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We present a case of proximal pyogenic granuloma in 4-year-old child. The patient presented to our Department due to a fast-growing lesion on the proximal part of the nail unit. The lesion had appeared over several weeks, and it was extremely painful for the child. On the day of the 1st visit, the lesion was not bleeding but was very painful during examination and photo-documentation. Clinically, it presented as an exogenous tumoral lesion of the proximal 1/3 of the nail, partially exulcerated with one part exhibiting coagulated hemorrhage and with uneven coloration (Figure 1). The lesion was not sharply demarcated. Dermoscopically, the majority of the lesion presented an unspecific dermoscopic structure, orange background color, and matched the criteria for a vascular lesion: few unspecific vessels and hemorrhage. The “sticky fiber” sign was also present (Figure 2). Since the lesion was fast-growing and due to the unspecific dermoscopic appearance, the child was referred to a pediatric surgeon and a complete excisional biopsy of the lesion was performed. The dermoscopy of pyogenic granuloma has been already described (1). The histology report confirmed pyogenic granuloma

Acne vulgaris is a common chronic skin disorder of the pilosebaceous unit with a wide range of clinical presentations, which depend on the age of onset of acne, sex, family history of acne, and genetic factors, especially the genes affecting keratinization and desquamation. This retrospective study investigated pediatric acne using the patients’ past medical history, with patients aged from newborns to 15 years of age. Acne were further stratified by 5 parameters: sex, age, family history, acne type, and localization. Our main aim was to investigate the possible association between selected parameters and the presence or absence of family history of acne. We did not find statistically significant correlation between sex, age of onset, and positive family history of acne. Furthermore, we did not find any association between age of onset and family history according to family members (mother/father/brother or sister). However, we found statistically significant correlation between sex and type of acne. This retrospective analysis of pediatric acne in Croatia did not reveal statistically significant correlation between positive family history and sex, age of onset, and clinical type of acne. In analyzing the correlation between family history and localization of acne, however, we found that the number of patients with acne localized on both the face and trunk and positive family history was statistically significant higher than expected.

Rijetka prezentacija histiocitoze Langerhansovih stanica s lošijom dugoročnom prognozom. Važno je pravodobno posumnjati u svih bolesnika s dugotrajnim kožnim promjenama i GI simptomatologijom.

Pediatric patients and their parents are particularly vulnerable to the burden of skin disease. Chronic disease in childhood may negatively affect development and overall quality of life (QoL). Interest in QoL measurement in pediatric patients with skin disease has grown in recent years and started with an increased recognition of the psychosocial burden experienced by young patients with disease and their families. The most common studies were conducted on atopic dermatitis, psoriasis, vitiligo and acne. Children with these most common skin diseases are more likely to experience depression, low self-esteem, and lack of sleep, bullying, poor social interactions, poor medical compliance and poorer health outcomes as adults and therefore a significant impairment of QoL. Among other impacts the burden of pediatric skin disease affects the family unit as a whole. In that context one must pay attention to the intense emotional and biological connection between children and their caregivers and the degree to which this relationship regulates and influences children’s behavior. The skin has an important role in this connection because it is through the skin that the child perceives its first sensations and begins to identify what is pleasurable or not. Thus, the presence of skin disease can have repercussions on the children-adult bond and the healthy development of a relationship.The literature also identifies the influence of the caregiver’s behavioral disturbances on the child’s illness, the evolution of the disease and even on the development of future adults. In studies on the QoL on these most common chronic skin diseases anxiety and depression occur most frequently among caregivers of pediatric patients. Exposure to negative experiences related to anxiety and depression in their main caregiver can have the effect of reducing their quality of life. In turn, psychosomatic mechanisms may be linked to the worsening of skin diseases reported in pediatric studies. It is important that dermatologists be aware of available QoL indices and to use them to recognize the specific emotional vulnerability within this group of pediatric patients and not to minimize the role of their parents and their impact in an overall treatment that contributes to their QoL and emotional development.

INTRODUCTION & OBJECTIVES: Fungal scalp infections caused by Microsporum (M.) canis tend to be noninflammatory, but recently, progressive numbers of cases of tinea capitis characterized with highly inflammatory infection caused by M. canis and M. gypseum, have been registered. We present case of highly inflammatory tinea capitis, also known as kerion celsi with dermatophytide reaction caused by M. canis. MATERIAL & METHODS: A 6-year-old, otherwise healthy girl, with tender, infiltrated, 6x4 cm large plaque in the occipital region of the scalp, of 2.5 months duration has been examined. Almost complete loss of hair, a few satellite plaques with pustules on the surface, and exudation from some of the follicular orifices could be observed. Multiple annular lesions spread over the neck and shoulders. In addition, papular exanthema of the trunk and bilateral cervical lymphadenopathy were present. The patient was in a good condition, and routine investigations were all within the normal limits. Fungal culture on modified Sabouraud dextrose agar medium, revealed flat, white to creamy colonies with cottony surface and golden brownish-yellow reversed pigment. Diagnosis of kerion due to M. canis was established. M. canis has been confirmed in the isolate by the use of the molecular methods (PCR-RFLP), as well. Thus, ITS1 and ITS4 universal primers were used to amplify ITS1-5.8s rDNA-ITS2 region. By the RFLP analysis of the PCR product of the isolated strain and reference strain of M. canis ATCC 36299, using Hinf1 restriction enzyme a unique pattern for M. canis has been revealed. Mycological examination of the papular lesions of the trunk was negative, so these lesions were considered as dermatophytide reaction. The treatment with oral terbinafine 125 mg/day had been prescribed together with topical gyrodalate ointment and triamcinolone acetonide cream followed with miconazole cream. Systemic prednisolone, 10 mg/day for 7 days has been also administered in order to relive symptoms of “ide” reaction and to prevent scarring. After 12 weeks of therapy, complete clinical and mycological regression was observed. CONCLUSIONS: Changes in epidemiology and clinical pattern of fungal infections due to M. canis have become significant in the recent years. M. canis, thus not only Trichophyton spp. as previously reported can also be responsible for kerion and dermatophytide reactions. Greater awareness is needed in order to establish proper diagnosis and successful treatment strategy for those patients.

Uvod: Među općenito rijetkim, ali vjerojatno i subdijagnosticiranim autoinflamatornim bolestima kostiju, kronični rekurentni multifokalni osteomijelitis (CRMO) i sinovitis, akne, pustuloza, hiperostoza, osteitis (SAPHO) sindrom predstavljaju dva najčešća entiteta. Klinički se prezentiraju znakovima upale različitih dijelova skeleta te spektrom kožnih manifestacija, koje ne moraju biti prisutne u svih bolesnika ili se mogu razviti godinama nakon početka bolesti. Obzirom na niz sličnosti, dio autora smatra da je CRMO, koji se dominantno javlja u dječjoj dobi, podtip SAPHO sindroma, koji se najčešće klinički prezentira u adolescenciji ili odrasloj dobi. Cilj: Analizirati i usporediti karakteristike bolesnika s CRMO i SAPHO sindromom. Metode: Retrospektivna analiza i usporedba podataka iz medicinske dokumentacije bolesnika s CRMO i SAPHO sindromom liječenih u Referetnom centru za pedijatrijsku i adolescentnu reumatologiju u periodu od 2008. – 2016. godine. Rezultati: U periodu od 2008. – 2016. godine u Referetnom centru obrađivane su i liječene 3 djevojčice s CRMO prosječne dobi od 7 godina i 5 mladića sa SAPHO sindromom, prosječne dobi od 15 godina u vrijeme postavljanja dijagnoze. Svi bolesnici su inicijalno imali umjereno povišene upalne parametre. U svih bolesnica s CRMO obradom su nađene multifokalne upalne promjene različitih dijelova aksijalnog i perifernog skeleta, u samo jedne bolesnice promjene su bile simetrične. Niti jedna nije imala kožnih promjena. Liječene su nesteroidnim protuupalnim lijekovima, u jedne je navedenom terapijom postignuta remisija, dok je u dvije bolesnice inidicirana i kraća sistemska primjena glukokortikoida s istim, povoljnim ishodom. U dva bolesnika sa SAPHO sindromom nađen je tipični scintigrafski nalaz upalnog zahvaćanja sternoklavikularnih zglobova i sternuma, dok su u ostalih bolesnika promjene detektirane u različitim drugim dijelovima skeleta, uključujući maksilu i mandibulu. Kožne promjene u vidu opsežnih akni imali su svi bolesnici, u 4 su akne predstavljale inicijalni simptom bolesti, dok su se u jednog razvile 2 godine nakon počekta upalnih promjena skeleta. U četiri bolesnika zadovoljavajuća kontrola bolesti uspostavljena je primjenom indometacina, glukokortikoida ili metotreksata, a u jednog bolesnika anti TNF pripravkom. Zaključak: CRMO i SAPHO sindrom imaju niz zajedničkih karakteristika te se prema dijelu recentne literature CRMO smatra dječjom formom SAPHO sindroma, koji se dominantno javlja u adolescenata i odraslih. Rezultati usporedbe naših bolesnika s navedenim bolestima sukladni su literaturnim podacima. Tek će otkrivanje još uvijek nepoznate etiopatogeneze definitivno razjasniti odnos dviju najčešćih autoinflamatornih bolesti kostiju.

Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma (CTCL). Primary cutaneous lymphomas (PCLs) are exceedingly rare in children and adolescents, with mycosis fungoides (MF) being the most frequent PCL diagnosed in childhood. The incidence of MF is 6.4 per 1, 000, 000 per year in adults, but the occurrence in children and young adults is rare and has not been well established yet. Hypopigmented mycosis fungoides (HMF) is an atypical and rare subtype of MF characterized by solely hypopigmented patches or in combination with erythematous patches or plaques. There are no criteria that define a typical case of HMF. We present three cases of juvenileonset HMF at Department of Dermatology and Venereology, University Hospital Center Zagreb between November 2014 and January 2015. Patients were between 9 and 12 years old at the time of diagnosis. The diagnosis was reached based on clinical, histopathological and immunohistochemical correlation. All patients were investigated at the time of diagnosis with complete blood count, peripheral smear, ultrasonography of abdomen and pelvis, and chest X-ray. They were all without extracutaneous progression of disease. Narrowband UVB (311nm) phototherapy and/or potent topical steroids were used as a first- line treatment. HMF is rare in Caucasians and with only few cases described in children. Juvenile-onset MF is often misdiagnosed at early stages as benign condition. HMF may simulate atopic dermatitis, pityriasis alba, pityriasis lichenoides, tinea versicolor, vitiligo, postinflammatory hyperpigmentation or leprosy (Hansen? disease). Although HMF has good prognosis, it is a malignant skin lymphoma and should always be treated as such. Treatment modalities for juvenile MF are based on general strategies for adults according to disease stage.

Entitet psorijatični nefritis rezerviran je primarno za odrasle osobe koje boluju od psorijaze i u kojih se biopsijom bubrega nalazi IgA nefropatija. Do sada je opisano svega 10-tak slučajeva u odraslih i samo jedan u djeteta. Nikad do sada nije opisan slučaj s histološkim karakteristikama triju glomerularnih bolesti

Nasljedne bulozne epidermolize (EB) skupina su genetski uvjetovanih bolesti obilježenih osjetljivošću kože, u nekim oblicima i sluznica, s nastankom mjehura i erozija nakon beznačajne mehaničke traume. Radi se o multisistemskoj bolesti jer se komplikacije u tih bolesnika javljaju na brojnim organima i organskim sistemima. Kako izlječenja za sada nema, terapija se sastoji od pravodobnog prepoznavanja i liječenja komplikacija, a ključnu ulogu ima pravilna njega rana i zaštita kože. Način zbrinjavanja pojedinih rana ovisi ponajprije o podtipu bolesti, lokalizaciji i izgledu rane. Uz pravilnu njegu rana nužna je i kvalitetna suportivna terapija koja zahtijeva multidisciplinarni pristup.

Sveukupno gradivo iz dermatovenerologije za studente medicine.

Psoriasis may occur at any age and childhood psoriasis is relatively common. Although psoriasis in children is well recognized, few pidemiological studies are available.Objectives: The aim of this study was to present the clinical and epidemiological profile of childhood psoriasis in Croatia.The family history was positive in 151 children (36.9%). The ages of the children ranged from 3 months to 16 years. All children were treated with topical medications, mostly with topical corticosteroids, followed by vitamin D derivatives and keratolytics. Dithranol was used in some children for resistant lesions, and topical tacrolimus and pimecrolimus were commonly used for facial and flexural involvement. In case of non efficacy of local modalities, treatment with narrow band UVB phototherapy was considered. Systemic treatments, PUVA –bath, methotrexate and retinoids were used only in severe cases of plaque psoriasis ; retinoids were used in a child with pustular and in a child with erythrodermic psoriasis. Cyclosporine was used only in one patient. Although biological treatment with etanercept has been introduced for childhood psoriasis in 2009, we have not gained any experience with it until today. Results obtained in population studies are used on patient counseling. The appropriate choice of therapy is extremely important in order to acchieve good control of the disease and to minimise side effects of prolonged therapy. Successful management requires education of children and parents regarding the course of the disease and treatment options. They should be properly explained the chronic nature of the disease and its tendency to exacerbations as well as spontaneous remission, especially in childhood.

Eritrodermije u novorođenačkoj i dojenačkoj dobi predstavlja dijagnostički i terapijski izazov, u čijoj podlozi mogu biti brojni različiti uzroci. Etiološku dijagnozu eritrodermije je teško potaviti, a zbog niske specifičnosti kliničke i histološke slike često je dijagnoza odgođena. Diferencijalna dijagnoza eritrodermija je složeni proces koji uključuje kliničku procjenu, poznavanje relevantne obiteljske anamneze, te provođenje odgovarajućih laboratorijskih pretraga. U slučajevima stanja teške eritrodermije u novorođenačkoj i dojenačkoj dobi, uz koju je prisutno i slabo napredovanje na tjelesnoj masi, uz alopeciju, teške infekcije ili odgovarajuću histološku sliku, potrebno je razmatrati stanja imunodeficijencije ili Nethertonov sindrom, u kojima je prognoza loša sa visokim mortalitetom.

Urtikarija predstavlja učestalu bolest, naročito u dječjoj dobi. Razlikovati treba akutnu i kroničnu spontanu urtikariju od fizikalnih i drugih tipova urtikarije, čiji je tijek u pravilu kroničan. U djece s akutnom urtikarijom važno je isključiti infekciju, naročito onu izazvanu piogenim streptokokom. Hrana i lijekovi rjeđi su etiološki čimbenici nastanka urtikarija. U slučaju spontane kronične urtikarije nužna je detaljna klinička obrada. Anamneza i detaljan fiziklani pregled u bolesnika s urtikarijom važni su u diferencijiranju fizikalnih urtikarija, a nerijetko i otkrivanju okidača simptoma u pojedinog bolesnika. U liječenju je uz eliminaciju uzroka bolesti, u slučajevima gdje je on utvrđen, najvažnija primjena nesedirajućih H1-antihistaminika. Važeće preporuke u liječenju odraslih bolesnika s urtikarijom sugeriraju četverostruko povećanje doze antihistaminika, ako je to nužno. U djece također preporučuje dozu antihistaminika po potrebi povisiti , dok ostala terapija ostaje rezervirana samo za bolesnike čiji se simptomi na navedeno liječenje ne smiruju.

Poremećaji pigmentacije su lako uočljivi, pa stoga imaju jak utjetac na psihosocijalni život pedijatrijskih bolesnika. Melanin proizvode melanociti - specijalizirane dendritičke stanice koje potječu iz neuralnog grebena.One migriraju tijekom embriogeneze u bazalni sloj epidermisa. Melanin se nalazi unutar melanosoma koji se prenose duž dendritskih nastavaka u okolne keratinocite epidermisa i dlačnog folikula. Postoje brojne bolesti koje prate znaci hipopigmentacije kao što su vitiligo, albinizam, pijebaldizam, Wardenburgov sindrom, kemijski inducirana i postinflamatorna hipopigmentacija. Među pormećajima hiperpigmentacije, najčešće su pjege, Bekerov madež, lentiga, mrlje boje bijele kave, melazma te madeži, lijekovima inducirana i postinflamtorna hiperpigmentacija. Među miješane oblike najčešće se dijagnosticiraju inkontinencija pigmenta, pigmentni mozaicizam i diskromatoze.

Vulgarna akne je polietiološka (multifaktorska)dermatoza karakterizirana abnormalnom sebacealnom produkcijom, folikularnom deskvamacijom, bakterijskom proliferacijom i upalom. Jedna je od najčešćih dermatoza uopće. Pogađa sve rase podjednako kao i oba spola, s najčešćom pojavnošću u adolescenata (oko 85%). Međutim, bolest se viđa i kod mlađe djece (9-10 godina) kao i kod starijih od 20 godina, kada je za očekivati nestanak akne. Nešto teži oblici vulgarna akne opisani su kod muškog spola. Vulgarna akne predstavlja i znatan psihološki problem osobama koje ih imaju, na što treba posebno obratiti pozornost u adolescenata.

Langerhans' cell histiocytosis (LCH) is a disease characterised by pathologic accumulation and proliferation of histiocytes, cells from the monocyte-macrophage system, in various tissues and organs. In this retrospective study we analyzed patients charts treated in the Department of pediatric hematology and oncology at the University Hospital Zagreb with the diagnosis of LCH. Twenty-two children were diagnosed between January 1st 1996 and December 31st 2010, and all were treated with chemotherapy. 19 patients survived (86%) and the remaining 3 (14%), all under the age of 2 with multisystem disease, died. At the time of diagnosis 12 children (55%) presented with single-system disease, the most common were bone lesions in 8 children (36%). All children were treated according to protocols LCH-I and LCH -III. Eight children had mild complications of treatment and the disease itself. Diabetes insipidus remains in 4 children.

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare type of T-cell lymphoma of CD3+CD8+ phenotype characterized by deep-seated skin nodules or plaques mimicking panniculitis, a result of neoplastic lymphocytes infiltrating the subcutaneous fatty tissue. We present a case of a 19-month year old boy with SPTCL diagnosed and successfully treated in our institution. Disease first presented with symptoms of high fever and painful erythematous nodule located below the umbilicus. Later on the infiltrates appeared on the face, legs, arms and the back of the body. As the most decisive in obtaining the diagnosis, skin biopsy showed atypical, small to medium-sized lymphatic cells infiltrating the deeper dermal layers as well as the subcutaneous adipous tissue surrounding the adipocytes. Immunohystochemical analysis showed neoplastic lymphocytes positive for CD2, CD3, CD5, CD7, CD8, Tia-1, granzyme B and perforine, and negative for CD20, CD34, TDT and CD56. No infiltration of blood vessels or epidermis was evident. Specific T-cell lymphomas protocol (EURO-LB 02) was then initiated which resulted with rapid regression of all general and local symptoms. The treatment was completed according to schedule and the child is now, 24 months after the initiation of the treatment, in complete remission.

Background: Phototherapy and photochemotherapy have for decades been very successfully used in the treatment of vulgar psoriasis in adults. Numerous study reports confirm their effect in adults, whereas only few publications describe their use and effects in children. Objectives: The objective is to present our experience in treating psoriasis in children with phototherapy and photochemotherapy. Methods: Only narrow band UVB (311 nm) and PUVA-bath are used in children. With the advent of narrow-spectrum phototherapy emitting UVB wavelengths of 311 (±1) nm and PUVA-baths, the use of phototherapy in pediatric patients has become safer and more efficient, while being associated with a lower erythemogenic potential and longer period of remission. Depending on the diagnosis, 8-methoxypsoralen in PUVA-bath therapy is applied either in full or partial bath. The risk of skin cancer increases with the cumulative dosage of UVB radiation received during lifetime. Therefore, it is of great importance to make an accurate indication for phototherapy in childhood, along with strict follow up of the cumulative UVB dosage administered. Results: We present our experience and data acquired in the treatment of psoriasis in children with phototherapy and photochemotherapy in the last 10 years. Conclusion: Phototherapy and PUVA-bath are valuable and safe therapeutic options for selected children not responding to other treatments. In spite of the ever growing fear from UV exposure, even for therapeutic purpose, we believe that phototherapy and photochemotherapy will for quite a while remain one of the modalities in rotation therapy of psoriasis in children.

Whereas mollusca contagiosa (MC) are rather frequent in the 1-5 years old children and can be localised almost anywhere on the body, their appearance in adults is mostly regarded as sexually transmitted infection (STI). Molluscipox virus (MCV) might be transmitted directly from person to person or, by autoinoculation. MC in adults characteristically involve the genital area. However, the extragenital appearance of MC in adults can be more typically noticed in patients with immunosuppressive conditions, especially in HIV/AIDS patients. The onset of MC in HIV-positive individuals can be, according to the current literature data, regarded as a part of immune reconstitution inflammatory syndrome (IRIS). It is most probable that MC affect both sexes equally in children’s age, whereas it seems that in adult age the incidence in males prevails. Thus, in STD clinics in England and Wales, slightly more than twice as many men as woman were diagnosed with MC. Therapy may be beneficial in preventing transmission or autoinoculation. Unfortunately, there is no aetiological treatment of MC so far, and majority of treatment options are mechanical, causing sometimes a certain degree of discomfort, or are not enough “evidence-based”. Special attention should be given to the extragenital site of involvement of MC in adults, and HIV serology testing should certainly be recommended in such patients. Both children and adults with MC should be educated to avoid skin contact and scratching with others to prevent transmission and autoinoculation. Besides, the adult patients with MC should be carefully screened for other STIs and counselled appropriately.

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare type of T-cell lymphoma of CD3+CD8+ phenotype characterized by deep-seated skin nodules or plaques mimicking panniculitis, a result of neoplastic lymphocytes infiltrating the subcutaneous fatty tissue. We present a case of a 19-month year old boy with SPTCL diagnosed and successfully treated in our institution. Disease first presented with symptoms of high fever and painful erythematous nodule located below the umbilicus. Later on the infiltrates appeared on the face, legs, arms and the back of the body. As the most decisive in obtaining the diagnosis, skin biopsy showed atypical, small to medium-sized lymphatic cells infiltrating the deeper dermal layers as well as the subcutaneous adipous tissue surrounding the adipocytes. Imunohystochemical analysis showed neoplastic lymphocytes positive for CD2, CD3, CD5, CD7, CD8, Tia-1, granzyme B and perforine, and negative for CD20, CD34, TDT and CD56. No infiltration of blood vessels or epidermis was evident. Specific T-cell lymphomas protocol (EURO-LB 02) was then initiated which resulted with rapid regression of all general and local symptoms. The treatment was completed according to schedule and the child is now, 24 months after the initiation of the treatment, in complete remission.

Cutaneous squamous cell carcinoma (SCC) is the most significant and serious complication in patients with inherited epidermolysis bullosa (EB). We present three patients with recessive dystrophic severe generalized EB (previously called Hallopeau Siemens) with cutaneous squamous cell carcinoma. In all three patients the tumours developed on distal parts of the limbs, that were exposed to chronic nonhealing erosions and ulcerations, which were finally severely mutilated. One patient had two primarily sites of SCC, the dorsum of the foot and the sacral region. No regional or distant metastases were detected. All patients had surgical treatment ; in two patients partial limb amputations and in one patient excision of the tumour with wide surgical margins were performed. Cutaneous squamous cell carcinoma is predominantly seen in patients with dystrophic epidermolysis bullosa (DEB). The prevalence of SCC in recessive DEB Hallopeau Siemens is 23% with the cumulative risk of 90% by 55 years of age. These tumours have aggressive and fast grow and metastasise early representing the leading cause of death in these patients. Multiple appearance of SCC in EB patients is often observed. Early age of development is a rule and it has been described as early as 14 years of age. Several biopsies may be required to confirm or exclude the presence of tumour within a suspicious area. Surgical treatment is the treatment of choice for SCC with amputations that are often indicated. Regular follow-up of non-healing wounds with early recognition of SCC is mandatory for effective treatment in patients with epidermolysis bullosa.

Molluscum contagiosum (MC) is a common cutaneous infection caused by the molluscipox virus (MCV) and can affect both children and adults. Molluscum contagiosum is relatively frequent in children aged 1-5 years old and can be localized almost anywhere on the body, but in adults it is regarded as a sexually transmitted infection (STI). MCV can be transmitted directly from person to person or by autoinoculation. MC in adults characteristically involves the genital area but extragenital appearance can be more typically seen in patients with immunosuppressive conditions, especially in HIV/AIDS. The onset of MC in HIV-positive individuals can be regarded as a part of the immune reconstitution inflammatory syndrome (IRIS). MC probably affects both sexes equally in children, whereas it seems that in adults the incidence is more prevalent in males. Therapy is controversial but may be considerably beneficial in preventing transmission or autoinoculation. At present there is no aetiological treatment of MC and most treatment options are mechanical sometimes causing discomfort or are not sufficiently evidence-based. Attention should be given to the extragenital site of involvement in adults and HIV testing should be recommended. Both children and adults with MC should be educated to avoid scratching and skin contact with others to prevent transmission and autoinoculation. Adult patients with MC should be carefully screened for other STIs and appropriately counseled.

Atopijski dermatitis (AD) je veoma česta upalna alergijska dermatoza u genetski predisponiranih osoba, karakterizirana jakim svrbežom, kronično recidivirajućim tijekom i tipičnom distribucijom promjena, ovisnom o dobi bolesnika. Najčešća je dermatoza dječje dobi, a AD je i najčešća manifestacija atopijskih bolesti djece, osobito tijekom prve godine života. Uloga preosjetljivosti na hranu u induciranju kožnih simptoma u bolesnika s AD ispoljava se u 30% do 50% djece. zik da su simptomi AD inducirani preosjetljivošću na hranu to je veći što je bolesnik mladi i što je klinička slika izraženija. Cilj rada je bio utvrditi ulogu i učestalost preosjetljivosti na hranu u uzorku od djece s AD do sedme godine životana, a kontrolnu skupinu činilo je 50 djece s tikarijom iste životne dobi bez znakova atopije. Anamnestički smo obratili pozornost na pozitivnu obiteljsku anamnezu u smislu atopije, dob pojave prvih kožnih simptoma, duljinu prehrane majčinim lijekom i potencijalni alergen u prehrani. Za stupanj proširenosti i intenzitet bolesti, to i subjektivne smetnje bolesnika s AD koristili smo SCORAD indeks. Utvrdili ao razinu ukupnih IgE protutijela, apsolutnog i relativnog broja eozinofila te serumskog ECP. U bolesnika s AD utvrdili smo povezanost izmedju razine serumskog ECP i SCORAD indeksa kao i učestalost pozitivnih nalaza alergoloških testiranja (prick-ubodni test, skarifikacijski test i odredjivanje specifičnih IgE protutijela). Rezultate ispitivanja statistički smo obradili Kruskal-Wallisovim testom i testom, s posebnim osvrtom na preosjetljivost na hranu. Rezultati su pokazali da je pozitivnu obiteljsku anamnezu za atopiju imalo P/o ispitanika, a 82% ih je oboljelo od AD tijekom prve godine života. Ovim radom smo utvrdili koji su najčešći alergeni u hrani bili razlogom egzacerbacije bolesti u djece s AD. Svakako moramo naglasiti važnost prevnetivnih mjera kojima se može izbijeći senzibilizacija na neke alergene u hrani, a time se može utjecati i na sam tijek AD.

Paraneoplastic pemphigus (PNP) is an autoimmune mucocutaneous disease mostly associated with specific beta-cell lymphoproliferative neoplasm. A 11-year-old boy presented to our department five years ago with erosions on oral mucosa, on the lips and with change on the conjunctiva. His skin was brownish-gray as it is seen in graft-versus-host disease - lichenoid type. Evaluation of underlying malignancy was done repeatedly but no malignancy was detected until today. Since demonstration of underlying, mostly lymphoproliferative, neoplasm is one of the minimal criteria for diagnosis of PNP there is question is this case paraneoplastic pemphigus or a new entity.

Eosinophil cationic protein (ECP) is a cytotoxic agent secreted by activated eosinophils during allergic and inflammatory processes. The main aim of the study was to determine the existence of correlation between ECP serum levels and clinical severity (evaluated by SCORAD index) as well as some relevant laboratory findings in children with atopic dermatitis (AD). The study encompassed 70 children, 49 of who were AD children aged 3 to 36 months, and a control group of 21 non-atopic children the same age. Detailed history, serum ECP levels (UniCAP FEIA), relative and absolute eosinophil counts and total serum IgE antibodies were determined in both groups. The skin involvement was measured by SCORAD index in AD children. The calculated SCORAD index was between 16 and 83. IgE antibodies, relative and absolute eosinophil counts showed a much wider range of values and a statistically higher median (p0.05). The same was found for the correlation of serum ECP and intensity of skin changes (r = - 0.0952) and serum ECP and subjective symptoms (r = - 0.0451). The correlation was positive, but statistically not significant for serum ECP and extent of skin lesions (r = 0.0795, p>0.05). Although the correlation of ECP and SCORAD index was not determined in this study, this laboratory finding as well as IgE antibodies and eosinophils should be monitored as they represent an additional, non-invasive laboratory method in the evaluation, follow up and treatment of patients with AD.

It is known that eosinophilia is associated with different inflammatory disorders including atopic dermatitis. The eosinophils and their toxic products are seen in tissue specimens from inflammation foci e.g. in asthma and their granule products seem to be major causes of the tissue destruction of epithelial cells in the airways. ECP levels have been found elevated in activated eosinophils like in atopic dermatitis. The aim of our study was to evaluate the values of ECP found in 80 children with atopic dermatitis (aged 1-7 years) and SCORAD index between 20-70.Fluoroenzymeimmunoassay UNI CAPR ECP (Pharmacia Diagnostic) in vitro test system for the quantitative measurement of Eosinophil Cationic Protein (ECP) in children serum with atopic dermatitis was performed. Uni CAP ECP assay is specifically for use with Uni CAP 100, a dedicated measuring instrument (2.5ml or 4ml vacutainer hemogard, SST glass tube). Anti-ECP, covalently coupled to ImmunoCAP, reacts with the ECP in the patient serum specimen. After washing, enzyme labeled antibodies against ECP are added to form complex. After incubation unbound enzyme anti ECP is washed away and the bound complex is then incubated with developing agent. After stopping the reaction, the fluorescence of the evaluate is measurement. To evaluate the test results, the response for the patient samples are transformed to concentrations with the use of a calibration curve. Referent values were to 20 μ g/l. SCORAD index was calculated according to ETAC study group. ECP values in sera of 80 children were established between 3.25 to 75.7 μ g/l. Elevated ECP levels were found in 25 of children (20.8 to 75.7 μ g/l) mean value was 35.7μ g/l. The most elevated ECP values were in AD children with SCORAD index between 55 and 60. In 25 sera of children with atopic dermatitis ECP levels have been found elevated connected with activated eosinophils. Determination of released ECP may be one way to monitor conditions involving eosinophil activation and may be of value in monitoring the effect of therapy.

Trichotillomania is an impulse disorder where patients pull their hair from the scalp and/or other sites. Although the clinical presentation is characteristic, it can be confused with some other types of alopecia, particularly alopecia areata. This disturbance is most common in children aged betweeen 4 and 10 years, although it is not infrequent in adults either. Trichotillomania is usuallly considered a sign of an underlying emotional disorder and has been categorized as an obsessive-compulsive neurotic reaction. However, it can be a minor neurotic trait as well as a sign of serious psychiatric disorder. During a three-year period, we observed 39 children with trichotillomania (22 girls and 17 boys) aged 2 to 13 years. The lesions were mostly located in regions accessible to child's hands, such as parietal region (n=26), temporal region (n=9), frontal region (n=2), occipital region (n=1), and in one patient we found diffuse loss of hair. Parents of 11 children noticed the child's habit of playing with hair and pulling it, while onychophagia was observed in 2 patients. Five children were previously hospitalized for some other diseases, and 2 were permanently separated from their parents for social reasons. Treatment involved psychiatric consultation, although in most cases a detailed explanation to the parents might have been sufficient to terminate the hair-pullling.

Atopic dermatitis (AD) is a common, multifactorial, chronic, and often relapsing inflammatory skin disease. Current treatment of severe AD consists almost exclusively of topical and systemic corticosteroid therapy. Because long- term corticosteroid therapy is known to cause a variety of side effects, attempts have been made to develop alternative treatments such as phototherapy with UVB (narrowband) and UVA irradiation. The mechanisms of action of UV light in atopic dermatitis are presented. The application of UV light in the treatment of AD in childhood is discussed. Twenty– one children (7 boys and 14 girls, mean age 11, 5 years) with atopic dermatitis were treated with a combination of UVA and UVB (UVAB) irradiation three or five times a week. All of them had active disease involving at least 40% of the body area despite the use of topical steroids, emollients, antihistamines and antibiotics. Ten of these children had a positive family history of atopy. Six patients had coexisting hay fever. The entire body was irradiated including the face. The cumulative dose of UVB ranged from 1.3 to 10, 42 J/cm2 (mean 6, 14 J/cm2). The cumulative dose of UVA range from 27, 5 J/cm2 to 182 J/cm2. The number of treatments ranged from 9 to 47 (mean 18). Excellent response to UVAB therapy that resulted in almost complete disappearance of eczema and pruritus was observed in nine children (45, 5%). Good and moderate response to UVAB therapy was recorded in five (22, 7%) and seven (31, 8%) patients, respectively. Only minor side effects such mild erythema were observed in four patients. UVA and UVB (UVAB) is useful and acceptable method for treating mild to moderate atopic dermatitis in the childhood.

We presented a 5-year-old boy an atypical clinical picture of dermatomyositis. First symptoms of the disese appeared of 1 year.Livid macular eash distributed on the face, inner aspects of his arm, buttocks and lateral acpest of this trunk. He was suspected to have Rothmund-Thomson syndrome although typical poikiloderma was not present.We started treatment with prenisolone in the dose of 2mg/kg/day and methotrexate 0.5 mg/kg/week, Since he had severe osteoporosis abd soft tissue calcifications diltiazem, alendronate, vitamin D and calcium supplement was prescribed.Physical therapy was performed daily. The response to this therapy was fair regarding muscle strenght, his osteoporosis is less severe but soft tissue calcifications are still impressive. Clinical course of the disease was complicated by intestinal perforation and peritonitis, probably caused by vasculitis as well as by respiratory symptoms due to respiratory muscle weakness.

Staphyloccocal scalded skin syndrome (SSS) is a disease caused by a toxin šrpduced by coagulase-positive staphylococci. The most common isolatesd are group II phage 71 and 55 staphylococci. Two children aged 8 and 13 months were admitted to our Department. Both had diffuse erythema on their face and trunk with pronounced skin tenderness. Both had positive Nikolsky sign. Intravenous antibiotic was introduced in both patients, with prompt response. The eruption regressed in 5-7 days but desquamation persisted for 1-2 weeks. When a full-blown picture is present SSS should be differentiated from toxic epidermal necrolysis.

The purpose of this paper is to present the most significant diseases in the field of pediatric dermatology, which may be particularly important in dermatologic practice from the aspect of diagnosis and differentiaol diagnosis.

Atopic dermatitis (AD) is an inflammatory skin disorders characterized by extreme pruritus, chronically relapsiong course and typical distribution. Abnormalities of both humoral nad cellular immunity have been described in patients with AD. AD was the main symptom followed byurticaria and angioedema of food allergy in children. The symptoms change over time, with respiratory disorders, oral allergy symptom, ocular and gastrointestinal problems occuring later. Five allergens (egg, cow'a milk, peanut, soy and wheat) are responsible fore more than three quaters of food allergies in children. Diagnostis procedures in food allergy have a poor reputation. History ia a primary importance. The double-blind placebo controlled food challenge is considered to be the "gold standard" in the assessment of clinically relevant food allergy.

Seborejički dermatitis je bolest nedovoljno razjašnjene etiologije koja se pojavljuje u prvih 6 mjeseci života, a poslije nestaje. Klinička slika se ispoljava u tzv. "seboprejičkoj regiji", po čemu je bolest dobila ime. U dojenačkom periodu često zahvaća pelensku regiju. Širenje promjena na tijelo iz pelenske regije je tipično. Pridruženi znaci su jaki eritem i masne ili seborejičke ljuske u vlasištu te u aksilama, što pomaže u dijagnozi.Stav o potpunoj odijeljenosti od atopijskog dermatitisa je izmijenjen, jer oko 50% tipičnih slučajeva seborejičkog dermatitisa dojenačke dobi može prijeći u atopijski dermatitis dojenačke dobi. Kandida često kolonizira lezije u pelenskoj regiji. Ponekad seborejički dermatitis dojenačke dobi može podsjećati na psorijazu (napkin psoriasis). U većini slučajeva liječenje se sastoji od vodenih krema, blagih i razblaženih steroidnih krema, te steroidno-antibiotksih kombinacija, kada su lezije vrlo eksudativne.

Atopic dermatitis (AD) is a chronic inflammatory skin disease, occurring more commonly in children. In recent years it has become increasingly clear that eosinophils play an active role in the pathogenesis of atopic diseases. Eosinophil cationic protein (ECP) is a cytotoxic agent secreted by activated eosinophils during allergic and inflammatory processes. Elevated levels of ECP have been detected in serum, sputum or nasal secretion during allergic reactions, therefore, serum concentrations of this protein could be a helpful in vitro parameter in monitoring disease activity in patients with AD. For the evaluation of patients with AD we performed standard diagnostic procedures and measured serum ECP levels (UniCAP FEIA, Pharmacia). The secverity of AD was objectively assessed by the SCORAD Index, developed by the European Task Force on Atopic Dermatitis in the year 1993. Fourteen children with moderate to severe forms of AD, younger than 3 years of age, were evaluated. Median serum levels of ECP were 17.1 ug/l (ranging from 3.01 to 57.9 ug/l), which were much higher, compared to results of serum ECP in normal non-atopic children. In conclusion: measurement of serum ECP could be a good marker for active inflammation with eosinophil involvement in AD patients.