Etiology of psoriasis is still not known and comprises a range of assumptions and very complex etiological and pathogenetic mechanisms. Along with genetical predisposition, mental disorders and ...stresses might have a key role in the occurrence of this disease. Total number of 70 patients suffering from psoriasis were included in the investigation. Generally accepted structured clinical interview (SCID - The Structured Clinical Interview for DSM-IV) was applied in diagnostics of mental disorders. Various mental disorders were found in as many as 90% of patients suffering from psoriasis. The most frequent mental disorders were depressive disorder (19.2%), the posttraumatic stress disorder (17.8%), alcoholism (16.4%), adaptation disorder (15.1%), anxiety - depressive disorders (13.7%) and generalized anxious disorder (9.6%). The authors have concluded that in patients with psoriasis both various mental disorders and various stress events are frequent. The results have implied that there is a link between psoriasis on the one hand and various mental disorders and various stressors on the other. The investigation implies that there is a need to improve multidisciplinary approach in diagnostics and treatment of psoriasis and multi disciplinary team should consist of dermatologist, psychiatrist and psychologist.
Psoriasis is a chronic and stigmatising disease with significant and hard to meet clinical needs in patient management. Psoriasis is a relatively common disease, affecting up to 2% of the population. ...The impact of psoriasis on quality of life is significant given its chronicity and visibility. Psychological stress is a well-established systemic triggering factor in psoriasis. It has been associated with initial presentation of the disease as well as exacerbations of pre-existing psoriasis. The purpose of this study is to assess the psychological, social and financial implications of psoriasis.
51 patients participated in this study. After dermatological examination and determination of Psoriasis Area and Severity Index score, patients were referred to a psychological consult. Assessment was done through questionnaires concerning quality of life, depression, anxiety, illness perception, financial domain and personal data.
Results of our study indicate that psoriasis has a strong impact on patients' life. It influences working habits, poses a significant financial burden, but most of all, significantly impairs their quality of life and psychological status.
Psoriasis poses a substantial threat to several dimensions in patient's quality of life. Patients feel that the current treatment, although often effective, does not provide a satisfactory long-term solution. Thus, long-term psychologic support for patients with psoriasis is desirable.
A Case of Segmental Darier Disease Franceschi, Nika; Gašić, Ana; Šitum, Mirna ...
Acta dermatovenerologica Croatica
30, Številka:
3
Journal Article
Recenzirano
Darier disease (DD), also known as Darier-White disease, follicular keratosis, or dyskeratosis follicularis, is an uncommon autosomal dominant genodermatosis with complete penetrance and variable ...expressivity. This disorder is caused by mutations in the ATP2A2 gene and affects the skin, nails, and mucous membranes (1,2). A 40-year-old woman, without comorbidities, presented with pruritic, unilateral skin lesions on the trunk since she was 37 years old. Lesions had remained stable since onset, with physical examination revealing tiny scattered erythematous to light brown keratotic papules beginning at the patient's abdominal midline, extending over her left flank and onto her back (Figure 1, a, b). No other lesions were observed, and family history was negative. Skin punch biopsy revealed parakeratotic and acanthotic epidermis with foci of suprabasilar acantholysis and corps ronds in the stratum spinosum (Figure 2, a, b, c). Based on these findings, the patient was diagnosed with segmental DD - localized form type 1. DD usually develops between the ages of 6 and 20 and is characterized by keratotic, red to brown, sometimes yellowish, crusted, pruritic papules in a seborrheic distribution (3,4). Nail abnormalities, alternating red and/or white longitudinal bands, fragility, and subungual keratosis can be present. Mucosal whitish papules and palmoplantar keratotic papules are also frequently observed. Insufficient function of the ATP2A2 gene that encodes for the sarco/endoplasmic reticulum Ca2+ ATPase type 2 (SERCA2) leads to calcium dyshomeostasis, loss of cellular adhesion, and characteristic histological findings of acantholysis and dyskeratosis. The main pathological finding is the presence of two types of dyskeratotic cells, "corps ronds", present in the Malpighian layer, and "grains", mostly located in the stratum corneum (1). Approximately 10% of cases present as the localized form of disease, with two phenotypes of segmental DD having been observed. The more common, type 1, is characterized by a unilateral distribution along Blaschko's lines with normal surrounding skin, whereas the type 2 variant presents with generalized disease and localized areas of increased severity. Although generalized DD is associated with nail and mucosal involvement, as well as positive family history, these findings are rarely seen in localized forms (1). Family members with identical ATP2A2 mutations may have notable differences in clinical manifestations of the disease (5). DD is usually a chronic disease with reccurent exacerbations. Exacerbating factors include sun exposure, heat, sweat, and occlusion (2). Infection is a common complication (1). Associated conditions include neuropsychiatric abnormalities and squamous cell carcinoma (6,7). Increased risk of heart failure has also been observed (8). Type 1 segmental DD may be clinically and histologically hard to distinguish from acantholytic dyskeratotic epidermal nevus (ADEN). Age of onset plays an important role in differentiation, as ADEN is often congenital (3). However, some studies suggest ADEN is a localized form of DD (1). Other differential diagnoses include herpes zoster, lichen striatus, lichen planus (4), severe seborrheic dermatitis, and Grover disease. Our patient was treated with a topical retinoid, for the first two weeks in combination with a topical corticosteroid. She was advised on the use of proper daily skincare with antimicrobial cleansers and emollients, as well as behavioral measures such as avoiding triggering factors and wearing light clothing, resulting in substantial clinical improvement (Figure 1, c, d) and amelioration of pruritus. Other treatment options include salicylic and lactic acid as well as topical 5-fluorouracil, while oral retinoids are reserved for more severe disease (1-3). Doxycycline and pulsed dye laser have also been reported to be effective (2,9). One in vitro study showed that COX-2 inhibitors may reinstitute the dysregulated ATP2A2 gene (4). In summary, DD is a rare keratinization disorder that can present in a generalized or localized pattern. Although uncommon, segmental DD should be included in the differential diagnosis of dermatoses that follow Blaschko's lines. Treatment options include various topical and oral treatments, depending on disease severity.
Tijekom pandemije virusa SARS-CoV-2 onkološki pacijenti označeni su kao posebno rizična skupina. Posebnu skupinu čine pacijenti u tijeku imunoterapije inhibitorima kontrolnih točaka. Čini se kako su ...koristi imunoterapije u bolesti koje uzrokuje novi koronavirus potpuno potisnule početni strah od očekivanih negativnih utjecaja imunosnog sustava potaknutog inhibitorima kontrolnih točaka. Sprječavanjem iscrpljenosti CD8+ limfocita, smanjenjem razine interleukina-6 i indirektnom regulacijom neutrofila i NK stanica, imunoterapija djeluje na patofiziologiju razvoja blažih oblika bolesti COVID-19. Trenutne spoznaje ističu imunoterapiju kao sigurnu opciju onkološkog liječenja u doba pandemije COVID-19.
With regard to systemic oncological treatments, correlation of the use of immunotherapy with checkpoint inhibitors with the risk of more severe COVID-19 infection is uncertain. However, benefits of immunotherapy in the disease caused by the new coronavirus completely suppressed the initial fear of expected negative impacts of immune system triggered by checkpoint inhibitors. By preventing CD8 + lymphocyte exhaustion, reducing interleukin-6 levels, and indirectly regulating neutrophils and NK cells, immunotherapy affects the pathophysiology of COVID-19. The current findings highlight immunotherapy as a safe option of cancer treatment at the time of COVID-19 pandemic.
Skin Cancer and UV Protection Tarbuk, Anita; Grancarić, Ana Marija; Šitum, Mirna
AUTEX Research Journal,
03/2016, Letnik:
16, Številka:
1
Journal Article
Recenzirano
Odprti dostop
The incidence of skin cancer is increasing by epidemic proportions. Basal cell cancer remains the most common skin neoplasm, and simple excision is generally curative. On the other hand, aggressive ...local growth and metastasis are common features of malignant melanoma, which accounts for 75% of all deaths associated with skin cancer. The primary cause of skin cancer is long exposure to solar ultraviolet radiation (UV-R) crossed with the amount of skin pigmentation and family genetics. It is believed that in childhood and adolescence, 80% of UV-R gets absorbed while in the remaining, 20 % gets absorbed later in the lifetime. This suggests that proper and early photoprotection may reduce the risk of subsequent occurrence of skin cancer. Reducing the exposure time to sunlight, using sunscreens and protective textiles are the three ways of UV protection. Most people think that all the clothing will protect them, but it does not provide full sun screening properties. Literature sources claim that only 1/3 of the spring and summer collections tested give off proper UV protection. This is very important during the summer months, when UV index is the highest. Fabric UV protection ability highly depends on large number of factors such as type of fiber, fabric surface, construction, porosity, density, moisture content, type and concentration of dyestuff, fluorescent whitening agents, UV-B protective agents (UV absorbers), as well as nanoparticles, if applied. For all of these reasons, in the present paper, the results of UV protecting ability according to AS/NZS 4399:1996 will be discussed to show that standard clothing materials are not always adequate to prevent effect of UV-R to the human skin; and to suggest the possibilities for its improvement for this purpose enhancing light conversion and scattering. Additionally, the discrepancy in UV protection was investigated in distilled water as well as Adriatic Sea water.
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