Urticaria and angioedema are common allergic manifestations and medications are one of common triggering factors. The most severe immediate drug reaction is anaphylaxis. Apart from the well established IgE-mediated immediate type hypersensitivity reactions, the pathogenesis of drug-induced urticaria, angioedema and anaphylaxis often remains obscure. In this article, emphasis is put on nonallergic reactions to the most commonly used drug groups of nonsteroidal antiinflammatory drugs, angiotensin-converting enzyme inhibitors, radiocontrast media, volume expanders and drugs used in general anesthesia. Urticaria is the second most common drug eruption after maculopapular exanthema. The mechanisms of acute urticarial reactions are multiple, mostly IgE mediated, but some drugs can induce immune complex reactions and activate complement cascade, while others can induce direct activation of mast cells and degranulation or activation of complement by non-immune mechanisms. With different types of medications different pathomechanisms are involved. Non-steroid anti-inflammatory drugs are thought to cause reaction due to cyclooxygenase-1 inhibition and overproduction of leukotrienes, blamed for cutaneous and respiratory symptoms. Angiotensin-converting enzyme inhibitors can cause fatal angioedema, which is partially explained with bradykinin excess and impairment of aminopeptidase P and dipeptidyl peptidase IV that are involved in the metabolism of substance P and bradykinin. It remains unknown what additional mechanisms are involved. Radiocontrast media and local anesthetics mostly cause nonallergic hypersensitivity reaction, but in rare cases true allergic reaction can occur. Dextran is known to cause IgG mediated, immune complex anaphylaxis and it is recommended to use human serum albumin as the safest colloid.

Topical antibiotics are frequently introduced in therapy by various specialists, e.g., dermatologists-venereologists, ENT specialists, proctologists, ophthalmologists, and others. In dermatology, topical antibiotics are used in the treatment of superficial inflammatory skin lesions, acne and rosacea. These agents are also used in the prevention of inflammatory lesions after surgical and corrective procedures. Long-term and uncontrolled application of topical antibiotics, on the skin with impaired protective barrier in particular, implies a risk for the development of hypersensitivity to these agents. Considering the very wide utilization of these agents, hypersensitivity to topical antibiotics poses a major problem worldwide. The groups at a high risk of contact sensitivity to topical antibiotics include patients with chronic venous insufficiency, chronic ulcers and chronic otitis externa, as well as individuals at occupational exposure to antibiotics, e.g., human medicine and veterinary medicine professionals, pharmaceutical industry workers, cattle breeders, etc. When long-term therapy fails to result in improvement in the above mentioned chronic states, the possibility of allergic reactions to topical agents should be taken in consideration. Cross-sensitivity, which is frequently associated with the use of topical aminoglycoside antibiotics, poses a significant problem.

Dear Editor, I read with great interest the article "Subcutaneous dirofilariasis caused by Dirofilaria repens diagnosed by histopathologic and polymerase chain reaction analysis", published in the last issue of Acta Dermatovenerologica Croatica. The authors of the article describe a case of human dirofilariasis with typical subcutaneous presentation of the parasite. They cite this case as the fourth reported case of the disease in Croatia (1). However, dirofilariasis in Croatia has been reported more frequently than it looks at the first glance. The main reason for this discrepancy is that some cases have been reported in journals and other publications with poor or no visibility. The first case reported was the case of conjunctival dirofilariasis described by Bujger et al. in 1996, published in Ophthalmologia Croatica. Unaware of this case, due to its invisibility in the main journal databases, in 2003 Puizina-Ivić et al. reported two cases of the disease as the first cases of human dirofilariasis in Croatia. Actually, these were the first reported cases of the subcutaneous form of the disease in our country, followed by the case presented as subcutaneous mammary nodule (3,4). All of these subcutaneous cases were from the southern part of Croatia, where additional cases were frequently encountered and reported (5,6). In 2007, another case of ocular dirofilariasis was reported, followed by two reported cases of the subcutaneous form of the disease, all from the inland part of Croatia (7,8). In all of the reported cases, Dirofilaria repens was identified as the causative agent. Altogether, including the case reported in your journal, at least 10 human cases of this emerging zoonosis have been reported in Croatia so far, confirming the conclusion by Marusić et al. that Croatia represents an endemic area, like other countries in the Mediterranean basin (1). As the majority of cases presented as subcutaneous nodules, dermatologists and dermatopathologists should familiarize themselves with the clinical and histologic aspects of the disease, considering it in the differential diagnosis of solitary nodules in subcutaneous tissue.

Treatment of cutaneous leishmaniasis is often difficult. Even though most cutaneous lesions will heal spontaneously, their duration cannot be predicted in an individual case. In general, only large, multiple or diffuse lesions of the face, head and neck need to be considered for therapeutic intervention. Pentavalent antimonials (sodium stibogluconate and meglumine antimoniate) administered intralesionally or parenterally (IM or IV) are the mainstays of systemic therapy despite the toxicity associated with their use. The objective of this study was to compare the clinical efficacy of intramuscular pentavalent antimonial compound meglumine antimoniate alone and in combination with intralesional therapy in the treatment of Old World cutaneous leishmaniasis. Study was conducted as a case controlled interventional prospective study. On the basis of demonstration of Leishmania tropica (LT) bodies in the skin slit smears/skin biopsies, 60 patients with cutaneous leishmaniasis were included in the study. The patients were randomly allocated to three groups of 20 patients each: group 1 treated with intramuscular injection of meglumine antimoniate (20 mg Sb/kg/day, maximum 850 mg) for 21 days; group 2 treated with intralesional injection of meglumine antimoniate (0.5 mL, 42.5 mg of Sb) into each lesion along with intramuscular injection of meglumine antimoniate (20 mg Sb/kg/day, maximum 850 mg) for 21 days; and group 3 as a control group. The patients were followed-up for therapeutic safety and efficacy at 10, 20 and 90 days. The rate of complete cure was 55% in group 1, 75% in group 2 and 10% of spontaneous cure cases in group 3. The conclusions derived from this study are limited by the relatively small number of patients. The combination of intramuscular meglumine antimoniate along with intralesional administration of the agent is superior therapy to intralesional administration of meglumine antimoniate alone.

Two patients with features of multiple symmetric lipomatosis type 2 are presented. This particular disorder with a characteristic distribution of fat should be considered on differential diagnosis of obesity. Besides being rare, it may occasionally be unrecognized, especially in females. The etiology remains unknown; however, the association with high alcohol consumption is very strong. Several issues about the possible metabolic role of lipomatous adipose tissue have been discussed. Patients with multiple symmetric lipomatosis should be treated by liposuction or surgery instead of being submitted to diets.

Sexually transmitted diseases and infections (STDIs) are known to have a major socioeconomic and biologic impact, par notticularly on women (e.g., sterility, ectopic pregnancies, neo notplasms, etc.) and fetus (intrauterine and perinatal mortality, infection, malformations). Sex work noters do not use health services appropriately and are a high-risk category. Despite this evidence, data on prostitution and STDIs in some countries are limited. Sexual health medicine is involved in the community by identifying and minimizing the STDI problems through laboratory screening, diagnostic testing, education, and research.

During the 1994-2003 study period, patch testing was carried out in 1102 subjects (740 female and 362 male, mean age 39.8, range 7-81 years) suspected to have allergic contact dermatitis (ACD). Epicutaneous patch test with a standard series of contact allergens was made by the Institute of Immunology, Zagreb, Croatia, according to the Internationational Contact Dermatitis Research Group (ICDRG) rules. During the study period, 399 (36.2%) subjects with one or more positive tests were recorded, and 640 positive tests were observed. The most frequent allergens were nickel sulfate identified in 214 (33.4%), cobalt chloride in 64 (10%), fragrance mix in 60 (9.4%), wood tar in 47 (7.3%), potassium dichromate in 39 (6.1%), balsam of Peru in 29 (4.6%) and other allergens in 187 (29.2%) cases. According to the localization of ACD, hands as the most common site were involved in 535 (48.5%) cases, followed by the face in 167 (15.2%) and other locations in 400 (36.3%) cases. It is concluded that nickel is the principal allergen as the cause of ACD, mostly affecting women. The areas most frequently involved by ACD were the hands and face.

Hemangiomas of infancy are the most common benign tumors of childhood. They are composed of proliferating endothelial tumor cells and usually manifest as cutaneous birthmarks. In most cases, these tumors characteristically follow a natural course of regression. However, they can cause a tremendous amount of anxiety. Hemangiomas can threaten vital life processes if located in certain areas of the body. They may also be part of larger syndromes associated with high rates of life-changing morbidity and mortality. In all of these situations, hemangiomas are often referred due to the uncertainties that exist regarding the most efficacious diagnosis and management.

Different clinical studies report the connection between malignant melanoma (MM) and vitiligo, as the etiology of both diseases evolves around melanocytes. A case is presented of a 70-year-old female patient with metastatic MM in lymphatic node of the right groin, which developed simultaneously with the "vitiligo-like patches" over the face and extremities. Some authors suggest that the appearance of depigmentation during the course of MM might be considered a good prognostic sign. However, our patient subsequently developed multiple lung metastases as well as metastases in lymphatic nodes of the other groin region. This case shows that MM and vitiligo may develop simultaneously, indicating the possibility of similar mechanisms in the destruction of both benign and malignant melanocytes.