Clinical and immunopathological characteristics of autoimmune blistering skin diseases.

Autoimmune blistering skin diseases (AIBDs) encompass several heterogeneous conditions clinically characterized by blisters and erosions on the skin and mucous membranes and are immunopathologically characterized by autoantibodies against structural proteins of the skin. Those proteins are responsible for the intercellular contact between epidermal keratinocytes and adhesion of the basal keratinocytes to the dermis. Therefore, AIBDs are divided into two main groups: intraepidermal (the pemphigus group) and subepidermal (the pemphigoid) groups. The diagnostic methods for AIBDs have made tremendous progress in the last 2 decades due to the availability of standardized serological assays that allow precise diagnosis in most patients. If left untreated, these diseases are potentially life-threatening due to superinfections and loss of body fluids, and in some severe cases due to restricted food intake. Based on the available literature, this paper provides an overview of the clinical and immunopathological characteristics of the most common AIBDs.

Inappropriate Use of Topical Corticosteroides in the Dermatology Outpatient.

INTRODUCTION: Topical corticosteroids are group of drugs which have anti-in?ammatory, immuno-suppressive, anti-proliferative and vasoconstrictive effects and are among the most commonly prescribed medication, important and efficacious for management of various dermatological disorders. Strict implementation of the existing regulations is the need of the hour to prevent their widespread abuse. Aim of the study was to investigate the usage of topical corticosteroids therapy with the recipe of a doctor and without it. SUBJECTS AND METHODS: The subjects were patients who visited Pharmacies in Mostar from April to July 2020 and were buying topical corticosteroids with or without a recipe or medical report from the doctor. 80 subjects completed a questionnaire themselves included: the way of buying a topical corticosteroids, the information about using topical corticosteroids earlier, the information about subject's visits to the doctor; the length of time using topical corticosteroids, the type of topical corticosteroids used, the part of body the topical corticosteroids was applied on. RESULTS: A total of 80 subjects were treated in the observed period, 58.8% were female. 72.5% subjects had already used local corticosteroids, 62.50% purchased the drug at the recommendation of the pharmacist, 66.30% had no recent diagnosis or no diagnosed disease at all, 21.25% used the drug for more than a month, the most often purchased one was moderate potent local corticosteroid Betamethasone diproprionate 0.05%. Most commonly subjects applied local corticosteroids on arms (50%). CONCLUSION: Strict regulations regarding only prescription-based dispensing of local corticosteroids must be put into practice. This will hopefully bring down both the extremes of ever increasing cases of steroid-induced dermatoses in everyday dermatology practise on one hand and the irrational fears of using TCs in well justified indications on the other.

Efficacy and Safety of Azelaic Acid Nanocrystal-Loaded In Situ Hydrogel in the Treatment of Acne Vulgaris.

Acne vulgaris is a common, multifactorial, inflammatory skin disease affecting the pilosebaceous unit. Topical therapy is the first choice in the treatment of mild to moderate acne, and azelaic acid (AZA) is one of the most commonly used drugs. The aim of this study was to evaluate the safety and efficacy of a low-dose azelaic acid nanocrystal (AZA-NC) hydrogel in the treatment of mild to moderate facial acne. The study was designed as a double-blind, randomized controlled trial. Patients were randomized to treatment with AZA-NC hydrogel, 10%, or AZA cream, 20%, administered in quantities of approximately 1 g twice daily for 8 weeks. Efficacy of therapy was measured by the number of lesions and safety by the frequency and severity of adverse events. At week 8, the success rate of treatment with AZA-NC hydrogel, 10%, was 36.51% (p < 0.001) versus 30.37% (p < 0.001) with AZA cream. At week 8, treatment with AZA-NC hydrogel, 10%, resulted in a significant reduction in total inflammatory lesions from baseline of 39.15% (p < 0.001) versus 33.76% (p < 0.001) with AZA cream, and a reduction in non-inflammatory lesions from baseline of 34.58% (p < 0.001) versus 27.96% (p < 0.001) with AZA cream, respectively. The adverse event rate was low and mostly mild.

Sensitive Skin in the Population of Herzegovina-Neretva County: Prevalenceand Clinical Data.

INTRODUCTION: Sensitive skin has been described as a syndrome defined by the occurrence of unpleasant sensations (stinging, burning, pain, pruritus, and tingling sensations) in response to stimuli that normally should not provoke such sensations. Although often transient, and in many cases unaccompanied by visual dermatological responses, sensitive skin affects the quality of life. The aim of this survey was to assess the prevalence of sensitive skin and collect clinical data on sensitive skin in the population of Herzegovina-Neretva County. SUBJECTS AND METHODS: The survey included a total of 73 participants, 45 female and 28 male, aged 20 years and above, with a diagnosis of sensitive skin syndrome (SSS) confirmed by physicians. A dermatological exam assessing skin type, phototype and skin sensitivity was performed. The survey collected an assortment of information including demographics and included customized standardized questionnaires that closely examine skin sensitivity and the burden of sensitive skin. RESULTS: Findings concurred with existing evidence that individuals with sensitive skin represent almost half the examined population. The prevalence of perceived sensitive skin was significantly higher in females than in males. The main skin symptom was itching, followed by prickling, warmth and numbness. Our results clearly show that there is a burden of sensitive skin. CONCLUSION: This study investigated the prevalence of sensitive skin and the burden of sensitive skin in the population of Herzegovina-Neretva County. It is the first to focus on sensitive skin among Herzegovina-Neretva County population. Further studies are needed to bolster epidemiological data and physiological pathways of sensitive skin syndrome.

Knowledge, Attitudes, and Behaviors of Mostar University Students on the Harmful Effects of Ultraviolet Radiation Exposure - A KAB Study.

Various reports suggest that adolescents seem to be obsessed with tanning. Existing evidence on attitudes demonstrate that young adults focus on improving appearance through a tan, with protective behaviors often being absent. The popularity of tanning, primarily among the young adult population, further promotes unsafe sun-related behaviors. The aim of this study was to determine the knowledge level of Mostar University students on the harmful effects of ultraviolet radiation (UVR), their attitudes and sun-related behaviors, and whether medical students are more likely to apply preventive measures against UVR in comparison with students from other faculties. The survey included a total of 140 undergraduate Mostar University students: 70 medical students and 70 non-healthcare-related faculty students. The data were collected by completing the personal design questionnaire created for this study. This study shows that Mostar University students have a high level of knowledge about UVR and skin cancer, but their behavior is not sufficiently preventive and appropriate to their knowledge. Medical students often use UV protection measures and employ more preventive behavior than that of other faculty students, but it is still at a low level of prevention. Findings concurred with existing evidence that the knowledge of associated risks from UVR was not sufficient to motivate safer sun-related practices.

The Usage of Hypoallergenic Cosmetics in Patients with Atopic Dermatitis.

The aim of this study was to investigate how many patients with atopic dermatitis applied hypoallergenic cosmetics compared with topical corticosteroids. The study included 41 patients with atopic dermatitis (AD) who were treated from June 1 to July 1, 2017 at the Department of Dermatology and Venerology, Clinical Hospital Mostar. According to the data analyzed, 46.34% of patients used hypoallergenic cosmetics while 24.39% used them periodically. 32.7% patients used topical corticosteroids and 17.07 % used them periodically. 19.51 % of the patients with atopic dermatitis used alternative products, while 17.07% used them periodically. Out of the total number of patients, most of the patients used neutral products. 78.05% used neutral cosmetic products, and 19.51 % used them periodically. 65.85 % patients used sunscreens and 24.40 % used them periodically. The majority of patients used neutral cosmetic products and sunscreens. There was no statistically significant difference in the frequency of the use hypoallergenic cosmetics compared with topical corticosteroids (χ2 = 1.802; df = 2; P=0.405). Women used sunscreens more often (χ2 = 16,02; df = 1; p = <0,05).

Psychological Status and Quality of Life in Acne Patients Treated with Oral Isotretinoin.

INTRODUCTION: The acne patients are at higher risk of acquiring depresion and anxiety, which can lead to reduced quality of life. Effective treatment of acne can reduce symptoms of anxiety and depression and significantly improve other physiological parameters and quality of life of these patients. The aim of this study was to determine the psychological status and quality of life of acne patients before, during and after the treatment with oral isotretinoin. SUBJECTS AND METHODS: The prospective study included a total of 127 patients suffering from moderate to severe form of acne. To assess the psychological status and quality of life of studied groups the following standard psychometric questionnaires were performed before, during and after the treatment with oral isotretinoin: Beck Depression Inventory (BDI), Assessments of the Psychological and Social Effects of Acne (APSEA), State Trait Anxiety Inventory (STAI), Measure of Psychological Stress (MPS) and Dermatology Specific Quality of Life (DSQL). RESULTS: Results of the present study indicate that there is no increase in depressive and anxiety symptoms in the patients treated with oral isotretinoin. The psychological status by gender has shown the existence of differences between the genders in all measures of psychological status. Statistically significantly better quality of life was observed after healing than before treatment. CONCLUSION: The results of our study showed no higher risk of depression and anxiety within the patients with acne treated with oral isotretinoin. Improvement of quality of life after the treatment of acne with oral isotretinoin was confirmed.

Cutis Verticis Gyrata - A Case Report.

Cutis verticis gyrata (CVG) is a skin condition characterized by excessive growth of the skin of the scalp, resulting in furrows and folds which are similar to the gyri of the brain cortex. CVG can be classified into two forms: primary (essential and non-essential) and secondary. We report the case of a 53-year-old male patient with the primary type of CVG. The patient did not present with any cutaneous complication. His main complaint was the unaesthetic aspect of his scalp related to a psychological inferiority complex.

Aplasia Cutis Congenita in a Newborn Child Associated with Two Fetus Papyraceous.

Aplasia cutis congenita (ACC) is a rare inborn lesion, presenting with absence of skin. The etiology is unknown and is probably not attributable to a single cause but to a combination of genetic factors. Multiple causes have been suggested for ACC: syndromes and teratogens, intrauterine infection--varicella zoster virus, herpes simplex virus--fetal exposure to cocaine, heroin, alcohol, or antithyroid drugs. The most common site is the scalp. We report a case with multiple lesions on the trunk, resembling an instance with ACC group 5. This form of ACC occurs in association with the in utero death of a twin or more (in this case triple) fetus. Histological findings are available in very few reports. Therapy options depend on the characteristics of the lesion, but conservative treatment is usually chosen.

Distribution of Malassezia species on healthy human skin in Bosnia and Herzegovina: correlation with body part, age and gender.

BACKGROUND AND OBJECTIVES: The genus Malasezia currently includes fourteen species that have been isolated from healthy and diseased human and animal skin. However, there were differences with respect to the species most commonly isolated, not only in patients with various skin diseases but also between healthy individuals. The aim of this study was to analyze the prevalence of Malassezia species from clinically normal skin of the scalp and trunk of healthy individuals and to examine if the range of species varies according to body site, gender and age. MATERIALS AND METHODS: The study was conducted at the Department of Dermatovenerology, University Clinical Center in Sarajevo, Bosnia and Herzegovina from December 2012 to May 2013. One hundred healthy men and women with no skin diseases and aged from <1 to 82 years were studied. The samples were obtained by scraping the skin surface from the upper and middle part of trunk and from scalps of all subjects and then incubated on modified Dixon agar. The yeasts isolated were identified by their morphological and physiological properties according to Guillot et al. method. RESULTS: M. sympodialis was the predominant species on trunk skin in older subjects, M. restricta on scalp skin in age groups 21-35 years, while M. globosa was identified as common species in adults (36-50 years), both from scalp skin and trunk skin. From the trunk skin M. furfur was the most frequent in children. CONCLUSION: This study confirmed that cutaneous Malassezia microbiota in healthy subjects varies by body part and age but not by gender.

Prevalence of metabolic syndrome in patients with psoriasis at Mostar Clinical Hospital.

Psoriasis is a chronic inflammatory skin disease. Metabolic syndrome is composed of obesity, hyperglycemia, hypertension and dyslipidemia. Previous reports have shown higher prevalence of metabolic syndrome in patients with psoriasis. It is believed that similar inflammatory changes lie in the pathophysiological background of psoriasis and metabolic syndrome. The main objective of this study was to assess the prevalence of metabolic syndrome and its components in patients with psoriasis, as well as to investigate the presence of systemic signs of inflammation such as erythrocyte sedimentation rate and C-reactive protein. The study included 60 patients with psoriasis and the same number of control subjects. We measured anthropometric and laboratory parameters; metabolic syndrome was defined according to the National Cholesterol Education Program-Adult Treatment Panel III criteria and Psoriasis Area and Severity Index was determined in all patients with psoriasis. This study showed a statistically significant presence of obesity (48.3%) and hyperglycemia (23.3%) in patients with psoriasis, while the prevalence of metabolic syndrome was 46.7%. These findings should encourage practitioners to screen psoriasis patients, especially when the disease is severe, for metabolic disorders and introduce appropriate prevention strategies.

Analysis of psychopathological traits in psoriatic patients.

Psoriasis vulgaris is a multifactorial, heterogeneous disease that is associated with problems in skin image and feelings of shame and stigmatization. The aim of this study was to analyze psychopathological traits in patients with psoriasis and a comparative group. A total of 254 dermatological patients participated in the study: 124 patients with confirmed diagnoses of psoriasis vulgaris and 130 patients with melanocytic and non-melanocytic nevi on covered parts of the body. Psychometrically mensural and standardized instruments were used in the study: list of general data, appendix of disease data, Beck Depression Inventory test, State-Trait Anxiety Inventory, Measure of psychological stress and Eysenck's Personal Questionnaire. There is a significant statistical difference in the result of psychometric tests between the study groups. Patients with psoriasis have more severe symptoms of depression, more physical symptoms of anxiety and higher results on the anxiety scale as a state and as a trait p=0.000. Eysenck's personal questionnaire showed higher results on the psychoticism scale p=0.000 and lower results on the extraversion scale p=0.035 among psoriatic patients.

Most common skin tumours in correlation with solar ultraviolet radiation in the area of West Herzegovina.

Incidence rate of skin tumours, both, non-melanoma and melanoma, is increasing nowadays. Various etiological factors are of relevance for the occurrence of the diseases. The solar radiation, as well, long-term exposure to ultraviolet (UV) radiation, have the greatest impact on development of these skin tumours. Non-melanoma skin tumours, Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC), are the most common skin tumours in humans, and usually develop on the chronically photo-exposed areas. As for the Malignant Melanoma (MM), one of the most aggressive skin tumours, the exposure to solar radiation also plays an important role. This study investigates the correlation between the skin tumours and UV radiation in the area of West Herzegovina, on the sample of 1676 patients. It presents the occurrence of skin tumours in the period from 1997 to 2003. The study investigates the incidence and the risk factors separately for every skin tumour which can be etiologically related to the occurrence of skin tumours and UV radiation: occupation, exposure to UV radiation, skin type, and family history on malignan tumours within the patient's family. The exact incidence rate of non-melanoma and melanoma skin tumours in Bosnia and Herzegovina is still unknown, for the reason that the united National Cancer Register does not exist yet.

Epidemiological and clinical characteristics of malignant melanoma in area of West Herzegovina from 1997 to 2010.

Incidence rate of cutaneous malignant melanoma (MM), one of the most aggressive skin tumours, is increasing nowadays. Etiology of MM has not been fully understood. Various etiological factors are of relevance for the occurrence of the disease. The solar radiation as well as long term exposure to ultraviolet radiation has the greatest impact on development of this skin tumour. Melanoma risk factors have different associations with melanoma on body sites. This study investigates the epidemiological and clinical characteristics of MM such as age, gender, distribution of MM on the body and type of melanoma in the area of West Herzegovina, on the sample of 205 patients. It presents the occurrence of MM in the period from 1997. to 2010. Both, females and males have increased the risk of melanoma on the trunk (45.9%). Different body sites receive various amounts of sun exposure, yet melanomas occur on all parts of the body. This may represent different pathways in the etiology of melanoma based on body location. The most frequent type of MM was superficial spreading melanoma (SSM) 47.8%. According to our investigation incidence rate was 18.6% (per 1000 patients).

Knowledge and attitudes towards sun protection in Croatia.

Skin cancer is the most common form of cancer; the World Health Organization estimates that more than 2 million cases of skin cancer are being diagnosed each year worldwide. Excessive sun exposure and ultraviolet (UV) radiation are the major avoidable risk factors for skin cancer, including melanoma. Sun protection can be achieved through behavioral modification, social changes and environmental changes: regular use of sunscreen, wearing hats and protective clothes, staying in the shade, creating shade by planting trees or constructing canopies, practicing work and sport activities during the time of the day when the sun is not the strongest and many others. The aim of this paper was to investigate the knowledge and attitudes about sun protection and sun behavior patterns in Croatia, as well as the perception of melanoma among general population. Our results indicate relatively good sun behavior patterns among our participants and their mostly correct perception of melanoma.

Risk factors associated with the occurrence of basal cell carcinoma.

Basal cell carcinoma (BCC) is the most frequent malignant skin tumor, which is associated with both genetic factors and environmental influences. The objective of this study was to investigate the risk factors associated with the occurrence of BCC in the inhabitants of the Western Herzegovina area. The study took place during 1997-2003. We examined the risk factors which are presumably associated with the occurrence of BCC: skin type, exposure to UV rays and family occurrence of BCC, supplemented by the examination of the skin type, UV rays and existence of malignant tumors amongst the family members. We recorded a high correlation between the type of skin and the risk of occurrence of BCC. Long term and frequent skin exposure to UV rays were also associated with BCC. We also recorded increased risk for BCC in persons whose family members suffered from malignant skin tumors. Avoiding exposure to the sun as well as protection from UV rays may decrease the risk of BCC.

Quality of life in psoriatic patients and the relationship between type I and type II psoriasis.

Psoriatic patients, along with skin changes, frequently show various psychological changes such as depression, anxiety and have overall lower quality of life. The aim of this study was to evaluate the quality of life in patients with psoriasis compared to other dermatological patients, as well as to investigate the differences between the two subgroups--type I and type II psoriasis. A total of 94 dermatological patients were included. The patients were divided into two groups, the first group made of psoriatic patients which was further divided into two subgroups, and the second, control group made of patients with other skin diseases. DSQL quality of life questionnaire was used. The study showed that among psoriatic patients there was no significant difference in the quality of life, but there was a significant difference between the psoriasis type I and the control group, which could be explained by the strong influence of the disease on the quality of life in psoriatic patients.

Psychological impact of isotretinoin treatment in patients with moderate and severe acne.

Acne patients are subject to different degree of psychosocial distress. The emotional impact of acne vulgaris due to disfigurement caused by the disease is undisputed. Most common reactions to the acne are depression and anxiety. The use of isotretinoin, one of the most effective options in acne treatment, increases depression symptoms. The aim of this study was to investigate the psychological status of the patients with moderate to severe acne and to compare patients treated with isotretinoin with patients treated with vitamin C. A total of 85 patients suffering from acne vulgaris were included in the study. The results of this study do not find a significant correlation between the use of isotretinoin and the psychological effects of the drug.