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BACKGROUND: Pseudoxanthoma elasticum (PXE) is a rare, genetic, metabolic disease with autosomal recessive inheritance caused by mutations in the ABCC6 gene. The lack of functional ABCC6 protein leads to ectopic mineralization that is most apparent in the elastic tissues of the skin, eyes, and blood vessels. Dermatologic manifestations consist of small yellow papules on the nape and sides of the neck and in flexural areas that coalesce into reticulated plaques resembling the cobblestone aspect, and then the skin becomes loose and wrinkled. Histopathologic findings provide characteristic clues such as short, fragmented, clumped, and calcified mid-dermal elastic fibers. CASE PRESENTATION: A 27-year-old Albanian female was referred to the dermatology clinic with skin complaints for approximately 17 years. On physical examination, we observed “cobblestone pattern” lesion located in the anterior, lateral, and posterior aspects of the neck, bilateral axillary, inguinal, antecubital, and popliteal regions, and periumbilical area. A biopsy was performed and the histopathology confirmed the typical changes in the dermis because of ectopic mineralization. The funduscopy revealed the “peau d’orange” aspect, bilateral angioid streaks but no neovascularization. Carotid echography showed minimal intimate thickening with flow acceleration but without significant stenosis of the right common carotid artery (ACC). Different laboratory exams were conducted that resulted within the normal range. CONCLUSION: There is no specific treatment, and therapeutical management is based on prevention, tracking, and follow-ups to increase surveillance of clinical complications through a multidisciplinary team. The dermatologist is usually the first who faces Pseudoxanthoma elasticum manifestations. Therefore, the dermatologist should provide the patient with the best therapeutical and preventive approaches.

Introduction NMSC is the most common cancer in countries with a largely fair skin phenotype population and moderate sun exposure. Objectives Assessing risk factors in the military personnel. Comparing the risk factors in this occupational group to the general population. Materials and methods 200 active-duty military members and 1000 individuals (the control group) were randomly selected from the general population. We used transversal data collection through a questionnaire, filled in by all participants in the study based on self-report on general data, skin type, habits, lifestyle and inheritance risk for cutaneous cancer. Results Analyzing the connection between risk factors reported and incidence for NMSC and melanoma, the following factors resulted significant: The control group the age variable >50 yo and BMI ≥ 25 were significant. The study group (military personnel), among the variables statistically examined through Pearson's test resulted significant: age> 50 years old, fair skin phenotype, sunburn during childhood, familial history of cutaneous cancer, dark spots (> 20) on the arm and coffee consumption as a protective factor. Conclusions Military personnel has more significant risk factors for developing cutaneous cancer compared to other population groups therefore, prevention and early detection strategies are needed. This article is protected by copyright. All rights reserved.

Acne vulgaris is a common adolescents' disorder. Nevertheless, there is lack of knowledge about acne among adolescents. To evaluate the adolescents' knowledge and beliefs about acne, to investigate help-seeking behavior and treatment preferences. A cross-sectional study conducted in 10 public high schools in Tirana. A total of 2036 students enrolled. All participants were asked about socio-demographic data, knowledge and beliefs about acne, treatment-seeking behaviors and clinical preferences. Of participants 45.3% thought acne is a medical problem, 23.1% thought it's a cosmetic problem, and less than 10% thought acne is a normal condition for their age. Of adolescents 30% did not know that acne is not contagious, 49.7% believed acne is curable with prescribed medication, 33.4% thought acne heals by itself, and only 0.9% believed acne is non-curable. Male adolescents were more likely to have lower level of knowledge and misconceptions about acne compared to females. Only 18.5% had consulted a dermatologist. The majority (54.7%) were using anti-acne products recommended by their friends or pharmacists. Only minority of Albanian adolescents with acne consults a dermatologist. Age, gender and acne severity play a significant role in determining help-seeking behavior. Patient and parent education can significantly improve the treatment outcome.

To compare results of different treatment regimens based on stratification of acne to prescribe the right treatment protocol according to clinical form and grade of acne. A transversal, cohort study conducted in 230 patients with acne vulgaris. Patients were divided into three groups according to acne severity and the results of each protocol determined in 0, 4, 6, 8, 12, 18 and 24 weeks. Statistical analysis was conducted using Wilcoxon and Mann-Whitney tests 230 patients (99 females and 131 males) took part in the study. In first grade acne (70 patients), the most effective drug for papulo-pustular lesions was azelaic acid, where the average value of the reduction was 1.03% per week. For comedone reduction, the most effective drug resulted retinol with 17.7% mean reduction per week. In second grade acne (66 patients), the most effective scheme was: doxycycline + topical retinoid + benzoyl peroxide. In the third grade (92 patients), the most effective drug was oral isotretinoin. Accurate stratification, based on clinical characteristics is required for better outcome. Treatment success is related to the respective individually tailored treatment schemes in patients with acne.

Acne vulgaris is a common adolescent disorder but the data related to acne vulgaris is insufficient in Albania. The aim of this study was to assess the epidemiologic features of acne vulgaris and to identify lifestyle and constitutional factors in formulating a proper management protocol. A cross-sectional study conducted on a representative sample of 2036 adolescents from 10 high schools located in Tirana. A self-administered questionnaire was administered to collect the data. The binary logistic regression was applied to assess the factors linked to the presence of acne vulgaris in adolescents. The mean age in the study population was 16.2 ± 0.9 years. The self-reported prevalence of acne was 50.3% (52.1% in females and 47.9% in males). Lifetime prevalence was 68.5%. The factors significantly associated with an increased likelihood over time were: frequent consumption of sweets, frequent endurance of stress, poor quality of sleep, positive family history of acne, oily and combination skin, menstrual disorders. Acne vulgaris is common among adolescents in our country. The identification of various modifiable factors related to acne generates opportunities to tailor and focus prevention efforts and better management and treatment planning in relevant high-risk groups.

Wegener's granulomatosis, is a rare form of systemic vasculitis characterized by necrotic granulomas around the blood vessels. We report a case of a healthy 43-year-old man presented with multiple ulcerated lesions in head and all over the body, that has appeared spontaneously. It was characterized by a giant deep ulceration covered by thick purulent, in size from 3 to 4 cm, deep; sub febrile temperature, and minimal pain associated. Skin biopsies results pyoderma gangrenosum (PG)-like features: anti-neutrophil cytoplasmic antibody (cANCA) positive. Six months later, the patient developed dispea episodes. CT scan (CT) result with multiple focal opacities. He was diagnosed with wegener granulomatosis (WG) and was treated with corticosteroids and ciclophosphamide. Skin involvement in WG is not common and lesions in the skin vary from purpura, paniculitis to ulceration. In our case, skin elements are the first manifestations. Whether these elements are Wegener manifestation or we have coexistence of PG with WG, it remains a still uncertain question to answer. There is no histopathologic pathognomic elements for both. Skin involvement in WG with PG-like lesions have been rarely reported. In front of this type of widespread ulcerations, resistant to treatment we should be aware that one of the reasons may be a disease of autoimmune etiology such as WG.

Psoriasis is a chronic, immune-mediated skin disease that also has systemic manifestations. Biologic preparates: Adalimumab, Etanercept, and Infliximab are licensed for psoriasis vulgaris treatment in Albania. To compare the efficacy of biologic therapies used for psoriasis based in our experience. A cohort prospective study during the years 2016-2018 at UHC "Mother Teresa" Tirana. In the study took place 78 patient diagnosed with psoriasis and treated with biologic therapies. Psoriasis Area Severity Index (PASI) 50 and PASI 75 index were the parameters of response outcomes. PASI 50 was achieved for 6.8, 7.02, and 7.2 weeks in patients with Etanercept, Adalimumab, and Infliximab respectively and PASI 75 for 12.8, 11.4, and 11.42 weeks. X2 = 0.076, p > .05, nonsignificant difference. PASI 50 was achieved in 27.2% of subject treated with Etanercept, 67.4% Adalimumab, and 55.5% with Infliximab for the weeks mentioned above. Meanwhile PASI 75 was achieved in 45.4% of subject treated with Etanercept, 61.7% Adalimumab, and 25% with Infliximab. X2 = 15.28, p < .05, significant difference. Biologics have revolutionized the treatment of psoriasis. To select the most appropriate agent for patient, should be considered multiple factors including adverse effects, tolerance, patient preference, cost, and mode of administration.

Syphilis is an infectious disease with Treponema Pallidum being its causative agent. When not treated it can pass through 4 stages: primary, secondary, latent and tertiary. Syphilis has a broad spectrum of skin and mucosal manifestations and can imitate many other skin disease, hence the name ldquo;The great Imitatorrdquo;. The number of patients infected with syphilis has declined dramatically after penicillin invention. Albania has not had a significant number of cases but eruptions has been seen time after time. Herein, we describe 5 cases of suspected syphilis presented at our clinic.

Introduction: Onychomycosis is a fungal infection of the nail unit. Anatomical and physiological characteristics of the nail apparatus impose the need for long-term treatment to achieve complete cure. Goal: The main goal of this project is to study the effectiveness of several treatment protocols for onychomycosis based on Scoring Clinical Index for Onychomycosis (SCIO). Material and methods: The study included 133 patients with onychomycosis, diagnosed by KOH microscopy and culture. Based on disease severity, patients were grouped into groups with SCIO values: 6-9, and 12-16. These groups were randomly subdivided to 5 subgroups according to the given treatment protocols: fluconazole 150 mg 1x weekly, itraconazole continual therapy, itraconazole pulse therapy, terbinafine 250 mg/d, and terbinafine + ciclopirox 8% lacquer, respectively. The cure rate was evaluated at the end of 48 week. Results: The obtained cure rates according to the above mentioned protocols were: 92.30%, 81.81%, 83.33%, 90.90%, and 100%, respectively for groups of patients with SCIO values 6 – 9. Within patients with SCIO values 12-16, were achieved cure rates as follows: 78.57%, 78.57%, 75%, 80%, and 86.66%. Conclusions: There was no statistically significant difference in cure rate between five treatment protocols applied in this study. In patients with high SCIO values is expected a decrease in cure rate.

This review presents a concise delineation of the historical roots of nomenclature and first reports of entities recognized today as immunoblistering dermatoses. The scope of the perspective of terminology is the time from Hippocrates BC to past mid-twentieth century AD, and pemphigus is the core of the matter. Researchers in this field may find these important historic facts interesting and useful as a quick reference.

Idiopathic calcinosis cutis is an uncommon condition characterized by calcium deposits in the dermis, subcutis, and muscles that most commonly are localized in one area. We report the rare case of a 16-year-old adolescent girl who exhibited unusually widespread calcium deposits. The laboratory results showed a normal biochemistry profile. Ultrasonography revealed calcifications in the fat tissue under the skin but not in deeper tissues or muscles. The histopathologic evaluation showed deep cutaneous and subcutaneous calcium deposits. Laboratory investigation revealed normal calcium, phosphate, and parathyroid hormone levels. Calcium excretion in a 24-hour urine sample was normal, but phosphate excretion was slightly low. Scintigraphic research showed no pathology in the thyroid and parathyroid glands but revealed soft-tissue calcification. A chest roentgenogram, blood tests, and testing of stools for occult blood showed no indication of internal malignancy. On the basis of these findings,the diagnosis of idiopathic calcinosis cutis was made. We discuss the pathogenesis, clinical and histologic picture, and differential diagnosis of calcinosis cutis.

Introduction: Exfoliative Erythroderma syndrome is a serious, at times life-threatening reaction pattern of the skin characterized by generalized and uniform redness and scaling involving the entire skin and often associated with systemic toxicity, lymphadenopathy and fever. Diffuse Cutaneous Leishmaniasisis observed in anergic patients with a low immune response. Case report: We are presenting a case of a 17-year-old patient diagnosed with Diffuse Cutaneous and Visceral recidivial Leishmaniasis, which clinically presented Erythroderma and skin exfoliation. The most common causes of Erythroderma are Psoriasis, Allergic Dermatitis, Drug Reactions, Lymphoma and Pityriasis Rubra Pilaris. Conversely, Diffuse Cutaneous Leishmaniasis is characterized by the presence of non-ulcerative nodules which resemble Lepromatous Leprosy, scattered in in every part of the body.To the best of our knowledge, the present clinical manifestation of Leishmaniasis has not yet been reported in the literature. Conclusion: In the correct clinical and epidemiological scenario, diffuse Cutaneous Leishmaniasis should be suspected in patients presenting Exfoliative Erythroderma and diffuse nodular lesions.

The term "Diabetes mellitus" encompasses a heterogeneous group of disorders characterized by insulin hyposecretion and/or insensitivity. Type 1 DM is a chronic autoimmune disease associated with selective destruction of insulinproducing pancreatic b-cells. A variety of gene loci have been studied to determine their association with type 1 DM. The early studies suggested that the B8 and B15 of HLA class I antigens were increased in frequency in the diabetics compared to the control group. However, more recently the focus has shifted to the class II HLA-DR locus. It was found that DR3 and DR4 were more prevalent than HLA-B in type 1.DM than HLA-B. The nature of autoantigen(s) responsible for the induction of type 1 DM is unknown. The identification of autoantigens in type 1 DM is essential both for diagnostic purposes and for potential immunotherapeutic intervention in the disease process. Type 2 DM has a greater genetic association than type 1 DM. The 100% concordance rate in identical twins is thought to be overestimated, due to a selection or reporting bias. A population based twin study in Finland has shown a concordance rate of 40%. Environmental effect may be a possible reason for the higher concordance rate for type 2 DM than for type 1 DM. Perturbations in glucose metabolism due to insulin resistance are further exacerbated when insulin production is compromised.Insulin resistance is a characteristic feature of most patients with Type 2 diabetes mellitus.Several cross-sectional studies in non diabetic subjects on the general population or in individuals with impaired glucose tolerance (IGT)/impaired fasting glucose (IFG) have confirmed that acute-phase reactants such as CRP (and sometimes the cytokines IL-6 and TNF-┙) are positively correlated with measures of insulin resistance/plasma insulin concentration, BMI/waist circumference, and circulating triglyceride and negatively correlated with HDL cholesterol concentration. In general, increasing components of the metabolic syndrome in individuals are associated with higher levels of inflammatory markers. In subjects with IGT or IFG, IL-6 but not TNF-┙ appears to be elevated compared with individuals with normal glucose tolerance and in one study, inflammatory markers were related to insulin resistance but not to insulin secretion . Psoriasis is a chronic inflammatory disease of the skin, scalp, nails, and sometimes joints that affects 1-2 percent of the general population.Psoriasis is a clinical diagnosis. The disease is characterized by erythematous and indurate plaque which usually are covered by thick silvery white scales and can manifests as psoriatic arthritis (PsA), an inflammatory joint

Background Pyoderma gangrenosum is a rare inflammatory disease of unknown etiology and unspecific histopathology. There are no clear-cut criteria for the diagnosis of this disease. The diagnosis is usually made based on clinical appereance, course of disease and possible, commonly coexisting disorders. In atypical cases the diagnosis is based on exclusion of other causes of similar appearing cutaneous ulcerations.