Widening Competency Gaps In The State Of The Art Dermatology

<abstract xmlns="http://www.w3.org/1999/xhtml"> Visual perception of human skin is determined by the light that reflects off the skin surface to retina and interpretation of these information by visual centers in the brain cortex. Skin has a partly translucent and turbid structure and visual perceptions depend on interactions between the light and structures of the skin surface and below it, through absorption, reflection and scattering. Light absorption by the skin depends on the composition, absorption spectra and amount (volume fraction) of chromophores. Subsurface scattering occurs within the skin layers: Rayleigh scattering (subcellular structures sized up to 1/10 of incident wavelength) and Mie scattering (collagen, melanosomes). Due to fluctuations of the refractive index within tissue components and intense scattering, the spatial distribution of light within the skin is diffuse. Skin images are created by the light that reflects off the skin after being color-modified by absorption and being scattered on the skin surface and internal skin structures.</abstract>

Institute of Child and Youth Health Care of Vojvodina, Novi Sad, Serbia

Clinic of Dermatovenereology Diseases, Clinical Center of Vojvodina, Novi Sad, Serbia

Optical properties of the human skin / Optičke osobine ljudske kože

<abstract xmlns="http://www.w3.org/1999/xhtml"> Linear IgA bullous dermatosis is a chronic, acquired, autoimmune subepidermal vesiculobullous disease. Both children and adults are affected. It is characterized by direct immunofluorescence findings of linear immunoglobulins class A (IgA) deposits along the dermal-epidermal junction (basement membrane zone). In children, the disease is commonly referred to as chronic bullous disease of childhood and it mostly affects children between 2 and 5 years. The onset of the disease is acute; the first episode is the most severe, while recurrences tend to wax and wane in severity and last till puberty or even longer. Diaminodiphenylsulfone is the treatment of choice, although systemic corticosteroids are reported to be very effective as well. We report a 3-year-old boy with a vesiculobullous eruption which developed one week following administration of cephalexin for upper respiratory infection. He was referred to our Clinic from other health institutions as treatment failure for suspected <italic>strophulus </italic>or <italic>impetigo bullosus</italic>. On admission, the patient had fever and numerous vesiculobullous and erosive lesions distributed on the face and trunk. After immunohistological verification, the treatment with prednisone 25 mg/d was introduced, due to rapid progression of the disease and the fact that diaminodiphenylsulfone was not available. Improvement occurred after 2 weeks, so the dose was carefully tapered, taking into account the possibility of adrenal suppression. The medication was completely excluded within the next three months. No serious side effects were observed, except transitory hirsutism. The patient has had no relapses over the last 20 months of clinical follow-up.</abstract>

Chronic bullous disease of childhood – A case report / Hronična bulozna bolest Kod Dece – Prikaz Slučaja

<abstract xmlns="http://www.w3.org/1999/xhtml"> In clinical practice, positive personal history is considered to be as an indication of increased melanoma risk. The thickness of melanoma (Breslow Index) is the most important independent predicting factor of survival for stage I patients. We present a case of a second primary melanoma and basal cell carcinoma in a 48-year-old female patient with personal history of a superficial spreading melanoma located at the dorsal trunk with Breslow’s thickness of 0,5 mm and Clark’s II (stage IA) excised a year before, and a family background of melanoma. We would like to emphasize the benefits of digital dermatoscopy as well as teledermoscopy, and new teledermatology web services, in the follow-up of high-risk patients.</abstract>

Risk of a second cutaneous primary melanoma and basal cell carcinoma in patients with a previous primary diagnosis of melanoma: true impact of dermoscopy follow-up in the identification of high-risk persons/  Značaj dermoskopskog praćenja u identifikaciji osoba s visokim rizikom od pojave drugog primarnog kutanog melanoma – prikaz slučaja

<abstract xmlns="http://www.w3.org/1999/xhtml"> Granulomatous rosacea is considered to be the only true variant of rosacea. Diascopy of larger lesions often reveals apple-jelly nodules, indicating their granulomatous histology. Other signs and symptoms of rosacea are not required to make a diagnosis of granulomatous rosacea. The response to treatment may be slow, which must be the most important consideration for both the clinician and the patient. We present an otherwise healthy 62-year-old non-atopic woman with a 15-year history of episodic facial flushing, often accompanied by a burning sensation without sweating. Exclusively affecting the face, lesions had a high tendency to spread each year. The patient was a lifelong non-smoker. A seller on the local market, she spent most of her time outdoors. She had no positive family history of rosacea. At the time of presentation, she was not taking any medications, except for topical neutral creams. Multiple reddish-brown papules without comedones, associated with telangiectasia were scattered over the erythematous background on the chin, forehead, cheeks, nose, glabella and eyelids, while small pustules clustered over the eyelids. The nasolabial folds, neck and ears were not affected. There was neither lymphadenopathy, nor ocular involvement. Based on the history, physical, laboratory and other relevant investigations including histopathology, the diagnosis of granulomatous rosacea was established. The therapy was conducted with topical azelaic acid 20% cream, twice daily for six months. Clinical evaluation was done every 14 days during the first month, and once monthly during the next five months. Affter two weeks, there was a significant decrease in the mean inflammatory lesion count. At the end of the therapy, telangiectasia and facial erythema almost disappeared. There were no side effects. Apart from several short episodes of erythema, during the five-year-long follow-up, there were no other signs of the disease. In conclusion, azelaic acid 20% cream may be an effective and safe treatment option for some patients with granulomatous rosacea.</abstract>

Institute of Histopathology and Cytology, Clinical Center of Vojvodina, Novi Sad, Faculty of Medicine, Novi Sad

A Case of Granulomatous Rosacea: Successful treatment with Topical Azelaic acid 20% cream / Granulomatozna rozacea – lokalno lečenje azelaičnom kiselinom u obliku 20% krema – prikaz slučaja

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Serbian Journal of Dermatology and Venereology

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