Jovanović M

Erythema multiforme due to contact with weeds: a recurrence after patch testing.

Erythema multiforme (EM) as a complication of patch testing (PT) is rare. A 52‐year‐old woman with a 13‐year history of episodes of EM, after contact with weeds during home gardening, had had no recent history of herpes simplex, other infection, drug ingestion or vaccination. On examination, EM lesions were distributed on the exposed skin. 5 weeks after complete resolution, PT and photopatch testing (PPT) were done with fresh plants she brought in. She was PT with a standard series and the Hermal‐Trolab plants, woods, tars, balsams and flavors series. Intradermal testing, with a 3 + reaction to mixed weed pollens, was done 3 weeks later. Specific IgE to weed pollens class 1 (CAP‐Pharmacia) was detected. Eczematous PT reactions were obtained with fresh leaves: common chickweed (Stellaria media Caryophyllaceae), dandelion (Taraxacum officinale Compositae), field‐milk thistle (Sonchus arvensis Compositae) and white clover (Trifolium repens Leguminosae). Photoaggravation was seen to common chickweed and dandelion. Positive PT was also seen with alantolactone. By the 4‐day reading, a typical EM had commenced, coming up to quite the same extent as seen on admission. There was no photosensitivity (UV skin tester, K. Waldmann). In the essential oil obtained from common chickweed, thin layer chromatography (TLC) revealed the well‐known contact allergens borneol, menthol, linalool, 1,8‐cineole, and other terpenes such as epoxy‐dehydro‐caryophyllene, monoterpene alcohol‐ester and caryophyllene. Up to now, no data on essential oil in Stellaria media (common chickweed) have been reported. It can be concluded that EM developed due to contact with weeds, and recurred after patch testing. Neither blistering nor eczematous lesions have been seen on her skin, making this case very unusual. As far as the world literature is concerned, this is only the 4th report of EM developing in association with patch testing.

Sesquiterpene lactone mix patch testing supplemented with dandelion extract in patients with allergic contact dermatitis, atopic dermatitis and non-allergic chronic inflammatory skin diseases

We investigated the value of patch testing with dandelion (Compositae) extract in addition to sesquiterpene lactone (SL) mix in selected patients. After we detected a case of contact erythema multiforme after patch testing with dandelion and common chickweed (Caryophyllaceae), additional testing with common chickweed extract was performed. A total of 235 adults with a mean age of 52.3 years were tested. There were 66 men and 169 women: 53 consecutive patients with allergic contact dermatitis (ACD); 43 with atopic dermatitis (AD); 90 non‐atopics suffering from non‐allergic chronic inflammatory skin diseases; 49 healthy volunteers. All were tested with SL mix 0.1% petrolatum (pet.) and diethyl ether extracts from Taraxacum officinale (dandelion) 0.1 and 3.0% pet. and from Stellaria media (common chickweed) 0.1 and 3% pet. A total of 14 individuals (5.9%) showed allergic reaction (AR) to at least 1 of the plant allergens, 4 (28.6%) to common chickweed extract, and 11 (78.6%) to Compositae allergens. These 11 persons made the overall prevalence of 4.7%: 8 (3.4%) were SL‐positive and 3 (1.3%) reacted to dandelion extract. 5 persons (45.5%) had AD, 2 had ACD, 2 had psoriasis and 2 were healthy controls. The Compositae allergy was relevant in 8 cases (72.7%). The highest frequency of SL mix sensitivity (9.3%) was among those with AD. Half the SL mix‐sensitive individuals had AD. ARs to dandelion extract were obtained only among patients with eczema. A total of 9 irritant reactions (IRs) in 9 individuals (3.8%) were recorded, 8 to SL mix and 1 to common chickweed extract 3.0% pet. No IR was recorded to dandelion extract (P = 0.007). Among those with relevant Compositae allergy, 50.0% had AR to fragrance mix and balsam of Peru (Myroxylon pereirae resin) and colophonium. SLs were detected in dandelion but not in common chickweed. Our study confirmed the importance of 1 positive reaction for emerging, not fully established, Compositae allergy. In conclusion, the overall prevalence of 4.7% in our study represents a basal SL mix detection rate of 3.4% reinforced and safely supplemented by testing with the dandelion extract.

Some epidemiological features of pemphigus chronicus in South Vojvodina: A 12-year retrospective study

calcipotriol has become one modality for treating GPP. To date, only one case report has implicated topical calcipotriol cream as a possible precipitating factor of GPP. 3 Here, we have reported another case. Calcipotriol ointment is a known irritant. 4 In irritation dermatitis, keratinocytes deliver various kinds of cytokines, including IL-1, IL-6, TNFα , and IFNγ . 5,6 If the area of irritation dermatitis is considerably large, it is possible that the amount of delivered cytokines may be sufficient to precipitate GPP. Dermatologists should keep in mind that calcipotriol ointment may precipitate GPP.

Psoriasis and autoimmune skin diseases

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 Fishers 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.

Linear porokeratosis: a case report

Abstract Porokeratosis is a rare genodermatosis based on chronic keratinization disorder histologically characterized by the presence of a cornoid lamella and various clinical manifestations. Five most commonly described types of poroketarosis are porokeratosis of Mibelli or ”classic” porokeratosis, disseminated superfi cial actinic porokeratosis, disseminated palmoplantar porokeratosis, linear porokeratosis, and punctate porokeratosis. In all of the fi ve clinical types of porokeratosis described today, cases of planocellular skin carcinoma are described, except in punctate type cases. Use of topical CO2 laser ablation, cryotherapy and topical use of 5% Imiquimod cream, have shown favorable effects in local treatment of porokeratosis. The authors present a clinical case of a girl suffering from linear porokeratosis over the course of the last four years, spreading on the inside of her right arm along the lines of Blaschko. Linear porokeratosis was histologically confi rmed by biopsy of skin lesions and dermoscopy. Dermoscopic fi ndings, used as an auxiliary method, also indicated linear porokeratosis. Successful liquid nitrogen cryotherapy prompted the authors to present a case in which the applied treatment proved to be successful, but also to emphasize the need for timely treatment in order to prevent malignant alterations of these changes. Sažetak Uvod: Porokeratoza predstavlja retku genodermatozu u čijoj osnovi se nalazi hronični poremećaj keratinizacije sa karakterističnim histološkim nalazom kornoidne lamele i različitim kliničkim ispoljavanjem. Naj-češče se opisuje 5 tipova porokeratoze: ”klasična” porokeratoza Mibelli, diseminovana superfi cijalna aktinička porokeratoza, diseminovana palmoplantarna porokeratoza, linearna porokeratoza i punktatna porokeratoza. U svim do danas poznatim kliničkim tipovima porokeratoze, opisani su slučajevi nastanka planocelularnog karcinoma kože, izuzev kod punktatnog oblika. U lokalnoj terapiji porokeratoze, povoljan terapijski efekat su ispoljili: CO2-laser, krioterapija i lokalna primen 5% imikvimod krema. Prikaz slučaja: Autori prikazuju slučaj devojke sa linearnom porokeratozom prisutnom tokom poslednje četiri godine, koja je zahvatila desnu ruku sa unutrašnje strane, pružajuči se duž Blaškovih linija. Nalaz linearne porokeratoze potvrđen je histološki posle uzete biopsije kožnih promena, a urađen je i pregled metodom dermoskopije. Dermoskopski nalaz, kao pomoćni dijagnostički metod, takođe je ukazivao na linearni oblik porokeratoze. Uspešna krioterapija tečnim azotom, koja je sprovedena kod bolesnice, navela je autore da prikažu ovaj slučaj u kome se primenjena metoda lečenja porokeratoze pokazala uspešnom, ali i da bi istakli potrebu blagovremene terapije porokeratoze sa ciljem prevencije maligne alteracije u ovim promenama. Diskusija: „Klasičan oblik“ porokeratoze (PK) prvi je opisao Mibelli 1893. godine (1, 2) kao oboljenje koje se obično pojavljuje u detinjstvu u vidu jednog ili nekoliko diskretnih keratotičnih plakova sa deskvamacijom, koji se mogu pojaviti na bilo kom delu kože i/ili sluznicama (3). Respighi iste 1893. godine opisuje diseminovani superfi cijelni oblik PK, a 1967. godine Chernosky daje detaljan opis diseminovane superfi cijelne aktiničke forme bolesti (4). Linearni oblik PK prvi put je opisan 1918. godine. Guss 1971. godine prvi opisuje diseminovanu palmoplantarnu PK (5). Rahbari 1974. godine izdvaja linearnu PK kao posebnu formu bolesti (6), a 1977. godine kliničkim oblicima PK dodaje punktatni oblik (7). PK se smatra naslednom bolesti sa autozomnodominantnim načinom prenosa, ali najveći broj slučajeva nastaje sporadično (8). Inače, „klasična“ PK je češća kod muškaraca, čak 2-3 puta, dok je kod palmoplantarne diseminovane PK odnos muškarci : žene − 2:1. Kod diseminovane aktiničke PK postoji predominacija ženskog pola nad muškim u odnosu 3:1 (8). Učestalost linearne porokeratoze kao kliničkog oblika među svim ostalim kliničkim oblicima porokeratoze prema podacima Nacionalnog centra u Singapuru iznosi 12,9 % i obično se otkriva u četvrtoj deceniji života (9). Linearni oblik PK je nađen kod monozigotnih blizanaca (10, 11) i u porodicama u kojima su istovremeno prisutni i ostali oblici PK (11, 12); ostaje nepoznat način prenošenja (8, 11 ); odnos polova je 1:1 i češći se javlja kod pripadnika bele rase (11). PK najčešće zahvata ekstremitete u vidu malih, asimptomatskih, keratotičnih i/ili lihenoidnih papula ili plakova smeđe do boje kože, koji su oštro ograničeni, promera jednog do nekoliko centimetara, sa naglašenom keratotičnom ivicom tvrde konzistencije sa hipopigmentovanim ili hiperpigmentovanim centrom koji se lako uleže; atrofi čnog je izgleda. Kod linearne PK mogu nastati multiple promene, zatim lokalizovane i unilateralne, slede Blaškove linije na koži. U svim do danas danas poznatim kliničkim tipovima PK, opisani su slučajevi maligne alteracije i nastanka, najčešće planocelularnog karcinoma kože (PCK) u lezijama PK (8), izuzev kod punktatnog oblika (11). Zaključak: U ovom radu, autori prikazuju slučaj devojke sa linearnim porokeratozom, prisutnom unazad četiri godine, koja je zahvatila desnu ruku sa unutrašnje strane, pružajući se duž Blaškovih linija, da bi istakli potrebu blagovremene terapije porokeratoze radi prevencije maligne alteracije u ovim promenama.

Urticaria pigmentosa in a patient with acquired immunodeficiency syndrome – a case report / Urtikarija pigmentoza kod obolelog od sindroma stečene imunodeficijencije – prikaz slučaja

Abstract The authors present a case of a man with urticaria pigmentosa and acquired immunodeficiency syndrome - AIDS. The patient was diagnosed as HIV (human immunodeficiency virus) - positive in the year 2000, at the Infectious Diseases Clinic, Clinical Center of Vojvodina in Novi Sad. Urticaria pigmentosa was detected (nine years later) during a dermatological examination at the Dermatovenerology Department of the Outpatient Clinic, Clinical Center of Vojvodina. Urticaria pigmentosa is the most common manifestation of cutaneous mastocytosis. The patient was taking long term antiviral therapy for several years. Approximately 2 years after the onset of urticaria pigmentosa, this patient developed septicemia and ascites along with hepatosplenomegaly, liver damage, chronic cholecystitis, leukopenia, thrombocytopenia and relative eosinophilia. The patient had increased total serum IgE levels and tested positive for 5-hydroxyindoleacetic acid in a 24-hour urine test from the very beginning of urticaria pigmnentosa and during the course of his illness. Immunohistochemical results of dermal biopsy of the affected area confirmed the diagnosis of urticaria pigmentosa. Histology findings confirmed presence of typical dermal mast cell infiltrates with distinct oval and spindle granules that were CD117+ and CD1a-. Systemic mastocytosis was excluded by liver and bone marrow biopsies. To our knowledge, we present the third case of associated mastocytosis and acquired immunodeficiency syndrome published in world literature so far, in order to indicate the possible interaction between HIV infection and mast cells. Sažetak Uvod: Urtikarija pigmentoza je najčešća manifestacija kutane mastocitoze kod dece i odraslih. Kod dece kutana mastocitoza može da recidivira ali i da spontano involuira. Klinička prezentacija oboljenja kod dece i odraslih razlikuje se, kako po toku tako i po prognozi. Bolest ima tipične kliničke manifestacije u smislu pojave žutosmeđih makuloznih ili crvenih papuloznih promena na koži sa simetričnim rasporedom. Kosmati deo glave, šake, stopala i lice mogu biti pošteđeni. Sluznice su retko zahvaćene. Blaga iritacija (trljanje ili grebanje) izazivaju oslobađanje medijatora inflamatorne reakcije (histamina, prostaglandina, leukotrijena, citokina) koji dovode do pojave urtika na mestu iritacije, što se označava kao Darijeov znak. Cilj: Prikazujemo slučaj kutane mastocitoze sa urtikarijom pigmentozom kod obolelog od sindroma stečene imunodeficijencije kao treći do sada objavljeni slučaj u nama dostupnoj svetskoj literaturi. Cilj nam je da ukažemo na mogućnost razvoja kutane mastocitoze kod obolelih od AIDS-a zbog imunogenetskih oštećenja i mogućih imunogenetskih rearanžmana. Prikaz slučaja: Kod bolesnika (osoba, muškog pola, 36 godine, radnik, zaposlen, neoženjen) je 2000. godine utvrđeno prisustvo infekcije sa virusom humane imunodeficijencije (eng. Human immunodeficiency virus - HIV). U Dermatovenerološkom odeljenju Poliklinike Kliničkog centra Vojvodine urtikarija pigmentoza je otkrivena devet godina kasnije pri dermatološkom pregledu. Bolesnik se nalazi na HAART (Highly Active Anti Retroviral Therapy) terapiji: (HAART): ddi (didanosine), 3TC (lamivudine), EFV (efavirenz) od 2001. godine. Od tada ima stabilan broj CD4 limfocita oko 300 ćelija/ml i sve vreme nakon uvođenja terapije ima nedetektabilan PCR HIV RNK u krvi. Od pre oko 2 godine dolazi do pojave žućkastosmeđih makula i crvenkastih papula na koži poglavito trupa i gornjih udova, praćenih povremeno jačim svrabom i crvenilom pri trljanju istih. Ove promene se intenziviraju s jeseni 2009. godine. Tada se javlja na pregled u dermatovenerološku službu Poliklinike Kliničkog centra Vojvodine. Na pregledu je utvrđen veći broj žućkastosmeđih makulo-papuloznih eflorescencija na koži trupa i udova, praćenih jačim svrabom. Urađena je „punch biopsija“ kožnih promena od strane dermatologa, kojom je (Giemsa bojenjem) potvrđena dijagnoza urtikarije pigmentoze. Od pojave urtikarije pigmentoze pa nadalje, bolesnik je imao povišen nivo ukupnih IgE u serumu i pozitivan nalaz 5-hidroksiindol-sirćetne kiseline u 24-časovnom urinu. Imunohistohemijski nalaz, posle uzete biopsije sa mesta kožne promene, potvrdio je dijagnozu pigmentne urtikarije, otkrivanjem tipičnih dermalnih infiltrata mast ćelija sa izraženim granulama, ovalnog i vretenastog oblika koji su bili CD117 + i CD1a- . Bolesnik se javlja na Kliniku za infektivne bolesti zbog visoke temperature do 39˚ C i bolova u stomaku, deset dana kasnije. Iz krvi je iskultivasan Streptococcus agalactiae. Bolesnik se dobro osećao posle započinjanja odgovarajuće antibiotske terapije, pokazatelji inflamacije u serumu su bili u padu. Međutim, tada dolazi do naglog razvoja ascitesa. Kontrolni broj CD4 limfocita bio je u daljem padu i iznosio je 198/ ml, a PCR HIV RNK u krvi je i dalje bio negativan. Primenjena simptomatska terapija je dovela do iščezavanja ascitesa ali sa održavanjem splenomegalije. U ličnoj anamnezi postojao je podatak o svrabu na mestu promena na koži, neredovnom pražnjenju creva, prolivu, kao i o preosetljivosti na različite nutritivne alergene. Podaci dobijeni u porodičnoj anamnezi nisu imali značaj za sadašnju bolest. U toku 2009. godine pacijent je hospitalizovan na Klinici za infektivne bolesti Kliničkog centra Vojvodine u Novom Sadu još 4 puta, 2010. godine 6 puta, a 2011. godine dvaput, kada je invazivnim dijagnostičkim procedurama (ponovljene kostne srži i biopsije jetre) isključeno postojanje sistemske mastocitoze. Broj CD4+ ćelija je u toku poslednje hospitalizacije iznosio 237/ml, a PCR HIV RNK u krvi je i dalje bio negativan. Pregledom abdomena doplerom, kompjuterizovane tomografije i pomoću nuklearne magnetne rezonancije utvrđena je samo kriptogena portna hipertenzija sa prisustvom variksa jednjaka IV stepena, prisusustvo manje količine ascitesa i hronični holecistitis. Bolesnik je nastavio da po otpustu prima HAART terapiju i desloratadin (5 mg dnevno). Diskusija: Dijagnoza urtikarije pigmentoze je kod bolesnika postavljena na osnovu anamneze, kliničke slike, relevantnih laboratorijskih nalaza (značajno povišene vrednosti ukupnih IgE u serumu i povišene vrednosti 5-hidroksi-indol sirćetne kiseline u 24-časovnom urinu i histološkim pregledom (specifično bojenje) biopsije kožnih promena i, posebno, imunohistohemijskim nalazom prisustva brojnih vretenastih i ovalnih ćelija u dermisu koje su CD117+ i CD1a-. Kod našeg bolesnika pronađena su i oštećenja jetre, hronični holecistitis, leukopenija, trombocitopenija i eozinofilija (relativna) koji su u jednom momentu pobuđivali ozbiljnu sumnju na sistemsku mastocitozu. Sistemska mastocitoza se karakteriše progresivnom infiltracijom različitih organa mast ćelijama koje često ispoljavaju ćelijsku atipiju. Hematološke abnormalnosti i splenomegalija su uobičajene. Iz ovih razloga rađene su višestruke biopsije jetre i kostne srži, kao i CT i MR pregled jetre i abdomena. Kako ovi pregledi i metode nisu mogle potvrditi prisustvo mast ćelija u većem broju, došlo se do zaključka da u ovom momentu nema elemenata za dijagnozu sistemske bolesti. Biopsija jetre je otkrila samo blag oblik hroničnog persistentnog hepatitisa sa fibrozom. Prema podacima iz literature, kod obolelih od AIDS-a utvrđena je interakcija između virusa i bazofilnih granulocita: HIV transaktivacioni protein (Tat) predstavlja specifični hemoatraktant za ćelije koje na svojoj površini poseduju receptore visokog afiniteta za vezivanje imunoglobulina klase E (FcεRIα pozitivne ćelije), hemotaksija se odvija uz pomoć hemokinskog receptora tip 3 (CCR3); peptidi u sastavu virusnog glikoproteina gp41 − HIV gp41 predstavljaju hemoatraktante za bazofilne granulocite; na svojoj površini, bazofilni granulociti poseduju HIV receptore (CD4, CCR3, CCR5, CXCR4) koji zajedno sa HIVTat proteinom povećavaju ekspresiju CCR3. Ipak, za sada nedostaju publikovani radovi o interakciji između virusa humane imunodeficijencije (HIV) i mast ćelija (koji takođe na svojoj površini nose isti receptor FcεRI, kao i bazofili). Zaključak: Prikazani slučaj ne predstavlja samo treći do sada u svetu publikovan slučaj mastocitoze kod bolesnika sa AIDS-om, nego, ukazuje i na potrebu za daljim ispitivanjem moguće patogenetske uloge imunogenetskih oštećenja i imunogenetskih rearanžmana kod obolelih od AIDS-a.

History of dermatology and venereology in Serbia – part IV/3: Dermatovenereology in Serbia from 1919 – 1945, part 3 / Istorija dermatologije i venerologije u Srbiji - IV/1-3: Dermatovenerologija u Srbiji u periodu 1919 - 1945

Abstract The seven years’ war (1912 - 1918) and epidemics of infectious diseases, led to a great loss of lives and medical corps of Serbia. As already stated, venereal and skin diseases were spreading in the postwar period that can be seen from medical reports of dermatovenereology institutions. They contain appropriate pathologies and some specific conditions under which they developed. In dermatovenereal pathology, venereal diseases were still dominating. In the outpatientClinic for Skin and Venereal Diseases, 10.000 patients were examined during the period from 1919 to 1921, venereal diseases accounted for 73.13%, whereas skin diseases accounted for 26.87% of all established diagnoses. A similar distribution existed at the territory of Serbia (Belgrade excluded) in 1931: venereal diseases accounted for 73.4%, and skin diseases for 26.6%; moreover, in Belgrade, the situation was even more drastic: venereal diseases accounted for 84.7%, and skin diseases for 15.3%. However, in the student population, the distribution was reversed: 43% and 57%, respectively. In regard to venereal diseases, in the series from 1919 to 1921, non-endemic syphilis was the most common disease, if serologically positive cases (latent syphilis) were added up to the clinically manifested cases. In the same series of patients, syphilis was staged as follows: syphilis I in 10%, syphilis II in 29.3%, syphilis III in 1.7%, tabes dorsalis in 0.8%, and latent syphilis in 56% of patients. In regions with endemic syphilis, from 1921 to 1925, the distribution was as follows: syphilis I in 4%, syphilis II in 49.8%, syphilis III in 18.3%, hereditary syphilis in 1.3%, and latent syphilis in 26.5% of patients. In patients suffering from gonorrhea, balanitis was found in 4.5%, and arthritis in 0.43% of cases. Generally, spreading of prostitution had a significant role, and its abolition was an important preventive action. In regard to skin diseases, in the above-mentioned series of patients, treated at the Outpatient Clinic for Skin andVenereal Diseases (1919 - 1921), scabies was the commonest skin disease (26.7%), eczemas were the second most common (21.8%), followed by pyococcal diseases (20.4%), while fungal diseases (4.5%) and skin tuberculosis (1.9%) were considerably less frequent. This is the final report about the foundation of modern dermatovenereology in Serbia. Sažetak Zakonodavstvo i organizacija dermatovenerološke službe: Posle Prvog svetskog rata Srbija je ostala opustošena i razrušena, a organizacija zdravstvene službe bila je uništena. Organizacija i reorganizacija zdravstvene službe počela je borbom protiv zaraznih bolesti koje su se širile. Otvaranje specijalističkih zdravstvenih ustanova bio je jedan od prvih zadataka. Zdravstvene ustanove: Već 1920. godine otvorena je Ambulanta za kožne i venerične bolesti sa šefom prof. dr Đorđem Đorđevićem. On je 1922. godine osnovao Kliniku za kožne i venerične bolesti i bio njen prvi direktor. Opštinska ambulanta za kožne i venerične bolesti osnovana je 1928. a 1938. Godine uz novu zgradu dobila je savremenu organizaciju službe. Kožnovenerično odeljenje Opšte vojne bolnice u Beogradu, otvoreno 1909. radilo je do Prvog svetskog rata, kada je Opšta vojna bolnica, pod austrijskom okupacijom, postala Das K. und K Reservspital Brško. Posle rata, Odeljenje nastavlja s radom do početka II svetskog rata. Od 1941. do 1944. godine ponovo okupatorska vlast koristi Glavnu vojnu bolnicu za svoje potrebe. Odeljenje za kožne i venerične bolesti (100 kreveta) pri Opštoj državnoj bolnici (ODB), kao i samostalnu Državnu ambulantu za besplatno lečenje veneričnih bolesnika u Novom Sadu, osnovao je 1921. godine dr Jovan Nenadović, prvi Srbin dermatovenerolog u Vojvodini. On je rukovodio obema ustanovama. Napominjemo da je 1909. godine bila otvorena u Novom Sadu Gradska bolnica sa Dermatovenerološkim odeljenjem, ali posle Prvog svetskog rata oboleli od kožnih i veneričnih bolesti nisu imali gde da se leče. Prva Organizaciona jedinica za venerične bolesti u Nišu osnovana je 1912. godine; Venerično odeljenje sa Ambulantom nastalo je 1921. godine; njime je rukovodio dr Petar Davidović. Kožno-venerično odeljenje pri Opštoj državnoj bolnici u Nišu otvoreno je 1927. godine, od kojeg će posle osnivanja Medicinskog fakulteta u Nišu (1960. godine), postati nastavna baza. Prvi šef Odeljenja bio je dr Petar Zurin, dermatovenerolog. Dermatovenerološko odeljenje Vojne bolnice u Nišu osnovano je 1920. godine. Na inicijativu prof. dr Đorđa. Đorđevića, 1921. godine u Srbiji su radile kompletne ambulante u Nišu, Petrovcu, Užicu, Boljevačkom srezu, Subotici, Velikom Bečkereku i Mitrovici. Već 1923. godine u bolnicama opšteg tipa postojalo je 14 veneričnih i jedno kožno-venerično odeljenje, u Subotici. Uočljivo je da su odeljenja nazivana venerična, kao što su i lekari specijalisti nazivani venerolozi, što još jednom pokazuje da su venerične bolesti i dalje bile glavni dermatovenerološki problem. Lekari: Posle Prvog svetskog rata u organizaciji zdravstvene službe, pored nedovoljnog broja bolnica, postojao je i nedovoljan broj lekara. Oba problema bila su neposredno povezana sa dermatovenerologijom. Za razvoj dermatovenerologije kao savremene discipline, najznačajniji doprinos dali su prof. dr Đorđe Đorđević, koji je bio prvi direktor Klinike za kožne i venerične bolesti, u Beogradu (1922-1935), i njegov najbliži saradnik i naslednik prof. dr Milan Kićevac (1935- 1940). U timskom radu, oni su koncipirali zakonske propise, organizovali suzbijanje veneričnih bolesti i prostitucije i postavili temelje stručnoj i naučnoj dermatovenerologiji u Srbiji. Prof. dr Đorđe Đorđević je 1922. godine bio glavni osnivač dve institucije značajne za srpsku dermatovenerologiju - Klinike za kožne i venerične bolesti (KKVB), čiji je bio direktor, i Katedre za dermatovenerologiju, kao prvi nastavnik dermatovenerologije na Medicinskom fakultetu u Beogradu. Prof. dr Đorđe Đorđević je 1927. godine učestvovao i u osnivanju Dermatovenerološke sekcije Srpskog lekarskog društva, a iste godine, on i njegov saradnik i naslednik - prof. dr Milan Kićevac, bili su glavni organizatori Udruženja Dermatovenerologa Jugoslavije. Sa ovim udruženjem, sva ostala regionalna dermatovenerološka društva u zemlji uvedena su u Sveslovensko dermatološko društvo. Prof. dr Đorđe Đorđević je zajedno sa prof. dr Milanom Kićevcem organizovao Prvi, Drugi i Treći jugoslovenski dermatovenerološki kongres (1927, 1928. i 1929.), a 1931. godine i Drugi kongres Sveslovenskog dermatološkog društva. Dr Vojislav Mihailović (1879-1949), značajno ime za srpsku dermatovenerologiju, bio je šef na Kožnoveneričnom odeljenju Opšte državne bolnice u Beogradu. Radovi i knjige dr Vojislava Mihailovića iz istorije dermatovenerologije i opšte medicine imali su veliki uticaj na srpsku dermatovenerologiju. Eksperimentalnom dermatovenerologijom bavio se doc. dr Sava Bugarski (1897-1945), koji je bio đak prof. Kićevca a kasnije i direktor na Klinici za kožne i venerične bolesti u Beogradu (1940-1945). Dr Jovan Nenadović (1875-1952), jedan od najuglednijih lekara u Novom Sadu, učestvovao je u osnivanju i radu Dermatovenerološke sekcije Srpskog lekarskog društva i bio njen doživotni počasni predsednik. U periodu između dva svetska rata, među najznačajnijim lekarima zaslužnim za razvoj dermatovenerologije u okviru vojnog saniteta bili su načelnici Dermatovenerološkog odeljenja Opšte vojne bonice u Beogradu: major, kasnije sanitetski brigadni general, dr Božidar Janković i sanitetski brigadni general dr Milivoje Pantić. Eminentni lekari vojnog saniteta, kao što je bio dr Petar Davidović, dali su značajan doprinos radu civilnih dermatoveneroloških ustanova tog vremena. Sedmogodišnji rat (1912-1918) i epidemije zaraznih bolesti dovele su do velikih ljudskih i materijalnih gubitaka u sanitetu Srbije. Zarazne bolesti su se proširile, uključujući i venerične bolesti, pa je bilo nephodno time otpočeti organizovanje i reorganizovanje sanitetske službe. Dermatovenerološke bolesti: U dermatovenerološkoj patologiji i dalje su dominirale venerične bolesti. U Ambulanti za kožne i venerične bolesti, u periodu 1919-1921. godine venerične bolesti su bile zastupljene sa 73,13%, a kožne sa 26,87%. Sličan odnos postojao je i 1931. godine na teritoriji Srbije (bez Beograda): 73,4% prema 26,6%, kao i u Beogradu: 84,7% u odnosu na 15,3%. U studentskoj populaciji (1938- 1939) odnos je bio obrnut, 57% prema 43%. Od veneričnih bolesti, prema navedenoj seriji iz perioda 1919-1921. godine, sifilis je bio najčešće oboljenje, ako se klinički manifestnim slučajevima dodaju serološki pozitivni slučajevi (latentni sifilis). U istoj seriji pojava sifilisa prema stadijumima bila je: sifilis I kod 10%, sifilis II kod 29,3%, sifilis III kod 1,7%, tabes dorsalis kod 0,8% i latentni sifilis kod 56% obolelih. U krajevima sa endemskim sifilisom, u periodu 1921-1925. godine registrovan je: sifilis I kod 4%, sifilis II kod 49,8%, sifilis III kod 18,3%, hereditarni sifilis kod 1,3% i latentni sifilis kod 26,5% obolelih. Kod obolelih od gonoreje, balanitis je nađen u 4,3%, a artritis u 0,43 slučajeva. U navedenoj seriji, u Ambulanti za kožne i venerične bolesti (1919-1921) među kožnim bolestima najčešči je bio skabijes (26,7%), potom ekcemi (21,8%), piokokna oboljenja (20,4%), dok su gljivična oboljenja ( 4,5%) i tuberkuloza kože (1,9%) bili znatno ređi. Zaključak: Ovim završavamo izlaganje o postavljanju temelja dermatovenerologije u Srbiji. U tekstu ograničenog obima nije bilo moguće davati analize, već samo bitne činjenice koje su ukazivale na kompleksnost organizacije naše sanitetske službe. Ovaj proces je pokazao da je dermatovenerologija u Srbiji u toku poslednjih dvadeset godina premostila razorne ratne periode kroz koje je prolazila u svojoj dugoj, turbulentnoj istoriji i usvojila savremenu medicinsku misao, stvaranu u toku gotovo dva veka. Na kraju bismo istakli da su u ovakvom poslu neizbežni nedostaci, bilo zbog nepotpunih, izgubljenih ili kontra

History of dermatology and venereology in Serbia – part IV/2: Dermatovenereology in Serbia from 1919 – 1945, part 2

Abstract This paper deals with the period from 1881 to 1918, when the following Sanitary Laws were passed: Law on the Organization of the Sanitary Profession and Public Health Care (1881), which implemented measures for protection from venereal diseases, as well as restriction of prostitution; Public Sanitary Fund (1881), with independent budget for health care; Announcement on Free of Charge Treatment of Syphilis (1887). Dermatovenereological Departments were also founded: in the General Public Hospital in Belgrade (1881), and in the General Military Hospital (1909). The Hospital in Knjaževac for Syphilis was reopened (1881), as well as mobile and temporary hospitals for syphilis, and a network of County and Municipality hospitals. The first Serbian dermatovenereologist was Dr. Jevrem Žujović (1860 - 1944), and then Dr. Milorad Savićević (1877 - 1915). Skin and venereal diseases were treated by general practitioners, surgeons, internists and neurologists. Although Dr. Laza Lazarević (1851 - 1890) was not a dermatologist, but a physician and a writer, he published three papers on dermatovenereology, whereas Dr. Milorad Godjevac (1860 - 1933) wrote an important study on endemic syphilis. From 1885 to 1912, organization of dermatovenereology service has significantly improved. Considering the fact that archive documents are often missing, only approximate structure of diseases is specified: in certain monthly reports in Zaječar, out of all the diseased persons, 45% had skin or venereal diseases, while in Užice the number was 10.5%, which points to different distribution of these diseases. High percentage of dermatovenereology diseases was caused by high frequency of venereal diseases and syphilis. During the war: 1912 - 1918, the military medical service dominated, and in 1917 Prince Alexander Serbian Reserve Hospital was founded in Thessaloniki with a Department for Skin and Venereal Diseases. During this period, work of the Civilian Health Care Service was interrupted, consequently leading to a considerable aggravation of public health.

Treatment of venous leg ulcers with an ointment containing yarrow (Achillea millefolium) extract / Primena preparata sa ekstraktom hajdučke trave (Achillea millefolium) u lečenju venskih ulkusa potkolenice

Abstract Traditional medicine credits yarrow (Achillea millefolium) with the ability to accelerate wound healing. The purpose of this research was to determine the effects of yarrow on the epithelization of the lower leg venous ulcers. The study included 39 patients with venous leg ulcers. They were divided into two groups: the first (experimental) group of patients were treated with an ointment containing 7.5% of yarrow extract. In the second (control) group, saline solution dressings were applied to ulcers, within the period of three weeks. In the experimental group, at the beginning of the therapy, the total surface of all the ulcers was 44736 mm2. After three weeks, the total surface of all the ulcers was 27000 mm2 (a decrease of 39.64%). In the control group, at the beginning of the therapy, the total surface of all the ulcers was 46116 mm2. At the end of the study (21 days) the total surface of all the ulcers was 39153 mm2 (a decrease of 15.1%). Herbal preparations are suitable for application in the therapy of venous ulcers, but their efficiency in wound healing is still to be investigated. Sažetak Uvod: U Tradicionalnoj medicini hajdučka trava (Achillea millefolium) je dobro poznata po svojoj sposobnosti da ubrzava zarastanje rana. Cilj: Cilj ovog istraživanja bio je da ispitamo uticaj hajdučke trave na zarastanje venskih ulkusa potkolenice. Materijal: U našem istraživanju lečeno je ukupno 39 pacijenata sa venskim ulkusima. Bili su podeljeni u dve grupe. U prvoj (eksperimentalnoj grupi) pacijenti su lečeni preparatom u obliku krema koji je sadržao 7,5% ekstrakta hajdučke trave. U drugoj (kontrolnoj) grupi su na ulkuse primenjivani oblozi fiziološkog rastvora, tokom perioda od 3 nedelje. Rezultati: Na početku ispitivanja u eksperimentalnoj grupi ukupna površina ulkusa iznosila je 44 736 mm2. Posle tri nedelje terapije ukupna površina ulkusa bila je 27 000 mm2 (smanjenje za 39,64%). U kontrolnoj grupi ukupna površina ulkusa na početku eksperimenta je bila 46116 mm2. Na kraju ispitivanja (21 dan) ukupna površina ulkusa bila je 39 153 mm2 (smanjenje za 15,1%). Zaključak: Primena biljnih preparata pogodna u terapiji venskih ulkusa, ali efikasnost njihovog dejstva na zarastanje ulkusa tek treba da bude detaljnije ispitana.

Precancerous skin lesions in patients treated at the Clinic for Dermatovenereologic Diseases in Novi Sad

Precancerous skin lesions in patients treated at the Clinic for Dermatovenereologic Diseases in Novi Sad The aim of this study was to demonstrate the epidemiologic features and therapeutic outcomes in patients with precancerous skin lesions treated at the Clinic for Dermatovenereologic Diseases, Clinical Center, Novi Sad, between 1994 and 2004. Using all available medical information, we performed a retrospective study of the frequency of precancerous skin lesions observed during this 10-year period. The clinical history and physical examination, as well as histologic evaluation of skin biopsy specimens, were reviewed. The distribution of patients according to employment status and place of residence is shown in Table 1. Of the 13,125 patients seen during the 10-year period, 411 (3.1%) had precancerous skin lesions; the average age was 69.4 years; there were 166 males and 245 females, with a male to female ratio of 1 : 1.5. The frequency of patients increased with increasing age in both genders. The peak occurrence of skin lesions was in the eighth decade of life, with a decrease in the ninth decade. The spectrum of diagnoses in our 411 patients is given in Table 2. Leukoplakia was noted in three patients (0.7%), Bowen’s disease in 14 (3.4%), cutaneous horn in 59 (14.4%), and actinic keratosis in 335 (81.5%). The three patients with leukoplakia (average age, 64.3 years) had precancerous changes on the lower lip. In all three cases, leukoplakia was treated surgically and no recurrence was observed during the following 5 years. Data on the average age, employment status, and place of residence suggested that prolonged exposure to ultraviolet (UV) radiation from the sun was a risk factor for leukoplakia. Our data regarding age and location of skin changes are consistent with results from Chile. No patient in our study had a history of organ transplantation. Of the 14 patients with Bowen’s disease (average age, 65.6 years), 12 had solitary lesions and two had involvement of multiple sites on the trunk. Lesions were located on the trunk in seven cases (50%), four cases (28.6%) involved the extremities, and three patients (21.4%) had lesions on the head. Treatment consisted of surface X-ray in eight patients, curettage plus 5-fluorouracil 5% cream (twice daily for 2 weeks) in four cases, and surgical therapy in two patients. In the 5 years following treatment, no patient showed recurrence. One of the 14 patients with Bowen’s disease had lesions on sun-exposed regions, indicating UV radiation as a possible risk factor. Furthermore, according to a recent Australian study, Bowen’s disease is most frequently located on the head and neck. Localization at other sites, such as the extremities and trunk, could explain the hypothesis of follicular histogenesis. Our data concerning the age group and predominance in males are consistent with results from Hawaii, but our results do not support the association between Bowen’s disease and internal malignancy, contrary to some previous reports. With regard to the therapeutic options for Bowen’s disease, other than those administered to the patients in our study, local photodynamic therapy with 5-δ-aminolevulinic acid and simultaneous use of different sources of coherent and incoherent light has been proposed. Of the 59 patients with cutaneous horn (average age, 69.4 years), 49 (83.1%) had lesions on the head, neck, and face, five patients (8.5%) had lesions on the trunk, and five (8.5%) on the dorsal hands. In 18 cases, the cutaneous horn was not associated with cutaneous malignancy, but with seborrheic keratosis; these lesions were removed by electrocauterization. In 23 patients, the cutaneous horn was associated with squamous cell carcinoma (SCC) at its base, and the SCC was surgically removed. In the remaining cases, the cutaneous horn had an actinic keratosis at its base, which was surgically removed. There was no reccurrence in any patient with cutaneous horn during the 5 years following treatment. The predominant finding of cutaneous horn on the head, neck, and face may be explained by the adverse effect of exposure to UV radiation. Our results agree with the commonly accepted opinion that actinic keratosis or SCC occurs at the base of most cutaneous horns. In Croatia, the prevalence of cutaneous horn seems to be lower than in our study.