Dubravka Vuković

Background and Objectives: Atopic dermatitis (AD) is a prevalent, chronic, relapsing itchy skin disorder, affecting up to 20% of the pediatric population. Topical corticosteroids are the cornerstone of AD treatment, but their use is often limited due to topical corticosteroid phobia among parents. Research on chronic illnesses highlights the significant role of personality traits in treatment adherence, with emotional stability and conscientiousness—within the framework of the Five-Factor Model—emerging as key predictors. The aim of our study was to examine the relationship between parental personality traits and their adherence to the treatment of their children with AD. Materials and Methods: A cross-sectional study was conducted at the Department of Dermatovenereology, University Hospital of Split, involving 90 parents of children diagnosed with AD. Personality traits were evaluated using the abbreviated version of the International Personality Item Pool Big-Five Personality Questionnaire (IPIP 50s). Treatment adherence was assessed through a valid and reliable questionnaire, the Morisky Medication Adherence Scale (MMAS-8). Statistical analyses were performed using JASP v.0.18.1.0. Results: According to MMAS-8, only a small proportion of the sample reported having high adherence (14.4%). The only significant associations between personality traits and adherence were found between conscientiousness and adherence and emotional stability and adherence, where more conscientious participants and more emotionally stable participants reported higher scores. Conclusions: The results suggest that parents of children with AD with higher scores on conscientiousness and emotional stability are more likely to demonstrate better treatment adherence. These insights may encourage a holistic and multidisciplinary approach to the treatment of children with AD, with an emphasis on providing psychological support to both the children and their parents in order to improve treatment adherence and the further clinical course of the disease.

Background and Objectives: Psoriasis is a chronic, immune-mediated inflammatory dermatosis affecting approximately 125 million people worldwide. Biologic therapy (BT) has significantly improved treatment outcomes for moderate-to-severe psoriasis, but real-world adherence to these therapies is not fully understood. This study aimed to evaluate adherence to BT among patients with moderate-to-severe psoriasis and examine how general and treatment-specific beliefs about BT are associated with adherence. Materials and Methods: This cross-sectional study was conducted from March to August 2025 at the University Hospital of Split, Croatia. A total of 122 adults with moderate-to-severe psoriasis receiving interleukin-17 or interleukin-23 inhibitors completed validated Croatian versions of the Beliefs about Medicines Questionnaire–General (BMQ-G), Beliefs about Medicines Questionnaire–Specific (BMQ-S), and the Medication Adherence Report Scale (MARS-5). Adherence was assessed using MARS-5, and beliefs were analyzed using BMQ-G, BMQ-S, and the Necessity–Concerns Framework. Correlation and group-based analyses were used to explore associations between beliefs, adherence, and sociodemographic factors. Results: Adherence to BT was high, with 96.7% of participants reporting that they use their medication as prescribed and 84.4% stating they always followed dosing instructions. Most participants endorsed strong necessity beliefs regarding BT; however, concerns remained common—40.2% reported worry about long-term effects and 15.6% about dependence. General beliefs about medicines influenced treatment-specific perceptions: BMQ-G Overuse scores were negatively correlated with adherence (r = −0.27; p = 0.003) and positively correlated with BMQ-Specific concerns. Participants classified as Distrustful (low necessity, high concerns) made up 31.1% of the cohort and had the highest Harm and Overuse scores. Lower educational attainment was associated with stronger negative beliefs about medicines. Conclusions: Although adherence to BT was high, a considerable proportion of patients expressed residual concerns, especially those with more negative general beliefs about medicines. These findings underscore the importance of assessing medication beliefs in routine care. Tailored education and communication strategies may help address concerns and support long-term adherence to BT in psoriasis.

Background and objectives: Melanocytic nevi are among the most common skin lesions, yet their relationship with the peripheral nervous system has remained understudied. Given the neural crest origin of melanocytes and Schwann cells, and the neurotrophic signaling capabilities of pigment cells, this study aimed to investigate the density of nerve fibers within nevi and assess how it varies with respect to histological subtype and anatomical location. Materials and Methods: A total of 90 nevi were analyzed, including junctional, compound, and intradermal types, distributed across the head, trunk, and limbs. Immunofluorescence staining for the pan-neuronal marker PGP 9.5 and for CGRP were performed and nerve fiber density was quantified. Statistical evaluation using two-way ANOVA revealed that both nevus type and anatomical site significantly influenced the degree of total innervation. Results: Junctional nevi demonstrated the highest total nerve fiber density, significantly exceeding that of compound and intradermal nevi. Likewise, nevi located on the head exhibited a significantly greater density of PGP 9.5-positive nerve fibers compared to those on the trunk and limbs. No significant correlation was observed between nevus type and location, suggesting that both factors contribute independently to the differences in innervation. CGRP-positive innervation was uniform regardless of the histological type of nevus and anatomical location. Conclusions: These findings likely reflect the facts that junctional nevi reside at the dermo-epidermal junction, where nerve fibers are most abundant, while the skin of the head and neck is well known to be more richly innervated than other regions. In contrast, analysis of CGRP-positive fibers suggests that the heterogeneity detected with PGP 9.5 is primarily driven by other neuronal populations. The results support the hypothesis of a dynamic relationship between nevi and the peripheral nervous system, potentially mediated by neurotrophic factors. Understanding this interaction may provide insight into nevus biology, sensory symptoms reported in some lesions, and the evolving role of nerves in the tumor microenvironment.

The literature describes niacinamide, but also postbiotics and peptides, as ingredients that improve skin barrier function, but also affect melanin and sebum levels in individuals. However, the combined effects of these ingredients in a single cosmetic serum have not been sufficiently investigated. Therefore, the aim of this randomized controlled study, conducted at the University of Split School of Medicine (Croatia), was to evaluate the effects of cosmetic products containing these active ingredients. This study was registered with ClinicalTrials.gov (NCT06189105) and has been completed. Primary outcomes were the levels of trans epidermal water loss, skin hydration, erythema, melanin, and sebum, all measured in 25 healthy Caucasian participants. Significant differences between hydration levels were observed at week 4 (61.0 ± 11.2 vs. 68.6 ± 13.3 AU, control and intervention). Moreover, a significant decrease in erythema values from the first to last measurement in the intervention group was observed, (379.9 ± 106.8 vs. 333.6 ± 73.5 AU, baseline values and week 4, intervention group). Interestingly, both the increase in skin hydration levels and the decrease in skin erythema after niacinamide serum application were significant in study participants who did not use sun protection products. It is well known that ultraviolet radiation has detrimental effects on human skin, and our results suggest that niacinamide could help counteract these effects.

Contact dermatitis is a common inflammatory skin disease that often requires prescription therapy and is associated with adverse reactions. Omega fatty acids have been recognized for their anti-inflammatory effect and could serve as a safer option in contact dermatitis treatment. Therefore, the aim of this randomized controlled study, conducted at the University of Split School of Medicine, was to evaluate the efficacy and safety of omega fatty acids containing topical products in an experimental model of irritant contact dermatitis. This study was registered with ClinicalTrials (NCT06189144) and is closed. The primary outcomes were levels of transepidermal water loss, skin hydration, and skin erythema, all measured using an MPA6 device in 25 healthy participants. A significant difference was observed between the hydration values of the intervention (45.7 ± 12.4) and control groups (31.6 ± 12.3) (p < 0.05) on final measurements (day 10). Moreover, higher erythema levels were observed in participants who were smokers, compared to non-smokers. No adverse drug reactions were observed during the study period. In conclusion, omega fatty acids topical product use shows promise in the treatment of irritant contact dermatitis, and further studies are needed to evaluate efficacy in a larger sample of patients.

Background and Objectives: This study demonstrates the factor structure and reliability of the Croatian version of the TOPICOP (Topical Corticosteroid Phobia) questionnaire, thereby contributing to further validation and standardization of the measurement of topical corticophobia with dermatological patients or their parents, which directly affects patient or parent compliance, as well as the final therapeutic effect. Materials and Methods: The cross-sectional, observational study was conducted at the University Hospital Centre Split, Department of Dermatovenerology. The research involved inviting 120 participants (age 12–68) who attended the University Hospital Centre Split’s Atopy School, patients examined in the Dermatology Outpatient Clinic of the University Hospital Centre Split and diagnosed with atopic dermatitis (AD) or allergic contact dermatitis (ACD), and parents or legal representatives of patients younger than 12 years old. The TOPICOP questionnaire consists of 12 items assessing the three different components of topical corticophobia (worries, beliefs, and behaviour). Respondents evaluated their perception of the correctness of each statement within 10 min of filling out the questionnaire on a four-point Likert scale. Results: The response rate was 94%, resulting in a sample of 113 respondents (109 adults and 4 children). Factor analysis yielded one common factor of relatively high reliability (Cronbach α = 0.85, 95% CI 0.81 to 0.89). No differences were found in questionnaire scores between male and female participants, nor between the parents/legal representatives of dermatological patients and other patients. Conclusions: This research contributes to further development of the appropriate measuring instrument, its practical application, and thus, the better recognition, resolution, and prevention of topical corticophobia as part of the better overall healthcare and treatment of chronic dermatological patients.

Background: Vitiligo is a disease that affects people of all skin shades and can impact their quality of life. Reliable evidence on the effectiveness and adverse events associated with the recent use of Janus kinase (JAK) inhibitors to treat vitiligo is needed. This protocol for a systematic review and meta-analysis seeks to collect evidence from both randomized controlled trials (RCTs) and observational studies to determine the effectiveness and patient-centered outcomes concerning treatment with JAK inhibitors. Methods: We will conduct a systematic review of the literature for RCTs and observational studies that used upadacitinib, ritlecitinib, brepocitinib, ifidancitinib, cerdulatinib, deglocitinib, baricitinib, tofacitinib, and ruxolitinib JAK inhibitors as treatments for vitiligo compared to placebo, no treatment, or combination therapies. We will systematically search from inception in Epistemonikos, MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, EMBASE, ClinicalTrials.gov, PsycINFO, Allied and Complementary Medicine Database, Latin American and Caribbean Health Sciences Literature, Web of Science Core Collection, relevant preprint servers, and the gray literature. Ethics approval was not sought as the protocol and systematic review will not involve human participants, but rather summarized and anonymous data from studies. Primary outcomes include quality of life, percentage repigmentation, decreased vitiligo within 1 year or more, lasting repigmentation after a 2-year follow-up, cosmetic acceptability of repigmentation and tolerability or burden of treatment, and adverse events. Secondary outcomes are patient and study characteristics. We will include full-text articles, preprints, and clinical trial data in any language and all geographic regions. For data sources unavailable in English, we will obtain translations from global collaborators via the Cochrane Engage network. We will exclude articles for which sufficient information cannot be obtained from the authors of articles and systematic reviews. At least two investigators will independently assess articles for inclusion and extract data; reliability will be assessed before subsequent selection and data extraction of remaining studies. The risk of bias and certainty of evidence with Grading of Recommendations Assessment, Development, and Evaluation guidelines will be assessed independently by at least two investigators. We will estimate treatment effects by random-effects meta-analyses and assess heterogeneity using I². Data that cannot be included in the meta-analysis will be reported narratively using themes. Discussion: The proposed systematic review and meta-analysis describe the methods for summarizing and synthesizing the evidence on the effectiveness and patient-centered outcomes concerning the treatment of vitiligo with JAK inhibitors that were recently approved for this indication. To disseminate further the results of our systematic review, we plan to present them at international conferences and meetings. Our findings will provide robust evidence to facilitate decision-making at the policy or practitioner level. Systematic review registration: PROSPERO CRD42023383920.

Kontaktni dermatitis je česta upalna bolest kože koja etiološki može biti alergijskog i iritativnog tipa. Iako djeca često imaju iritativni kontaktni dermatitis, dugo se smatralo da je kontaktni alergijski dermatitis (KAD) u ovoj populaciji rijedak,...

Systemic sclerosis (SSc) is an autoimmune disease characterized by fibrosis of the skin and internal organs. Although its pathogenesis is not fully understood, connexins (Cxs) and pannexins (Panx) could be involved in the process of fibrosis. We analyzed the protein expression of Cx37, Cx40, Cx43, and Panx1 in the gastric mucosa of patients with SSc and healthy volunteers, using immunofluorescence staining. Protein levels of Cx37 were slightly increased, while the levels of Cx40 were significantly decreased in the lamina propria of the gastric mucosa of SSc patients compared to the controls. The changes were proportional to SSc severity, with the most prominent changes found in patients with severe diffuse cutaneous SSc. No differences in Cx43 or Panx1 levels were found between the analyzed groups of samples. The lack of changes in Cx43 expression, which has been previously associated with fibrosis, could be due to the weak expression of Cx43 in the gastric mucosa in general. Further studies on full-thickness gastric biopsies containing muscle layers and animal SSc models are needed to fully elucidate the role of Cxs and Panxs in SSc-associated fibrosis.