WOUNDS AND DERMATOSES

Rane su dio kliničke slike brojnih dermatoza. najčešće su znak kronične venske insuficijencije i vaskulopatija. Autoimune, infektivne, metaboličke, maligne, kao i pojedine psihijatrijske bolesti, te stanja uzrokovana djelovanjem vanjskih čimbenika poput radiodermatitisa, karakterizira pojava erozija ili ulceracija na koži. Bolesti poput lihena planusa, lihena sklerozusa, toksične epidermalne nekrolize, Kaposijevog sarkoma i genodermatoze poput Hailey-Haileyeve i Darierove bolesti, pripadaju različitim skupinama dermatoza, razlikuju se u etiologiji, patogenezi i kliničkoj slici, a zajednička im je pojava erozija ili ulceracija kao komplikacije neliječenih stanja ili dio kompleksnije kliničke slike. Prisutnost rana mijenja terapijski pristup bolesniku, zahtijeva analgeziju, dodatnu njegu, ali i posebne uvjete i praćenje bolesnika kako bi se izbjeglo superinfekciju, ali i fatalni ishod kao posljedicu maligne transformacije stanica u kroničnim ranama. rane su često prisutne u oralnom i genitalnom obliku lihena planusa kod žena, ali i genitalnom obliku lihena sklerozusa na vulvi. Kroničnost rana svrstava oralni lihen planus u prekancerozu. toksična epidermalna nekroliza je za život opasno stanje nalik na opekline gdje su ranama zahvaćene velike površine kože i sluznica, a visoka smrtnost je posljedica komplikacija kao što su sepsa, poremećaj termoregulacije, elektrolita i proteina uz razvoj šoka. u kliničkoj slici brojnih kožnih tumora, ali i drugih malignih dermatoza poput Kaposijeva sarkoma ili limfoma, dolazi do pojave rana kroničnog tijeka. rane su sastavni dio kliničke slike i brojnih genodermatoza, od bulozne epidermolize, do pojedinih nasljednih poremećaja keratinizacije poput Darierove bolesti.Wounds are a hallmark of various skin diseases. Most patients with wounds suffer from chronic venous insufficiency or other vascular diseases. Autoimmune, infective, metabolic, malignant, some psychiatric and diseases caused by environmental factors like radiation, present with skin and mucosal erosions and ulcerations. Lichen planus, lichen sclerosus, toxic epidermal necrolysis, Kaposi sarcoma, genodermatoses like Hailey-Hailey and Darier’s disease belong to different dermatological entities, they have different etiology, pathogenesis and clinical presentation, but at some stage ulcerations and erosions dominate through the disease course as a result of complications of untreated disease or as part of a complex clinical presentation. Wounds demand a different multidisciplinary therapeutic approach, sometimes even in intensive care unit, where special care is available. Most patients are followed-up to avoid fatal complications like sepsis, as well as a potential malignant transformation of cells in the environment of chronic inflammation. Wounds are found in female genital lichen planus and lichen sclerosus. Oral lichen planus has a potential for malignant transformation and is considered a precancerous disease. Toxic epidermal necrolysis is a life threatening disease similar to burns. Wounds cover most of the body surface as well as mucosa. The high mortality rate is due to complications like sepsis, loss of thermoregulation, electrolyte and fluid disbalance and shock. Chronic wounds are also a hallmark of skin tumors and other skin malignancies like Kaposi sarcoma and lymphoma. The primary treatment goal in genodermatoses like epidermolysis bullosa is wound care, and to a less extent in other inherited skin diseases like Hailey- Hailey and Darier’s disease wound healing is important for sustaining a good quality of life in affected individuals