Objectives: Students studying health-related majors in medical universities reportedly experience high stress levels due to the nature of their occupation, which predisposes them to adopt unhealthy dietary habits. This study aimed to investigate the association between depressive symptoms and adiposity in Bulgarian students considering other sociodemographic and contextual factors. Methods: This online cross-sectional study surveyed a sample of 752 students from the two largest medical universities in Bulgaria. Their mean was 22 ± 3.11 years and the majority were females (n = 503, 66.9%). Students self-reported socio-demographic and education-related information, dietary habits using a food frequency questionnaire, and symptoms of depression using the Zung Depression Scale. Associations between these constructs were examined using multivariate logistic regression analyses. Results: The obesity rate was 29 (3.9%) and overweight was 107 (14.2%). For depression, the distribution was: mild 230 (30.6%), moderate 168 (22.3%), severe 94 (12.5%). An association was observed between depression and obesity, with OR 2.357 (95% CI = 1.054, 5.271) observed among students from MU-Sofia. Factors determining a positive relationship towards high odds of depression are: female gender, academic stress and financial burden. Inverse relationship can be observed in the same sample - development of depression leads to high risk of overweight, with OR = 1.712 (95% CI = 1.035–2.833). Regarding dietary habits, consumption of eggs, red meat, dairy products and fruits was associated with a trend towards high BMI. Conclusion: These findings highlight the need for integrated university-based strategies addressing mental health and nutrition to prevent obesity and depression during the study.

Selective sodium-glucose cotransporter-2 (SGLT2) inhibitors act only at the renal level, promoting glucose excretion. Their glucose-independent mechanism makes them effective in advanced type 2 diabetes mellitus, when pancreatic β-cell reserves are permanently reduced. In addition to glucosuria, SGLT2 inhibition induces natriuresis, contributing to negative salt and water balance. The aim of this study is to evaluate the efficacy and safety of SGLT2 inhibitors in patients with type 2 diabetes mellitus through a systematic review of scientific publications, examining clinical trials with this class of glucose-lowering medicinal products. We performed a literature search in MEDLINE, the Central Library of Medicine, and peer-reviewed journals for the period January 2004 to December 2024. The systematic review is conducted in accordance with the PRISMA standard and the PICOS tool. The results of the PICOS analysis show that the most significant reduction in HbA1c level is observed after administration of Ertugliflozin 15 mg (−0.90%) and Ipragliflozin 50 mg (−0.88%). The body weight reduction is the most significant after administration of Ertugliflozin 15 mg, by 2.93 kg. Common adverse drug reactions include urinary tract infections and genital mycotic infections. The results of the conducted PICOS analysis prove the high efficacy of SGLT2 inhibitors in terms of their cardiovascular safety and cardio-renal benefits. In addition to their glucose-lowering properties, they are associated with a very low risk of hypoglycemia.

This review traces European medical device regulation from fragmented national systems to the harmonized framework established by Regulation (EU) 2017/745 (MDR) and Regulation (EU) 2017/746 (IVDR). It examines the pre-harmonization period (1957–1985), characterized by diverse national approaches in Western and Eastern Europe, including Bulgaria’s regulatory development during the post-communist transition. It explores the New Approach to technical harmonization (1985), the directive era (1990–2000), and how regulatory crises—including the Guidant pacemaker failures, the DePuy ASR hip prosthesis scandal, and the PIP breast implant fraud—served as stress tests confirming the necessity of reforms. Special attention is given to emerging challenges from artificial intelligence in medical devices following the adoption of the AI Act (Regulation (EU) 2024/1689).

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease requiring long-term pharmacological treatment and active patient engagement. Low to moderate levels of treatment adherence were observed in most participants, while disease activity was predominantly moderate to high. A statistically significant moderate positive association was identified between reported adherence and symptom burden, indicating higher adherence among patients with more active disease. Educational level emerged as a key determinant of adherence, with lower adherence observed in patients with higher education. Disease activity was significantly influenced by sex, comorbidities, smoking status, physical inactivity, and the use of biological therapy. These findings suggest that adherence behavior is dynamic and strongly driven by symptom severity rather than functioning as an independent predictor of disease control. The results highlight the importance of continuous monitoring of medication-taking behavior and the need for targeted pharmaceutical care interventions, particularly during periods of lower symptom intensity. Larger longitudinal studies are warranted to further clarify adherence patterns and their impact on long-term outcomes.

Objectives : Vitamin D deficiency has been associated with obesity, insulin resistance, chronic inflammation, and cardiovascular disease (CVD). This study aimed to evaluate the association between serum vitamin D concentrations, body mass index (BMI), and cardiometabolic risk factors in adults. Methods : A cross-sectional observational study was conducted among 264 adults (109 men and 155 women) aged 19–60 years (mean age, 41.19 years). Anthropometric measurements, body composition parameters, blood pressure, biochemical markers, and questionnaire-derived health information were assessed. Participants were classified according to serum 25-hydroxyvitamin D [25(OH)D] concentrations and BMI status. Statistical analyses included the χ 2 test, Fisher’s exact test, Student’s t -test, ANOVA, Spearman correlation analysis, and multiple linear regression. Results : CVD was more prevalent among participants with vitamin D deficiency than among those with sufficient vitamin D concentrations (15.9% vs. 7.1%, p < 0.01). Obesity (70.5% vs. 48.6%, p < 0.001), diabetes (8.0% vs. 4.3%, p < 0.001), and depression (25.0% vs. 10.0%, p < 0.001) were also more common in the vitamin D-deficient group. Serum 25(OH)D concentrations were inversely associated with BMI, waist circumference, waist-to-height ratio, fat mass, triglycerides, fasting insulin, HOMA-IR, and hsCRP. Serum 25(OH)D concentrations decreased significantly across BMI categories, from 48.8 nmol/L in normal-weight participants to 22.2 nmol/L in those with class III obesity ( p < 0.001). Individuals with vitamin D deficiency had a longer history of overweight or obesity (14.95 ± 9.40 vs. 10.85 ± 6.24 years, p < 0.01). BMI, waist-to-height ratio, body fat percentage, and lipid ratios demonstrated the strongest predictive value for serum 25(OH)D concentrations. Conclusion : Vitamin D deficiency is associated with an unfavorable cardiometabolic profile characterized by increased adiposity, insulin resistance, inflammation, and a higher prevalence of CVD. The coexistence of vitamin D deficiency and excess BMI may further increase cardiometabolic risk and should be considered in preventive and clinical risk assessment strategies.

Background: Mental disorders are a serious challenge to public health. In recent years, the epidemiological burden of anxiety disorders in a global and European context has increased significantly (WHO 2022). The aim of the study is to measure drug utilization and assess rational drug use in the treatment of patients with anxiety disorders in Bulgaria through quantitative and qualitative indicators at a national level. Materials and methods: The study design is a retrospective, observational, longitudinal study of data from international analytical companies and literature references for the period 2015–2024, using the WHO ATC/DDD methodology and descriptive statistical methods. Results and discussion: Epidemiological, health-demographic, and clinical-pharmacological data of the studied population were analyzed. Various qualitative indicators were used—costs of the disease (cost per year), cost per capita per year, monthly cost (cost per month), and cost per treatment day. The studied segment is not reimbursed. The cost per DDD and the cost per prescribed daily dose were calculated. One of the most important indicators—drug utilization, better known in practice as the “top-ten list”—was determined. The top 10 INNs in the different aspects of drug utilization are presented. The results show that the system is not well balanced. Bulgarian doctors are familiar with and apply modern standards, as evidenced by the dominance of SSRIs, but financial dependence distorts their decisions and patients’ options. The growing consumption of pregabalin and the use of lorazepam are symptoms of a system in which the lack of reimbursement leads to market self-regulation, which is not always conducive to rational drug use.

Introduction : Chronic myelogenous leukemia (CML) is a malignant disease of the pluripotent hematopoietic stem cell, characterized by the presence of the BCR-ABL1 fusion gene, resulting from a balanced translocation between the long arms of chromosomes 9 and 22 [t(9;22)(q34;q11)], known as the Philadelphia (Ph) chromosome. CML is an acquired disease of the hematopoietic stem cell, common to myelo- and lymphopoiesis, characterized by the uncontrolled proliferation of granulopoiesis—current status and goals. The introduction of targeted therapy with tyrosine kinase inhibitors (TKIs) for this rare, life-threatening disease has turned it into a chronic disease that can be controlled in over 90% of cases. Second-generation TKIs (nilotinib, dasatinib, and bosutinib) have an advantage over imatinib (first-generation) in terms of the frequency and speed of achieving cytogenetic and molecular responses in CML. However, they cause more severe adverse effects and are much more expensive than imatinib, especially when compared with the prices of several already registered generic products of imatinib and dasatinib. On the other hand, the constantly increasing costs of diagnosis, treatment, and monitoring of the response of CML to different therapeutic strategies require periodic pharmacoeconomic analyses of the cost-effectiveness, cost-benefit, and cost-utility types to assess which therapeutic strategies are cost-effective for a given period and in the long term, including due to changes in the annual costs of treatment when cheaper generic products for some strategies appear on the pharmaceutical market, with a view to their use in therapeutic practice. In addition, over the past decade, patients with CML who have achieved a stable deep molecular response for at least 2–3 years have been enrolled in large-scale clinical trials evaluating treatment-free remission (TFR). The present study aims to analyze and estimate savings from a portion of the costs of drug therapy under different strategies that include patients in remission in the so-called treatment-free phase of first- and second-line therapy for chronic-phase CML (CML-CP). The research perspective is that of the payer—the National Health Insurance Fund (NHIF)—and the cost research horizon is 20 one-year cycles. Methods : A diagram of a general Markov model of CML disease, including the three disease phases and possible transitions among health states, including death, was developed. Two alternative pharmacoeconomic Markov chain models were also developed. One is a model of the diagnosis and continuous treatment of CML-CP in the first and second lines of CML-CP treatment until the end of the patients’ lives, i.e., a standard model without the TFR phase, and the second is an extended model with the TFR1 and TFR2 phases included, i.e., with the inclusion of the TFR phase in both lines of CML-CP. The transition probabilities between states were extracted from real clinical data, with missing annual values imputed using the median. The analysis was conducted over 20 years. Both costs and health effects were discounted by 3% per year, in accordance with established pharmacoeconomic practices. Costs are based on annualized drug therapy costs for each treatment line. Health effects are measured in quality-adjusted life years (QALYs), assuming a utility value of 0.92 for all living health states, as reported in the literature. Transition to the TFR phase is defined as achieving a deep molecular response (MR4.5 log or MR5 log) after first- or second-line therapy. The duration of stay in the TFR phase is 5–7 years, assuming 50% of patients return to their respective treatment lines.

Background: Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease requiring effective pharmacological treatment, sustained self-management, and patient education. Pharmacists are increasingly recognized as key contributors to diabetes care; however, their role remains underutilized in Bulgaria. This study aimed to assess self-management behaviors, medication adherence, patient awareness, and the perceived role of pharmacists among patients with T2DM in Bulgarian primary care. Methods: A cross-sectional observational study was conducted among 105 patients with T2DM using an anonymous questionnaire based on the Diabetes Self-Management Questionnaire and supplementary items adapted to the local healthcare context. Data were analyzed using descriptive statistics and non-parametric tests to explore associations between demographic characteristics, treatment patterns, self-management behaviors, and educational needs. Results: Most patients were treated with oral antidiabetic therapy (90.0%), predominantly metformin-based regimens (64.0%). Adherence to prescribed pharmacological treatment was high (93.0%), while adherence to dietary recommendations (70.0%), regular physical activity (60.0%), and blood glucose self-monitoring (63.0%) was less consistent. Although 92.0% of participants reported good or excellent disease awareness, 41.0% expressed a need for additional education, particularly regarding confidence in managing hypoglycemia and the use of digital monitoring tools. More than half of respondents (54.0%) had received diabetes-related information from a pharmacist; however, only 38.0% expressed willingness to participate in pharmacist-led education, while 34.0% were undecided. Female sex was associated with a higher prevalence of comorbidities (p = 0.010), while increasing age was associated with reduced metformin use (p = 0.004). Conclusions: Despite good pharmacological adherence and self-reported awareness, gaps remain in lifestyle-related self-management and patient education. The findings support an expanded role for pharmacists in diabetes care, particularly through structured educational and counseling interventions to enhance self-management and complement physician-led treatment.

Nutritional rehabilitation is a critical but often overlooked element in clinical practice in the treatment of musculoskeletal injuries and postoperative recovery. This review analyzes the importance of nutritional support in overcoming the hypermetabolic response and anabolic resistance that occur as a result of immobilization. Optimizing caloric intake through an individualized stress factor and ensuring high protein intake (2.0–3.0 g/kg/bm) distributed evenly throughout the day are key strategies for minimizing muscle atrophy. The article outlines the role of specific nutraceuticals such as beta-hydroxy-beta-methylbutyrate (HMB), creatine monohydrate, omega-3 fatty acids (4,000 mg/day), and free forms of essential amino acids for stimulating protein synthesis and bone remodeling. The additional inclusion of vitamin D, antioxidants (vitamins A, C, and E), and probiotics optimizes immune function and tissue healing. Nutrient timing relative to therapeutic sessions is defined as a decisive factor in accelerating functional recovery. The integration of these dietary guidelines into the interdisciplinary care model is essential for a faster and safer return of patients to physical activity.

Background/Objectives: Oscillatory rheology is widely used in hot-melt extrusion (HME) and fused deposition modeling (FDM), but its translation into compact formulation-screening criteria remains limited. This study re-analyzed an existing PVA–sorbitol–paracetamol dataset to derive rheology-informed working thresholds for HME/FDM processability. Methods: Temperature-ramp oscillatory rheology was used to extract formulation-level descriptors: process-temperature complex viscosity (|η*|) at 185 and 200 °C, Processing Window Fraction (PWF) within the 0.8–10 kPa·s corridor, and crossover-related temperature information. These descriptors were interpreted against empirical extrusion at 200 °C and printing at 185 °C. Results: S1.25 and S1.5 showed rheological behavior compatible with successful extrusion, whereas S1.75 showed pronounced softening consistent with over-plasticization and process failure. Paracetamol further reduced complex viscosity while maintaining processability in P5–P15. The lowest successful process-temperature viscosity values, observed for P15, supported working thresholds of approximately 0.460 kPa·s at 200 °C and 0.899 kPa·s at 185 °C. PWF complemented thresholding by describing the practical temperature flexibility of each formulation. Conclusions: Process-temperature |η*|, PWF, and crossover-informed interpretation provided a compact, formulation-specific screening framework for this PVA-based HME/FDM model system. The proposed thresholds are operational derivation outputs and require prospective external confirmation.

Adverse drug reactions (ADRs) pose a significant patient-safety concern, contributing to substantial morbidity, mortality, and healthcare utilization. Source-grounded chatbots have the potential to enhance pharmacovigilance by improving access to regulated medicine information and reducing barriers to ADR reporting. We created a prototype of a web-based chatbot (PharmaBot) designed using retrieval-augmented generation methods to provide responses grounded in summaries of product characteristics and package leaflets. Subsequently, we conducted a cross-sectional survey among 37 participants who were treated with insulin to assess their digital literacy, perceived usefulness, trust, and intended use of the chatbot for drug safety information. The results indicated that most respondents (70.3%) demonstrated high to very high smartphone app skills. Moreover, 73.0% rated the chatbot as useful or very useful, and 78.4% expressed moderate to very high levels of trust in it. About 56.8% of participants reported an intention to use the chatbot regularly (frequently or very frequently). The most popular intended use cases were therapy reminders (81.1%) and information about insulin and therapy (70.3%), while 51.4% chose guidance on ADR reporting. These preliminary findings suggest that users have an acceptable perception of a source-grounded chatbot as a supportive tool for pharmacovigilance-related workflows.

Bulgaria occupies a unique position among European Union member states, with the lowest per capita healthcare expenditure (€990 annually) yet demonstrating the second-highest growth rate in health spending between 2014 and 2022. This economic paradox reflects the dynamics of a developing market operating under resource constraints while facing growing needs from an aging population. The medical devices sector is an essential component of Bulgaria‘s healthcare system, including products ranging from simple consumables to sophisticated implantable devices and advanced diagnostic equipment. This review examines the Bulgarian medical device landscape through multiple dimensions: historical evolution from medieval surgical instruments to contemporary AI-integrated systems, fundamental distinctions from pharmaceuticals and dietary supplements based on mechanisms of action, the comprehensive regulatory framework under Medical Device Regilation (MDR) 2017/745, institutional interactions among key organizations (the Bulgarian Drug Agency, the National Health Insurance Fund, the Ministry of Health), and market trends shaped by demographic transformation. With a population of 6.44 million (23.8% over 65 years), Bulgaria faces pressing demographic challenges that reshape healthcare demand patterns. The analysis reveals a market exceeding €300 million, dependent on imports (>90%), with limited domestic manufacturing capacity. Despite the financial constraints, Bulgaria has achieved an international recognition through top-tier regulatory inspections and active participation in the European regulatory structures. The review outlines perspectives for short-term priorities (2025–2027), medium-term objectives (2027–2030), and long-term vision (2030+) for sector development, emphasizing the digital transformation, regional coverage improvement, and demographic crisis management through the technological innovation.

Modern pharmaceutical marketing operates at the delicate intersection of business and healthcare. This review systematizes the multifaceted impact of marketing pressure on the rational use of medicines and dietary supplements. It examines the evolution of theoretical marketing frameworks, supplemented by contemporary neuromarketing research on the central nervous system (CNS) and peripheral nervous system (PNS), as well as specific cognitive biases (evaluative conditioning, authority bias, and the fear of missing out [FOMO] phenomenon). Furthermore, the regulatory filters of Directive 2001/83/EC, the Law on Medicinal Products in Human Medicine (LMPHM), and the Food Law (BFSA) are analyzed against four categories of documented social consequences: polypharmacy, erosion of professional trust, cyberchondria, and health inequality. Finally, a dedicated analysis of the pediatric segment highlights the clinical and psychological vulnerabilities of marketing directed at children and parents. In this complex market reality, the strategic role of the pharmacist as the ultimate clinical corrective is highlighted.

Lanolin is a lipoid—an animal wax obtained from the sebaceous secretions of domestic sheep. According to the European Pharmacopoeia, lanolin is referred to as Adeps lanae. Various lanolin derivatives are used in personal care products, cosmetics, and topical medications, including lanolin oil, wax, alcohol, acetylated, and hydrogenated lanolin. Cosmeticians and cosmetology students may be exposed to lanolin through occupational and educational activities. Lanolin is considered a potential contact sensitizer. This study aims to evaluate the prevalence of contact sensitization to lanolin among cosmeticians and cosmetology students. Skin patch testing with lanolin alcohol was conducted on 109 participants: 37 cosmetology students, 26 cosmeticians, and 46 controls. A high positivity rate (30.8%) was observed, particularly among occupationally exposed cosmeticians who regularly use skin care products. This rate was significantly higher than that of students (p = 0.028), but not significantly different from that of the control group. Proper risk information and comprehensive programs for occupational skin disease prevention are recommended.

Obesity is one of the risk factors for the development of socially significant diseases from the group of chronic non-communicable diseases, and obesity in women of reproductive age and in particular in pregnant women is an extremely important medico-social problem affecting both the mother and her child, and indeed all of modern society. In this article, the influence of some biological and social determinants influencing this medico-social problem, leading to changes in the trends of medico-demographic health indicators serving to assess public health, will be examined and analyzed.

Objectives: Monitoring pregnancies is essential for community well-being. However, not all pregnancies progress normally, and some require termination. The objective was to emphasize the importance of trust in the doctor–patient relationship during this challenging time for expectant parents. Case report: During fetal morphology examination, parents were warned of a poor fetal prognosis, prompting a request for pregnancy termination. They consulted another specialist, who reassured them that the fetus appeared normal, though slightly hypotrophic. The child was born at 35 weeks gestational age and admitted to the neonatal ICU level III in an impaired general condition and polymalformative syndrome (triangular facies, epicanthic eyes, hypertelorism, retrognathia, low base of the nose, triangular mouth, lips angled downward, and small, dysplastic, and low-set earlobes). The child had syndactyly of fingers and toes. Cytogenetic analysis revealed a karyotype of 69, XX, +mar. The indirect DNA analysis revealed that the third gonosome is a Y chromosome. Death occurred 30 days post delivery, following severe dyspnea and bronchial obstruction, with desaturation and bradycardia. Conclusions: Triploid pregnancies are usually lost in the first trimester; however, very rarely, live births can occur. Hope for a positive outcome encouraged parents to continue the pregnancy, leading to a profoundly sorrowful experience and added strain on the healthcare system. Complex decisions put pressure on the patient–doctor relationship, as misplaced hope can impact both parties. Expectant parents facing difficult diagnoses require attentive support during this challenging time, grounded on a foundation of trust between doctor and patient.

Vitamin D deficiency is a widespread problem throughout the world, often resulting from impaired synthesis in the skin and insufficient intake. The present study aimed to provide an in-depth analysis of vitamin D intake in individuals who are normal weight, overweight, and obese in relation to plasma vitamin D levels in these individuals. Materials and methods: There were 264 participants in the study. Nutrition was evaluated using the 24-hour memory recall approach. Weight and body composition were determined by expert bioelectrical impedance using Tanita equipment (420 BC MA), while nutritional status was evaluated using anthropometric indicators, including morphological indicators and anthropometric indices. Results: The average daily intake of vitamin D was determined to be 7.6 μg for normal-weight participants, 6.6 μg for individuals who are overweight, and 6.0 μg for subjects who are obese, based on BMI categories. When comparing people who consumed more than 10 μg of vitamin D, the group with adequate vitamin D consumption had the largest relative proportion (37.3%). Those with vitamin D deficiency and obesity class I had the lowest average daily intake of vitamin D (3.3 mcg). The correlation between plasma levels of vitamin D and the main indicators of dietary intake in the subjects, separated by sex and anthropometric parameters, revealed the existence of a weak correlation between plasma levels of vitamin D and individual indicators of dietary intake, such as total fat (g; E%), MUFAs (d; E%), PUFAs (d; E%), magnesium, and retinol. Conclusion: Vitamin D deficiency affects many groups worldwide, including Bulgaria’s elderly citizens. In order to address this severe issue, health experts must design health policies and guidelines based on current and future scientific facts, which will only be available through new studies.

Background: The prevalence of food intolerances (FIs) in 1679 individuals over 18 years of age from Bulgaria and some cross-reactivities between the intolerances to different foods were studied. Method: A blood test was used: Food Detective – CNS (Cambridge Nutrition Sciences Ltd.) to identify the foodstuffs to which the body exhibits intolerance. The basis of the study is the formation of antibodies of class IgG, which are markers for intolerance to different food groups and food products. Individuals were tested for 46 foods. Results: The most common food intolerances are to cereals (60–90% of the subjects), probably related to the high consumption of such products in Bulgaria; to milk and eggs (about 50–68%); legumes (about 24–43%) and nuts (24–40%); and fish and shellfish (about 12–25%). Gluten intolerance is shown by 41.2% of the subjects. Intolerance to vegetables, fruits, and meat has the lowest relative share in the study. Significant correlations were found for 20 pairs of foods, with a high degree of correlation between simultaneous intolerance to soy, tomatoes, and legumes; peppers and mushrooms; and eggs with peppers, mushrooms, and tomatoes. Conclusion: Specific features of the Bulgarian population in the prevalence of food intolerances and the correlations between them have been identified, contributing to the prevention and treatment of nutritional diseases, overweight, and other eating disorders; optimization of dietary regimens at the individual level; prescription of healthy individual diets; and maintenance of individual health.

Background: Scleroderma-like disorders are heterogenous diseases characterized by sclerosis of the dermis, subcutis and sometimes the underlying soft tissues and bones. The clinical course of diseases may range from a benign local disease to a widespread systemic, life-threatening disease. There is a high risk of developing a systemic disease indistinguishable from idiopathic scleroderma in miners in coal and gold mines exposed to silica dust (silicon dioxide SiO2). Several cases of scleroderma morphea (circumscripta), a localized form with limited areas of skin sclerosis without Raynaud’s phenomenon or visceral involvement, have described in response to inhalatory exposure to silica dust. A 52-year-old woman was admitted to Rheumatology Clinic for clinical investigation of skin thickening on the abdomen, chest, and proximal thighs, along with pain, redness, and mild itching, a few months after taking fossil shell dust for six months, purchased from a pharmacy in Sofia. The instructions for use state that the product is a natural mineral – not a food, medicine, or dietary supplement that can be used as an additive in animal feed (for birds and mammals) with an anti-adhesive effect, and that it has a number of applications in the food industry. The patient took a level tablespoon of the contents of the package, dissolved in a glass of water, once a day – approximately 10 g of dust. The clinical skin findings consisted of violaceous erythema-infiltrative plaques. The histological diagnosis after skin biopsy of a lesion was scleroderma circumscripta. The chemical analysis of the skin sample showed a silicon content about ten times more than normal.