Collision Lesions: Genuine Collision (Conflict) or not?

By definition, the term "collision lesion" refers to two or more tumors coinciding in the same anatomic position or visceral organ. Collision lesions coexisting on the same skin location are defined as collision skin lesions (CSLs). Although this term implies a conflict between the tumors, this is not the case. CSLs appear to be rare, but still pose a significant diagnostic problem in everyday clinical practice and clinicians should be aware of their existence. The aim of this study was to elucidate the problem of CSLs in clinical practice, with an emphasis on classification of CSLs according to position dependence, tumor histogenesis, etiology, and possible lesion combinations in CSLs, as well as diagnostic possibilities. According to our results, accurate clinical diagnosis could be only rarely reached, requiring lesion excision and pathohistological confirmation of CSLs. Considering the fact that tumors in CSLs can be partially or completely overlying or can even be positioned one within the other, the existence of two or more tumors is extremely difficult to detect.

Melanoma Controls the Metastatic Process only in Terms of Metastatic Cell Dissemination - What Is Responsible for Metastatic Cell Proliferation?

The process of melanoma metastasis can be divided into two stages of metastatic cell dissemination and proliferation. The whole process should be observed and distinguished through the variable or prism of time. The fact that melanoma metastases are detected in visceral organs at the stage when they are macroscopically visible does not imply that their onset has occurred much earlier. Additionally, it is quite obvious that the entire process is not driven by melanoma but rather only the initial stage of metastatic cell dissemination, whereas the later stage of metastatic cell proliferation is driven by other factors, firstly by mutated genes in the presence of melanoma or without it. Dissemination of metastatic cells occurs at approximately the same time in all melanomas, at MIS transition to MM, but is not immediately followed by metastatic cell proliferation; instead, some time has to elapse for a particular gene mutation to occur, and this timing varies among melanomas. Following dissemination of metastatic cells to visceral organs, they remain inactive, and in this period the presence of melanoma is not necessary anymore for metastatic cell proliferation, as they are waiting for a signal to start multiplying. This is clearly discernible from the fact that melanoma is today detected and removed frequently and early, but visible metastases then develop in the absence of melanoma, which may also regress spontaneously. Accordingly, MM is no longer necessary for metastasis later on. Finally, let me rephrase the title: melanoma is only responsible for initial dissemination of metastatic cells, whereas subsequent proliferation of metastatic cells is driven by other factors, most probably mutated genes.

Dermatomycosis in Cutaneous Tumors is a Predictor for Non-malignancy: A Cross-sectional Study

The aim of this study was to evaluate the presence of spores and/or hyphae in benign cutaneous tumors (CT) and compare their presence in malignant cutaneous tumors. In this cross-sectional study we evaluated 328 CTs positive for spores and/or hyphae. The results show that the greatest number of involved CTs which contained spores and/or hyphae were found in compound nevi 181 (55.18%) and seborrheic warts 61 (18.60%). No spores and/or hyphae were observed in the melanoma samples, and a very low prevalence was found in squamous cell carcinomas (SCCs) (2; 0.61%) and basal cell carcinoma (BCC) (1; 0.30%). The presence of spores and/or hyphae could be a good indicator for non-malignancy, allowing differential diagnosis between benign CTs and SCCs or BCCs as well as between melanoma and nevi.

Orthopedic and Cutaneous Reactions to Nickel after Total Hip Replacement

Implant degradation products have shown signs of a cutaneous allergic response after implantation of a metal orthopedic replacement, loosening and failure of the joints as well as skin rashes, general fatigue, pain, and impaired wounds and bone healing. The prevalence of contact skin sensitivity in patients with a joint replacement device is higher than that in the general population. This delayed hypersensitivity to metallic orthopedic implants is more clearly defined and is a contributing factor to implant failure. Nickel was associated with hypersensitivity responses as the first cause in metallic orthopedic implants as early as 1966 by Foussereau and Laugieru and is a commonly used metal in alloys because it grants necessary strength and durability to the implant. Herein we report on delayed hypersensitivity to nickel sulfate in a patient with pain, fatigue, and contact allergic dermatitis in both inguinal regions, with instability of the left acetabular part and with five hip replacements from 1987 to 2013. The findings of this report support that primary sensitization to a metal due to an implant itself might develop. Proper investigation in patients with history or prior hypersensitivity reactions to metals and test evaluation before orthopedic device implantation is needed. before orthopedic device implantation is needed.

A Giant Basal Cell Carcinoma Misdiagnosed and Mistreated as a Chronic Venous Ulcer

Basal cell carcinoma (BCC) is the most common cutaneous malignancy. Giant BCCs are quite rare. They can cause extensive local invasion, disfigurement, and metastasis. We present a case of a 58-year-old woman with an unrecognized and inadequately treated ulcerated giant BCC sized 12.5 × 10.0 cm that occurred on her left lower leg without any sign of metastasis. Neglect and inadequate treatment of the primary lesion are the most important contributing factors responsible for size in giant BCC.

[ASSOCIATION OF SKIN PHOTOTYPE AND UV EXPOSURE WITH EXPRESSION OF HER RECEPTORS, Ki67 AND p53 IN PATIENTS WITH CUTANEOUS SQUAMOUS CELL CARCINOMA]

An increase in the incidence of cancer, in particular skin cancer, has been observed in the last few decades. Skin cancer represents a significant public health problem in Croatia and worldwide. Cutaneous squamous cell carcinoma (cSCC) is a malignant tumor arising in epidermal keratinocytes. Together with basal cell carcinoma it belongs to non-melanoma skin cancers, which are the most common cancers in humans. The lifetime risk of cSCC development in Caucasian population is nowadays estimated to about 15%, which makes it double compared to 20 years ago. The most probable causes are increased ultraviolet light (UV) exposure (exposure to artificial UV sources in suntan parlors, spending more time outdoors, changes in fashion, as well as ozone holes), and longer life expectancy. In its etiopathogenesis, important risk factors include genetic factors, fair-skin phototype, UV exposure, chronic degenerative and inflammatory conditions, chemical factors, oncogenic viruses, immunosuppression, ionizing radiation, as well as habitual risk factors. Human epidermal growth factor receptor (HER) family is involved in the control of multiple signal pathways. Their dysregulation is associated with development of many cancers such as breast carcinoma, non-small cell lung carcinoma, ovarian carcinoma, carcinoma of pancreas, head and neck carcinoma, as well as glioblastoma. The objective of our investigation was to establish if there is association of the skin phototype and UV exposure with the expression of HER receptors, Ki67 and p53 in patients with cSCC. Study group included 101 cSCC patients. Inclusion criteria were age >50, both sexes, histopathologically confirmed cSCC, no previous therapy, specimens sufficient for immunohistochemistry, and complete clinical data collected by a questionnaire. Material obtained by excisional biopsy was completely histopathologically evaluated and additional tissue slices were immunohistochemically analyzed. Statistical analysis of the sample included non-parametrical statistical methods and statistical reviews. Analysis was done using R statistical package. Statistical significance was set at p<0.05. The following skin phototypes (according to Fitzpatrick) were present in our study: 54 (53.47%) patients with phototype II and 47 (46.53%) patients with phototype III. The majority of patients (n=93; 92.08%) were exposed to increased UV radiation during lifetime. Forty (39.60%) patients had three or more sunburns during childhood. Study results showed a signifi cantly higher expression of EGFR receptors, Ki67 and protein p53 in patients with light skin phototype that had been exposed to increased UV light during lifetime or had acquired 3 or more sunburns in childhood, suggesting that UV exposure led to the induction of EGFR, Ki67 and protein p53, and consequently to development of cSCC.

History of venereal diseases from antiquity to the renaissance

Sexually transmitted diseases (STDs), previously known as venereal diseases (VD), were present among the populations of antiquity as well as during the Middle Ages. Clay tablets from Mesopotamia, Egyptian papyri, along with mythology, paintings of erotic scenes, and presence of prostitutes give sufficient information to assume that some form of urethral and vaginal discharge, and also herpes genitalis were present among people at that time, and that these diseases were considered a divine punishment. Some passages of the Bible say much about the sexual behavior of the ancient Hebrews. The writings of the Greek and Roman physicians and of their satiric poets (Martial, Juvenal, Ovid) described diverse genital diseases. Celsus described various diseases of the genitals, that he called the "obscene parts". Galen made a strange description of the female genitals and coined the term gonorrhea - flow of semen. The ancient Chinese and Indian physicians also gave some account on the presence of venereal diseases in their books, and the temple sculptures depict their sexual life. During the Middle Ages, numerous physicians and surgeons from Europe as well as from Arabic countries wrote on local diseases of the genitals, describing chancres, condylomata, erosions, pustules, urethral and vaginal discharge, and their treatment. Some were aware that the alterations were connected with sexual activity. In spite the fact the Christian church propagated abstinence, the spread of venereal diseases was possible because the diffusion of prostitution, communal baths, and wars. During the 19th century, some of the physicians and historians, especially J. Rosenbaum, F. Buret, and E. Lancereaux believed syphilis was as old as mankind, whereas later authors had the opinion the disease appeared at the end of the 15th century.

[140 years of CMA--53 years of AMSC]

Croatian Academy of Medical Sciences was established in 1961 as the Commission for Scientific Research of the Croatian Medical Association Main Committee. In 1983 was separated from the Croatian Medical Association and became an independent organization--Croatian Academy of Medical Sciences. The Academy is a society of chosen scientists dealing with promotion of medical sciences to improve public health. To introduce Croatian medicine to the world the Academy publishes journals Acta Medica Croatica, Socijalna psihijatrija and Croatian Medical Journal.

Will nonablative rejuvenation replace ablative lasers? Facts and controversies

Since the early 1980s, the field of skin rejuvenation has evolved rapidly. Traditional ablative resurfacing with carbon dioxide and Er:YAG lasers offered dramatic improvement of the skin tone and texture, but prolonged postoperative period and an increased risk for side effects and complications were unacceptable for the majority of patients. It prompted the development of nonablative lasers and non-laser systems, which stimulate dermal neocollagenesis without epidermal disruption, and therefore, produce less adverse effects with little or no healing time. Recently, fractional nonablative and ablative lasers have been introduced, employing a completely new concept of fractional photothermolysis, which ensures high efficacy and fewer risks. Ablative laser resurfacing still remains the gold standard for treating advanced and severe photoaging providing excellent results in experienced hands. Alternatively, ablative fractional resurfacing can be used, with the results, which are comparable to fully ablative lasers with better standard of safety. Nonablative resurfacing is ideal for patients under the age of 50 years with minimal facial sagging, and for those who are unwilling to undergo expensive and demanding ablative procedures. It can be concluded that the key of therapeutic success is in proper patient selection, setting appropriate expectations and combining different rejuvenation technologies with other therapeutic modalities, such as botulinum toxin and fillers.

Human papillomavirus status in extragenital nonmelanoma skin cancers

About 5% of all cancers worldwide can be attributed to human papillomaviruses (HPVs); namely, six sites are strongly associated with HPV infections: cervix, penis, vulva, vagina, anus, and oropharynx. Nonmelanoma skin cancers (NMSC), basal cell carcinoma (BCC), and squamous cell carcinoma (SCC) are the most common malignancies in Caucasians. In fact, there is an intense connection between sunlight exposure, fair skin, HPV, and development of NMSC. We have conducted a pilot study that included tissue samples from 26 carcinoma patients, of which there were 13 BCC and 13 SCC. HPV detection and typing was done with DNA amplification and sequencing, respectively. In total, 23.1% of SCC samples (3/13) and 7.7% of BCC samples (1/13) were positive for HPV DNA. The importance of understanding all aspects of NMSC carcinogenesis may be to reveal novel therapeutic options or preventive measures for HPV containing NMSC patients.

Palisaded neutrophilic and granulomatous dermatitis in association with subcutaneous nodular and systemic sarcoidosis

Palisaded neutrophilic granulomatous dermatitis (PNGD) is a rare entity that has been clearly defined neither clinically nor histopathologically. PNGD has been associated with some immune-mediated disorders such as rheumatoid arthritis, systemic lupus erythematosus, systemic vasculitis, Behçet's disease, as well as with lymphoproliferative conditions, bacterial endocarditis, sarcoidosis, and various drugs. We present a 44-year-old Caucasian woman with roundish erythematous-livid plaque and erythematous papules on the left calf that were present for three months. Histopathology of plaque lesion showed palisading neutrophilic and granulomatous dermatitis. Subsequently, she developed a firm and tender nodule on the right calf. Histopathology of the nodule showed typical naked sarcoid granulomas in the dermis and subcutis. Additionally, the patient developed non-tender subcutaneous nodules on the cheeks, submandibular region and left breast with normal overlying skin, which were histopathologically diagnosed as sarcoid granuloma. Red eyes and lower visual acuity on the right eye were diagnosed as anterior uveitis. Therefore, systemic sarcoidosis was established. This is a case of PNGD described in an adult patient with sarcoidosis with cutaneous, breast, eye and lung involvement established by clinical, radiographic, laboratory, and histopathologic criteria.

Patch test reactions to metal salts in patients with different types of dermatitis

Metal allergies can be a clinical problem, especially in atopic individuals. This study is unique and contributes with new knowledge in everyday life skin care of irritant and atopic dermatitis patients. The aim of the study was to determine the frequency of positive patch test reactions to metal contact allergens (potassium dichromate, cobalt chloride, nickel sulfate, white mercury precipitate) in patients diagnosed with allergic contact dermatitis, irritant contact dermatitis, and atopic dermatitis. Between 2007 and 2011, patch testing was performed in 2185 patients according to the International Contact Dermatitis Research Group technique. Study results showed statistically significant differences in patch test responses to 2 allergens, nickel sulfate (χ(2)=24.22; p<0.001) and cobalt chloride (χ(2)=22.72; p<0.001). Nickel sulfate was the most common allergen in allergic contact dermatitis and atopic dermatitis, while for irritant contact dermatitis the most common allergen was cobalt chloride. Among the 4 tested metal allergens, the most common and relevant was nickel sulfate (χ(2)=17.25; p<0.004), found in almost all study subjects. In conclusion, the increased awareness of allergens and their potential sources may help limit the use of these chemicals in consumer product manufacturing.

Autoimmune bullous diseases associations

The presence of one autoimmune disorder helps lead to the discovery of other autoimmune conditions. It is thought that diseases in which autoimmunity is a feature tend to be associated together more often than one can ascribe to chance. A variety of diseases have been implicated in the onset of intraepidermal and subepidermal autoimmune diseases. The presence of one autoimmune disease should alert the physician to watch for a second immunologic disorder. A list of autoimmune bullous diseases associations includes autoimmune bullous diseases, pemphigus, pemphigoid, epidermolysis bullosa acquisita, dermatitis herpetiformis (Duhring), linear immunoglobulin A disease, and multiple autoimmune syndrome.

Pemphigoid gestationis

Pemphigoid gestationis is a rare autoimmune subepidermal bullous dermatosis that occurs during pregnancy and postpartum. Diagnosis is made on the basis of the presence of a subepidermal vesicle on routine histologic examination and of linear deposition of complement along the basement membrane zone of perilesional skin. The disorder is accompanied by severe pruritus and polymorphous bullous skin lesions. Clinical diagnosis is confirmed by histology and positive cutaneous immunofluorescence and immunoelectron microscopy tests (linear deposition of C3, with or without immunoglobulin G, along the basement membrane zone, within the lamina lucida, and localized to the proximal part of anchoring filaments of the epidermal fragment of salt-split skin). Enzyme-linked immunosorbent assay for pemphigoid gestationis antibody (BP180) is commercially available. If local treatment fails, systemic corticosteroid therapy should be administered. Oral corticosteroids are the therapeutic mainstay in pregnancy and postpartum. The prognosis is good for mother and child, except that there is a risk of preterm delivery and of moderate fetal growth restriction. Recurrence is possible during subsequent pregnancies. There is no significant maternal morbidity or mortality.

Psoriasis vulgaris - an inflammatory skin disease and/or benign epidermal hyperplasia

Psoriasis vulgaris (PV) is a systemic inflammatory disease in which immune and genetic factors are involved in the pathogenesis. Some treatment approaches in PV patients have been similar to therapy of some tumors. This fact has led to a new scientific approach to PV not only as an inflammatory disease, but also as a benign epidermal hyperplasia or a benign tumor. In this article, we hypothesize that there has been a parallel between some benign tumors and neoplasms and PV. The aim of this article is to present the approach to PV as an inflammatory disease as well as benign epidermal hyperplasia or tumor, and to introduce a new meaning.

Immunology of allergic contact dermatitis

Allergic contact dermatitis (ACD) is a T-cell mediated skin inflammation caused by repeated skin exposure to contact allergens. This review summarizes current knowledge on the immunology of ACD. Different phases in ACD are distinguished, i.e. sensitization, elicitation and resolution phases. We discuss contact allergen presentation and the central role of antigen presenting cells during sensitization phase. There is an extremely complex interaction of different kinds of immune cells, such as antigen presenting cells, T, B, NK lymphocytes, keratinocytes (KCs), endothelium, mast cells (MCs) and platelets, and this complex interaction is guided through orchestration of numerous cytokines and chemokines. The role of adaptive immunity has been recognized in contact hypersensitivity but we also discuss the important role of some parts of innate immunity such as natural killer T lymphocytes (NKT) and complement system. Cooperation of innate and adaptive immunity, in this case NK cells and B cells, initiates elicitation phase by complement cascade activation, vasoactive substance release and endothelial activation. KCs are not only innocent bystanders, on the contrary, they are involved in all phases of ACD, from the early phase of initiation through sending "danger" signals and activation of innate immunity, through their role in Langerhans cells (LCs) migration, T-cell trafficking, through the height of the inflammatory phase with direct interactions with epidermotropic T-cells, and finally through the resolution phase with the production of anti-inflammatory cytokines and tolerogenic presentation to effector T-cells. Th-1 and Th-17 cells are the main effector cells responsible for tissue damage. At the end, we point out several subsets of T regulatory cells, which exert down-regulatory function and regulate the magnitude and duration of inflammatory reaction.

Drug induced psoriasis

Psoriasis is a chronic inflammatory skin disorder clinically characterized by erythematous, sharply demarcated papules and rounded plaques covered by silvery micaceous scale. While the exact causes of psoriasis have yet to be discovered, the immune system and genetics are known to play major roles in its development. Many external factors including infections, stress and medications may exacerbate psoriasis. Some of the most common medications know to trigger or worsen existing psoriasis include lithium, gold salts, beta blockers and antimalarials. Exacerbation of psoriasis due to the following medications has also been observed: adrenergic antagonists, interferon, gemfibrozil, iodine, digoxin and chlonidine. Having reviewed a variety of cases, we observed a relationship between certain medications and documented their involvement in exacerbating or inducing psoriasis.

Pyoderma chronica vegetans treated with mesh skin grafting

Pyoderma chronica vegetans is a rare condition clinically characterized by large verrucous plaques with elevated borders and multiple pustules. Although the etiology is unknown, it is generally believed that vegetating reaction is due to an immune system dysfunction or immunosuppressive state. We report on a 72-year-old man with pyoderma chronica of the buttocks. The lesion on the left buttock worsened two years before with gradual onset of fistulas, scarring and verrucous plaques. Laboratory test revealed medium high erythrocyte sedimentation rate, anemia, shift to left in differential white blood cell count, and polyclonal hyperglobulinemia. Streptococcus species and Escherichia coli were detected in tissue samples. T-cell functional tests for mitogens were decreased. Flow cytometry analysis of phagocytic capability of monocytes and granulocytes by was normal. Inflammatory bowel diseases were excluded with clinical and radiological examination. Anti-HIV test was negative. Histology revealed hyperplasia and irregular acanthosis of the epidermis, sinus and abscess formation, fibrosis and diffuse infiltration of inflammatory cells such as plasma cells, lymphocytes, histiocytes, eosinophils and neutrophils. Surgery was chosen as a therapeutic option as conservative treatment proved ineffective. Therefore, complete excision of the lesion was performed and skin grafting was required to close the defect because of extensity of the lesions. The skin-graft donor site was normal skin. Good postoperative result was achieved, without recurrence of the pyodermatic process.

A Case of Lichen Ruber Planus in a Patient with Familial Multiple Sclerosis

Multiple sclerosis and lichen ruber planus are clinically and histologically distinct complex disorders of putative autoimmune aetiology that are fairly commonly observed in isolation but rarely found in combination. Only two previous reports have described lichen skin disorders in association with multiple sclerosis. The present report describes the case of a 51-year old Caucasian woman exhibiting both familial multiple sclerosis and lichen ruber planus. This combination may have occurred by chance or it might imply that these disorders share common mechanisms in their pathogenesis.

Laser therapy of pigmented lesions: pro and contra

Although frequently performed, laser removal of pigmented lesions still contains certain controversial issues. Epidermal pigmented lesions include solar lentigines, ephelides, café au lait macules and seborrheic keratoses. Dermal lesions include melanocytic nevi, blue nevi, drug induced hyperpigmentation and nevus of Ota and Ito. Some lesions exhibit both an epidermal and dermal component like Becker's nevus, postinflammatory hyperpigmentations, melasma and nevus spilus. Due to the wide absorption spectrum of melanin (500-1100 nm), several laser systems are effective in removal of pigmented lesions. These lasers include the pigmented lesion pulsed dye laser (510 nm), the Q-switched ruby laser (694 nm), the Q-switched alexandrite laser (755 nm) and the Q-switched Nd:YAG laser (1064 nm), which can be frequency-doubled to produce visible green light with a wavelength of 532 nm. The results of laser therapy are usually successful. However, there are still many controversies regarding the use of lasers in treating certain pigmented lesions. Actually, the essential question in removing pigmented lesions with lasers is whether the lesion has atypical features or has a malignant potential. Dermoscopy, used as a routine first-level diagnostic technique, is helpful in most cases. If there is any doubt whether the lesion is benign, then a biopsy for histologic evaluation is obligatory.

Sexually transmitted infections and adolescence

Sexually transmitted infections (STIs) remain a public health problem of major significance in most of the world. Adolescents make up about 20% of the world population, of whom 85% live in developing countries. They are at a greater risk of STIs because they frequently have unprotected intercourse, biologically may be more susceptible to infection, often are engaged in multiple monogamous relationships of limited duration, and face multiple obstacles in accessing confidential health care services. Young people who begin to have sexual intercourse in early or middle adolescence are more likely to develop an STI than those who postpone intercourse until later adolescence or adulthood. The most common STIs among adolescents are chlamydia, gonorrhea, human papillomavirus infection, and trichomoniasis. Unfortunately, lately the incidence of HIV/AIDS and syphilis among adolescents is growing. Comprehensive sex education programs in schools can increase STI knowledge and prevent risky sexual behaviors. Health care providers can promote STI prevention methods, including counseling about safe sex.

Expression of e-selectin in the skin of patients with atopic dermatitis: morphometric study

Adhesion molecules may play an important role in the homing of T-cell subsets into allergen-exposed skin of atopic individuals. The aim of this study was to examine the expression of adhesion molecules in atopic dermatitis skin lesions. Biopsies were obtained from lesions in 30 adult patients with atopic dermatitis and 10 healthy adults as controls. Biopsy specimens were studied by immunohistochemistry for the expression of E-selectin in epidermis and dermis cells. Results showed significant changes in the epithelial cell expression of E-selectin, which were especially pronounced in vascular endothelium of the dermis of atopic dermatitis patients.

Focal porokeratosis of nuchae: case report

Porokeratosis is the common name of several diseases of unknown pathogenesis, which are similar in clinical appearance. It was first described in 1893 and was thought to be a disorder of sweat glands, hence the name porokeratosis. The lesion that can be found in all cases is annular, with atrophic center, and hyperkeratotic outer ring. Cases of porokeratosis have been linked with genetic heritage, excessive ultraviolet exposure, kidney failure, and state of immunosuppression, but no definitive link has been established. As a rare condition, its main feature is that the correct diagnosis can be delayed for a significant period of time. Porokeratotic lesions have a high incidence of malignant transformation and are considered premalignant. We present a case where a porokeratotic lesion was unsuccessfully treated as a psoriatic lesion for more than a year in a patient with previously diagnosed psoriasis. A skin biopsy was performed at our department, which revealed classic cornoid lamella and thus led to the correct diagnosis. The lesion was excised. Additional diagnostic tests revealed normal kidney function and intact immune system. A follow-up protocol was established for the patient, ensuring timely diagnosis of any future porokeratotic lesions. Porokeratosis, especially when there are only few lesions, is not difficult to manage - once it is diagnosed. A diagnosis of porokeratosis may also aid in identifying a serious systemic disease such as kidney failure. Importantly, a misdiagnosis of porokeratosis may lead to development of skin cancer.

Dermatologic lasers in the treatment of aging skin

Skin aging includes intrinsic aging, a universal and inevitable process attributable to the passage of the time alone; and photoaging, changes attributable to chronic sun exposure, which are neither universal nor inevitable. The major clinical features of aging skin include xerosis, laxity, wrinkles, slackness, and the occurrence of benign neoplasms such as seborrheic keratoses and cherry angiomas. Photoaging is characterized by dryness (roughness), actinic keratoses, irregular pigmentation (freckling, lentigines, guttate hypomelanosis, persistent hyperpigmentation), wrinkling, stellate pseudoscars, elastosis (fine nodularity and/or coarseness), inelasticity, telangiectasia, venous lakes, purpura (easy bruising), comedones (maladie de Favre et Racouchot) and sebaceous hyperplasia. Current antiaging therapy consists of lasers, intense pulsed light as well as fillers, neurotoxins, radiofrequency, microdermabrasion and chemical peeling. Over the last 50 years, lasers applications in dermatology have become more specific and often irreplaceable. In this manuscript laser resurfacing and laser therapy of vascular and pigmented lesions of aging skin will be overviewed. Current trends show an increase in the number of nonablative and fractional resurfacing procedures because they are followed by less intense side effects and faster recovery rates compared to ablative laser rejuvenation, although producing mild improvement.

Why don't we have more effective treatment for keloids?

Numerous treatment modalities have been used to treat keloids and hypertrophic scars, but optimal treatment has not yet been established. The failure of achieving better therapeutic results in treating keloids highlights the essential problem that the pathogenetic mechanisms causing keloids remain unclear. Increased understanding at the molecular level will lead to the development of new therapies. Prevention is the first rule in keloid therapy. Conventional and experimental therapeutic approaches are presented in this review but further investigation is needed in relation to safety, adverse effects, and therapeutic efficacy. Because of the high recurrence rate of keloid scars, a follow-up period of at least 1 year is required to enable the start of treatment of recurrences as expediently as possible and to evaluate long-term success.

Syphilis and Scherlievo in Dalmatia

The authors describe the emergence of syphilis in Dalmatia, the coastal part of Croatia, at the very end of the 15(th) and the beginning of the 16(th) century, its presence up to the 20(th) century, making reference to the most important physicians that tried to cure the new disease. The archives of Dalmatian towns, their statutes, some literary works, travel writers, physician books, and articles by historians of medicine contain data on syphilis in Dalmatia. Syphilis was first observed in Zadar (1500), Trogir (1501) and Dubrovnik (1502). Among the first physicians who treated patients in Dubrovnik were Mariano Santo and Amatus Lusitanus. The latter was the first to make prosthesis for the palate defect to cure tertiary syphilis lesions. According to the statutes of Dalmatia towns, each had one or more paid physicians and pharmacists. The Ottoman travel writer Evlija Celebi gave an account of syphilis in Dalmatia in the 17(th) century. At the end of the 18(th) century and during the 19(th) century, endemic syphilis known as morbus de Scherlievo and morbus Brenensis appeared in Dalmatia. Because of the numerous cases observed in the region, new hospitals were opened in Dalmatian towns and the patients were hospitalized. Among the physicians who were engaged in the fight against syphilis in the 19th century, mention should be made of Giovanni Battista Cambieri, Nikola Selak and Božo Peričić. They all treated the affected patients and described syphilis and 'Scherlievo disease'in Croatian as well as in other languages. Syphilis was present in Dalmatia towns during the 15(th)-20(th) century, remaining a challenge and arousing the interest of current dermatovenereologists as well as other specialists.

Ablative laser resurfacing: is it still the gold standard for facial rejuvenation?

A new era in dermatological cosmetology, especially in the field of nonsurgical skin rejuvenation, started with ablative resurfacing, at first by carbon dioxide laser and later by Er:YAG or their combination. Although ablative lasers result in major improvements in photodamaged skin, the related postoperative recovery time and side effects are currently unacceptable for most patients. During the last forty years, skin resurfacing has changed dramatically. After ablative laser systems, nonablative and now fractional laser systems have been developed, fulfilling the new demands for a lesser risk of side effects and minimal or no downtime.

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.