[Occurrence of sexually transmitted diseases in Vojvodina during the last 20 years]. / Prisustvo polno prenosivih bolesti u Vojvodini u poslednjih dvadeset godina.

INTRODUCTION: Sexually transmitted diseases are the most often registered communicable diseases in a great number of countries. The aim of this study was to analyze dynamics and distribution of gonorrhea, syphilis and scabies in Vojvodina region during the last twenty years. MATERIAL AND METHODS: Epidemiological characteristics of gonorrhea, syphilis and scabies were analyzed on the basis of data obtained from the Section of Epidemiology of the Institute of Public Health in Novi Sad. The research included the period between 1980 and 1999, with sex and age distribution of patients. Morbidity rates were given per number of inhabitants of Vojvodina. RESULTS: In the period between 1980-1999 there were 454 registered patients with the diagnosis of syphilis in Vojvodina. The morbidity ratio was highest in 1980 (3.41/100.000), and lowest in 1991 (0.24/100.000). In the twenty-year period there were more patients with gonorrhea, than patients with syphilis. There were 44.621 registered patients with gonorrhea. The maximum morbidity ratio was in 1980 (25.09/100.000), but the minimum was in 1998 (1.68/100.000). Within the examined period scabies was recorded in 56.490 patients. The highest morbidity ratio was in 1984 (232.37/100.000) and the lowest was in 1992 (73.56/100.000). DISCUSSION: The average morbidity ratio of syphilis in USA, between 1992-1994, was 11.8/100.000 and at the same time in Vojvodina it was only 0.42/100.000. In Vojvodina most patients with this disease were 20-39 years old. In the same period in USA the ratio of gonorrhea patients was 309/100.000 and in Vojvodina it was 2/100.000. In this group also, most patients were 20-39 years old. However, scabies mostly appeared at the age of 7-14. CONCLUSION: According to the obtained results, the number of registered patients with these three diseases in Vojvodina stagnates or it decreases. In order to deal with real data, it is necessary to report these diseases regularly.

[Lichen sclerosus et atrophicus--a diagnostic problem]. / Skleroticni atroficni lihen--dijagnosticki problem.

INTRODUCTION: Lichen sclerosus et atrophicus (LSA) is a rare disease with etiology that has not been clearly defined up to now. This disease appears up to 10 times more frequently among women, than among men. It occurs at the age of 40-60. Anogenital site is the most common, but in 20% of cases it is extragenital. CASE REPORT: We report a case of a 78-year-old woman with skin lesions on the hand and face, that appeared 7-8 years ago after intensive sun exposure. When admitted to hospital, she had a butterfly-shaped livid erythema on cheeks and nose hypopigmentation on its edges. Atrophic plaques were formed in some areas of lesions. On the dorsal side of hand clear atrophic plaques were noticed. Pathohistological analysis of skin lesions revealed epidermal hyperkeratosis and atrophy with follicular hyperkeratosis, dermal edema, with subepidermal blistering and edematous hyalinized connective tissue. Direct immunofluorescence of the face lesion has shown presence of IgA, IgG and IgM deposits along the epidermo-dermal interface. Based on all findings the following diagnosis was made: Lichen sclerosus et atrophicus bullosus. DISCUSSION: Differentiation between chronic discoid lupus erythematosus and LSA presents a diagnostic challenge. Both diseases have some common pathohistological changes, but a single mixed inflammatory dermal infiltrate as well as edema and hyalinized connective tissue were the most important facts in making diagnosis. CONCLUSION: Lack of knowledge in regard to etiology of this disease has caused some problems in differential diagnosis. This disease hasn't always been a separate entity, but we expect that many things regarding the etiology and pathogenesis to be explained in the future.

[Atrophic pilar keratosis of the face: case report]. / Atroficna pilarna keratoza lica: prikaz slucaja.

INTRODUCTION: Keratosis pilaris atrophicans faciei (KPAF), previously called ulerythema ophryogenes, belongs to a group of follicular syndromes with inflammation and atrophy. The disease often starts at birth or during the first months of life with autosomal dominant inheritance. CASE REPORT: We report a case of a 24-year-old woman, who noticed the first lesion two years ago. Skin lesion spread symmetrically on the cheeks, forehead and chin. Keratotic follicular papules were surrounded by erythema. After disappearance of follicular papules, atrophy occurred. Histopathological analysis from skin biopsy specimens confirmed the diagnosis of KPAF. DISCUSSION: Follicular syndrome with inflammation and atrophy starts in early childhood, but first lesions can also appear among teenagers or in adults. The course of the disease is progressive with permanent follicular destruction. The histopathologic changes are dynamic and follow the clinical course of the disease. A topical retinoid: tretinoin therapy was introduced. After one month of treatment good effects were visible, including decrease of erythema and follicular hyperkeratosis.

[Skin diseases and hepatitis virus C infection]. / Oboljenja koze i infekcija virusom hepatitisa C.

INTRODUCTION: Using a creative molecularbiologic technique in 1989 Choo and co-workers isolated a new virus of hepatitis C, an agent responsible for numerous cases of parenterally transmissible viral hepatitis. Hepatitis C virus is a RNA virus with unique genomic organisation. Six genotypes of hepatitis C virus have been identified, which differ in geographical distribution, tendency towards chronicity and sensitivity to antiviral therapy. Transmission occurs due to apparent and inapparent parenteral procedures (after transfusion, transplantation, transplacentally, during lactation, sexually or after accidental injury of medical staff). Mode of transmission through intact skin or mucosa has not been proved yet. Due to development of laboratory methods for detection of anti-hepatitis C virus antibodies and obligation for routine testing of blood donors for hepatitis C in majority of countries in the world, risk of post-transfusion hepatitis C is minimised to less than 1%. In 70% of patients the infection runs a chronic course, affecting numerous extrahepatic organ systems, including skin. VASCULITIS ASSOCIATED WITH MIXED ESSENTIAL CRYOGLOBULINEMIA: Mixed essential cryoglobulinemia is a disorder with deposition of circulating immune complexes in small and medium blood vessels. Clinical characteristics comprise palpable purpura on lower extremities, arthralgias and weakness. It might occur during autoimmune disorders, liver diseases and viral infections, among which hepatitis C infection has a central part. Mixed cryoglobulins can be detected in 35-54% of patients with hepatitis C and symptomatic vasculitis associated cryoglobulinemia, decreased C4 component of complement, positive rheumatoid factor and elevation of hepatic enzymes occurs in 10-21% of patients. Findings of anti-hepatic C virus antibodies and/or viral RNA in 96% of patients with mixed cryoglobulinemia can be considered as a definitive proof of etiopathogenetic association between hepatitis C infection and mixed cryoglobulinemia. Interferon alpha therapy is a first-choice therapy, although transient responses are frequent. PORPHYRIA CUTANEA TARDA: Hepatitis C infection has recently been recognised as an important precipitating factor of clinical porphyria cutanea tarda sympotomatology. Apart from high level of seropositivity among porphyria cutanea tarda patients (62-100%), association between these two entities hasn't been clearly revealed yet. The question whether hepatitis C infection is enough to be the only precipitating factor, or other hepatotoxic cofactors are necessary, still exits. Interferon therapy has been a meter of several studies, but no definite recommendations had been given about its administration in these cases. LICHEN PLANUS: About possible association between lichen planus and chronic liver diseases, and hepatitis C infection as well, suggest 35% prevalence of hepatic disorders in patients with lichen planus, and 9.8-23% of hepatitis C virus seropositivity. The clinical picture of lichen planus in hepatitis C virus infection is characterised by generalised skin lesions, with erosive involvement of oral mucous membrane, and by chronic course. Therapeutical efficiency of interferon is unpredictable, with possible improvement, cure or deterioration of lichen planus. OTHER DERMATOLOGICAL DISORDERS: Other dermatological disorders (erythema nodosum, erythema multiforme, urticaria) may be direct consequences of hepatitis C infection, of other extrahepaic non-dermatological manifestations, or fortuitous reports. CONCLUSION: Considering big pathogenetic potentials of hepatitis C virus with possible skin involvement, and proved association between cutaneous necrotising vasculitis with mixed essential cryoglobulinemia, porphyria cutanea tarda, lichen planus and chronic hepatitis C infection, all patients with these disorders should be tested for hepatitis C and all cases of hepatitis C should be searched for signs and symptoms of these skin diseases.

[What do we know today about diaminodiphenylsulfone?]. / Sta danas znamo o diaminodifenilsulfonu?

INTRODUCTION: Diaminodiphenylsulfone or dapsone is a chemical analogue of sulfapyridine, synthesized in 1908. Dapsone is a bacteriostatic agent that proved to be efficient in treating leprosy and malaria, but today it is used in treating dermatologic noninfectious inflammatory diseases. PHARMACOLOGY: Dapsone is orally used in a dose of 50-400 mg per day in treatment of dermatologic diseases, and also in a dose of 50-100 mg per day in leprosy treatment. Dapsone is mainly eliminated from the body by urine and smaller part by faeces. Pharmacological interaction was reported when it is used with rifampicin and probenecid. MECHANISM OF ACTION: The bacteriostatic effect of dapsone is well known. It involves inhibition of folic acid synthesis in susceptible organisms. The anti-inflammatory effect of dapsone, which proves to be efficient in treating noninfectious inflammatory diseases, has not been explained completely yet. There are some pieces of evidence that anti-inflammatory action is not connected with its antibacteriological action. CLINICAL USE: Based on previous studies about therapy efficiency of dapsone in treating some diseases, there are two groups of diseases: the group responding well to dapsone (leprosy, malaria, DH, linear IgA-dermatosis, erythema elevatum diutinum, bullous systemic lupus erythematosus) and a group responding with average good response to dapsone (pyoderma gangrenosum, bullous and cicatricial pemphigoid, acne conglobata, discoid cutaneous lupus erythematosus, subcorneal pustulosis dermatosis, granuloma faciale, rheumatoid arthritis, polychondritis, leucocytoclastic vasculitis). ADVERSE EFFECTS: Adverse effects depend on the dose and they rarely occur at doses less than 100 mg per day. They are mainly shown on skin, nervous system, digestive system, hepatobiliary system, and kidney and hematologic system. The most important adverse effects are hemolytic anaemia and methemoglobinemia. Hemolysis usually occurs at doses of 200 mg and more per day. In patients with glucose-6-phosphate dehydrogenase deficiency, hemolysis may be provoked by a dose less than 50 mg per day. For prevention, before using dapsone in therapy, clinical examination with history, blood parameters, liver and renal parameters and determination of glucose-6-phosphate dehydrogenase level are recommended. CONCLUSION: The use of dapsone is absolutely indicated in DH treatment and erythema elevatum diutinum. Because of anti-inflammatory effects, dapsone can also be used in treating other inflammatory noninfectious dermatoses when one should take care about "therapy efficiency/adverse effect" balance using the correct dose, monitoring relevant clinical and laboratory parameters and educating patients.