Cowden syndrome (CS) is a rare autosomal dominant, hereditary, multiorgan disease with higher risk for malignancies (breast, thyroid, endometrium). Mucocutaneous lesions occur in 90% of cases and are characterized by facial trichilemmomas, oral mucosal papillomas, and benign acral keratoses. We present the case of a 39-year-old female patient with the chief complaint of "white spots" on the upper and lower attached gingiva accompanied with skin changes on the face, hands, and soles. The patient's family medical history revealed that her mother had an endometrial polyp and the sister had thyroid cancer. In the patient's medical personal history she reported follicular thyroid adenoma, thyroid abnormalities (i.e. lymphocytic thyroiditis), fibrocystic changes and juvenile breast papillomatosis, lipoma, multiple fibromas, and genitourinary tumors. Based on extensive family and personal medical history, physical examination and histopathological findings, diagnostic criteria were fulfilled for the diagnosis of Cowden syndrome.

The "rainbow" pattern is a relatively new dermoscopic term that describes a bluish-reddish coloration together with various colors of the rainbow observable mainly through polarized light dermoscopy. Despite several theories, the rainbow pattern has not yet been clearly associated with any particular histological structure. This feature has been described in skin lesions with abundant vascularization such as Kaposi's sarcoma, basal cell carcinoma, scars, squamous cell carcinoma, melanoma, and others. In this paper we conducted a review of the available studies regarding the appearance of the rainbow pattern in different pathologies. Furthermore, we present a detailed description of the physical phenomenon in order to obtain a better understanding of this peculiar dermoscopic feature.

Bullous pemphigoid is an acquired autoimmune subepidermal blistering disease which is associated with mucocutaneous lesions. The type and amount of autoantibody deposition may have a role in mucosal lesions. We studied the association between mucosal involvement and direct immunofluorescence pattern in cutaneous lesions of patients with bullous pemphigoid. In this retrospective analytical cross-sectional study, we studied the demographic data, clinical presentations, and immunopathological findings of 69 patients with bullous pemphigoid admitted to our hospital 2008-2016. Patients were allocated into two groups on the basis of the mucosal involvement, and direct immunofluorescence patterns were evaluated. The data were analyzed using SPSS version18. The mean age of patients was 70.9±14.97 (mean ± Standard Deviation) years old. In our study, 56.5% of patients were women. All patients showed deposition of IgG and C3 in the dermoepidermal junction, with different severity. Patients with mucosal involvement (40.6% of cases) had a more prominent deposition of IgG, IgA, and C3 at the dermoepidermal junction compared with patients without mucosal involvement, which represented a statistically significant difference (P<0.05). Logistic regression analysis showed that lower age, IgA, and C3 deposition (P<0.05) were associated with mucosal involvement. Deposition of IgA and C3 (in addition to IgG) at the dermoepidermal junction seems to be a marker of mucosal involvement in patients with bullous pemphigoid. Attention to direct immunofluorescence pattern in patients with bullous pemphigoid may be helpful in prediction of mucosal involvement in these patients.

While the first traces of interest in skin diseases date back to the 14(th) century recipes from Glagolitic manuscripts, the scientific beginnings of dermatovenereology might be associated with the beginning of the 19(th) century, when in the Rijeka region a 'new disease', called after the village of Škrljevo, was studied by Giovanni Battista Cambieri. This, however, has not been the only disease named after a Croatian toponym; in 1826, Luca Stulli of Dubrovnik was the first to describe the 'mal de Meleda', nowadays recognized as a form of hereditary palmoplantar keratoderma. In 1876, Carl Heizmann, a Croatian from Vinkovci by birth, was one of the founders of the American Dermatological Association. In 1894, the first department for dermatologic and venereologic patients was opened at Sestre milosrdnice (Sisters of Charity) Hospital in Zagreb. The beginning of the 20(th) century brought an accelerated development to Croatian dermatovenereology; in 1910, while still in its experimental phase, the drug Salvarsan was used in Zagreb for the treatment of syphilis. In 1921, the chair of dermatovenereology was established at Zagreb School of Medicine, and in 1927, Franjo Kogoj was the first to describe the spongiform pustule. In 1950, Ante Vukas from Rijeka developed a special method of epidermotectoscopy. If one remembers that the first history of AIDS was written by the Croatian Mirko Dražen Grmek, it would be allowed to concur that the history of dermatology and venereology on the Croatian soil has been characterized by a fascinating profusion and dynamism.

This study examined the frequency of dermatophytoses in the Primorsko-Goranska County, a north-western part of Croatia, over a period of 21 years (1988-2008). All fungal samples were microscopically examined with 20% potassium hydroxide (KOH) solution. Fungal infections were confirmed in 26.9% cases. Out of these, dermatophytes were isolated in 38.3%, Candida spp. infection in 55.1% cases, while non-dermatophyte molds were identified in 6.6% isolates. The most frequently isolated dermatophyte was Trichophyton (T.) mentagrophytes var. interdigitalis (55.4%), followed by Mycrosporum (M.) canis (36.9%), T. violaceum (3.2%), M. gypseum (2.2%), and T. verrucosum (1.3%). Epidermophyton (E.) floccosum (0.9%) and T. rubrum (0.1%) were identified only sporadically. The most common dermatophytosis diagnosed in the 21-year period was tinea pedis (26.2%) followed by tinea capitis (21.8%) and tinea corporis (20.1%). Toenail onychomycosis (14.5%) was more common than fingernail onychomycosis (2.0%). T. mentagrophytes var. interdigitalis was the major pathogen causing tinea pedis (86.6%) as well as toenail onychomycosis (93.9%), while M. canis was most frequently isolated in tinea capitis (98.6%), tinea corporis (62.1%), and tinea faciei (40.2%). With regard to age and sex, T. mentagrophytes var. interdigitalis infections were predominant in middle-aged men. M. canis affected mostly children up to 9 years with a slight predominance in girls. Data from epidemiological trend analysis such as presented in our study are important for evidence-based public health measures for the prevention and control of dermatophytoses.

Onychomatricoma is a benign slow-growing fibroepithelial tumor arising from the nail matrix. The tumor was described as a new entity almost two decades ago. Although the clinical appearance is typical, most cases are probably misdiagnosed by physicians because of unfamiliarity with the condition. Herein we describe a case of onychomatricoma masquerading as candidal onychomycosis and paronychia and treated erroneously as such.

Recently, family history and increased frequency of some isolated manifestations of the disease in relatives of patients have been thought to play an important role in the etiopathogenesis of Behçet's disease (BD). Family history has been proposed to participate in diagnostic criteria. Investigating features of patients with different family histories may give an additional insight in understandings BD. The aim of this study was to explore the effect of familial occurrence and family history of recurrent oral ulcers (ROUs) on the clinical features of BD. We analyzed retrospectively 141 BD patients according to the International Study Group criteria. Family history of BD was present in 31.2%, family history of ROUs without BD in 31.9%, and negative family history for BD and ROUs in 36.9% of study patients. All patients were evaluated with respect to demographic and clinical features. There was no significant difference in most clinical features among patients with different family histories (p>0.05). Besides, patients with family history of BD and/or ROUs had longer duration of ROUs before diagnosis and more frequent extragenital ulcers than patients with negative family history of BD and ROUs (p<0.05 and p<0.01, respectively). These findings did not show any strong effect of familial occurrence or positive family history of ROUs on all clinical characteristics of BD. However, sporadic ROUs should be considered an early predictor of probable BD in patients with family history of BD and/or ROUs, and they should be followed up carefully. Further studies including genetic testing of patients and their relatives are needed.

We have developed a specialised Excel ® spreadsheet which records a panel of clinical variables for patients presenting to specialised bullous clinics at our institution. The spreadsheet incorporates scores for the two disease specific instruments for autoimmune bullous disease; the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and the Pemphigus Disease Area Index (PDAI), as well as medication doses, and quality of life (QOL) scores. The spreadsheet has automated arithmetic functions for tallying scores, explanatory pop-ups and restrictions on data values to prevent the inadvertent input of invalid data. The major strength of the spreadsheet is that using the graph function, one can instantly appreciated how the disease trajectory of a patient has evolved across a range of parameters (such as disease activity, QOL and the need for immunosuppression) through the visual depiction of their clinical course. The spreadsheet built by our group is practical for routine clinical use and is a useful tool for longitudinal monitoring of disease activity in bullous patients.