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Đorđije Karadaglić

University of Montenegro

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Silvija Brkić

University of Novi Sad

L Krstić

Marina Jovanović

Institute of General and Physical Chemistry

Marina Jovanović

University of Kragujevac

Cooperative Institutions

University of Novi Sad

University of Kragujevac

Klinički centar Vojvodine

Adan Hospital

Institute of General and Physical Chemistry

Clinical Centre of Kragujevac

University of Belgrade

University of Zenica

Military Medical Academy

University of Defence

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[Genitourinary infections caused by Chlamydia trachomatis].

PubMed (1987)

Đorđije Karadaglić L Krstić

Chlamydia trachomatis infection

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Genital Lichen Sclerosus – Has Th ere Been any Progress in Treatment?

Serbian Journal of Dermatology and Venerology (2014)

Đorđije Karadaglić

Abstract Lichen sclerosus (LS) is a chronic inflammatory dermatosis localized mainly in the anogenital region, accompanied by itching, atrophy and sclerosis. Progressive destructive scarring in genital lichen sclerosus (GLS) may result in burying of the clitoris in females and phimosis in males. Affected persons have an increased risk of genital cancers. It is often unrecognized in everyday clinical practice due to undiagnosed squamous cell carcinoma at the site of lesions. Remissions are rare and the estimated remission rate is only 16%. GLS is a lifelong, incurable condition, but signifi cant improvement can be achieved. Numerous therapeutic modalities have been used in GLS; unfortunately, the number of controlled studies is small and the results are mostly related to the management of symptoms, not the progression of the disease and destructive scarring. A systemic meta analysis of seven randomized controlled trials on local therapy of GLS was performed. It included a total of 249 patients treated with six topical agents: clobetasol propionate, mometasone furoate, testosterone, dihydrotestosterone, progesterone and pimecrolimus. Topical corticosteroids, clobetasol propionate 0.05% (highly potent) and mometasone furoate 0.05% (potent), showed to be significantly more efficient compared to placebo. Pimecrolimus 1% cream and clobetasol propionate 0.05% showed similar efficacy. Both agents have proven effective in the treatment of GLS: there was no statistically significant difference in relieving symptoms of pruritus and burning/pain. Tacrolimus 0.1% ointment also proved to be effective in the treatment of GLS. Topical androgens and progesterone did not show significant efficacy. Topical tretinoin and calcipotriol have been used with limited success, but they may induce irritation, so they are rarely used in the treatment of GLS. Other therapeutic options for GLS include ultraviolet A1 (UVA-1) phototherapy, methotrexate, retinoids, cyclosporine, stanozolol, hydroxychloroquine, calcitriol, laser and photodynamic therapy, but the number of patients is small to allow for conclusive assessment. Surgery is not a standard therapeutic option for GLS. In conclusion, treatment of GLS should be carried out in two phases: introduction of remission and maintenance of remission; topical therapy should include highly potent corticosteroids once daily during three months, followed by twice per week, or twice daily during 4 to 6 weeks, and then twice per week. There are different opinions regarding maintenance therapy: application of super potent or potent topical corticosteroids; these patients need long-term, several-year follow-up, although there is no agreement what parameters should be assessed; treatment efficacy is often reduced to monitoring GLS symptoms.

Mometasone furoate

Pimecrolimus

Clobetasol propionate

Topical steroid

Itching

Clitoris

Vitiligo

10.2478/sjdv-2014-0005

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Contact urticaria and allergic contact dermatitis to lidocaine in a patient sensitive to benzocaine and propolis

Contact Dermatitis (2006)

Marina Jovanović Đorđije Karadaglić Silvija Brkić

Montenegro

10.1111/j.0105-1873.2006.0560f.x

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Actinic Keratosis: A New Approach to the Treatment / Aktinična Keratoza: Novi Pristup Lečenju

Serbian Journal of Dermatology and Venerology (2009)

Đorđije Karadaglić Marina Jovanović

Abstract Actinic keratosis is an intraepidermal proliferation of transformed, atypical keratinocytes, induced by exposure to solar ultraviolet radiation. Many authors believe that it is the earliest form of squamous cell carcinoma. More than 40% of all metastatic squamous cell carcinomas develop from actinic keratosis. The clinical, histological and molecular characteristics of actinic keratosis are those of squamous cell carcinomas. Since it can be extremely hard to distinguish actinic keratosis from some squamous cell carcinomas, treatment can be rather difficult. The best treatment of actinic keratosis is its prevention. The main reason for therapy which is universally accepted, is prevention of squamous cell carcinoma. A number of options are available, but when considering the efficacy, invasive procedures remain the standard treatment. Treatment of individual lesions may prevent further progression of actinic damage present in the surrounding skin

Actinic keratosis

Keratosis

10.2478/v10249-011-0004-1

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Palmoplantar pustulosis – is there any progress in the treatment? / Palmoplantarna pustuloza – ima li pomaka u lečenju?

Serbian Journal of Dermatology and Venerology (2011)

Đorđije Karadaglić Silvija Brkić

Abstract Despite, the fact that palmoplantar pustulosis is still widely known by this name, it is currently regarded as a disease distinct from psoriasis. The real cause is still unknown. Septic foci have been blamed, but their removal may not cure eruptions. A case series of de novo occurrence of palmoplantar pustulosis induced by tumor necrosis factor-alpha antagonist therapy has been reported. It has been shown that stress may be related to exacerbation of palmoplantar pustulosis. Some authors suggest that palmoplantar pustulosis is an autoimmune disease. In sera of patients with palmoplantar pustulosis circulating autoantibodies against nicotinic acetylcholine receptors were detected. The differences between palmoplantar pustulosis and pustular palmoplantar psoriasis are numerous. Genetic studies have failed to find any link between palmoplantar pustulosis and major genetic susceptibility locus for psoriasis vulgaris. Most patients with palmoplantar pustulosis have no evidence of psoriasis elsewhere. Histologically, it closely resembles psoriasis. However, accumulation of neutrophils just beneath the corneal layer, finding known as Munro’s microabscess, and dilation of capillaries in the papillary dermis are lacking. Approximately 90% of patients are women. A significantly higher prevalence of smokers was found in the group with palmoplantar pustulosis than in the normal population and a particularly strong association was confirmed between smoking and pustular lesions in patients with psoriasis, OR=5.3 (2.1-13.0). Nevertheless, according to a recent review from the Cochrane Library, there is no evidence that smoking cessation improves the condition once it has developed. Topical corticosteroids under occlusion are the first-line therapy. Prolonged therapy is needed on a second or third-day basis, in order to sustain the obtained effects. Oral retinoids in combination with oral PUVA are the best second-line therapy. No difference in the efficacy between etretinate and acitretin was found. The disadvantage of systemic retinoid therapy is its teratogenicity. Oral PUVA is effective and the response is enhanced by combination with retinoids. There is an established increased efficacy of a combination of retinoids with PUVA therapy over each treatment modallity when used alone. Liarozole may be an effective and well-tolerated therapy, but side effects are like in retinoids. The advantage over acitretin is that raised levels of retinoic acid fall to normal within a few days after cessation of therapy. Significant improvement, but no complete clearance, occurs in most patients treated with low dose cyclosporine. Before starting the treatment, it is necessary to consider: patient’s individual factors, since many patients have already received some previous treatment; specific treatment factors such as formulation, way of administration, dose, different drug combinations; regimens and periods of treatment; site of involvement, due to differences between hands and feet in the probability of response to treatment.

Palmoplantar pustulosis

10.2478/v10249-011-0041-9

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