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Condyloma acuminatum relatively rarely involves the urethra, and when it does it is usually only in the most distal por- tion of the urethra. A number of treatments have been described for urethral condylomas. These treatments are extensive and vari- able, comprising laser treatment, electrosurgery, cryotherapy, and topical application of cytotoxic agents such as 80% trichloroacetic acid, 5-fluorouracil cream (5-FU), podophyllin, podophyllotoxin, and imiquimod. Laser is still considered to be therapy of choice for treat- ment of intrauretral condylomata. We present the case of a 25-year- old male patient with meatal intraurethral warts who was success- fully treated with 5-FU, after many unsuccessful treatment attempts with laser treatment, electrosurgery, cryotherapy, imiquimod, and 80% trichloroacetic acid.

Introduction: Crusted (Norwegian) scabies is a rare, severe, very contagious form of scabies, presented as localized or generalized scaly rash. This form of scabies may occur in a people with weakened immune system, AIDS especially, patients with neurological diseases, transplant recipients, malnutrition, intellectual deficit, or very old age. We present case of crusted scabies in a patient on a prolonged topical corticosteroid therapy, misdiagnosed as psoriasis. Case: A 71- year-old man with scaly, crusted plaques on the hips, torso and elbows, have been examined. Necrotic lesions on the knees and excoriated papules disseminated over hands, limbs and trunk were also present. The patient had multiple underlying diseases, including diabetes mellitus, congestive heart failure, hypertension and chronic obstructive pulmonary disease. But he had no history of any immunodeficiency or neurological disease. He was referred to dermatologist because of a very intensive pruritus with 2 months duration. The first lesions have been reported to start 2 years before visit, as small erithematouse pruritic papules spread over the trunk, hips and hands. Topical treatment with betamethason cream, prescribed by his general physician, lessened symptoms for a short period of time. After few months of therapy scaly, crusted plaques appeared and patient had been diagnosed with psoriasis, by his general physician. Therapy with salicylic acid and topical corticosteroids had been continued, but without improvement. The clinical suspicion of scabies we confirmed with parasitological examination. Light microscopy of skin scrapings with 10% KOH revealed adult mites, larvae and ova of Sarcoptes scabiei in a large number. Diagnosis of crusted scabies had been established. Before using of acaricides, we used keratolytic agent, 5% salicylic acid, to remove hyperkeratotic skin. Ivermectin was not available. Then therapy with 25% benzyl benzoate had been administered. After 6 days of therapy parasitological examination still positive, revealing mites of Sarcoptes scabiei, in a significant low number. Because of irritated and tender skin, previously treated with topical steroids for a long time, we continued therapy with 20% Balsam of Peru ointment for 5 days. At the same time the therapy was administered for his wife. After the therapy, complete parasitological regression had been observed. Conclusion: Prolonged use of topical corticosteroids may change clinical appearance of scabies lesions, leading to misdiagnosis and inappropriate treatment. Crusted scabies is the most severe form of scabies and repeated applications of acaricides are necessary for successful therapy. The laboratory diagnosis of scabies is simple, therefore is recommended in any suspicious case, in order to prevent misdiagnosis, which is crucial for therapeutic and infection control of disease.

Humani papiloma virusi (HPV) su mali, epitelotropni DNK virusi. Dosadašnji podatci ukazuju na postojanje više od dvjesto genotipova virusa, od kojih oko četrdeset uzrokuje infekcije genitalnog područja. S obzirom na onkogeni potencijal, razlikujemo genotipove visokog (HPV 16, HPV 18, itd.) i genotipove niskog rizika (HPV 6, HPV 11, itd.). Genitalni HPV najčešće se prenosi kontaktom s inficiranom kožom ili sluznicom. Ostali načini prijenosa uključuju neizravni kontakt s kontaminiranim predmetima te autoinokulaciju. HPV uzrokuje različite promjene genitalne regije poput kondiloma, intraepitelnih neoplazija i invazivnih karcinoma cerviksa, vulve, penisa ili anusa. Također, HPV može prouzročiti lezije u područjima izvan genitalne regije kao što su usna šupljina, ždrijelo, grlo i jednjak. Ne postoji suglasnost vezana uz prevalenciju HPV-a tijekom trudnoće, pa ona varira u različitim zemljama između 5,5% i 65%. Vertikalni prijenos HPV-a označava mogućnost prijenosa HPV-a s majke na dijete tijekom trudnoće. Do perikonceptualnog prijenosa HPV DNA dolazi u vrijeme fertilizacije, dok se antenatalni prijenos događa isključivo za vrijeme trudnoće. No, većina HPV infekcija novorođenčadi nastaje perinatalnim prijenosom tijekom porođaja. Incidencija anogenitalnih kondiloma u trudnoći iznosi između 11,6% i 28,2%. Oni predstavljaju rizik od kontaminacije novorođenčeta HPV-om tijekom porođaja. Porastom učestalosti pojavljivanja anogenitalnih kondiloma u odraslih uočen je i usporedni porast incidencije anogenitalnih kondiloma u djece. HPV u djece može uzrokovati i rekurentnu respiratornu papilomatozu koju karakterizira nastajanje multiplih papiloma glasnica. Rijetko dolazi do totalne opstrukcije dišnog puta ili progresije u karcinom., Human papilloma viruses (HPV) are small, epitheliotropic DNA viruses. More than two hundred different HPV genotypes are known today, of which around forty types cause genital infection. According to their oncogenic potential the viruses are divided in high-risk HPV genotypes (HPV 16, HPV 18, etc.) and low-risk genotypes (HPV 6, HPV 11, etc.). Genital HPV is most frequently transmitted through contact with infected skin or mucous membranes. Other routes of transmission are via contaminated fomites and autoinoculation. HPV causes genital warts, intraepithelial neoplasia and invasive carcinoma of cervix, vulva, penis or anus.Also, HPV can cause lesions in non-genital areas such as oral cavity, pharynx, throat and esophagus. There is no consensus regarding the prevalence of HPV during pregnancy, so it varies in different countries between 5.5 % and 65 %. The otential route of HPV transmission from mother to child during pregnancy is known as vertical transmission. Periconceptual transmission of HPV DNA occurs during fertilization, while prenatal transmission happens only during pregnancy. Most infant HPV infections occur via perinatal transmission during delivery. The incidence of anogenital warts in pregnancy is between 11.6 % and 28.2 %. Anogenital warts increase the risk of infant HPV contamination during delivery. As the incidence of anogenital warts increased in adults, increased incidence was also reported in children. HPV can cause recurrent respiratory papillomatosis in children, a disease characterized with laryngeal papillomatosis. In rare cases, total obstruction of airway or progression in carcinoma can occur.

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.

A 21-year-old female student with a 3-month history of mild psoriasis (erythematosquamous plaque on the elbows and nail pitting on the nails of the hand) was referred to our Department. One month earlier, suddenly appearance of erythematous, smooth, clearly demarcated plaques was observed on the labia majora, the mons pubis, the perineal and perianal region together with a brownish hyperkera-totic papule on the pubic region (Figure 1, a-b). The patient underwent excisional biopsy at the Department of Surgery, and the pathohistological finding was unavailable to us. The elbows were treated with corticosteroid-keratolytic preparation, whereas the anogenital lesions were treated with moderately potent topical corticosteroids. In addition to anogeni-tal erythema, on clinical examination we noticed an erythematosquamous plaque on the site of excision with a hyperkeratotic verrucous papule on the edge of the lesion (the Koebner phenomenon on the site of skin injury). In the pubic region, we noticed two hyperkeratotic papules and a few verrucous papules on labia majora. Localized dermatophyte or candida infection were excluded with a KOH test and scrapings culture. Serology for syphilis, HIV, and hepatitis were negative. Cervical Pap smear was normal. Biop-sy of erythematosus lesion from the mons pubis was conclusive for psoriasis, and of the keratotic papule with the genital wart with positive HPV 6 and 11. The patient’s older sister had chronic plaque psoriasis.

ICDRG Symposia was organized in co-operation with Croatian Dermatovenerological Society of the Croatian Medical Association, and was held in Zagreb, Croatia, from 29th-31st March 2019. This Symposium presented an opportunity to exchange scientific ideas, knowledge and experience among colleagues with expertise in contact sensibility, patch and prick testing, occupational allergy, urticaria, atopic dermatitis and cutaneous drug hypersensitivity reactions, from all around Europe and many other parts of the World.

Infekcije humanim papilloma virusom (HPV) su najčešće virusno spolno prenosive infekcije. Svake godine otprilike 17, 500 žena and 9, 300 muškaraca dobiju karcinom uzorkovan HPV-om. Otprilike 1 od 100 spolno aktivne osobe ima šiljaste kondilome. Osobe s HPV infekcijom sklonije su nastanku HIV infekcije - rizik za infekciju HIV-om u osoba s HPV infekcijom je udvostručena. HIV pozitivni bolesnici imaju povećanu prevalenciju i incidenciju HPV infekcije (posebice HPV povezanih displazija). Karcinomi povezani s HPV-om su najučestaliji karcinomi u bolesnika s HIV-om. Zbog visoke incidencije i perzistencije infekcije, HIV pozitivni bolesnici imaju povećani rizik za nastanka karcinoma povezanih s HPV-om. Incidencija analnog karcinoma, orofaringealnog karcinoma, karcinoma penisa, vulvovaginalnog karcinoma u HIV pozitivnih osoba je u povećanju neovisno o uvođenju HAART terapije. Incidencija cervikalnog karcinoma u HIV pozitivnih osoba je visoka, po uvođenju HAART-a ne raste, ali nema dokaza niti o smanjenoj učestalosti

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.

A wide range of infectious, neoplastic, and inflammatory dermatoses can affect the anogenital region and manifest with ulcerations. The most frequent causes of painful genital ulcers are herpes simplex infection, syphilis and Haemophilus ducreyi infection (chancroid). Granuloma inguinale and lymphogranuloma venereum are rare causes of genital ulcerations. However , various other infectious and noninfectious dermatoses should also be considered as a possible cause of ulcerations in anogenital region. We present a case of a 22- year-old patient who, during a physical examination, had an ulceration of 1cm in diameter surrounded by a few smaller ulcerations in the perianal region. All the ulcerations were painful on palpation, with a yellowish discharge appearing on pressure. There was no regional lymphadenopathy and the patient denied having any prodromal symptoms. The patient history revealed occasional sexual intercourse with male partners. The first suspected diagnosis was syphilis with the coexistence of herpes genitalis, but due to the clinical picture and patient history, lymphogranuloma venereum was also suspected. Serology for syphilis, HIV and hepatitis was negative. Urethral swabs for Chlamydia trachomatis, Mycoplasma hominis, Mycoplasma genitalis were negative, except for Ureaplasma urealyticum which was unremarkably positive 103. Perianal and rectal swabs for Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma hominis, Mycoplasma genitalis and Ureaplasma urealyticum were positive for Neisseria gonorrhoeae. Polymerase chain reaction (PCR) analysis for HSV 1 and HSV2 of perianal ulcerations was positive (HSV IgM: positive). The patient was treated with acyclovir 3x400 mg for 7 days, doxycycline 2x100 mg for 3 weeks and ceftriaxone 1gr intramuscular injection, which led to complete resolution of clinical symptoms. We believe that our patient had perianal ulcerations of multiple etiologies combined, such as herpes simplex infection, gonorrhea and/or lymphogranuloma venereum. All the patients with genital ulcers thought to be caused by an STI should be tested for syphilis, HIV, and herpes simplex, and also to other STI causative agents like Neisseria gonorrhoeae and Chlamydia trachomatis (serovars L1, L2, and L3), depending on patient’s history.

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.

Prilikom postavljanja dijagnoze u bolesnika s ulceracijom u anogenitalnoj regiji liječnici se često susreću s problemima u razlikovanju i prepoznavanju pojedinih stanja i uzroka ulceracija. Iako su genitalni herpes i sifilis najčešći uzroci ulceracija u anogenitalnoj regiji, uzroci mogu biti i mnoge druge spolno prenosive bolesti, kao što su: ulcus molle (chancroid), lymphogranuloma venerum, granuloma venerum (donovanosis, granuloma inguinale), infekcija humanim papiloma virusom (HPV), molluscum contagiosum i skabijes. Ulceracije u anogenitalnoj regiji ponekad mogu biti posljedica bolesti koje se ne prenose spolnim putem, od kojih su neke infektivne etiologije, a mnoge su posljedica neinfektivnog uzroka. Detaljna anamneza i klinički pregled smanjuju broj bolesti koje ulaze u diferencijalnu dijagnozu, ali potrebno je i laboratorijsko testiranje na najčešće patogene. Ponekad tek biopsija lezija i patohistološka analiza dovode do konačne dijagnoze. Zadaća je liječnika utvrditi uzrok anogenitalnih ulceracija te postaviti ispravnu dijagnozu kako bi mogao ordinirati ispravnu terapiju i smanjiti rizik za prijenos bolesti.

Humani papiloma virus (HPV) u anogenitalnoj regiji može uzrokovati raznolike kliničke slike, od benignih šiljastih kondiloma do preinvazivnih neoplazija i invazivnih karcinoma. Većina HPV genitalnih infekcija je tranzitorna i asimptomatska. Oko 70% HPV infekcija genitalne regije regredira unutar godinu, a 80% unutar 2 godine. Opisane su 3 varijante intraepitelne neoplazije penisa. Analna intraepitelna neoplazija predstavlja značajan zdravstveni problem u imunosuprimiranih osoba. Ukoliko se ne prepozna na vrijeme i ne započne liječenje iz intraepitelne neoplazije će nastati karcinom.

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.

Osjetljivost genitalne regije kao i kontakt s raznim iritansima često uzrokuju svrbež, pečenje i crvenilo u području anogenitalne regije. Potrebno je temeljito pregledati čitavu anogenitalnu regiju te prema potrebi uzeti materijal radi mikrobiološke, odnosno pathistološke analize. Ovakav pristup omogućava postavljanje točne dijagnoze i pravovremeni početak odgovarajuće terapije.

Anogenital warts (condylomata acuminata) are the most common HPV lesions presented in men, however, during the last decade the other HPV- associated exaggerated lesions such as condylomata plana, penile, scrotal, and anal intraepithelial neoplasias (so, not only cervical!), as well as the penile, oropharyngeal and tonsillar cancer have been studied a little bit more extensively. Some examples of “not to do” situations are listed. If, for example, a pregnant woman turns out to be positive for the high-risk types of HPV associated with cervical cancer, she should be monitored during the pregnancy to watch for cervical tissue changes. If possible, treatment should be postponed, because it may lead to premature labour. Genital warts can be removed surgically, as well as with cryotherapy or curettage. However, chemical cytotoxic drugs for genital warts removal should not be used during pregnancy! More than 35 types of HPV infect the genital tract ; types 16 and 18 inducing about 70% of high-grade intraepithelial genital neoplasias, and HPV 6 and 11 causing 90% of anogenital warts. However, the “banality” of anogenital warts should not be underestimated providing that the high risk HPV DNA 16 and 18 can be isolated (PCR) from “benign" HPV-associated genital lesions (anogenital warts) in 10-20% of patients, i.e. more than it is usually expected. We definitely need the HPV vaccination programme to get rid of one of the oldest and up to now unsolved problems of mankind. Since HPV is transmitted by sexual intercourse, managing both partners (thus, not only female patients) is necessary in order to eliminate the virus in the population. Approaches to this include prophylactic vaccines such as quadrivalent HPV vaccine for both men and women. Besides, a proper dermatological training is required as the clinical criterion is still very important and the HPV-induced lesions get quite often misdiagnosed unless managed by the skilled professional. It can be thus concluded that the HPV-genital infections represent a significant dermato-venereological issue.

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.

Tinea incognita is a fungal infection in which topical or systemic steroids as well as topical application of calcineurin inhibitors, have modified the clinical appearance of the mycosis and mimicking other skin diseases. Clinical entity could be presented in various clinical forms ranging from lupus erythematosus discoid-like, eczema-like, rosacea-like, impetigoJike dermatitis, but it can resembled psoriasis, purpura, seb¬orrhoeic dermatitis and lichen planus. Physical examination usually revealed plaques with erythema and papules on the treated area, along with pruritus. The diagnosis is confirmed by direct microscopic examination of the skin scrapings with 10o/o potassium hydroxide preparation includ¬ing culture, Complete clinical resolutions is observed with oral and topical antimycotic treatment. Tinea incognita is not a rare clinical entity. Atypical erythematous plaques should be investigated in terms of presence of fungi and trea¬ted accordingly to establish total clinical and mycological cure.

Anogenital warts (condylomata acuminata) are the most common HPV lesions presented in men, however, during the last decade the other HPV-associated lesions such as condylomata plana, penile, scrotal, and anal intraepithelial neoplasias, as well as the penile, urine bladder and prostate cancer have been studied a little bit more extensively. However, consistent studies are still sparse for male population. More than 35 types of HPV infect the genital tract ; types 16 and 18 inducing about 70% of high-grade intraepithelial genital neoplasias, such as penile, anal, scrotal, vulvar, vaginal etc. (thus not only cervical), and HPV 6 and 11 causing 90% of anogenital warts. However, the "banality" of anogenital warts should not be underestimated providing that the high risk HPV DNA 16 and 18 can be isolated (PCR) from "benign" HPV-associated genital lesions (anogenital warts) in 10-20% of patients, i.e. more than it is usually expected. On the other hand, the presence and the recalcitrant course of HPV DNA 6 and 11 associated diseases represent a significant physical and psychological problem for both men and women. A prophylactic vaccine that targets these types should thus substantially reduce the burden of HPv-associated clinical diseases. Ultimately, within the spectrum of therapeutic options for condylomata, no method is really superior to others ; recurrences occurred in 30-70% of cases. We definitely need the HPV vaccination programme to get rid of one of the oldest and up to now unsolved problems of mankind. Since HPV is transmitted by sexual intercourse, managing both partners is necessary in order to eliminate the virus in the population. Approaches to this include prophylactic vaccines such as quadrivalent HPV vaccine for both men and women. This should be the only way to significantly decrease the numbers of infected persons. Besides, a proper dermatological training is required as the clinical criterion is still very important and the HPV induced lesions get quite often misdiagnosed unless managed by the skilled professional. It can be thus concluded that the HPV-genital infections represent a significant dermatovenereological issue, and the dermatovenereologists should definitely be the part of the HPV vaccine programme team

The causal role of human papillomavirus (HPV) in all cancers of the uterine cervix has been firmly established biologically and epidemiologically. Most cancers of both the vulva and the vagina are also induced by HPV. Papillomaviruses are perfectly adapted to their natural host tissue, the differentiating epithelial cell of skin or mucosae, and exploit the cellular machinery for their own purposes. The infectious cycle is initiated once the infectious particles reach the basal layer of the epithelium, where they bind to and enter the cells. The critical molecules in the process of virus replication are the viral proteins E6 and E7, which interact with a number of cellular proteins. In experimental system these interactions have been shown to induce proliferation and eventually immortalization and malignant transformation of cells. Binding of E7 to pRb activates the E2F transcription factor, which then triggers the expression of proteins necessary for DNA replication. Unscheduled S-phase would normally lead to apoptosis by the action of p53. However, in HPV-infected cells, this process is counteracted by the viral E6 protein, which targets p53 for proteolytic degradation. Besides blocking p53 function in regulation of apoptosis, high-risk HPV proteins interact with both extrinsic and intrinsic apoptotic pathways. As an aberration of virus infection, constant activity of the viral proteins E6 and E7 leads to increasing genomic instability, accumulation of oncogene mutations, further loss of cell-growth control and ultimately cancer. The immune system uses innate and adaptive immunity to recognize and combat foreign agents that invade the body, but these methods are sometimes ineffective against human papillomavirus. HPV has several mechanisms for avoiding the immune system. Furthermore, HPV infections disrupt cytokine expression with the E6 and E7 oncoproteins, particularly targeting the expression of interferon genes. Approximately 10% of individuals develop a persistent infection, and it is this cohort who is at risk of cancer progression, with the development of high-grade precursor lesions and eventually invasive carcinoma.

Anogenital warts (condylomata acuminata) are the most common HPV-induced lesions presented in men, however, during the last decade the other HPV-associated entities such as condylomata plana, penile, scrotal, and anal intraepithelial neoplasias, as well as the penile, urine bladder and prostate cancer have been studied a little bit more extensively. Consistent studies are still lacking for male population. Over the last twelve years, different diagnostic tools have been used for the patients with HPV genital infection including pathohistology and peniscopy in some cases. We wanted to evaluate the significance of viral tests (PCR, hybridization) for HPV-induced, clinically visible lesions. According to our results, HPV 16 and 18 have been isolated (PCR) from “ benign" HPV-associated genital lesions (anogenital warts) in 20% of patients, i.e. more than it is usually expected. Therefore, the diagnostic approach to HPV genital infections needs to be complex including HPV DNA typing whenever it seems appropriate. We definitely consider HPV detecting and typing of male genital HPV lesions as important part of the diagnostic procedure, treatment, follow-up, and, most recently, prevention of the HPV-genital infections.

Background. Balanoposthitis is a rather demanding clinical entity including the broad range of aetiological factors and clinical variations. Therefore, the purpose of this survey was to analyze the clinical variations of balanoposthitis in the light of various aetiological factors. Patients and Methods. The retrospective analysis of data obtained from the STD and General Dermatovenereology Outpatient Clinics of University Department of Dermatology and Venereology, Zagreb University Hospital and Medical School of Zagreb University has been performed for the five-year period. The total of 599 patients with clinical findings of balanoposthitis (clearly visible signs of inflammation of the glans penis and the prepuce) attending our Clinics from the year 2003 to 2007 have been included in our study. In general, the results were based on medical history and clinical findings confirmed with the results of the mycological, histopathological and bacteriological (urethral swabs) examination whenever indicated (and/or available). Results. In 326 out of 599 patients, even with the slightest clinical suspicion of balanoposthitis of mycotic aetiology (Candida balanoposthitis), the mycological testing has been performed (direct microscopy and the cultivation on the modified Sabourad medium in the Reference Laboratory for Dermatological Mycology and Parasitology of the Ministry of Health and Social Welfare of Republic of Croatia in our Department). In 227 patients out of these 326, the result of the mycological testing was negative. However, in 99 patients out of 326, Candida spp. has been verified. In the rest of 263 out of the total of 599 patients the lesions were mostly clinically consistent with irritant balanitis (217) followed with: balanitis circumscripta plasmacellularis (Zoon balanitis) (16 patients), circinate balanitis (10 patients), lichen sclerosus et atrophicus (7 patients), lichen planus genitalis (4 patients) and inverse psoriasis (3 patients). In two patients circinate balanitis was found to be a part of Reiter’ s syndrome, the other two patients were HLA B 27+, DR+ positive, but the other criteria have not been fulfilled to establish the diagnosis of Reiter’ s syndrome, whereas in the rest of 6 patients there were no signs of Reiter’ s syndrome. In 8 patients with clinical features of irritant balanitis, serotypes D-K Chlamydia trachomatis have been isolated from urethral swabs ; Ureaplasma urealyticum in 10 patients ; Mycoplasma hominis in 6 patients and Trichomonas vaginalis in 4 patients. In 9 patients considering medical history and clinical findings a Latex allergy has been suspected, but the allergological testing has not been performed due to the patients’ poor compliance. In 6 patients the artefact dermatitis of the genital region has been seriously suspected. Discussion and Conclusion: It can be thus concluded that different aetiological agents can induce similar clinical findings in balanoposthitis, as well as the single aetiological agent of balanoposthitis can induce different clinical features. Moreover, we observed that a certain number of patients with clinical findings of balanoposthitis were referred to as STIs, but these lesions have been finally proven as purely dermatological disorder(s). Under the name of “ irritant balanitis” many other entities might be misdiagnosed, thus the proper and very careful manner of taking history, precise clinical examination, rational laboratory testing and combined “ dermatovenereological” approach are required in order to solve the complexity of this problem.

Objective To detect Mycoplasma genitalium in urine samples of infertile men and men without any signs of infection in order to investigate whether M. genitalium and other genital mycoplasmas ( Mycoplasma hominis and Ureaplasma spp) are found more often in urine samples of infertile men than in asymptomatic controls and to determine resistance to macrolides. Methods The study included first void urine samples taken from 145 infertile men and 49 men with no symptoms of urethritis. M. genitalium, Chlamydia trachomatis and Neisseria gonorrhoeae were detected by commercial PCR. Trichomonas vaginalis was detected by microscopy and culture. M. hominis and Ureaplasma spp were detected by culture. M. genitalium was detected by in-house conventional and real-time PCR. Results Two M. genitalium positive samples were found among samples obtained from infertile men. All asymptomatic men were M. genitalium negative. Macrolide resistance was not found in either of the two positive samples. Conclusions In comparison with reported data, an unusually low prevalence of M. genitalium was found in infertile men. The reasons for this unexpected result are not known; possibly, local demographic and social characteristics of the population influenced the result. Further studies to investigate M. genitalium in infertile and other groups of patients are needed.

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.

Diagnostic procedures for Mycoplasma genitalium are described.

Introduction: Tinea incognita is an initially unrecognized dermatophyte infection, usually modified by the inappropriate topical or systemic corticosteroid therapy. We report case of an extensive tinea incognita caused by zoophylic dermatophyte Trichophyton mentagrophytes (var. granulosa) in a patient with CREST syndrome. Materials and Methods: Forty-nine-year-old female patient has been referred to our Department due to the extensive erythematous, not well demarcated lesions on the trunk, neck and arms. Ichtyosiform scales and excoriations were observed, as well. Prior to this visit, the lesions had been unsuccessfully treated with topical betamethasone cream. Very intensive pruritus urged the patient to visit dermatologist. Fifteen years before, the patient was diagnosed with CREST syndrome, with biliary cirrhosis and had been continuously receiving systemic steroids, 10 mg of prednisone daily. The physical examination revealed also sclerodactyly and calcinosis of the fingers, with yellowish discoloration of the nails. Numerous teleangiectasias were spread over the face, neck, upper trunk and even lips. Results: Direct microscopic potassium hydroxide examination of the skin scrapings was positive revealing fungal hyphae and Trichophyton mentagrophytes (var. granulosa) was confirmed by culture on the Sabouraud medium. Direct examination and fungal culture of the nails were negative. The topical treatment with terbinafine cream was initiated. Systemic antimycotic therapy was not administered because of the very good response on the topical therapy and because of high level of liver enzymes, as well. After the four weeks of treatment, a complete clinical and mycological regression was observed. Conclusion: Immunocompromized patients are susceptible to dermatophyte infections with atypical clinical presentation. Therefore, close monitoring and mycological skin examination is recommended in order to avoid misdiagnosis and to give the patient the best chance of cure.

INTRODUCTION AND OBJECTIVES: Majocchi’s granuloma is a deep folliculitis due to a cutaneous dermatophyte infection. It might occur as a result of the use of topical steroids on unsuspected tinea. Majocchi’s granuloma is also known as granuloma trichophyticum, as the most frequently reported agents are Trichophyton rubrum and Trichophyton violaceum. We report case of a Majocchi’s granuloma caused by geophylic Microsporum (M.) gypseum in a fifty- three-year- old female patient. MATERIALS AND METHODS: Fifty-three-year-old, otherwise healthy female patient, has been referred to our Department due to solitary, well- circumscribed plaque on the left forearm, with perifollicular papulopustules, erythema and scaling. Pressure did not result in pus exudation. Prior to this visit the lesion had been unsuccessfully treated with topical hydrocortisone/oxitetraciklin-hydrochloride ointment, for a month. Moreover the condition had even deteriorated, with lesion becoming bigger and pruritic. RESULTS: Direct microscopic potassium hydroxide (KOH) examination of the skin scrapings was positive, revealing fungal hyphae and M. gypseum was confirmed by culture on the glucose-modified Sabouraud medium. Topical antimycotic treatment with terbinafine cream and oral terbinafine, 250 mg daily, have been administered during 6 weeks. The liver enzymes, as well as the serum lipids level were within normal ranges at the beginning during and at the end of treatment. After 6 weeks of therapy, almost complete regression with slight residual erythema could be clinically observed. The results of the mycological examination were negative at the end of treatment. CONCLUSION: Majocchi’s granuloma is uncommon, but well recognized dermatophyte infection. Although Trichophyton spp. has been traditionally the expected pathogen, and, accordingly, the term granuloma trichophyticum has been used, in our patient geophylic fungus Microsporum gypseum has been confirmed by culture as an aetiological agent. Thus, the change of the name to “Majocchi’s granuloma” instead of traditional “Granuloma trichophyticum Majocchi” should be seriously considered.