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Pojavnost atopijskog dermatitisa (AD) tijekom posljednjih desetljeća u porastu je, što je osobito izraženo u zemljama zapada. Smatra se da je uzrok smanjena izloženost mikroorganizmima tijekom najranijeg djetinjstva i posljedično smanjena stimulacija imunološkog sustava. Budući da crijevna mikroflora predstavlja prvi i najveći izvor mikrobnog opterećenja, promjene u njezinu sastavu i raznovrsnosti smatraju se čimbenikom nastanka AD-a. To je razlog zašto se probiotici, zahvaljujući svojoj sposobnosti manipulacije sastavom mikroflore i imunomodulatornim učincima, smatraju mjerom prevencije i liječenja atopijskog dermatitisa. Dosadašnje studije ukazuju na njihov preventivni potencijal, no kao terapijska intervencija nisu pokazali pozitivne učinke. Ipak, primjena probiotika u AD-a za sada je ostala predmetom istraživanja, a buduće studije trebale bi razjasniti zaslužuju li oni mjesto među ostalim preventivnim i terapijskim mjerama te razriješiti nedoumice glede njihove primjene., The prevalence of atopic dermatitis (AD) has risen over the past decades, and this is especially expressed in western countries. Reduced microbial exposure during infancy and therefore reduced stimulation of immune system is considered to be the cause for this rising prevalence. Intestinal microbiota represents the first and major source of microbial exposure and therefore the changes in its composition and diversity are considered to be responsible for development of AD. That is why probiotics are, owing to their ability to manipulate the composition of microbiota and their immunomodulatory effects, considered to be a promising prevention and therapeutic intervention of atopic dermatitis. Former studies indicate that they have a preventing potential, but their therapeutic effects have not been proven. However, probiotic use in AD is a subject of reasearches at the moment, and future studies should clearify if they deserve a place among the other preventive and therapeutical measures and resolve uncertanities regarding their administration.

Pojavnost atopijskog dermatitisa (AD) tijekom posljednjih desetljeća u porastu je, što je osobito izraženo u zemljama zapada. Smatra se da je uzrok smanjena izloženost mikroorganizmima tijekom najranijeg djetinjstva i posljedično smanjena stimulacija imunološkog sustava. Budući da crijevna mikroflora predstavlja prvi i najveći izvor mikrobnog opterećenja, promjene u njezinu sastavu i raznovrsnosti smatraju se čimbenikom nastanka AD-a. To je razlog zašto se probiotici, zahvaljujući svojoj sposobnosti manipulacije sastavom mikroflore i imunomodulatornim učincima, smatraju mjerom prevencije i liječenja atopijskog dermatitisa. Dosadašnje studije ukazuju na njihov preventivni potencijal, no kao terapijska intervencija nisu pokazali pozitivne učinke. Ipak, primjena probiotika u AD-a za sada je ostala predmetom istraživanja, a buduće studije trebale bi razjasniti zaslužuju li oni mjesto među ostalim preventivnim i terapijskim mjerama te razriješiti nedoumice glede njihove primjene., The prevalence of atopic dermatitis (AD) has risen over the past decades, and this is especially expressed in western countries. Reduced microbial exposure during infancy and therefore reduced stimulation of immune system is considered to be the cause for this rising prevalence. Intestinal microbiota represents the first and major source of microbial exposure and therefore the changes in its composition and diversity are considered to be responsible for development of AD. That is why probiotics are, owing to their ability to manipulate the composition of microbiota and their immunomodulatory effects, considered to be a promising prevention and therapeutic intervention of atopic dermatitis. Former studies indicate that they have a preventing potential, but their therapeutic effects have not been proven. However, probiotic use in AD is a subject of reasearches at the moment, and future studies should clearify if they deserve a place among the other preventive and therapeutical measures and resolve uncertanities regarding their administration.

Hrvatsko dermatovenerološko društvo i Hrvatsko društvo za plastičnu, rekonstrukcijsku i estetsku kirurgiju ­Hrvatskoga liječničkog zbora ustrojili su radnu skupinu liječnika s kliničkim iskustvom u dijagnostici i liječenju gnojnog hidradenitisa (hidradenitis suppurativa). Skupina je kritički proučila mjerodavnu znanstvenu literaturu te je donijela smjernice za dijagnostiku i liječenje., Croatian dermatovenerologic society and Croatian society for plastic, reconstructive and esthetic surgery of the Croatian Medical Association formed the working group which consists of physicians with experience in diagnostics and treatment of hidradentitis suppurativa. After a critical analysis of relevant scientific papers, the working group has developed practice guidelines for the diagnosis and treatment.

Background: The purpose of this study was to examine the differences in satisfaction with life and coping strategies between patients with acute and chronic urticaria. Subjects and methods: Sixty patients with urticaria were divided into 2 groups after 6 weeks of standardized dermatology treatment (33 patients with acute and 27 patients with chronic urticaria). At baseline, all patients answered the following questionnaires: Satisfaction with Life Scale (SWLS), Personal Wellbeing Index (PWI-A), The Multidimensional Coping Inventory (COPE) and General questionnaire (age, gender, education, employment, marital status). After six weeks all the participants were re-tested with 2 questionnaires: SWLS and PWI-A. Results: Six weeks after the initial testing there was a statistically significant difference in satisfaction with life between patients with acute and chronic urticaria. Patients with acute urticaria were more satisfied with their lives than patients with chronic urticaria. Also, there was a statistically significant difference in the use of emotion-focused coping, seeking social support for emotional reasons and seeking social support for instrumental reasons. Patients with acute urticaria used emotion-focused coping and sought social support for emotional and instrumental reasons to a greater degree than patients with chronic urticaria. Conclusion: Patients with acute urticaria were more satisfied with their lives than patients with chronic urticaria. Patients with acute urticaria used emotion-focused coping and sought social support for emotional and instrumental reasons to a greater degree than patients with chronic urticaria.

Cilj: Istražiti učestalost haplotipskih sveza HLA-DRB1-DQA1-DQB1 te produženog haplotipa Cw*0602-B57-DRB1*07-DQA1*0201 DQB1*0201 u pacijenata s pozitivnom i negativnom obiteljskom anamnezom psorijaze. Ispitanici i metode: Istraživanje povezanosti gena sustava HLA razreda I i II sa psorijazom obuhvatilo je 118 nesrodnih pacijenata s vulgarnom psorijazom. Učestalost haplotipskih sveza ispitana je serološki i metodom hibridizacije specifičnim probama. Rezultati: Utvrđena je povišena učestalost haplotipa DRB1*07-DQA1*0201- -DQB1*0201 i DRB1*07-DQA1*0201-DQB1*0303 u psorijatičara s pozitivnom obiteljskom anamnezom te također produženog haplotipa Cw6-B57-DRB1*0701-DQA1*0201- -DQB1*0201 (P = 0,004). U psorijatičara s negativnom obiteljskom anamnezom učestalost produženog haplotipa gotovo je ista kao u kontrolnoj skupini. Zaključak: Rezultati istraživanja ukazuju na jaču i značajniju povezanost s podložnim haplotipovima HLA za pacijente s pozitivnom obiteljskom anamnezom psorijaze, stoga upućuju na značajnu ulogu gena sustava HLA u nasljeđivanju psorijaze., Aim: To analyze the distribution of HLA-DRB1-DQA1-DQB1 haplotypes as well as the extended haplotype Cw*0602-B57-DRB1*07 DQA1*0201-DQB1*0201 in patients with positive and negative family history of psoriasis. Patients and methods: The association of HLA genes classes I and II with psoriasis has been studied in 118 patients with chronic stable psoriasis. The frequency of HLA haplotypes was analyzed by means of serology and hybridization with specific oligonucleotide probes. Results: The group with positive family history showed a significant association with DRB1*07-DQA1*0201-DQB1*0201 and DRB1*07- DQA1*0201-DQB1*0303 as well as with the extended haplotype Cw6-B57-DRB1*0701- DQA1*0201-DQB1*0201 (P = 0,004). The frequency of extended haplotype in the group with negative family history was similar to the control group. Conclusion: Psoriatics with positive family history show stronger association with susceptible

Cilj: Istražiti učestalost haplotipskih sveza HLA-DRB1-DQA1-DQB1 te produženog haplotipa Cw*0602-B57-DRB1*07-DQA1*0201 DQB1*0201 u pacijenata s pozitivnom i negativnom obiteljskom anamnezom psorijaze. Ispitanici i metode: Istraživanje povezanosti gena sustava HLA razreda I i II sa psorijazom obuhvatilo je 118 nesrodnih pacijenata s vulgarnom psorijazom. Učestalost haplotipskih sveza ispitana je serološki i metodom hibridizacije specifičnim probama. Rezultati: Utvrđena je povišena učestalost haplotipa DRB1*07-DQA1*0201- -DQB1*0201 i DRB1*07-DQA1*0201-DQB1*0303 u psorijatičara s pozitivnom obiteljskom anamnezom te također produženog haplotipa Cw6-B57-DRB1*0701-DQA1*0201- -DQB1*0201 (P = 0,004). U psorijatičara s negativnom obiteljskom anamnezom učestalost produženog haplotipa gotovo je ista kao u kontrolnoj skupini. Zaključak: Rezultati istraživanja ukazuju na jaču i značajniju povezanost s podložnim haplotipovima HLA za pacijente s pozitivnom obiteljskom anamnezom psorijaze, stoga upućuju na značajnu ulogu gena sustava HLA u nasljeđivanju psorijaze., Aim: To analyze the distribution of HLA-DRB1-DQA1-DQB1 haplotypes as well as the extended haplotype Cw*0602-B57-DRB1*07 DQA1*0201-DQB1*0201 in patients with positive and negative family history of psoriasis. Patients and methods: The association of HLA genes classes I and II with psoriasis has been studied in 118 patients with chronic stable psoriasis. The frequency of HLA haplotypes was analyzed by means of serology and hybridization with specific oligonucleotide probes. Results: The group with positive family history showed a significant association with DRB1*07-DQA1*0201-DQB1*0201 and DRB1*07- DQA1*0201-DQB1*0303 as well as with the extended haplotype Cw6-B57-DRB1*0701- DQA1*0201-DQB1*0201 (P = 0,004). The frequency of extended haplotype in the group with negative family history was similar to the control group. Conclusion: Psoriatics with positive family history show stronger association with susceptible

Hrvatsko dermatovenerološko društvo Hrvatskoga liječničkog zbora ustrojilo je radnu skupinu vodećih hrvatskih stručnjaka koji se bave psorijazom. Radna je skupina kritički proučila mjerodavnu znanstvenu literaturu te donijela smjernice za dijagnostiku i liječenje psorijaze., Croatian dermatovenerological society of the Croatian Medical Association formed the working group which consists of leading experts for psoriasis in Croatia. After a critical analysis of relevant scientific papers, the working group has developed guidelines for the diagnosis and treatment of psoriasis

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.

Cilj: Perioralni dermatitis je kronična ekcematoidna i papulopustulozna upalna dermatoza kože lica od koje najčešće obolijevaju žene mlađe i srednje dobi. Etiopatogeneza je nepoznata, a od mogućih etioloških čimbenika u obzir dolaze dugotrajna uporaba topičkih kortikosteroida, kozmetičkih preparata na bazi petrolata i parafina, infektivni uzročnici, hormoni, gastrointestinalni poremećaj, neurogena upala i emocionalni stres. Prikaz slučaja: Prikazana je 49-godišnja žena s izrazitim eritemom kože lica, edemom kapaka te brojnim grupiranim papulama i papulopustulama na koži lica, uz brojne subjektivne simptome. Bolesnica je samoinicijativno duže od godinu dana na licu primjenjivala potentni kortikosteroidni pripravak. Rasprava i zaključak: Prikaz slučaja govori u prilog hipotezi o važnoj ulozi topičkih kortikosteroida u patogenezi perioralnog dermatitisa. U radu je prikazan i pregled recentne literature o etiologiji, patogenezi i liječenju bolesti., Aim: Perioral dermatitis is a chronic papulopustular and eczematous facial dermatitis which predominantly affects young to middle aged women. The etiology of perioral dermatitis is unknown, and possible etiological factors include long time use of topical corticosteroids, cosmetics with petrolatum or paraffin base, microbiological factors, hormonal factors, gastrointestinal disturbances, neurogenic inflammation and emotional stress. Case report: A 49-year-old woman presented with expressive facial skin erythema, edema of the eyelids, a number of grouped papules and papulopustules on the face, accompanied with a number of subjective symptoms. Patient used potent corticosteroid preparations on the face for more than a year. Discussion and conclusion: The case supports the hypothesis that topical corticosteroids have an important role of in the pathogenesis of perioral dermatitis. This paper presents an overview of recent literature on the etiology, pathogenesis and treatment of the disease.

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.

Cilj: Perioralni dermatitis je kronična ekcematoidna i papulopustulozna upalna dermatoza kože lica od koje najčešće obolijevaju žene mlađe i srednje dobi. Etiopatogeneza je nepoznata, a od mogućih etioloških čimbenika u obzir dolaze dugotrajna uporaba topičkih kortikosteroida, kozmetičkih preparata na bazi petrolata i parafina, infektivni uzročnici, hormoni, gastrointestinalni poremećaj, neurogena upala i emocionalni stres. Prikaz slučaja: Prikazana je 49-godišnja žena s izrazitim eritemom kože lica, edemom kapaka te brojnim grupiranim papulama i papulopustulama na koži lica, uz brojne subjektivne simptome. Bolesnica je samoinicijativno duže od godinu dana na licu primjenjivala potentni kortikosteroidni pripravak. Rasprava i zaključak: Prikaz slučaja govori u prilog hipotezi o važnoj ulozi topičkih kortikosteroida u patogenezi perioralnog dermatitisa. U radu je prikazan i pregled recentne literature o etiologiji, patogenezi i liječenju bolesti., Aim: Perioral dermatitis is a chronic papulopustular and eczematous facial dermatitis which predominantly affects young to middle aged women. The etiology of perioral dermatitis is unknown, and possible etiological factors include long time use of topical corticosteroids, cosmetics with petrolatum or paraffin base, microbiological factors, hormonal factors, gastrointestinal disturbances, neurogenic inflammation and emotional stress. Case report: A 49-year-old woman presented with expressive facial skin erythema, edema of the eyelids, a number of grouped papules and papulopustules on the face, accompanied with a number of subjective symptoms. Patient used potent corticosteroid preparations on the face for more than a year. Discussion and conclusion: The case supports the hypothesis that topical corticosteroids have an important role of in the pathogenesis of perioral dermatitis. This paper presents an overview of recent literature on the etiology, pathogenesis and treatment of the disease.

Koža je najgušće inerviran organ ljudskog tijela, u vrlo bliskom kontaktu sa živčanim sustavom. U međusobnu intenzivnu komunikaciju uključene su sve strukture živčanog, endokrinog i imunološkog sustava, kao i sve stanice kože. Interakcija je posredovana različitim tipovima kožnih živčanih vlakana koja otpuštaju neuromedijatore i aktiviraju specifične receptore na ciljnim stanicama kao što su keratinociti, mastociti, Langerhansove stanice, endotelne stanice, stanice mikrovaskulature, fibroblasti i infiltrirajuće imunološke stanice. Ove interakcije utječu na brojne fiziološke i patofiziološke funkcije, uključujući rast i razvoj stanica, diferencijaciju, imunost, vazoregulaciju i cijeljenje rana. Nova saznanja o čimbenicima uključenim u ove interakcije utvrdila su suvremeni koncept neurobiologije kože., The skin is the most densely innervated organ in the body and there is a close relationship between the skin and the nervous system. Monodirectional and/or bidirectional pathways exist in which the central and peripheral nervous system, endocrine and immune system, and almost all skin cells are involved. The interaction between peripheral nerves and immune system is mediated by different types of cutaneous nerve fibers which release neuromediators and activate specific receptors on target cells in the skin such as keratinocytes, mast cells, Langerhans cells, microvascular endothelial cells, fibroblasts, and infiltrating immune cells. These interactions influence a variety of physiologic and pathophysiologic functions including cellular development, growth, differentiation, immunity, vasoregulation, leukocyte recruitment, pruritus, and wound healing. Information is emerging about the factors involved in these immunomodulatory mechanisms. Recent findings have established a modern concept of cutaneous neurobiology.

Procjenjuje se da virusne infekcije pridonose nastanku 15 – 20 % svih malignih tumora ljudi. Kao obligatorni intracelularni paraziti, virusi kodiraju proteine koji reprogramiraju signalne puteve odgovorne za kontrolu proliferacije, diferencijacije, smrti stanice, genomskog integriteta, kao i prepoznavanja od strane imunološkog sustava. Virusni sustavi podržavaju koncept da je za razvoj tumora potrebna akumulacija međusobno povezanih događaja. Virusi koji su do sada prihvaćeni kao etiološki čimbenici ljudskih malignoma uključuju hepatitis B virus, Epstein-Barr virus, humani papiloma virus, virus leukemije ljudskih T-stanica, hepatitis C virus, te još nekoliko ljudskih onkogenih virusa. Obično protekne niz godina od infekcije do razvoja tumora i većina inficiranih osoba ne razvije rak, iako imunološki kompromitirane osobe pokazuju veći rizik za nastanak tumora povezanih s virusima. Malo je vjerojatno da je virus sam dovoljan da transformira normalnu stanicu u tumorsku. Vjerojatnija je mogućnost da kombinirano djelovanje virusnih proteina i mutacije staničnih gena zajedno vode tumorogenezi., It is estimated that viral infections contribute to 15-20 % of all human cancers. As obligatory intracellular parasites, viruses encode proteins which reprogramme host cellular signalling pathways which in turn control proliferation, differentiation, cell death, genomic integrity, and recognition by the immune system. Viral systems support the concept that cancer development occurs by accumulation of multiple cooperating events. Viruses are now accepted as etiologic factors of human cancer, and include hepatitis B virus, Epstein-Barr virus, human papillomaviruses, human T-cell leukemia virus and hepatitis C virus, plus several candidate human cancer viruses. Many years may pass between initial infection and tumor appearance. Most infected individuals do not develop cancer, although immunocompromised individuals are at elevated risk of viral-associated cancers. It is unlikely that a tumor virus is sufficient to convert a normal cell to a tumor cell. Rather, a combination of the action of viral proteins and cellular gene mutation cooperate to drive tumorogenesis.

Psorijaza je diljem svijeta jedna od najčešćih upalnih bolesti kože kroničnog tijeka. Dok se blagi oblici bolesti uspješno liječe primjenom lokalne terapije, trećina bolesnika s umjereno teškim do teškim oblikom bolesti zahtijeva primjenu sustavne terapije. Tradicionalni lijekovi za sustavnu primjenu u dosadašnjem su iskustvu, kao i u mnogim kliničkim studijama, pokazali visoku učinkovitost u liječenju psorijaze. Metotreksat, ciklosporin i acitretin cjenovno su isplativi i pružaju odličnu kontrolu bolesti. Njihova primjena ograničena je isključivo mogućnošću teških nuspojava koje se pažljivim praćenjem bolesnika mogu uspješno kontrolirati i svesti na minimum., Psoriasis is one of the most common chronic inflammatory skin disease worldwide. While mild forms of the disease can be successfully controlled by applying local therapy, one third of patients with moderately severe to severe form of psoriasis, requires the application of systemic therapy. As indicated in many clinical studies, the conventional drugs for systemic use in so far experience have shown high efficacy in treating psoriasis. Methotrexate, cyclosporin and acitretin are cost affordable and provide excellent disease control. Their application is limited only by the possibility of serious side effects, which can be successfully controlled and kept to a minumum through carefully monitoring of patient.

Koža je najgušće inerviran organ ljudskog tijela, u vrlo bliskom kontaktu sa živčanim sustavom. U međusobnu intenzivnu komunikaciju uključene su sve strukture živčanog, endokrinog i imunološkog sustava, kao i sve stanice kože. Interakcija je posredovana različitim tipovima kožnih živčanih vlakana koja otpuštaju neuromedijatore i aktiviraju specifične receptore na ciljnim stanicama kao što su keratinociti, mastociti, Langerhansove stanice, endotelne stanice, stanice mikrovaskulature, fibroblasti i infiltrirajuće imunološke stanice. Ove interakcije utječu na brojne fiziološke i patofiziološke funkcije, uključujući rast i razvoj stanica, diferencijaciju, imunost, vazoregulaciju i cijeljenje rana. Nova saznanja o čimbenicima uključenim u ove interakcije utvrdila su suvremeni koncept neurobiologije kože., The skin is the most densely innervated organ in the body and there is a close relationship between the skin and the nervous system. Monodirectional and/or bidirectional pathways exist in which the central and peripheral nervous system, endocrine and immune system, and almost all skin cells are involved. The interaction between peripheral nerves and immune system is mediated by different types of cutaneous nerve fibers which release neuromediators and activate specific receptors on target cells in the skin such as keratinocytes, mast cells, Langerhans cells, microvascular endothelial cells, fibroblasts, and infiltrating immune cells. These interactions influence a variety of physiologic and pathophysiologic functions including cellular development, growth, differentiation, immunity, vasoregulation, leukocyte recruitment, pruritus, and wound healing. Information is emerging about the factors involved in these immunomodulatory mechanisms. Recent findings have established a modern concept of cutaneous neurobiology.

Procjenjuje se da virusne infekcije pridonose nastanku 15 – 20 % svih malignih tumora ljudi. Kao obligatorni intracelularni paraziti, virusi kodiraju proteine koji reprogramiraju signalne puteve odgovorne za kontrolu proliferacije, diferencijacije, smrti stanice, genomskog integriteta, kao i prepoznavanja od strane imunološkog sustava. Virusni sustavi podržavaju koncept da je za razvoj tumora potrebna akumulacija međusobno povezanih događaja. Virusi koji su do sada prihvaćeni kao etiološki čimbenici ljudskih malignoma uključuju hepatitis B virus, Epstein-Barr virus, humani papiloma virus, virus leukemije ljudskih T-stanica, hepatitis C virus, te još nekoliko ljudskih onkogenih virusa. Obično protekne niz godina od infekcije do razvoja tumora i većina inficiranih osoba ne razvije rak, iako imunološki kompromitirane osobe pokazuju veći rizik za nastanak tumora povezanih s virusima. Malo je vjerojatno da je virus sam dovoljan da transformira normalnu stanicu u tumorsku. Vjerojatnija je mogućnost da kombinirano djelovanje virusnih proteina i mutacije staničnih gena zajedno vode tumorogenezi., It is estimated that viral infections contribute to 15-20 % of all human cancers. As obligatory intracellular parasites, viruses encode proteins which reprogramme host cellular signalling pathways which in turn control proliferation, differentiation, cell death, genomic integrity, and recognition by the immune system. Viral systems support the concept that cancer development occurs by accumulation of multiple cooperating events. Viruses are now accepted as etiologic factors of human cancer, and include hepatitis B virus, Epstein-Barr virus, human papillomaviruses, human T-cell leukemia virus and hepatitis C virus, plus several candidate human cancer viruses. Many years may pass between initial infection and tumor appearance. Most infected individuals do not develop cancer, although immunocompromised individuals are at elevated risk of viral-associated cancers. It is unlikely that a tumor virus is sufficient to convert a normal cell to a tumor cell. Rather, a combination of the action of viral proteins and cellular gene mutation cooperate to drive tumorogenesis.

Psorijaza je diljem svijeta jedna od najčešćih upalnih bolesti kože kroničnog tijeka. Dok se blagi oblici bolesti uspješno liječe primjenom lokalne terapije, trećina bolesnika s umjereno teškim do teškim oblikom bolesti zahtijeva primjenu sustavne terapije. Tradicionalni lijekovi za sustavnu primjenu u dosadašnjem su iskustvu, kao i u mnogim kliničkim studijama, pokazali visoku učinkovitost u liječenju psorijaze. Metotreksat, ciklosporin i acitretin cjenovno su isplativi i pružaju odličnu kontrolu bolesti. Njihova primjena ograničena je isključivo mogućnošću teških nuspojava koje se pažljivim praćenjem bolesnika mogu uspješno kontrolirati i svesti na minimum., Psoriasis is one of the most common chronic inflammatory skin disease worldwide. While mild forms of the disease can be successfully controlled by applying local therapy, one third of patients with moderately severe to severe form of psoriasis, requires the application of systemic therapy. As indicated in many clinical studies, the conventional drugs for systemic use in so far experience have shown high efficacy in treating psoriasis. Methotrexate, cyclosporin and acitretin are cost affordable and provide excellent disease control. Their application is limited only by the possibility of serious side effects, which can be successfully controlled and kept to a minumum through carefully monitoring of patient.

Alopecija areata (AA) česta je bolest koja se očituje neožiljnim gubitkom dlake na vlasištu i/ili tijelu. Folikul dlake u alopeciji areati nije nepovratno uništen, stoga potencijal za ponovni rast kose ostaje. Budući da je etiopatogeneza nepoznata, liječenje AA je simptomatsko i usmjereno na zaustavljanje aktivnosti bolesti. Limfociti oko dlačnog folikula, povišena razina autoprotutijela, poremećaj citokina te udruženost s drugim autoimunosnim bolestima, podupiru hipotezu da je AA organ-specifična autoimunosna bolest. Nova su istraživanja stoga usmjerena na razvoj lijekova koji bi imunomodulatornim ili imunosupresivnim djelovanjem potaknuli rast dlake. Proučavanje utjecaja novih bioloških lijekova na rast kose, kao i razvoj genske terapije u tijeku su. U radu će biti raspravljeni suvremeni principi i dostupne metode liječenja alopecije areate., Alopecia areata (AA) is a frequent disease with nonscarring hair loss on the scalp and/or body. Hair follicle in alopecia areata is not irreversibly destroyed, so potential for hair regrowth remains. Considering unknown etiopathogenesis, treatment of AA is symptomatic and directed toward halting disease activity. Lymphocytic inflammatory infiltrate around hair follicle, increased levels of autoantibodies, cytokine abnormalities and increased prevalence of autoimmune comorbidities, support the hypothesis of AA as an organ-specific autoimmune disorder. Therefore, investigations are directed toward new immunomodulatory or immunosupresive drugs with induction effect on hair growth. New biologic drugs and their influence on hair growth as well as genetic therapy for alopecia areata are currently under investigation. Contemporary principles in therapy of alopecia areata and treatments available will be discussed in this article.

Psorijaza je kronična, recidivirajuća bolest kože koja traje čitav život. Četvrtina bolesnika boluje od teškog oblika psorijaze koji zahtijeva primjenu sustavne terapije. Unatoč razvoju novih skupina lijekova, tradicionalna terapija i dalje je veoma važna. Metotreksat, ciklosporin i acitretin cijenom su prihvatljivi i pružaju odličnu kontrolu bolesti. Metotreksat i acitretin dobar su izbor u smislu terapije održavanja, dok je ciklosporin idealan kao intermitentna terapija. Strah od teških nuspojava tradicionalnih lijekova može se izbjeći individualnim određivanjem terapije i pažljivim nadzorom bolesnika., Psoriasis is a chronic, recurrent skin disease that lasts a whole life. A quarter of adults are suffering from severe forms of psoriasis that requires the application of the systemic treatment. Despite the development of new groups of medicines, traditional therapy is still of great importance. Methotrexate, cyclosporine and acitretin are cost-effective and provide excellent disease control. Methotrexate and acitretin are good choice in terms of maintenance therapy, whereas cyclosporin would ideally be used as intermittent therapy. Fear of serious side effects of traditional drugs can be avoided by setting individualized plan for each patient and careful monitoring.

Apoptoza je fiziološki proces programirane smrti stanica odgovoran za održavanje homeostaze u organizmu. U koži se procesom apoptoze nadzire proliferacija i diferencijacija keratinocita te tako održava homeostaza unutar epidermisa. Proces programirane stanične smrti nadziru proteini porodice Bcl-2 uključujući više proapoptotskih (Bax, Bak, Bad) i protuapoptotskih molekula (Bcl-2, Bcl-xl). Danas se smatra da poremećaj procesa apoptoze ima važnu ulogu u razvoju mnogih kožnih bolesti. Psorijaza je kroničnorecidivirajuća upalna bolest kože obilježena poremećajem diferencijacije i proliferacije keratinocita te sniženom apoptozom keratinocita unutar epidermisa. Na temelju dosadašnjih spoznaja o ulozi programirane stanične smrti u nastanku psorijaze, čini se da apoptoza ima važnu ulogu u razvoju epidermalne hiperproliferacije psorijatične lezije. Budući da proteini porodice Bcl-2 nadziru proces apoptoze, važno je razjasniti njihovu ulogu u patogenezi psorijaze. Naime, uočena povećana ekspresija protuapoptotskih, a sniženo izražavanje proapoptotskih molekula porodice Bcl-2 u psorijatičnoj koži upućuju na njihovu važnost u razvoju bolesti., Apoptosis is a physiological process of programmed cell death responsible for homeostasis in the body. In skin, apoptotic process regulates keratinocyte proliferation and differentiation in that way maintaining homeostasis of epidermal compartment. The process of apoptosis is controlled by proteins of the Bcl-2 family, several proapoptotic (Bax, Bak, Bad) and antiapoptotic (Bcl-2, Bcl-xL) proteins. Nowadays, it seems that dysfunctional apoptosis has an important role in the pathogenesis of several skin diseases. Psoriasis is a chronic hypeproliferative inflammatory skin disease characterized by abnormal keratinocyte hyperproliferation and differentiation as well as by decreased keratinocyte apoptosis. Based on recent studies, it is likely that apoptosis has an important role in epidermal hyperproliferation of psoriatic lesion. Having in mind the significance of Bcl-2 family proteins in apoptosis, it is important to elucidate their role in psoriasis pathogenesis. Observed upregulation of antiapoptotic and downregulation of proapoptotic Bcl-2 family molecules in psoriatic skin implies their significance in psoriasis development.

Alopecija areata neožiljni je upalni gubitak dlake na vlasištu i/ili tijelu, nepoznate etiopatogeneze. Najčešće zahvaćeno mjesto je vlasište. Histopatologija se očituje povećanim brojem katagenih i telogenih folikula te nazočnošću upalnog limfocitnog infiltrata u peribulbarnoj regiji. U liječenju alopecije areate najčešće se primjenjuju kortikosteroidi. U radu je opisana klinička i patohistološka slika uz suvremene metode liječenja alopecije areate., Alopecia areata is a nonscarring, inflammatory hair loss on the scalp, and/or body. Etiology and pathogenesis are still unknown. The most common affected site is the scalp. Histopathology is characterized by an increased number of the catagen and telogen follicles along with the presence of inflammatory lymphocytic infiltrate in the peribulbar region. Corticosteroids are the most popular drugs for the treatment of this disease. Clinical features, histological data as well as modern treatment options will be discussed in this article.

Alopecija areata neožiljni je upalni gubitak dlake na vlasištu i/ili tijelu, nepoznate etiopatogeneze. Najčešće zahvaćeno mjesto je vlasište. Histopatologija se očituje povećanim brojem katagenih i telogenih folikula te nazočnošću upalnog limfocitnog infiltrata u peribulbarnoj regiji. U liječenju alopecije areate najčešće se primjenjuju kortikosteroidi. U radu je opisana klinička i patohistološka slika uz suvremene metode liječenja alopecije areate., Alopecia areata is a nonscarring, inflammatory hair loss on the scalp, and/or body. Etiology and pathogenesis are still unknown. The most common affected site is the scalp. Histopathology is characterized by an increased number of the catagen and telogen follicles along with the presence of inflammatory lymphocytic infiltrate in the peribulbar region. Corticosteroids are the most popular drugs for the treatment of this disease. Clinical features, histological data as well as modern treatment options will be discussed in this article.

Tinea incognito is a dermatophyte infection modified by inappropriate and often prolonged use of topical steroids. We present a case of tinea incognito in a 72-year-old woman, referred by her family physician who had unsuccessfully treated the lesions for 3 weeks with topical steroid cream. Physical examination revealed multiple nummular scaly papules and plaques which spread over her arms and trunk. The lesions were circular, erythematous, sharply demarcated with raised scaly edge some coalescing to form moderately infiltrated areas. Direct microscopy was positive for fungal hyphae. Fungal culture on Sabouraud’s agar grew Trichophyton rubrum. The patient was successfully treated with oral terbinafine 250mg daily and 1% clotrimazole cream twice daily. The present case highlights the importance of considering a dermatophytosis when clinical presentation of dermatosis is atypical. Disseminated scaly infiltrate lesions should be investigated for fungal infection in patients previously treated with steroids, as to avoid misdiagnosis and spread of infection.

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

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

Recent studies have indicated an increasing incidence of melanoma worldwide. Although UV signature mutations are found rarely in melanoma cells, there is some evidence that intense intermittent exposure to sunlight can induce melanocyte tumorigenesis, and this is also observed after UV irradiation in some animals. The purpose of this paper is to review some of the most important mechanisms involved in the pathogenesis of this tumor. Genetic studies showed the familiar melanoma is linked to the mutation or deletion of the suppressor gene CDKN2A, and perhaps to CDK4. Studies showed that BRAF mutation is frequent in primary and metastatic melanoma cells but also in naevocytic nevi. This mutation activates the RAF/MEK pathway. Exposure to UV radiation induces immunosuppression. Recent investigations showed that chemokines, angiogenesis, metalloproteinases can play a role in the mechanism of metastasis. In spite of these advances the initiating events are still not completely understood. In conclusion, the pathogenesis of melanoma is very complex because numerous genetic and epigenetic factors are implicated in its development and progression, but some of the showed mechanisms can be targets for new therapies.

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.

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.