Treatment of vitiligo: current methods and new approaches.

Vitiligo is an acquired idiopathic hypomelanotic disorder characterized by circumscribed depigmented maculae. It can be treated in many ways. The choice of therapy is individually adjusted depending on various factors, such as the patient age, type and stage of disease, and affected body site. Current treatment modalities include psoralen with exposure to ultraviolet A (PUVA) radiation therapy, narrow-band UVB therapy, topical corticosteroids, depigmentation therapy with monobenzylether of hydroquinone, and surgical treatments (minigrafting, thin split-thickness grafting, suction blister grafting, micropigmentation). There are also some new treatment modalities, such as 308-nm excimer laser, vitamin D analogues, tacrolimus, depigmentation with Q-switched ruby laser, and grafting of cultured melanocytes.

Candida infections today--how big is the problem?

Thirty years ago, superficial fungal infections were common, but systemic fungal infections were not as frequent as today. Since that time incidence in both superficial and systemic fungal infection has been increasing. The reasons are many. Due to advances in medicine, human life span is extended and many people suffer from various immunodeficiencies. Transplantation of organs and tissues, wide application of parenteral feeding and parenteral administration of drugs, infection with human immunodeficiency virus (HIV), and long-term peroral administration of antibiotics are the main reasons for appearance of many immunologic dysfunctions and thereby systemic fungal infections. The most usual predisposing factors for systemic fungal infection are skin and mucosal damage, hypofunction of T-cell-mediated immunity, decreased function of neutrophiles, long-term administration of corticosteroids, as well as dysfunction of microbial flora. Systemic fungal infections are a great problem, because they are very difficult to prove and to treat. This is why prevention of systemic infections is extremely important today, including the removal of predisposing factors as well as rational drug administration.

The use of emollients as sophisticated therapy in dermatology.

Emollients are agents designed to make the stratum corneum softer and more plant by increasing its hydration. A large number of preparations are available today, many of which are marketed as cosmetic and therapeutic moisturizers. They are the most prescribed products in dermatology. Their structure and function are surprisingly complex and sophisticated, and many are equidistant between cosmetics and drugs. The use of the emollients corrects the problems in scaling disorders. It is well known that the electrical properties of the stratum corneum change after application of an emollient. It is also possible that they have suppressive effects on epidermal thickening. Emollients have an anti-inflammatory activity and also give some transient relief from irritation. In clinical use emollients are employed as treatments for ichthyoses, xeroderma and disorders of keratinization, atopic dermatitis, psoriasis, and photodamaged skin. Emollients of the new millennium include agents that mimic natural ingredients and function as botanicals, including vitamins, hydroxy acids, and retinoids. Emollients can cause a few side effects, such as irritant dermatitis, allergic contact dermatitis, fragrance allergy or allergy to other constituents (preservatives or additives), stinging, cosmetic acne, and pigmentary disorders. We can conclude that emollients, continuously evolving to ever more sophisticated products, are very important in the treatment of different dermatoses.

Skin photodamage and lifetime photoprotection.

Ultraviolet (UV) radiation is a very small part of the electromagnetic radiation spectrum, released and transported from the source in the form of photons. Disposal of these photons within the skin causes cutaneous photodamage, which leads to clinical, histologic, and biochemical changes. Aging is a complex process characterized by cellular attrition, decreased cellular reserve capacity, and compromised ability to perform normal cellular function. Intrinsic aging, which steadily develops with time, is linked to chronologic age; it is the result of a genetic program. Photoaging, on the other hand, develops as a consequence of UV radiation-induced degenerative changes in the skin. Intrinsic aging is a universal, inevitable process, whereas photoaging is neither universal nor inevitable and can be prevented. UV radiation can also suppress the immune system in both local and systemic way and lead to simultaneous and sequential biochemical events that ultimately cause photocarcinogenesis. Therefore, everyday use of products that protect against UV radiation is necessary to prevent acute and long-term photodamage (clinical and cellular changes) leading to photoaging, photoimmunosuppression, and photocarcinogenesis.

The rise in melanoma incidence in Croatia.

The incidence of skin cancer, and particularly of cutaneous melanoma, has increased substantially over the recent decades. It has generally been assumed that early diagnosis may in fact be responsible for a part of incidence increase. The aim of the study was to analyze the prevalence and distribution of primary cutaneous melanoma among biopsy specimens during the 1991-2000 period. The Surgical Pathology computerized registry was used to identify patients with primary cutaneous melanoma. The distribution of primary cutaneous melanoma according to Clark showed an increased number of melanoma in situ diagnosed during the 1997-2000 period. It could not be definitely concluded whether these data resulted from more common excision of suspicious pigmented skin lesions or there was an increase in the melanoma rate as a consequence of environmental changes. Fortunately, nowadays new patients with cutaneous melanoma are mostly diagnosed early in the clinical course of disease when it can be successfully managed by simple surgical treatment.