Background / Aim: Hidradenitis suppurativa (HS) is a chronic inflammatory disease that most often affects apocrine gland-bearing areas of the skin. The treatment depends on the severity of the clinical presentation. The paper objective was to present new modalities in management and treatment of HS. Methods: The subjects in this research included the patients suffering from the severe form of HS, who were treated in the University Clinical Centre of the Republic of Srpska for the past three years. The effect of treatment of HS were monitored. In four patients, biologic therapy with adalimumab or adalimumab biosimilars was administered, while four patients received radiotherapy and 17 of them, were treated surgically. Depending on the type of treatment, the effects of therapy were monitored after 6-12 weeks by using clinical examination and by assessing the disease stage according to the Hurley staging. Due to a small number of subjects, especially in patients treated with biologic and radiotherapy, it was not possible to perform any statistical analysis and the results were presented by description, in tables and photographs. Results: Biologic therapy: Adalimumab was administered subcutaneously 80 mg, twice a month. After 12 weeks, in 4 patients was observed a regression of changes by 60-70 % when compared to previous skin changes. Radiotherapy: the total radiation dose was 5 Gy, distributed in 5 or 10 fractions. After 12 weeks an improvement by 60-70 % was observed. Surgical treatment: after 6-8 weeks, the patients were fully recovered. Conclusions: Application of biologic and radiotherapy after 12 weeks had similar results, ie it brought to regression of changes by 60-70 %. The best results were achieved after surgical treatment of HS.

Leser-Trélat (LT) sign (syndrome) is a rare, distinctive clinical phenomenon that is manifested by a sudden, eruptive, appearance of multiple itchy seborrheic keratoses (SK) that sometimes coincide with occult malignancy. A 73-year-old patient came for examination of numerous, large seborrheic keratoses (SK) on the skin. According to the patient's statement, SK did not occur suddenly and "eruptively". Nevertheless, ultrasound and endoscopic evaluation were suggested to the patient to exclude the Leser-Trélat phenomenon. The patient was then diagnosed with an occult, asymptomatic rectal neoplasm. The occurrence of numerous seborrheic keratoses (especially if they are "eruptive", large and bizarre in shape), should raise suspicion of LT phenomenon, or internal malignancy in the patient, and result in relevant diagnostic procedures to detect possible latent malignancy. It would be wise for the doctors of all disciplines to be acquainted with the existence of the LT sign (syndrome) and possible clinical implications of it.

Sažetak. Pemfigus označava grupu organospecifičnih autoimunskih oboljenja kože koje karakteriše pojava intraepidermalne bule, nastale akantolizom na eritematoznoj ili neizmjenjenoj koži. Osim na koži, pemfigus može da počne promjenama na sluznicama u vidu bula i erozija, najčešće u usnoj duplji i može dugo ostati neprepoznat. Oboljenja koja su često pridružena pemfigusu su dijabetes melitus, arterijska hipertenzija i razlčite infekcije (bakterijske, gljivične i virusne). Takođe, ustanovljena je povezanost pemfigusa sa drugim autoimunskim oboljenjima i malignitetima. Prikazan je muškarac, star 81 godinu, koji je više puta hospitalizovan zbog brojnih žućkastozelenkastih pustula i erozija, prekrivenim žutozelenim krustama na neizmijenjenoj ili eritematoznoj koži lica, trupa i gornjih ekstremiteta. Patohistološkom analizom je utvrđena dijagnoza pustuloznog oblika pemfigusa. Nakon dvije godine bolesnik se javio sa novim promjenama u vidu dva lividna plaka na licu i leđima. Po urađenoj biopsiji postavljena je dijagnoza Mycosis fungoides. Ostaje neriješeno pitanje da li je u ovom slučaju limfom osnovna bolest, a pemfigus pridružena ili obrnuto. Ključne riječi: Pemphigus vulgaris, Mycosis fungoidesSummary. Pemphigus represents a group of ogranospecific autoimmune skin diseases characterized by incidence of intraepidermal bullae, originated by acantholysis on erythemic or unchanged skin. Except on the skin, pemphigus may commence with changes on the mucosa in the form of bulla and erosion, most often in the oral cavity, and may stay unrecognized for a long time. The diseases, often joined with pemphigus, are diabetes mellitus, arterial hypertension and various infections (bacterial, fungal and viral). Also, it was established the relation of pemphigus with other autoimmune diseases and malignances. It was shown the case of an 81 year old man who has been hospitalized several times, due to numerous yellowish-green pustules and erosions, covered with yellowish-green crusts on the unchanged or erythemic skin of face, upper body and upper extremities. Pathohistological analysis has established a diagnosis of pustular form of pemphigus. Two years later, the patient appeared with new changes in the form of two livid plaques on the face and on his back. Upon the performed biopsy, it was established the diagnosis of Mycosis fungoides. The question remains whether this is the case of a lymphoma as the basic disease, with joined pemphigus, or vice versa.

before admission to our Clinic, because of persistent symptoms of high fever (body temperature above 38°C), severe nonproductive cough, nasal secretion, facial swelling, especially around the nose, and erythema on the hands. A diff erential white blood cell count and urinalysis were performed, and except mild eosinophilia of 6% (normal range 0 -5%) all other fi ndings were within normal limits. She was advised to stop taking all drugs. Th e patient was using three drugs (olanzapine: an antipsychotic serotonin blocker; lamotrigine: an antiepileptic and mood stabilizer; and losartan: an antihypertensive and angiotensin II receptor blocker), since she was discharged from the Clinic of Psychiatric Diseases a month before, where she was hospitalized under the diagnosis of paranoid personality disorder. Due to persistent high temperature and worsening of respiratory symptoms, the patient was examined by the specialist for infectious diseases, who set the diagnosis of acute bronchiolitis, and introduced azithromycin 500 mg once daily D rug-induced delayed multiorgan hypersensitivity syndrome (DIDMOHS) (1), also known as drug rash (reaction) with eosinophilia and systemic symptoms (DRESS) syndrome, is a severe, unexpected drug reaction which aff ects several organ systems at the same time (2, 3, 4). Most commonly it causes a combination of high fever, morbiliform skin rash and infl ammation of one or more internal organs including the liver, kidneys, lungs and/or heart. It generally starts two to eight weeks after taking the off ending medicine. Th e drugs most often reported with DRESS include anticonvulsants (particularly those with aromatic structures), sulfa derivatives, antidepressants, non-steroidal anti-infl ammatory drugs, and antimicrobials (5, 6, 7). Case reportWe present a 44-year-old unemployed nurse with psychiatric history since her teens. She was fi rst admitted to the Emergency Department seven days AbstractDrug-induced delayed multiorgan hypersensitivity syndrome, also known as drug rash (reaction) with eosinophilia and systemic symptoms (DRESS) syndrome, represents a drug-induced cluster of skin, hematologic and systemic symptoms. More than forty drugs have been associated with this syndrome. We present a case of DRESS syndrome suspecting that lamotrigine was directly responsible for the patient's rash and other symptoms. A female patient presented with extensive skin rash, fever, hematologic abnormalities, organ involvement such as hepatitis, pancreatitis and respiratory symptoms. The symptoms developed four weeks after the initiation of the offending drug, and disappeared eight weeks after its discontinuation.

Sažetak. Nevusi su definisani kao benigne proliferacije melanocita, odnosno varijeteti hamartomskih i/ili neoplastičnih lezija u koži. Za razliku od melanomskih lezija, nevusi nakon određenog perioda rasta stagniraju, a potom involuiraju. Angiogeneza je neophodna, kako za početak, tako i za završetak procesa metastaziranja. Vaskularizacijom primarnog tumora počinje ekspanzivan rast, tumor dobija metastatski potencijal. Cilj rada je da se odrede stereološki parametri (volumenska, površinska i dužinska gustina) vaskularne mreže nevusa i okoline, te melanoma i peritumorskog područja na različitim anatomskim regijama. Istraživanje je obavljeno na 10 uzoraka benignih melanocitnih promjena (nevusi) i 10 malignih melanocitnih promjena (melanomi). Materijal dobijen biopsijom je fiksiran u 10% formalinu, a od uzoraka su pravljeni serijski rezovi. Vizuelizacija krvnih sudova je vršena Mallory metodom. Pomoću mikroskopa i digitalne kamere vršeno je fotografisanje uzoraka. Dobijene fotografije su obrađivane uz pomoć programa ImageJ, verzija 1.42e (National Institutes of Health, Bethesda, USA) uz korištenje testnog sistema A 100. Statistička analiza je urađena uz korištenje programa SPSS, verzija 15.0. Statistički značajna razlika postoji u volumenskoj i dužinskoj gustini vaskularne mreže nevusa i okoline nevusa, te u dužinskoj gustini vaskularne mreže melanoma i peritumorskog područja.