[Experimental vaccines for sexually transmitted infections].

INTRODUCTION: Sexually transmitted infections (STIs) are major global public health problems. Present strategies for prevention have limitations. Vaccines are an attractive addition to the current prevention armamentarium because they provide durable protection and do not require repetitive adherence to be effective. Challenges for vaccination include induction and long-term maintenance of mucosal immune responses in the female genital tract. VACCINES: A REALISTIC GOAL? For the time being, US Centers for Disease Control and Prevention have recommended only hepatitis and HPV immunization to be routinely offered. Final, III stage trials are underway on other prophylactic vaccines for human papillomavirus and genital herpes. Though vaccines against Chlamydia trachomatis and Neisseria gonorrhoeae are in early stages of development they do offer the hope of preventing pelvic inflammations. The high incidence of HIV-infection for which a vaccine would not be readily available, "cries out" for an effective vaccine. VACCINES FOR HPV INFECTIONS: According to a recent meta-analysis of worldwide prevalence data, vaccinating with HPV-16/18 VLP against HPV-16 and HPV-18 could prevent over 70% of invasive cervical cancer worldwide. The latest release of data from the phase III trial of a quadrivalent recombinant non-infectious vaccine HPV-6/11/16/18 L1 VLP, including HPV types 6, 11, 16, 18 have given complete protection against HPV-16/18-related cervical intraepithelial neoplasias 1, 2/3, and adenocarcinoma in situ and cancer through 2 years of post-vaccination follow up. CONCLUSION: Despite the fact that the development of vaccines for STI prevention was rather slow in the past, the ideal vaccine would decrease transmission of the infection between partners and would prevent complications of disease. Moreover, in future decades, increasingly successful universal vaccination of newborns and children will substantially reduce the need for vaccination of persons with specific risk factors, including sexual risk.

Influence of different types of electromagnetic fields on skin reparatory processes in experimental animals.

Wound healing is a very complex process, some phases of which have only recently been explained. Magnetic and electromagnetic fields can modulate this process in a non-thermal way. The aim of this research was to compare the influence of constant and pulsed electromagnetic fields and low-level laser therapy (LLLT) on wound healing in experimental animals. The experiment was conducted on 120 laboratory rats divided into four groups of 30 animals each (constant electromagnetic field, pulsed electromagnetic field, LLLT and control group). It lasted for 21 days. Under the influence of the constant electromagnetic field the healing of the skin defect was accelerated in comparison with the control group. The difference was statistically significant in all the weeks of the experiment at the P < 0.01 level. Accelerated healing was also observed under the influence of the pulsed electromagnetic field (P < 0.05). In the group of animals exposed to LLLT, the healing of the skin defect was faster than in the control group. The statistical significance was at the P < 0.05 level. Different types of electromagnetic fields have a promoting effect on the wound healing process.

Contact sensitivity in patients with psoriasis in Vojvodina.

BACKGROUND: Immunologic studies indicate that psoriasis may represent an organ-integrated response. OBJECTIVE: We assessed contact hypersensitivity in plaque-type psoriasis, its frequency, etiology and association with severity of psoriasis. METHODS: Contact hypersensitivity was defined as a positive patch test (PT) to at least one of 44 ubiquitous contact allergens. Patients with exclusively plaque psoriasis and control groups (patients with allergic contact or extrinsic atopic dermatitis and healthy persons) were tested with the European standard series; plant-related standard allergens; Compositae allergens, and our own extracts from Compositae plants ubiquitous in Vojvodina. Sensitization rates to allergens were standardized for age and sex, and rates in women and in men were both standardized for age. Disease severity was evaluated using the Psoriasis Area Severity Index score. RESULTS: 15,123 PTs were performed. Among psoriatic patients in Vojvodina, the overall rate of sensitivity, standardized for age and sex, was 18.9%. Rates in women (27.7%) and men (5.8%), both standardized for age, were significantly different. Male psoriatic patients reacted less than healthy males, the difference being on the margin of significance. There was no relationship between severity of disease and PT reactivity. Yarrow extract, nickel and a Compositae mix were the most common allergens that produced positive reactions. CONCLUSION: Although patch testing in psoriatic patients can be quite challenging, time-consuming and difficult, it will provide further insight into the pathophysiology of psoriasis. Factors other than different exposure to allergens may also be responsible for a sex-related difference in contact sensitivity. Future studies should focus on this field.

[Presentation of the Department and Clinic of Dermatology and Venereology].

THE DEPARTMENT OF DERMATOVENEROLOGY: The Department of Dermatovenereology was established in 1963, as part of the Department of Internal Medicine with Professor Dimitrije Stanulovic as its head. Since 1983, it has been an independent department of the Faculty of Medicine in Novi Sad. DEPARTMENT ACTIVITIES: The Department participates in undergraduate education of medical and dentistry students (serbian and english language), advanced training of graduate students specializing in dermatovenereology, general medicine, urgent and occupational medicine, pediatrics and subspecialists of oncology. During the period 1969-1999, the Department was included in work of the Department of Dermatovenereology of the Faculty of Medicine in Banja Luka. THE DEPARTMENT HISTORY: The Department of Dermatovenereology of the City Hospital in Novi Sad was founded in the 5th decade of the 20th century, and it was situated in Kisacka street, near the railway station. It became an independent institution: Dermatovenereology Clinic in 1963, part of the Clinical Center of Vojvodina in Novi Sad. THE DERMATOVENEREOLOGY CLINIC TODAY: The Dermatovenereology Clinic is a teaching facility, but also an institution for prevention, diagnosis and therapy of skin diseases of adnexal structures (sebaceous and sweat glands, hair, nails) and sexually transmitted diseases. The Clinic works both as an outpatient and an inpatient facility with male and female wings.

[Lupus vulgaris: isolation of Mycobacterium tuberculosis from the affected skin scraping and mucous membranes].

INTRODUCTION: In the second half of the last century skin tuberculosis has become a rarity. With the appearance of resistance to different kinds of pathogenes, HIV-immunodeficiency and decreasing standard of living, the incidence of skin tuberculosis increases. Lupus vulgaris is a chronic form of the secondary tuberculosis of the skin. CASE REPORT: This is a case report of a 66-year-old woman who presented with a growing, painless, brownish-red, slab-shaped, jelly, cutanesous mass, 2.5 centimeters in diameter, on the tip of her nose, reaching the mucous membrane of the nose. RESULTS: Apart from accelerated erythrocyte sedimentation rate (43/73) and a positive tuberculosis test (Mantoux 10 TU = 25x25 mm), all relevant findings were within reference values. Using Ziehl-Neelsen staining, no acido-resistent bacilli were found. The skin scraping sample, taken from the affected skin and the mucous membrane, was cultivated in Lowenstein medium base, and this resulted with cultivation of Mycobacterium tuberculosis. Using three-drug combination therapy for ten months, complete remission was achieved. CONCLUSION: Successful cultivation of pathogens represents an absolute diagnostic criterion. We present a case of a woman with lupus vulgaris, because there is a small number of cases documented around the world where the diagnosis was confirmed by culture of Mycobacterium tuberculosis.

[Is Vojvodina a risk area for contact weed allergies?].

INTRODUCTION: After detecting erythema multiforme due to contact with weeds, dandelion (Taraxacum officinale, Compositae) and common chickweed (Stellaria media, Caryophyllaceae), which are ubiquitous plants in Vojvodina, and concerning properties of commercial screening allergens in detection of allergy to plants, we investigated contact allergy to dandelion and to common chickweed, using their extracts. MATERIAL AND METHODS: Epicutaneous tests were performed using originally prepared ether extracts of these plants, 0.1% and 3% pet., in 263 individuals: 43 with extrinsic atopic dermatitis, 55 with allergic contact dermatitis, 118 with non-allergic chronic inflammatory skin diseases and 47 healthy adults. RESULTS: Our results have shown that testing with both extracts (both concentrations) represents a safe method, since no irritation or sensibilization occurred. The overall prevalence of allergy to dandelion extract was 1.14%, and for common chickweed extract 2.28%. DISCUSSION: Plant allergies (especially Compositae) cannot always be detected by standard screening allergens. Additional testing with dandelion extract can detect most cases, which is in agreement with our results. Isolation of essential oil from common chickweed proved the allergenic potential of this plant. The prevalence of detected allergy to dandelion as well as to common chickweed was higher than 1%. CONCLUSION: These ubiquitous weeds and high prevalence of detected allergies have included Vojvodina into a risk zone for getting contact sensitivity to dandelion and common chickweed. Dandelion extract should be considered for Compositae screening series and common chickweed extract for specific plant series in Vojvodina.

Contact allergy to Compositae plants in patients with atopic dermatitis.

To investigate the frequency of Compositae sensitivity is one of the most important goals of current dermatology and allergology. We have patch tested 30 adult patients suffering from "extrinsic" atopic dermatitis with sesquiterpene lactone mix and Compositae mix including Compositae mix individual ingredients, extracts of arnica (Arnica montana), chamomile (Chamomilla recutita), tansy (Tanacetum vulgare), fever few (Tanacetum parthenium) and yarrow (Achillea millefolium) as well as with specific series for patients with atopic dermatitis. All allergens were purchased from Hermal-Trolab (Reinbek, Germany). There were 6 (20%) patients positive to Compositae mix only, and 3 (10%) patients positive to both Compositae mix and sesquiterpene lactone mix. Among 9 Compositae mix-sensitive patients 8 (88.8%) were positive to at least 1 of its individual ingredients: 5 (55.5%) to chamomile, 4 (44.4%) to arnica, 2 (22.2%) to tansy, and 2 (22.2%) to fever few. Among Compositae-sensitive patients 78.8% had other contact allergies, most often to nickel (33.3%). Since our study represents the first report on contact allergy to Compositae among patients with "extrinsic" type of atopic dermatitis, it substantiates the statement that atopy represents a risk factor for Compositae allergy. In conclusion, the overall prevalence of 30% Compositae-sensitive among patients with "extrinsic" atopic dermatitis detected in our study represents a basal sesquiterpene lactone mix detection rate of 10%, reinforced and safely supplemented by 20% by testing with the Compositae mix.

[Autoantibodies in children with vitiligo]. / Autoantitela kod dece obolele od vitiliga.

INTRODUCTION: Vitiligo is an acquired, sometimes familial skin depigmentation disorder. In about half of patients it occurs before the age of twenty. The aim of this study was to investigate the incidence and significance of autoantibodies (AT) and associated autoimmune and endocrine diseases in children with vitiligo, in relation to adults with vitiligo and children without vitiligo. MATERIAL AND METHODS: The research was conducted in fifty children with clinically diagnosed vitiligo from 2 to 16 years of age. Children were compared with control groups of children with other skin diseases (aged from 2 to 16) and with adults with vitiligo. Each group comprised 30 patients. A detailed history was obtained and physical examination was performed in each patient to determine presence of autoimmune and endocrine diseases in patients with family history of vitiligo. Routine blood examination, routine urinalysis and stool were performed in all patients. We evaluated the incidence of antinuclear (ANA) and antithyroid antibodies (ATA) in each patient, as well as the incidence of antibodies to gastric parietal cell (APCA), smooth muscle (SMA), cord (ACA) and mitochondrial antigens (AMA) in 38 children with vitiligo and in control groups. RESULTS: Children with vitiligo had positive family history of vitiligo more often compared to children without vitiligo (p<.05). Presence of ANA, ATA, APCA, SMA, ACA and AMA was not considerably increased in children with vitiligo compared with their age group. ANA was more common in adults with vitiligo, in comparison with children with vitiligo (p<0.05). None of the children with vitiligo had an associated autoimmune and endocrine disease in contrast to adults with vitiligo (p<0.05). DISCUSSION AND CONCLUSION: Several studies have shown a significant incidence of positive autoantibodies in children with vitiligo, compared to children without vitiligo. However, in our series, presence of ANA, ATA, APCA, SMA, ACA and AMA was not significantly increased in children with vitiligo, compared with children without vitiligo. Further studies are necessary in this area in order to draw more conclusions. In the previous studies, it has been established that children with vitiligo were generally healthy, whereas adults with vitiligo had an increased incidence of autoimmune and/or endocrine diseases. No studies have shown this association in children with vitiligo. Our results support findings of previous studies.

[Low level laser irradiation and its effect on repair processes in the skin]. / Lasersko zracenje male snage i njegov uticaj na reparatorne procese koze.

INTRODUCTION: Application of laser beams for therapeutic purposes is of relatively recent date, but today there is no field of medicine where lasers cannot be used. PHYSICAL CHARACTERISTICS OF LASER RADIATION: Laser radiation is a type of electromagnetic radiation with some specific characteristics such as coherence, monochromaticity and parallelity. TYPES OF LASER DEVICES: Nowadays, there are many laser devices on the market used in medicine and dentistry. According to the type of their active medium, lasers can be classified as solid, gas, semiconductor and liquid. EFFECTS OF LOW LEVEL LASER THERAPY ON BIOLOGICAL SYSTEMS: The exact mechanism of action of low level laser therapy is still not completely understood. Its basic feature is to modulate cell behaviour, without causing significant temperature increase. During irradiation of a tissue with a laser beam, an interaction between cells and photons takes place--photochemical reaction. After a cell absorbs the photon, the photon stops existing, and its energy is incorporated into the molecule which has absorbed it. Once this energy is transferred to different biomolecules, it can be transferred to other molecules as well. The energy transferred to the molecule can increase its kinetic energy, and activate or deactivate enzymes or alter physical or chemical properties of main macromolecules. EFFECTS OF LOW LEVEL LASER THERAPY ON WOUND HEALING: Effects of low level laser therapy on wound healing process is one of the most fully studied aspects of this type of therapy. It affects all phases of this very complex process. This paper offers a more detailed analysis of these aspects.

[Compositae dermatitis]. / Compositae dermatitis.

INTRODUCTION: Compositae dermatitis is an allergic contact dermatitis caused by plant species of the Compositae family. The first report of a cutaneous reaction to the Chrysanthemum genus was made by Howe JS in 1887. In 1895 Maiden JH reported about skin lesions among men working with Tagetes minuta. Case reports of contact allergic-ragweed dermatitis appeared in the American literature as early as 1919. The North American feverfew--Parthenium Hysterophorus was brought to India from America in 1956 and it caused thousands of cases of so-called parthenium dermatitis. Ragweed and parthenium dermatitis became prototypes for the classic, so-called "airborne" Compositae dermatitis, that affects primarily exposed skin surfaces, and produces a universal erythroderma. EPIDEMIOLOGY: The frequency of contact allergy to Compositae in Europe is higher than previously believed. It occurs most frequently in middle-aged and elderly persons, but also in all age groups. During the two past decades a more equal sex ratio has been established. The prevalence varies from 0.7-1.4% in the general population, up to 4.5% among occupationally exposed persons. Compositae allergy is among the top ten contact sensitivities in Europe. In North Europe plants were the cause of 4.4% cases of occupational allergic contact dermatitis. ETIOLOGY AND PATHOGENESIS: Among cultivated Compositae plants, Chrysanthemum is considered to be a major sensitizer in Europe (60%). Among the edible types, it is lettuce--Lactuca sativa and endive Cichorium endivia (20-30%), and wild-growing feverfew--Tanace--tum parthenium (70-90%), tansy--Tanacetum vulgare (54%), and dandelion--Taraxacum officinale (65%). Sesquiterpene lactones are the main sensitizers of the Compositae family. Other components, thiophenes and acetylenes are said to elicit only phytophotodermatitis, but recent studies have demonstrated that some thiophenes and benzofuran derivates possess not only phototoxic activity, but also sensitizing properties. Photosensitivity is present in 22-75% Compositae sensitive individuals. Extracts from Compositae are known to be phototoxic in vitro. Photoreactivity of alpha-methylene-gamma-la-ctone group of sesquiterpene-lactone directed towards the DNA base thymine, thus producing intermolecular 2 + 2 photoadducts (antigen within the cell), was also thought to be related to photosensitivity. Clinical manifestations vary from generalized eczema (20-30%), eczema of hands and face (24%), hand (36-44%), or facial eczema (11-28%). 65% of patients have vesicular hand eczema. DIAGNOSIS: Routine patch testing with sesquiterpene lactone mix, aimed testing with Compositae extracts screening mix, Compositae plants, and with their extracts, whereas the treatment of choice is a specific allergen-immunotherapy.

[Psoriasis and autoimmune skin disorders]. / Psorijaza i oboljenja koze autoimunske prirode.

INTRODUCTION: Presuming that psoriasis is an autoimmune skin disease, the aim of this study was to establish its association with other autoimmune skin diseases. The material was obtained at the Dermatovenereological Clinic--Clinical Center Novi Sad. MATERIAL AND METHODS: This 10-year retrospective study (1990-1999) included 1743 psoriasis patients. The control group consisted of 7492 nonpsoriatic dermatological patients. RESULTS: Association of psoriasis with other dermatological diseases of autoimmune nature has been established in 13 (0.74%) patients. The most frequent association was with lichen ruber planus in five patients, with alopecia areata and vitiligo in three patients, and in one with bullous pemphigoid and herpetiform dermatitis. Using Fisher's test no significant association was established. DISCUSSION AND CONCLUSION: According to literature data association of psoriasis with other autoimmune diseases is well known, but rare, which is in accordance with our results. The question arises whether this association is the matter of poor coexistence or the matter of genetic mutations. However, once established, these associations can further highlight the autoimmune nature of psoriasis. The research of autoimmunity would lead us to epithelial cells in thymus, and their badly learnt cognitive function about what is own, and what is not.

[Use of a computer program (POSSUM) in examination of residents in a home for developmentally handicapped children and adults in Veternik-Novi Sad for occurrence and diagnostic significance of dysmorphologic signs on the skin]. / Ucestalost i znacaj dijagnostikovanih dismorfoloskih znakova na kozi i prema racunarskom programu (POSSUM) kod sticenika doma za decu i odrasle ometene u razvoju u Veterniku-Novi Sad.

The authors have examined frequency of dysmorphological signs by POSSUM at the Home for developmentally handicapped children and adults in Vetemik--Novi Sad. The aim was to establish possible different hereditary and congenital skin diseases and genetic syndromes in this population. The study was based on the following methods: method of family history including genealogy; dermatoglyphic methods; screening tests methodology in medical genetics; method of cytogenetic analysis; histo-pathological analysis; method of dermatovenerologic, genetic and dysmorphologic examinations of skin diseases by analysis of dysmorphological signs on the skin using a special computer programme. The study included 504 wards with 269 males and 235 females, and sex ratio of 1:1.14 in favour to males. Non-parametric statistics and Log-linear analysis revealed a statistically significant difference between the incidence of dysmorphological signs in the studied group and the Vojvodina population. The obtained incidence of dysmorphological signs in the examined group is presented in tables. Our results regarding the incidence of dysmorphological signs in the examined group showed significantly increased values in comparison to the population of Vojvodina.

[Kyrle's disease]. / Kyrleova bolest.

INTRODUCTION: Hyperkeratosis follicularis et parafollicularis in cuten penetrans known as Kyrle's disease is a recessive hereditary genodermatosis. Generally, Kyrle's disease appears between 30 to 50 years of age and women are affected more than men. CASE REPORT: We report a case of a 40-year-old man, a worker in a cement factory, who noticed the first skin lesions six years ago. Those were follicular papules on the left leg. He had been in good health beforehand, although an alcoholic for many years. Based on laboratory and other findings, chronic hepatitis was diagnosed. Histopathological analysis of skin lesions showed presence of hyperkeratosis and partial parakeratosis with acanthosis of the epidermis. DISCUSSION: Kyrle's disease is classified among the perforating dermatoses with perforating folliculitis, perforating serpiginous elastosis and perforating reactive collagenosis. Kyrle's disease is often associated with hepatic, renal or diabetic disorders, and may be a paraneoplastic disease. CONCLUSION: The course of this disease is chronic. If the associated diseases are treated, patients may have a better prognosis.

[Diagnostic importance of ultrasound in dermatology]. / Dijagnosticki znacaj ultrazvuka u dermatologiji.

INTRODUCTION: Utilization of 20 MHz ultrasound probes provided application of ultrasound in dermatology-dermatosonography. As a diagnostic tool, ultrasound was first registered in the early fifties of the past century. Great progress of dermatosonography occurred in the mid-nineties with introduction of the first 20 MHz scanner. METHODS OF ULTRASONOGRAPHY IN DERMATOLOGY: Several methods of ultrasonography have been developed: method A, method B, scannibg C method and Doppler ultrasound. They were based on different acoustic features of various tissues. ULTRASOUND IN DIAGNOSTICS: Today, dermatosonography is used in diagnosing: cutaneous neoplasms, inflammatory skin diseases and skin diseases of unknown etiology. Apart from that, it is used in differentiating benign and malignant tumors and may be helpful in monitoring morphea, dermatomyositis, cutaneous sarcoidosis, erythema nodosum, allergic diseases, postthrombotic syndrome, physiologic aging and aging due to sun exposure. It can be used in noninvasive monitoring of local treatment, therapeutic responses and adverse effects. CONCLUSION: Dermatosonography offers valuable possibilities in assessing skin morphology at an intermediate level: between clinical assessment and microscopy.

[Vitiligo in childhood]. / Vitiligo u decjem uzrastu.

INTRODUCTION: Vitiligo is an acquired, sometimes familial skin depigmentation disorder due to selective destruction of melanocytes. Vitiligo is primarily a disease of the young; in about half of patients it occurs before the age of twenty. The aim of this study was to investigate some epidemiological and clinical characteristics of vitiligo in children, in relation to adults with vitiligo and children without vitiligo. MATERIAL AND METHODS: The research was conducted in fifty children with clinically diagnosed vitiligo (2 to 16 years of age). Children were compared with control groups of children with other skin diseases (age 2 to 16) and with adults with vitiligo. Each group comprised 30 patients. A detailed history was obtained and physical examination performed in each patient to determine the age of onset, clinical type (segmental or generalized), family history of vitiligo and other autoimmune and/or endocrine diseases, association with halo nevi, poliosis and Koebner phenomenon. RESULTS: Of the 50 children with vitiligo, 29 (58%) were girls and 21 (42%) boys. The mean age at first visit was 9 years and the mean age of onset was 7 years. Children with vitiligo had positive family history of vitiligo and autoimmune and endocrine diseases more often compared to children without vitiligo (p < 0.05). Children with vitiligo had poliosis, especially in cases of segmental vitiligo, more often compared to their age group (p < 0.001). Children had an increased incidence of segmental vitiligo compared to adults (p < 0.05). Halo nevi were more common in children with generalized vitiligo, in comparison with children without vitiligo (p < 0.01) and adults with vitiligo (p < 0.05). DISCUSSION AND CONCLUSION: Our results show that segmental vitiligo and halo nevi occurred significantly more often in children than adults with vitiligo.