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Recently, several biologics have been associated with thedevelopment of new-onset or exacerbation of prior sar-coidosis.1–5We report a case of new-onset sarcoidosisinduced by secukinumab in a patient with severe plaquepsoriasis.

Case report of a patient developing severe bullous hemorrhagic Sweet syndrome following application of the first dose of the SARS- CoV-2 Oxford AstraZeneca vaccine.

The Hair Follicle (HF) is a vital component of mammalian skin and represents a unique, highly regenerative system that undergoes phases of rapid growth, regression, and resting periods. The hair cycling is of profound clinical relevance since majority of the hair growth disorders occur as a result of cycle changes. The influence of many molecules governing the formation of HF has been investigated and many of important cycle mediators have been identified. Cellular and molecular events during cycling are controlled by a network of sequential activation of autocrine, paracrine and endocrine signaling pathways. This implies variations in the expression or activity of the Wnt family molecules, Fibroblast Growth Factor (FGF), Transforming Growth Factor β (TGF-β), Hedgehog pathway, β-Catenin pathway, noggin, transcription factor Stat3, Epidermal Growth Factor (EGF), Insulin Growth Factor-1 (IGF- 1), Vascular Endothelial Growth Factor (VEGF), Thyrotropin Releasing Hormone (TRH), Polyamine, Spermidine, Neurotrophins (NT3, NT4), prolactin, retinoids, Bone Morphogenetic Protein 4 (BMP4), cathepsin L, 17-β estradiol, dihydrotestosterone and many others. Despite considerable progress in this area, the key elements of cycle control have not been identified. Therefore, for the most common hair disorders several agents are available, even none of these is curative or preventive. The one of the prime challenges of hair research is a better understanding of the molecular controls of hair cycling and developing drug which would effectively manipulate the cycle. Future therapy strategies will be based on new and better knowledge about the HF biology. Until than, alopecia areata, telogen effluvium and androgenetic alopecia, will remain unsolved medical problems.

The aim of this study was to determine the prevalence of true local anesthetic (LA) allergy among patients referred for suspected hypersensitivity and to describe the main characteristics of adverse drug reactions (ADR) induced by LA in our population. We retrospectively analyzed the medical files of patients referred to the Department of Dermatovenereology, University Hospital Center Rijeka, Rijeka, Croatia, for the investigation of LA hypersensitivity in the period between January 2000 and December 2012. A total of 331 patients underwent skin testing and, in cases of negative results, subcutaneous exposition to LA. In patients with suspected delayed reaction, patch test was performed. Altogether, 331 patients reported 419 independent ADR occurring during 346 procedures. Most commonly, patients reported having only one ADR, but 41 (12.4%) of them had two reactions, 14 (4.2%) had three, five (1.5%) had four and in one patient (0.3%) five ADR to LA were observed. The majority of reactions occurred during dental procedures when most commonly lidocaine and articaine were used. Local reactions were reported in 44 patients, whereas 490 general symptoms occurred during 375 independent ADR in 287 patients. The most common symptoms were cardiovascular system reactions in 89 patients (18.2%). Allergic reaction was detected in three patients (0.91%). One patient showed immediate-type reaction to bupivacaine and two patients had a delayed-type reaction to lidocaine. Adverse reactions to LA are common and are mostly due to their pharmacological properties and drug combinations or psychogenic origin. Allergic accidents to LA are rare.

Psoriasis is probably as old as mankind. Today, it is a well defined skin disease, in which genetic, environmental and immunologic factors participate in etiopathogenesis. However, despite its frequency, chronicity and visibility, it is quite hard to find a description of psoriasis in the works of the ancient physicians. Dermatology developed slowly, first with appearance of the protodermatologists at the end of the 18th century, and continued with the arrival of the first dermatologists. From those times psoriasis became a distinct entity. However, until the last century, the descriptions of disease considered «morbi in pulchredine», were rather vague, the denomination not standardized and the translation from one language to others discrepant. Different authors called the disease with various names, while diverse diseases had the same names. The confusion in terminology and description of psoriasis lasted for centuries.

Cilj: Ulcus cruris krajnja je posljedica komplikacija povezanih s venskom hipertenzijom donjih ekstremiteta, a nastaje zbog nemogućnosti cijeljenja nedovoljno opskrbljenog sklerotičnog tkiva. Danas se napredno liječenje vrijeda potkoljenice bazira na oblogama za rane koje mogu ili ne moraju sadržavati analgetike da bi umanjile bolove. Cilj ove jednogodišnje studije bio je analizirati učinke obloge s ibuprofenom na bolove u bolesnika s vrijedom potkoljenice u svrhu poboljšanja njihove kvalitete života. Metode: U ovoj jednogodišnjoj studiji obradili smo 288 bolesnika; 28 bolesnika koristilo se oblogama s ibuprofenom bez peroralne analgetske terapije, dok je 30 bolesnika primalo peroralnu analgetsku terapiju s oblogama sa srebrom kao kontrolna skupina. Rezultati: Uočili smo statistički značajan pad intenziteta bola u prva dva dana liječenja, ali ne značajan u odnosu na cijeljenje ulkusa u kontrolnoj skupini. Zaključak: Na osnovi ovih rezultata zaključujemo da bi obloge s analgeticima mogle biti lijek izbora za kronične nožne ulkuse s intenzivnim bolovima., Aim: Ulcus cruris represents one end-point of complications linked to the venous hypertension of lower extremities, as inadequately supplied sclerotic tissue breaks down and healing is largely impaired. Today the advanced leg ulcer treatment is based on wound dressing that can contain analgesics in order to diminish pain. The aim of this non randomized one year study was to analyze the effects of ibuprofen-releasing foam dressing on wound pain in leg ulcers in order to ameliorate the quality of life in patients. Methods: In this one-year study 288 patients with leg ulcers were analyzed, among which 28 patients were prescribed ibuprofen-releasing foam dressing without peroral analgesic therapy, while 30 patients continued peroral analgesic therapy with silver-releasing foam dressing as a control group. The primary endpoint was to determine wound pain relief in the first two days among patients treated with. Results: We observed a statistically significant decrease of pain intensity in the first two days of therapy, but not a significant different rate of ulcer healing compared to the control group. Conclusion: Based on these results we concluded that foams with analgesics could be a treatment of choice for chronic leg wounds with intense pain.

Lower limb symptoms have frequently been associated with increased severity of venous disease. In clinical practice they are reported by patients at all stages of chronic venous disease. This study assessed the contribution of Daflon 500 mg in improving venous symptoms and promoting venous ulcer healing in patients with primary chronic venous disease.

Since psoriatic epidermis is also characterized by hyperproliferation of keratinocytes, we aimed to investigate the expression of two DDR markers, p53-binding protein 1 (53BP1) foci and phosphorylated histone H2AX (gammaH2AX), in psoriatic lesions. Immunohistochemical and immunofluorescent staining was performed on paraffin-embedded tissue of lesional skin of patients with psoriasis and skin of healthy volunteers. The percentage of keratinocytes positive for Ki-67, 53BP1 and gammaH2AX and the number of foci per nucleus were determined. The number of cells positive for proliferation marker Ki-67, as well as the number of cells positive for gammaH2AX and 53BP1 foci, was significantly higher in psoriasis when compared to normal skin. In addition, the mean number of 53BP1 foci per nucleus, in cells expressing foci, was higher in psoriatic than in normal epidermis. Positive cells were predominantly localized in the basal and suprabasal epidermal layers. These results indicate that psoriasis, similarly to preneoplastic lesions, is characterized by high proliferative index and increased expression of DDR markers. It is possible that potent activation of DDR in psoriasis overcomes the effects of DNA replication stress and represents a part of the barrier to malignant transformation.

Apoptosis is a process of programmed cell death that maintains the homeostasis of the skin. Apoptotic cell death regulates keratinocyte proliferation and formation of stratum corneum as well. The process by which keratinocytes undergo apoptosis is a multistep program mediated by binding of specific death ligands to death receptors or by the release of effectors cell granules. Dysfunctional apoptosis has an important role in the development of several skin diseases. Psoriasis is a common chronic inflammatory skin disease characterized by hyperproliferation with incomplete differentiation of epidermal keratinocytes and decreased keratinocyte apoptosis. Psoriatic keratinocytes possess an enhanced ability to resist apoptosis what might be one of the key pathogenetic mechanisms in psoriasis. In addition, psoriasis is nowadays also recognized as the most prevalent autoimmune disease resulting from aberrant activation of both, innate and adaptive immunity. However, the role of cell cytotoxicity mediated by cytotoxic CD8+ T cells (CTLs) and NK cells in psoriasis is as yet unclear. Here, we shall review the role of different apoptotic pathways in psoriasis.

Cilj: Cilj rada je prikaz slučaja bolesnika s generaliziranim oblikom vitiliga koji je liječen lokalnim kortikosteroidima i uskospektralnom UVB fototerapijom, kao i pregled novih oblika liječenja vitiliga. Prikaz slučaja: Četrdesetdvogodišnji bolesnik zaprimljen je zbog generalizirane pojave vitiliga. Kliničkim pregledom uočene su depigmentirane mliječnobijele makule simetrično raspoređene po koži lateralnih strana trupa, gornjih i donjih ekstremiteta, kao i vratu te periorbitalno na desnoj strani lica. U terapiju je uvedena kortikosteroidna krema, mometazon furoat, a potom i uskospektralna UVB fototerapija koja se provodila tri puta tjedno uz povećanje doze za 20% prilikom svakog obasjavanja do pojave blagog eritema. Ukupna primljena doza iznosila je 69.213 J/cm2. Liječenje je dovelo do poboljšanja u smislu mjestimične repigmentacije vitiliginoznih lezija, zaustavljena je progresija postojećih, kao i nastajanje novih lezija. Rasprava i zaključak: Iako postoje brojne dostupne metode liječenja, ne postoji univerzalna terapija koja bi bila učinkovita u svih bolesnika s vitiligom. Raznolikost kliničke slike vitiliga posljedica je različitih patogenetskih mehanizama, stoga zahtijeva i različite pristupe u liječenju. Nova istraživanja na polju etiopatogeneze vitiliga omogućit će razvoj novih učinkovitijih modaliteta liječenja koji bi doveli do trajnog izlječenja bolesti., Aim: To present a patient with generalized vitiligo who was treated with topical corticosteroids and narrow band ultraviolet B phototherapy and to give an overview of treatment modalities for vitiligo. Case report: A 42 year-old men was admitted because of generalized vitiligo. Clinical examination revealed depigmented milky-white macules distributed symmetrically on lateral sides of trunk, upper and lower extremities, neck and periorbital region of the right facial side. A topical corticosteroid, mometazon furoat, was prescribed once a day and narrow band UVB phototherapy was initiated. Phototherapy was administered three times a week with the initial dose of 0.3 J/cm2 and dose increment at the rate of 20% of the previous dose until the formation of a mild erythema. Total dose received was 69.213 J/cm2. After received therapy, repigmentation was partially achieved, and the progression, as well as the appearance of the new vitiliginous lesions, were stopped. Discussion and conclusion: Various modalities of treatment are used in therapy of vitiligo, but there is still no universal therapy that could be effective in all vitiligo patients. Different clinical manifestations of vitiligo are the result of different pathogenetic mechanisms and require different treatment approaches. Therefore, future research is needed in order to clarify the etiopathogenetic mechanisms and provide new, more effective therapeutic opportunities

This open, multicenter, comparative, randomized study included 120 subjects with papulopustular stage of acne vulgaris. Subjects were randomized to one of the three treatment groups (A, total dose 4.5 g of azithromycin in 7 weeks; B, total dose 6.0 g in 10 weeks; and C, total dose 7.5 g in 13 weeks). The aim was to identify the optimum azithromycin dose in the treatment of acne vulgaris through monitoring the efficacy and safety of three dosage regimens. Clinical efficacy was assessed upon completion of study therapy and six months of therapy initiation. Posttherapeutic efficacy assessment was available in 104 subjects. The difference between three treatment groups was most pronounced in the “cure” category (36.11% in group A, 58.82% in group B and 55.88% in group C) and “failure” category (8.33% in group A, and no failures in groups B and C). Follow up efficacy assessment was available in 87 subjects. The group percentage of “cure” was lower and group percentage of “treatment failure” higher in group A than in groups B and C. Azithromycin in a total dose of 6.0 g in 10 weeks seems to be a promising agent in the treatment of papulopustular acne vulgaris with few side effects and good patient compliance. Key words: acne vulgaris

BACKGROUND: Bowel-associated dermatosis-arthritis syndrome (BADAS) is defined by the presence of pustular vasculitic skin lesions usually associated with blind loops of the bowel, either after Billroth II or ileojejunal bypass surgery or caused by a chronic inflammatory bowel disease such as Crohn's disease or ulcerative colitis. CASE REPORT: A 50-year-old patient is presented with an unusual case of pustulo hemorrhagic vasculitis over the lower arms and legs that appeared ten days before the first symptoms of appendicitis, partially regressed, and reappeared five days after appendectomy. Laboratory tests showed anemia, an elevated erythrocyte sedimentation rate, and C-reactive protein as well as a polyclonal increase in IgG and IgA levels, erythrocyturia and proteinuria. Histopathological examination of a skin biopsy indicated the suspected diagnosis. During hospitalization the patient developed arthropathy with swelling of the metacarpophalangeal and interphalangeal joints and ankles. The patient was treated with systemic antibiotics and corticosteroids, which caused resolution of the symptoms. CONCLUSIONS: This report speculates that appendicitis was the possible cause of BADAS in this case.

Multiple warts in a 32-year-old-man are reported that developed after tattooing and remaining exclusively confined to that area. The tattooing was done 2.5 years earlier by a professional tattoo artist. It was previously a lesion-free tattoo, but when damaged by sunburn developed multiple skin warts. The ability of a latent virus to induce warts after cutaneous ultraviolet exposure was discussed.

In order to analyze the meteorological factors possibly influencing the monosymptomatic optic neuritis in Rijeka County, northwestern part of Croatia, retrospective analysis of all cases diagnosed in Rijeka County in period from 1977 to 2001, was done. Meteorological data on monthly and yearly temperature, humidity, insolation in Rijeka County were collected from Croatian Meteorological and Hydrological Service. In the observed period there were 173 cases of monosymptomatic optic neuritis, female/male ratio was 1.66, and overall incidence was 2.18/100, 000 inhabitants. There was no correlation of incidence with average yearly and monthly temperature, humidity, insolation, or month of birth. This is the first study on meteorological factors and optic neuritis in Croatia.

The aim of this study was to compare the quality of screening for diabetic retinopathy in cities of Rijeka and Zagreb, Croatia. Review of a random sample of 500 diabetic patient records and prospective ophthalmologic survey of 466 randomly selected diabetic patients in a secondary level diabetologic service in Rijeka (coastal region of Croatia). The main outcome measures were proportion of diabetic patient records with notes on ophthalmologic examination ; rate of diabetic patients involved with screening for diabetic retinopathy ; comparison with rates in Zagreb (Croatian capital). A total of 67% patients visited the ophthalmologist at least once after diagnosed with diabetes, and notes on ophthalmologic examination were found in only 28% patient records. Fifty percent of patients underwent an ophthalmologic examination within two years. Only one third of patients diagnosed with DM in last two years visited the ophthalmologist within this time, and 14% of patients older than 50 years never visited the ophthalmologist. Model of screening for diabetic retinopathy in Croatia works better in Zagreb than in Rijeka region, and needs certain improvements. The authors suggested modern methods of screening, the incorporation of the mechanisms of quality control, the obligatory reporting of newly diagnosed diabetic patients to the national registry, and the direct referral from diabetologist to ophthalmologist.

Hyalinosis cutis et mucosae is an inherited disease, characterized by deposition of a hyaline-like substance in the dermis and internal organs. In the present study, we report a 30 year follow up in a female patient with hyalinosis cutis et mucosae treated using dermabrasion and oral retinoids. In our opinion, the lesion on uncovered body areas should be corrected as soon as possible to enable a normal psychophysical development. The lesions on skin and oral mucosa may be successfully removed without remission with dermabrasion in early childhood. In addition, oral retinoids in adulthood may produce some improvement.

An open, noncomparative study was performed to establish the efficacy of azithromycin in the treatment of early syphilis. Sixteen patients were treated with oral azithromycin: 1g the first day and then 500 mg for the following 8 days. Two patients were excluded from the study, leaving 14 patients for the evaluation of the efficacy. Venereal Disease Research Laboratory (VDRL) negativity was observed in 3 out of 6 patients treated for primary syphilis after 3 months and in all patients after 6 months. Two of 8 patients treated for manifest or early latent secondary syphilis had VDRL negativity after 3 months and 4 patients after 6 months. This study demonstrates that azithromycin is effective in the treatment of early syphilis. Two patients experienced gastrointestinal side effects which did not require treatment interruption.