Treatment Options for Pediatric Psoriasis.

Psoriasis is a multifactorial inflammatory papulosquamous disease affecting 0.5% to 2% of the pediatric population. Pediatric psoriasis, presenting similar to adult psoriasis, significantly reduces patient quality of life, often requiring an individualized treatment approach for each patient. Combination and rotational therapy are helpful in reducing toxicity and maximizing efficacy. Patients with mild and limited disease severity respond well to topical treatment with steroids or vitamin D analogues, unlike moderate and severe psoriasis where sufficient remission is rarely achieved. Therefore phototherapy, systemic immunomodulators, or biologic agents are the next line of treatment to be considered. There is limited data available on the use and long-term safety of biologics in the pediatric population. Biologic agents must be administered by experienced dermatologists, only in patients with moderate-to-severe plaque psoriasis who are intolerant or refractory to other systemic conventional disease-modifying treatment or phototherapy, or if those treatments are contraindicated.

Vitiligo in Croatia: a case report.

Vitiligo is an acquired, chronic, multifactorial disorder which involves complex interactions between genetic risk factors and environmental triggers. It is characterized by scattered circumscribed depigmented macules and patches anywhere on the skin that result from loss of functional melanocytes. According to our statistical data, 1.6% of the general population in Croatia suffers from vitiligo, but varies based on region. It affects all age groups equally, with female patients being more affected (53.95%) than male patients, and no difference in severity of vitiligo. We present a case of a sudden onset of vitiligo vulgaris from a female patient in her twenties, treated at the Department of Dermatology and Venereology. Her 12-year-old brother simultaneously developed acrofacial vitiligo, six months after their mother died in a car accident. She has been previously diagnosed with type I diabetes and autoimmune endocrinopathies. The depigmented patches covered approximately 60% of her body, with Koebner response on trauma. Although no characteristic UV fluorescence was detected on the affected area, histopathological and immunohistochemical analyses revealed a complete loss of melanocytes, while Langerhans and dermal dendritic cells replaced the DOPA-positive melanocytes. TSH levels were elevated, and the ultrasound showed thyroid enlargement, which substantiated for a hypothyroidism therapy. Treatment by systemic corticosteroids for a 6 month period was successful in stabilizing the disease.

[Wounds in the genital and oral region]. / Rane u genitalnoj i oralnoj regiji.

Wounds mean disruption of normal continuity of structures. Ulcers are excavations of the skin that reach at least to the depth of the dermis. More superficial defects are called erosions. Erosions and ulcerations are seen in a wide variety of conditions. Although many urogenital wounds have similar clinical appearances, their etiologies encompass many disorders. General categories of the causes of wounds are different types of trauma, viral, bacterial and fungal infections, neoplasms, autoimmune blistering diseases, immune and systemic diseases, and neoplasms. Many drugs are capable of causing erosions of the mucosal surfaces, such as nonsteroidal anti-inflammatory drugs, sulfonamides, penicillins, tetracyclines, antiepileptics and antimalarials. To determine the cause of erosions and ulcerations, it is essential to take careful history and perform full examination of the mucosal surfaces and skin. Swabs for bacterial and fungal culture are often necessary. Biopsies of lesional mucosal surfaces for light microscopy and perilesional mucosal surfaces for direct immunofluorescence are indicated if an autoimmune blistering disorder is suspected. Although orogenital region is an accessible site for examination, unfortunately, many health care providers are not aggressive in clinical examination. This, coupled with the fact that orogenital cancers are usually asymptomatic, often delays diagnosis.