Assoc. Dr. Razvigor Durlenski, MD, is a specialist in dermatology and venereology. Graduated in medicine with honors from the Medical University - Sofia in 2005. He specialized in the Department of Skin and Venereal Diseases in the capital. In 2010, he acquired a speci alty in dermatology and venereology. In 2014, he was elected as an associate professor at the Faculty of Medicine of Thrace University.
He specialized at the University Clinic of Dermatology at LMU - Munich, Germany (2010), the University Clinic of Dermatology and Allergology - Charite, Berlin, Germany (2007/2008), at the University Clinic of Dermatology and Allergology Schwabing - Munich, Germany (2004).
He is a member of the Bulgarian Dermatology Society, the European Academy of Dermatology and Venereology, the European Academy of Allergology and Clinical Immunology, the Bulgarian Society of Allergology, the International Society of Skin Pharmacology and Physiology, the European Society of Contact Dermatitis, the Union of Scientists in Bulgaria, the National Bulgarian Society for Aesthetic Surgery and Aesthetic Medicine.
Prof. Durlenski, to what extent does the expression: the skin is a mirror of human he alth express the modern understanding of the essence of skin diseases?
- This question can be considered in the light of two angles. On the one hand, many of the classic skin diseases, for example psoriasis, lichen planus, atopic dermatitis - were often and for a long time considered only skin diseases. In the 21st century, however, we have enough evidence that these diseases are associated, that is, they occur together with a number of other systemic symptoms.
For example, with psoriasis, not only the skin is affected - in about 20% of patients, the joints also suffer, in the form of arthritis. Also, these patients often have the so-called metabolic syndrome, obesity, dyslipidemia, arterial hypertension, impaired glucose tolerance. So, this reveals on the one hand how pervasive skin diseases are and how skin suffering is never alone. It comes hand in hand with complaints from the whole organism.
From another point of view, however, many internal diseases, such as diabetes and chronic kidney disease, have their effect on the skin and specific symptoms, by which a dermatologist can orientate and screen the patient for the respective affliction. And accordingly, by correctly "reading" the rashes and signs on the skin, we can orient ourselves to what is happening in the body.
Which systemic skin diseases in our country are diagnosed late?
- The truth is that about systemic symptoms in skin diseases the dermatologist is not taught to think because it is
relatively new concept - from the last 10 years. Therefore, we as dermatologists do not have enough experience to look for these systemic manifestations, for example, in a chronic skin disease.
That is why, in these cases, we allow ourselves to resort to consultations with our specialist colleagues. For example, if a patient comes in with atopic dermatitis, with complaints of hay fever or asthma, then we consult an allergist or a pulmonologist. They do the necessary diagnostic tests in this area and so the treatment of the patient is complex. That is, we do not look at the skin as an isolated organ, but the patient, with all his complaints.
But I wouldn't say that there is any specific disease in which the diagnosis is made late in our country. Although our equipment and instrumental techniques are not the best, I think our clinical training is strong enough to be able to make the correct diagnosis at an early stage.
For example, in a country like England, patients often have to wait three months to get from a GP to a dermatologist. And here the advantage is that patients have very quick access to specialists - literally, in the next day or two.
What is the relationship between the skin and the nervous system? Disorders in the central and peripheral nervous systems are indicated as one of the possible causes of dermatoses?
- This is a very interesting question because actually one of the first lessons we learn when dealing with skin diseases is about the origin of the skin in the human embryo. The epidermis, as well as part of the nervous system, from the spinal cord and the brain, originate from the ectoderm - the outermost layer of the human embryo, which, accordingly, determines the common origin of these two structures - skin and nervous system. Therefore, some speak of dermato-neuro-endocrinology, which reflects the relationship along this axis - nervous system, skin and endocrine organs.
That is, these are the endocrine glands. I will give a very simple example: when the nervous system is under stress, it leads to the synthesis of hormones, such as cortisol, adrenaline. They also cause certain skin reactions: vasoconstriction, barrier function disorders and an effect that mobilizes the resource from the periphery, that is, from the skin to the center of the body. This is a typical example of interaction between nervous system, skin and in this case - endocrine or immunological organs.
That's why we love this connection between nervous system - skin and their ectodermal common origin. So I firmly believe they are related.