Aida Pašić

Phototherapy in Pediatric Patients

Abstract: The treatment of children with psoriasis, atopic dermatitis (AD), pityriasis lichenoides, and scleroderma poses a therapeutic problem because all therapeutic options are associated with numerous side effects. Therefore ultraviolet A and B (UVA and UVB) phototherapy is presented as a possible alternative to some of these therapies, primarily topical and systemic corticosteroids, in children. Our results in treating children with phototherapy and psoralen plus UVA (PUVA) bath phototherapy over the past 5 years are reported. UVB therapy (TL01) was used in 20 psoriatic children (6 boys, 14 girls; ages 6–14 years) during the stage of disease exacerbation and in 9 children (3 boys, 6 girls; ages 8–16 years) with pityriasis lichenoides. Combined UVA/UVB phototherapy was applied in 21 AD children (7 boys, 14 girls; ages 4–15 years). Photochemotherapy with local application of a PUVA bath was used in six children (2 boys, 4 girls; ages 9–16 years) with circumscribed scleroderma and in one girl with systemic scleroderma. All children received short courses of phototherapy with either no maintenance or short maintenance. All three therapeutic protocols resulted in a certain degree of improvement in most of the study patients. None of the patients exhibited any early phototherapy side effects. We conclude that phototherapy and PUVA bath are valuable and safe therapeutic options for selected children who do not respond to other treatments.

New Treatment Modalities for Vitiligo Focus on Topical Immunomodulators

The development of effective treatment modalities for vitiligo is dependent on an understanding of the events leading to depigmentation. However, the exact pathogenesis of vitiligo is still mostly unknown. Abnormalities in both humoral and cell-mediated immunity have been documented in vitiligo patients and they present a basis for using immunomodulating agents, such as corticosteroids and macrolide immunomodulators, in the treatment of vitiligo. Macrolide immunomodulators, such as tacrolimus and pimecrolimus, which can be used topically, are known as topical immunomodulators (TIMs). TIMs inhibit the action of calcineurin, and consequently inhibit T-cell activation and the production of various cytokines; this is considered the working mechanism of action of TIMs in vitiligo. Several small studies and case reports on the use of TIMs in vitiligo have been published so far. Tacrolimus achieves better results on the face and neck than on other body areas.Particular advantages of TIMs are safety in treating these areas because of lack of skin atrophy and good tolerability. The incidence of application site adverse events in vitiligo seems to be lower than in the treatment of atopic dermatitis. On the face and neck, TIMs may become a useful tool in the treatment of adults and children with vitiligo despite possibly lower efficacy than topical corticosteroids. Further, larger, controlled clinical studies are warranted to determine the definite role of TIMs as monotherapy or in combination with other modalities in the treatment of vitiligo.

Visualization of basal cell carcinoma by fluorescence diagnosis and independent component analysis

Photodynamic detection (PDD) of skin tumours is based on the visualization of a fluorophores, with the ability to accumulate in tumour tissue, by the use of fluorescence imaging. Of particular importance is the application of δ-5-aminolaevulinic acid (ALA) that, through the process of biosynthesis causes formation of the protoporphyrin IX (PpIX). The PpIX has the ability of selective fluorescence after basal cell carcinoma (BCC) has been treated with ALA. Higher concentration of PpIX in tumour tissue compared to surrounding normal skin is the basis for PDD. Our contribution in this preliminary study is application of the independent component analysis (ICA) to extract the BCC spatial map, by processing fluorescent RGB image acquired under excitation with 405nm light. Comparative performance analysis with other two widely used image processing methods: ratio imaging and optimal threshold based imaging, reveals that ICA produces BCC spatial map that is most consistent in term of diagnostic quality by both visual assessment and calculation of the BCC demarcation line. We believe this represents a solid basis for the design of a compact and low-cost multi-spectral fluorescence imaging system, capable for real time calculation of the skin tumour demarcation.

An overview: the changing face of cutaneous infections and infestations

Our intention was to point out the importance of cutaneous infections and infestations in resolving this dermatological problems. Modern way of life and fast communications enable the spread of this conditions in all age groups and in all parts of the world. The main role of dermatologist is not only in the recognition and treatment, but also in the prevention of infections and infestations of the skin. Finally, investigation, prevention, and continuous education on infections and infestations in dermatology will provide healthier population in every environment.

Naphthalan Oil in the Treatment of Psoriasis and Psoriatic Arthritis

Background Naphthalan is a specific form of medicinal earth oil, and a number of subtypes are used in topical therapy for psoriasis and psoriatic arthritis. In the present study, yellow naphthalan oil that is enriched with steranes but that has a reduced content of polyaromatics was used. Objective The aim of the study was to assess the effect of naphthalan on psoriatic skin lesions, on painful and swollen joints, and on functional status of patients with psoriatic arthritis. Methods The study included 28 patients with chronic stationary psoriasis (psoriasis vulgaris) and 12 patients with psoriatic arthritis. Results In the psoriasis vulgaris study arm, the mean ± SD Psoriasis Area and Severity Index score was 23.1 ± 7.5 at baseline; it was 7.95 ± 4.08 after 3 weeks of naphthalan treatment. In the majority of patients, naphthalan treatment reduced articular pain and edema and improved mobility of affected joints. Conclusion Naphthalan provides efficacious therapy in the management of mild to moderate psoriasis and psoriatic arthritis.