcer appeared spontaneously on the lateral aspect of the right lower leg and progressed gradually. From the very onset, the ulcer was extremely painful. At first, it was diagnosed as pyoderma gangrenosum and treated with systemic corticosteroids and immunosuppressants. Since the response to therapy was not satisfactory, the histopathology was revised and the diagnosis of hypertensive ischemic leg ulcer was made. After initial wound debridement and local negative pressure therapy, split-thickness skin grafting was performed. The pain disappeared right away almost completely and complete epithelization was achieved two weeks after skin grafting. Conclusion. It is important to consider Martorell ulcer in hypertensive patients with extremely painful ulcers of the lower leg. In order to establish the appropriate diagnosis, it is essential to take a deep skin biopsy and correlate the finding with a specific histopathological picture. It is the only way not to confuse hypertensive ischemic leg ulcer with pyoderma gangrenosum, since the management of the two conditions is completely different. [ABSTRACT FROM AUTHOR]

Many studies have reported that Chronic venous disease (CVD) occurs more in females than males, due to pregnancy. The study was conducted over the period 2014–2015 at the Dermatovenereological clinic, Novi Sad, Serbia. We performed a cross-sectional study of 554 women. According to Clinical-Etiology-Anatomy-Pathophysiology (CEAP) staging, the sample was divided into three groups: Mild CVD (classes 1–3 by CEAP) – n = 72; Severe CVD (classes 4–6 by CEAP) – n = 122 and a Control (no CVD) – n = 360 patients. The age range of participants was 18 to 93 years (average 54.92 years). Most important CVD risk factors were examined in detail. Out of 554 examinees, 22.03% had severe CVD, and 12.99% had mild CVD. Bivariate analyses showed a significantly higher proportion of women who had deliveries in the severe CVD and mild CVD groups, compared with the control group. Other significantly related factors were older age, family history of varicose veins, standing job position and hypertension. After performing multiple logistic regression analysis, older age, standing job position and family history of varicose veins remained significant, while childbirth lost its significance. Our results suggest that childbirths are not associated with the occurrence of CVD [ABSTRACT FROM AUTHOR]

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 hydroxyurea. [ABSTRACT FROM AUTHOR]