Sofia, Bulgaria
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Kazandjieva J.,Medical University-Sofia | Tsankov N.,Tokuda Hospital
Clinics in Dermatology | Year: 2017

A variety of drugs may provoke acne, with drug-induced acne (DIA) often having some specific clinical and histopathologic features. DIA is characterized by a medical history of drug intake, sudden onset, and an unusual age of onset, with a monomorphous eruption of inflammatory papules or papulopustules. The location of the acne lesions is beyond the seborrheic zone. Corticosteroids, anabolic steroids, testosterone, halogens, isoniazid, lithium, and some new anticancer agents are drugs with undoubted causal relationship to acne. The diagnosis of DIA is made by a detailed history with a record of drug onset, dosage regimen and therapy duration, absence of additional triggering factors, and clinical relationship between the introduction of the drug and the onset of an acne-like eruption. In all cases, the withdrawal of the drug should be followed by lessening of the acne lesions. © 2016 Elsevier Inc.


Fluhr J.W.,Charite University Clinic | Darlenski R.,Tokuda Hospital | Lachmann N.,Laboratoires Expanscience | Baudouin C.,Laboratoires Expanscience | And 3 more authors.
British Journal of Dermatology | Year: 2012

Background Functional and structural skin adaptation is a dynamic process which starts immediately after birth in humans and in mammalian skin in general. This adjustment to the extrauterine dry environment is accomplished in the first year of postnatal life of humans. Objectives To assess the dynamic changes in vivo after birth in the molecular composition and skin physiology parameters compared with older children and adults. Methods The molecular composition of the stratum corneum (SC) and the water profile were investigated noninvasively by in vivo Raman confocal microscopy as a function of depth. Functional parameters including transepidermal water loss (characterizing epidermal permeability barrier), capacitance (as an indirect parameter for SC hydration) and skin surface pH were assessed noninvasively. The measurements were performed in 108 subjects divided into six age groups: full-term newborns (1-15 days), babies aged 5-6 weeks, babies aged 6 ± 1 months, children aged 1-2 years, children aged 4-5 years and adults aged 20-35 years. Results We showed that skin acidification is still under development during the first weeks of life. While the basal epidermal barrier is competent immediately after birth, the SC is less hydrated in the first 2 weeks of postnatal life. Similar continuous decreasing water content towards the surface for all age groups was observed, whereas this gradient was lower for the newborns. Dynamic changes in the amounts of the natural moisturizing factor constituents were revealed in the period of infancy. Conclusions We demonstrated the relation of formation of an acidic pH as well as underlying mechanisms in the induction of a fully hydrated SC over the first weeks of human life as a dynamic functional adaptation. © 2011 The Authors. BJD © 2011 British Association of Dermatologists.


Kleesz P.,German Social Accident Insurance Institution for the Foodstuffs and Catering Industry BGN | Darlenski R.,Tokuda Hospital | Fluhr J.W.,Charite University Clinic
Skin Pharmacology and Physiology | Year: 2012

Background/Aim: The skin, as the outermost organ, protects against exogenous hazards (outside-in barrier) and prevents the loss of essential parts of the body (inside-out barrier). The epidermal barrier exerts several functions with specific morphological elements. Regional differences in skin functions are well known. The aim of the present study was to assess and compare skin physiological parameters in vivo at 16 anatomical sites: Barrier function in terms of transepidermal water loss (TEWL), stratum corneum (SC) hydration (assessed by capacitance), skin surface pH, skin surface temperature, erythema index and skin pigmentation were quantified at 16 anatomical sites under basal conditions. In addition, casual skin lipid level as a function of sebaceous lipids was measured on the forehead. Material and Methods: The 6 functions at the 16 anatomical sites were assessed in a cohort of 125 volunteers working in the food processing industry. These functions were quantified with noninvasive instruments, namely a Tewameter (barrier function), a Corneometer (SC hydration), a pH-meter, a Mexameter (erythema index and pigmentation), a skin surface thermometer and a Sebumeter (casual sebum level). Results: We identified ranges for the 16 anatomical locations for each instrument and some parameters could be classified into distinctive groups. Furthermore, a left-right comparison was performed at 3 sites (dorsal hand, ventral hand and ventral forearm). Certain side differences could be shown for SC hydration, surface pH, erythema index, melanin index and skin surface temperature in the 3 assessed areas. A left-to-right, statistically nonsignificant difference was also established for TEWL. Conclusion: The detected site-specific characteristics could be attributed to factors such as occlusion, different degrees of UV exposure, microcirculation and distribution of afferent and efferent nerve endings as well as fat distribution. External factors, such as life style, UV exposure and working conditions need to be taken into account. The present data are intended for an adequate selection of parameters and anatomical locations when assessing working conditions and designing clinical dermatological and pharmaceutical studies. Copyright © 2011 S. Karger AG, Basel.


Kazandjieva J.,Medical University-Sofia | Tsankov N.,Tokuda Hospital | Pramatarov K.,Medical University-Sofia
Clinics in Dermatology | Year: 2014

Red face is not a rare finding in patients with connective tissue disorders. The malar eruption is the most frequent cutaneous manifestation of systemic lupus erythematosus (LE). This condition is more apparent among fair-skinned individuals, and it usually appears after sun exposure. A very important clinical sign is that nasolabial folds remain free of any erythematous or other changes. With subacute cutaneous LE, sun exposure can provoke a red face that resembles the malar eruption of systemic LE. The typical clinical findings of chronic cutaneous LE are the discoid lesions. There is a clinical form of chronic cutaneous LE called erythema perstans faciei. This form is purely erythematous, and it usually appears on the face. Other rare "red face" forms of chronic cutaneous LE are LE tumidus and LE telangiectaticus.Red face is not typical of systemic sclerosis, but facial telangiectasias are frequent, especially with CREST (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) syndrome. The differential diagnoses of other red face manifestations are easy due to the additional findings. Telangiectasias are accompanied by calcinosis, sclerodactyly, digital ischemia, and Raynaud disease. Many studies mention telangiectasias as markers of the severity of the systemic sclerosis, the disease duration, any pulmonary arterial hypertension, and any esophageal involvement.Purple- or violet-colored upper eyelids are the hallmark and one of the first clinical signs that is helpful for the diagnosis of dermatomyositis. This violaceous to dusky erythema can extend over the whole face and the upper aspects of the trunk. Erythematous changes on the face that are different from those of the heliotrope sign which occurs with dermatomyositis may be observed in both sun-exposed skin and non-sun-exposed skin. Malar and facial erythema, linear extensor erythema, V-sign or shawl sign, and other photodistributed eruptions can also appear. © 2014 Elsevier Inc.


Darlenski R.,Tokuda Hospital | Kazandjieva J.,Medical University-Sofia | Pramatarov K.,Sofia University
International Journal of Dermatology | Year: 2012

Hypersensitivity reactions to nickel are one of the most common in the modern world. Nickel allergy prevalence is constantly growing in many countries and represents a major health and socioeconomic issue. Herein the current understanding on nickel allergy is summarized with a practical approach to the dermatologist, allergist, and general practitioner. The personal experience with some practical clinical cases of nickel dermatitis is shared. A special emphasis is put on the possible strategies for treatment and prevention of the disease. © 2012 The International Society of Dermatology.


Darlenski R.,Tokuda Hospital | Kazandjieva J.,Medical University-Sofia | Tsankov N.,Tokuda Hospital | Fluhr J.W.,Charité - Medical University of Berlin
Experimental Dermatology | Year: 2013

The aim of the study was to disclose interactions between epidermal barrier, skin irritation and sensitization in healthy and diseased skin. Transepidermal water loss (TEWL) and stratum corneum hydration (SCH) were assessed in adult patients with atopic dermatitis (AD), rosacea and healthy controls. A 4-h patch test with seven concentrations of sodium lauryl sulphate was performed to determine the irritant threshold (IT). Contact sensitization pattern was revealed by patch testing with European baseline series. Subjects with a lower IT had higher TEWL values and lower SCH. Subjects with positive allergic reactions had significantly lower IT. In AD, epidermal barrier deterioration was detected on both volar forearm and nasolabial fold, while in rosacea, impeded skin physiology parameters were observed on the facial skin only, suggesting that barrier impediment is restricted to the face in rosacea, in contrast with AD where the abnormal skin physiology is generalized. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.


Kazandjieva J.,Medical University-Sofia | Gergovska M.,Medical University-Sofia | Darlenski R.,Tokuda Hospital
Pediatric Dermatology | Year: 2014

Contact allergic reactions to methlychloroisothiazolinone/ methylisothiazolinone also widely known as Kathon CG have been reported extensively reported. It is one of the most commonly used preservatives in rinse-off products, cosmetics, and others. Herein, a case of a 50-year-old girl is presented with chronic dermatitis in the anogenital area. The patient was patch tested and had positive reaction to Kathon CG. The detailed history taking revealed that the allergen was present in the moist cleaning wipes used instead of dry toilet paper. The presented case serves as a basis for a appraisal of the use of this preservative in wet wipes. In addition, the duration of the patch test protocol in children has also been discussed. © 2012 Wiley Periodicals, Inc.


Semkova K.,St Johns Institute Of Dermatology | Gergovska M.,Euro Derma Clinic | Kazandjieva J.,St Johns Institute Of Dermatology | Tsankov N.,Tokuda Hospital
Clinics in Dermatology | Year: 2015

Human sweat glands disorders are common and can have a significant impact on the quality of life and on professional, social, and emotional burdens. It is of paramount importance to diagnose and treat them properly to ensure optimal patient care. Hyperhidrosis is characterized by increased sweat secretion, which can be idiopathic or secondary to other systemic conditions. Numerous therapeutic options have been introduced with variable success. Novel methods with microwave-based and ultrasound devices have been developed and are currently tested in comparison to the conventional approaches. All treatment options for hyperhidrosis require frequent monitoring by a dermatologist for evaluation of the therapeutic progress.Bromhidrosis and chromhidrosis are rare disorders but are still equally disabling as hyperhidrosis. Bromhidrosis occurs secondary to excessive secretion from either apocrine or eccrine glands that become malodorous on bacterial breakdown. The condition is further aggravated by poor hygiene or underlying disorders promoting bacterial overgrowth, including diabetes, intertrigo, erythrasma, and obesity.Chromhidrosis is a rare dermatologic disorder characterized by secretion of colored sweat with a predilection for the axillary area and the face. Treatment is challenging in that the condition usually recurs after discontinuation of therapy and persists until the age-related regression of the sweat glands. © 2015 Elsevier Inc.


Lozanov B.S.,Tokuda Hospital
Endokrinologya | Year: 2013

The endogenous factors of goitrogenesis appearas a determining cause of the sporadic goiter. These are connected with the gender, the age, the pregnancy, the hormonal, family and genetic characteristics of the individuals. The genetic predisposition involves a number of genes and growth factors as well as some inherited defects of the synthesis, the transport, the metabolism of thyroid hormones (TH) or their binding to peripheral receptors. It includes also the resistance to TH (Refetof' Syndrome) which has been identified as an autosome -dominant mutation of T3-beta receptor. In most of the cases it appears familial but in some cases (15%) as a sporadic disorder manifested with a diffuse goiter, the normal or moderately elevated TSH in association with high level of serum FT3 and FT4. The exogenous goitrogenic factors are the main cause of the Iodine Deficiency Disorders (IDD) in endemic areas. IDD are a global medico-social problem which may be successfully eliminated by the appropriate programs for universal iodine supplementation. It has been achieved in Bulgaria towards the beginning of this century as a result of the obligatory implementation of iodized salt for all population groups as well as in the food industry. An important goitrogenic factor is also the deficiency of Selenium and other micronutrients which has been documented in many countries of South-Eastern Europe. The epidemiological studies in Bulgaria revealed Se deficiency in some areas correlating with the goiter frequency and the thyroid functional status in children and pregnant women. The goitrogenic effect has been established also for the cigarette smoking and many environmental agents contaminating the soil and the water. It is true also for a variety pharmacological compounds applied in the medical practice. In some cases the elevated background radiation of iodine isotopes may provoke benign hyperplasia or autoimmune disorders of thyroid gland.


Lozanov L.B.,Tokuda Hospital
Endokrinologya | Year: 2015

Obesity and thyroid disorders are common diseases affecting many populations in the last decades. Many hypotheses are available for their association. The thyroid hormones appear important and determining factors in energy expenditure and are involved in appetite regulation. On the other hand, the adipose tissue interacts with the central nervous system by adipicytokines signaling body energy storages which influence the hypothalamic-hypophyseal - thyroid axis. The continuous relationship between the thyroid gland and adipose tissue is very important for the control of body weight and the maintenance of optimal energy balance. The multiple effects of thyroid hormones on adipogenesis, metabolism of fats and thermogenesis raise the question of whether the thyroid dysfunction might be crucial for the changing of fat depots. A relationship between thyroid dysfunction and circulating levels of some adipocytokines as leptin was established but the data obtained were inconsistent. The causal relation between obesity and thyroid autoimmunity was not proven but some data show that obesity may increase the risk of some autoimmune thyroid disorders by chronic inflammation as a result of accumulated white adipose tissue. The introduction of medicines with selective effects on the different isoforms of thyroid receptors might be prospective in the therapeutic strategy of obesity and metabolic syndrome.

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