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Febrile ulceronecrotic Mucha-Habermann disease is a rare and severe variant of pityriasis lichenoides, characterized by sudden onset of generalized ulceronecrotic papules that rapidly coalesce into ulcers associated with high fever. Systemic manifestations such as intravascular disseminated coagulation and pulmonary, cardiac, gastrointestinal, and central nervous system involvement are common. Treatment is based on oral corticosteroids, immunosuppressive drugs such as methotrexate, and general supportive treatment. The present case describes a stepwise approach to a patient with Mucha-Habermann disease with insufficient response to methotrexate.

A simple and rapid method that is not based on race and ethnicity for classifying people with skin of color is of paramount importance in dermatology. The currently used Fitzpatrick classification of sun-reactive skin types is inadequate. Newer scales that have been used in immigration surveys and sociology studies are not applicable in the office setting. A new, non-racial and non-ethnic, colorimetric scale for skin of color has recently been proposed that is simple to perform. The scale has five colors: very light beige (skin color type 1), light brown (skin color type 2), medium brown (skin color type 3), dark brown (skin color type 4) and very dark brown (skin color type 5); an individual with white skin, such as in albinism, would have a skin color type 0 in this classification. In conclusion, the colorimetric scale enables the rapid classification of individuals with skin of color and allows for accurate assessment of skin cancer risk, more appropriate management of cosmetic dermatologic procedures and aesthetic devices, and enhanced ability for focused counseling regarding hair products, skin care interventions, and color-targeted makeup based on the person's skin tone.

We report a case of hairy tongue that developed in a young Caucasianwoman during systemic baricitinib therapy for severe alopecia areata.Because she experienced good clinical regrowth of her hair duringtreatment, she did not want to interrupt therapy. We recommended sheuse a toothbrush to debride her tongue on a daily basis, which wassuccessful. Hairy tongue most commonly occurs in elderly, debilitatedmales with poor oral hygiene. It is thought to occur because of overgrowthof chromogenic bacteria and/or yeast on the tongue. This unusual sideeffect during baricitinib therapy suggests that immune suppression mayplay a role. Clinicians should be aware of hairy tongue developmentduring baracitinib therapy.

Background Psoriatic disease, encompassing skin psoriasis and psoriatic arthritis, is a common condition affecting 2-3% of the Western population associated with reduced quality of life and increased healthcare costs. To improve patients’ lives and the stewardship of societal resources, a nuanced understanding of the associations between patient characteristics and health outcomes are needed for optimal clinical and societal decision making. While randomised clinical trials play a central role in evidence-based medicine, they have limitations relating to patient selection, follow-up duration, and idealised clinical conditions. In recent years, the role of real-world evidence in health research has grown, including in dermatology, due in part to its ability to describe and compare patients in routine clinical care. This thesis contains four analyses using Swedish real-world data describing associations between patient characteristics and outcomes in psoriatic disease. Methods Data from several administrative population registers in Sweden and the clinical registry PsoReg were collected for those with psoriatic disease in routine clinical care and linked at the patient level. The data include diagnoses, pharmacy dispensed medications, mortality, socioeconomic information, quality of life, and clinical severity. A matched non-psoriatic control group was also extracted. The first analysis assessed the association between disease severity (measured by the Psoriasis Area and Severity Index [PASI]) and health-related quality of life (measured the EuroQol 5-dimension instrument [EQ-5D]) in 2,674 patients with longitudinal follow-up in PsoReg, a fixed effects regression model was deployed adjusting for confounding factors including certain types of unobserved confounding. Second, the independent associations of skin psoriasis and somatic comorbidity with incident psychiatric illness were described across 93,239 psoriasis patients and 1.4 million controls. Their individual c

ChatGPT is a publicly available chatbot released by OpenAI. Its usefulness in responding to medical questions has been assessed in several specialties, but there is limited literature in dermatology. This study seeks to understand how well ChatGPT4 can provide accurate diagnoses and appropriate workup suggestions for clinical vignettes describing common dermatologic conditions. Ten vignettes were input into ChatGPT4 representing presentations of common dermatologic conditions, written from the perspective of a physician not board-certified in dermatology. ChatGPT4 was asked to identify the top five most likely diagnoses and its recommended workup for each vignette. Responses were assessed quantitatively by calculating the percentage of correct diagnoses, with accurate diagnoses defined by three board-certified dermatologists, and qualitatively using Likert scales describing the accuracy of diagnoses and appropriateness of workups scored by eleven board-certified dermatologists. Overall, 52% of ChatGPT4's diagnoses were accurate and 62% of its recommended workup suggestions were deemed completely correct by board-certified dermatologists. ChatGPT4 was better at recommending an appropriate workup than identifying accurate diagnoses across vignettes. ChatGPT4 was able to accurately diagnose and workup common dermatologic conditions in slightly more than half of cases. ChatGPT4 was better at determining an appropriate workup than an accurate diagnosis.Keywords: artificial intelligence, ChatGPT, dermatology, diagnosis, OpenAI, workup

We define the term ‘dermato-metabolic syndrome’ as the dermatologic (skin, hair, and nail) conditions associated with metabolic syndrome. These abnormalities can be classified as metabolic (hyperinsulinism, hyperandrogenism, hyperuricemia), mechanical (involvement of epidermal, dermal, sebaceous and sweat glands, subcutaneous tissue), mitogenic, miasmatic (infections) and microvascular/venous insufficiency. This construct highlights the importance of skin, and its related appendages, as a site of target organ damage in metabolic syndrome. The concept underscores the need for team-based approach towards dermato-vigilance in metabolic patients, metabolic vigilance in dermatologic patients, and management of both dermatological and metabolic manifestations of dermo-metabolic syndrome.

Producción Científica, Wounds are breaks in the continuity of the skin and underlying tissues, resulting from external causes such as cuts, blows, impacts, or surgical interventions. Countless individuals suffer minor to severe injuries, with unfortunate cases even leading to death. In today’s scenario, several commercial products are available to facilitate the healing process of wounds, although chronic wounds still present more challenges than acute wounds. Nevertheless, the huge demand for wound-care products within the healthcare sector has given rise to a rapidly growing market, fostering continuous research and development endeavors for innovative wound-healing solutions. Today, there are many commercially available products including those based on natural biopolymers, stem cells, and microRNAs that promote healing from wounds. This article explores the recent breakthroughs in wound-healing products that harness the potential of natural biopolymers, stem cells, and microRNAs. A comprehensive exploration is undertaken, covering not only commercially available products but also those still in the research phase. Additionally, we provide a thorough examination of the opportunities, obstacles, and regulatory considerations influencing the potential commercialization of wound-healing products across the diverse markets of Europe, America, and Asia., Comunidad Autónoma de Madrid - (grant 82017/BMD-3760 (NEUROCENTRO-CM) and P2022/BMD-7236 (MINA-CM)

Hidradenitis suppurativa (HS) is a chronic skin condition affecting approximately 1% of the US population. HS skin lesions are highly inflammatory and characterized by a large immune infiltrate. While B cells and plasma cells comprise a major component of this immune milieu, the biology and the contribution of these cells in HS pathogenesis are unclear. We aimed to investigate the dynamics and microenvironmental interactions of B cells within cutaneous HS lesions. Combining histological analysis, single-cell RNA sequencing, and spatial transcriptomics profiling of HS lesions, we defined the tissue microenvironment relative to B cell activity within this disease. Our findings identified tertiary lymphoid structures (TLSs) within HS lesions and described organized interactions among T cells, B cells, antigen-presenting cells, and skin stroma. We found evidence that B cells within HS TLSs actively underwent maturation, including participation in germinal center reactions and class switch recombination. Moreover, skin stroma and accumulating T cells were primed to support the formation of TLSs and facilitate B cell recruitment during HS. Our data definitively demonstrated the presence of TLSs in lesional HS skin and point to ongoing cutaneous B cell maturation through class switch recombination and affinity maturation during disease progression in this inflamed nonlymphoid tissue.

Mitochondria are eukaryotic cellular organelles that function in energy metabolism, ROS production, and programmed cell death. Cutaneous epithelial and hair follicle dermal papilla cells are energy-rich cells that thereby may be affected by mitochondrial dysfunction and DNA mutation accumulation. In this review, we aimed to summarize the medical literature assessing dermatologic conditions and outcomes associated with mitochondrial dysfunction. A search of PubMed and Embase was performed with subsequent handsearching to retrieve additional relevant articles. Mitochondrial DNA (mtDNA) deletions, mutation accumulation, and damage are associated with phenotypic signs of cutaneous aging, hair loss, and impaired wound healing. In addition, several dermatologic conditions are associated with aberrant mitochondrial activity, such as systemic lupus erythematosus, psoriasis, vitiligo, and atopic dermatitis. Mouse model studies have better established causality between mitochondrial damage and dermatologic outcomes, with some depicting reversibility upon restoration of mitochondrial function. Mitochondrial function mediates a variety of dermatologic conditions, and mitochondrial components may be a promising target for therapeutic strategies.

Background and Objectives: Significant progress has been made in skin cancer diagnosis, with a surge in available technologies in recent years. Despite this, the practical application and integration of these technologies in dermatology and plastic surgery remain uneven. Materials and Methods: A comprehensive 20-question survey was designed and distributed using online survey administration software (Google Forms, 2018, Google, Mountain View, CA, USA) from June 2023 to September 2023. The survey aimed to assess the knowledge and utilization of dermatologic diagnostic advancements among plastic surgeons in various European countries. Results: Data were obtained from 29 plastic surgeons across nine European countries, revealing a notable gap between diagnostic technologies and their routine use in surgical practice. The gap for some technologies was both cognitive and applicative; for electrical impedance spectroscopy (EIS) and multispectral imaging, only 6.9% of the sample knew of the technologies and no surgeons in the sample used them. In the case of other technologies, such as high-frequency ultrasound (HFUS), 72.4% of the sample knew about them but only 34.5% used them, highlighting a more significant application problem. Conclusions: Spotlighting this discrepancy provides a valuable foundation for initiating collaborative efforts between units and facilitating knowledge exchange among diverse specialists. This, in turn, contributes to advancing clinical practice by integrating the innovative opportunities presented by ongoing research., SCOPUS: ar.j, info:eu-repo/semantics/published

Objectives Self-reported hand eczema was previously found under-reported as an occupational disease to the authorities among Danish hairdressers graduating from 1985 to 2007. This study investigates whether self-reported hand eczema among Danish hairdressers graduating from 2008 to 2018 is under-reported as an occupational disease to the authorities.Methods A cross-sectional study on all Danish hairdressers graduating from 2008 to 2018 was conducted. The participants were identified using information from the Danish Hairdressers’ and Beauticians’ Union. In May 2020, a self-administered survey on hand eczema was sent to all hairdressers.Results A response rate of 30.7% (1485/4830) was obtained. The lifetime prevalence of self-reported hand eczema was 40.1%, and 84.1% of hairdressers with hand eczema believed it to be occupational of whom 27.0% answered it was reported as an occupational disease to the authorities. Of hairdressers believing their hand eczema was occupational, consulting a doctor and answering it was reported as an occupational disease, 94.4% had consulted a dermatologist. The main reason for not reporting was ‘I would probably not gain anything from it anyway’ (40.0%).Conclusions Based on hairdressers’ perception, occupational hand eczema still seems to be an under-reported disease which may lead to underestimation of the problem and impair prevention, diagnosis and treatment., Objectives: Self-reported hand eczema was previously found under-reported as an occupational disease to the authorities among Danish hairdressers graduating from 1985 to 2007. This study investigates whether self-reported hand eczema among Danish hairdressers graduating from 2008 to 2018 is under-reported as an occupational disease to the authorities. Methods: A cross-sectional study on all Danish hairdressers graduating from 2008 to 2018 was conducted. The participants were identified using information from the Danish Hairdressers' and Beauticians' Union. In May 2020, a self-administered survey on hand eczema was sent to all hairdressers. Results: A response rate of 30.7% (1485/4830) was obtained. The lifetime prevalence of self-reported hand eczema was 40.1%, and 84.1% of hairdressers with hand eczema believed it to be occupational of whom 27.0% answered it was reported as an occupational disease to the authorities. Of hairdressers believing their hand eczema was occupational, consulting a doctor and answering it was reported as an occupational disease, 94.4% had consulted a dermatologist. The main reason for not reporting was ' I would probably not gain anything from it anyway' (40.0%). Conclusions: Based on hairdressers' perception, occupational hand eczema still seems to be an under-reported disease which may lead to underestimation of the problem and impair prevention, diagnosis and treatment.

Eczema (or atopic dermatitis) is a skin condition characterised by impaired skin barrier function and its chronic and inflammatory nature; it affects children and adults worldwide and considerably impacts their quality of life. Throughout this thesis, I used the term eczema as interchangeable with atopic dermatitis. Eczema is the most frequent skin inflammatory disease in children and adults. Eczema has a wide variation in global prevalence, but it is common in developed and developing countries. Australia is among the countries with the highest prevalence of eczema. The prevalence from 6 to 7 years varied from 0.9% to 22.5%, and from 13 to 14 years, the prevalence ranged from 0.2% to 24.6%. Moreover, it is widely accepted that infants have the highest prevalence rates, which are between 6 and 31%. There are no worldwide estimates of adult prevalence; however, the World Allergy Organization reported a range of 2 to 10%. Eczema is the leading contributor to skin-related disability-adjusted life years or DALYs. The high DALY rate is due to years spent living with a disability. The peak eczema prevalence is during early life, which increases the potential years spent living with this condition. The exact pathogenesis remains unknown; the origin of eczema is most probably due to multiple pathogenic pathways in which there is an interplay between skin inflammation due to skin barrier dysfunction, innate and adaptive immunology, the effect of scratching and environmental factors. There needs to be more information on the environmental factors determining eczema development and its phenotypes, especially in adults. Moreover, eczema has a heterogeneous presentation, which varies in severity, age of onset, and response to treatment. For these reasons, the aims of my doctoral research are to assess(1) the eczema latent classes and their association with risk factors and allergic comorbidities in adulthood, (2) whether the exposure to air pollution is associated with eczema an

Background: Chronic inducible urticaria (CIndU) is a subtype of chronic urticaria (CU) which require specific physical or non-physical triggers to occur. They may be isolated or may coexist with chronic spontaneous urticaria (CSU). Despite their frequent appearance in dermatology clinics, there is scarce information on the distinguishing features among the most common subtypes of CIndU as well as isolated CIndU versus CSU plus CIndU. Objectives: To compare clinical and laboratory characteristics, and comorbid conditions among the most common CIndU types and isolated CIndU versus CSU plus CIndU. Methods: We retrospectively analysed CIndU patients and compared patients' demographic, clinical and laboratory characteristics across isolated CIndU, CSU plus CIndU, symptomatic dermographism (SD), cold urticaria (ColdU) and cholinergic urticaria (ChoU). Results: A total of 423 patients (similar to 70% isolated CIndU, similar to 30% CSU plus CIndU, similar to 5% mixed CIndU subtypes) were included in the study. The most frequent CIndU subtypes were SD (68.6%; 290/423), ColdU (11.4%; 48/423) and ChoU (10.9%; 46/423). Isolated CIndU patients were younger than CSU plus CIndU (33.74 +/- 12.72 vs. 37.06 +/- 11.84, p = 0.010). Angioedema, emergency referrals, need for systemic steroids, comorbid systemic disorders were more frequent and baseline urticaria control test scores were lower in CSU plus CIndU patients (vs. CIndU, p < 0.001, p = 0.008, p < 0.001, p = 0.031, p = 0.036, respectively). Among CIndU subtypes, ChoU patients were younger (24.9 +/- 12.2 vs. 34.47 +/- 12.12 vs. 31.38 +/- 14.95; p < 0.001) and had male predominance (p < 0.001) while SD patients had no angioedema (p < 0.001) and had higher frequency of increased total IgE levels (p = 0.006). Conclusions: Isolated CIndU and CSU plus CIndU seems to be different endotypes of CU where CSU plus CIndU presents a more severe and refractory course. There are distinctive features of each CIndU subtype. These suggest involve, NA

OBJECTIVES Adverse drug reactions are common, and dermatological manifestation is a common indicator. The potentially lethal "Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome" is one example of severe drug reactions manifesting within weeks after drug intake. It is characterized by "fever, skin rash, lymphadenopathy, eosinophilia and systemic symptoms". We present a case of DRESS syndrome secondary to anticonvulsants lamotrigine associated with dysphagia and responding to steroid pulse therapy.

OBJECTIVES This study aimed to determine the frequency of mucocutaneous manifestations in patients with COVID-19. METHODOLOGY This prospective cross-sectional study was conducted in the isolation ward of Hayatabad Medical Complex, Peshawar, for COVID-19-positive patients from 20th June to 30th July 2020. One hundred and twenty COVID-19-positive patients were included in our study. Patients fulfilling the inclusion criteria were subjected to a detailed clinical history and mucocutaneous and systemic examination. Relevant investigations were done. Data was recorded in predesigned proforma and analyzed for various statistical variables. RESULTS Among 120 patients included in our study, 87 were male and 33 female. Most patients belonged to the age group 21-40 years. A total of 17 patients showed mucocutaneous manifestations. Generalized pruritus and petechial rash were the most common, and the maculopapular rash were the least common. Mucosal involvement was seen in 2 patients. CONCLUSION Mucocutaneous manifestations are essential clues in the diagnosis of COVID-19. Early recognition may help in the effective management of patients

Training supervised models requires large amounts of labelled data, whose creation is often expensive and time-consuming, especially in the medical domain. The standard practice to mitigate the lack of annotated medical images is to use transfer learning and fine-tune supervised pre-trained ImageNet weights on a downstream task. While this approach achieves satisfactory performance, it still requires a large dataset to adjust the global features for a specific task. Another way to tackle data scarcity in the medical field is by simplifying the data collection process and ordering health workers to document skin conditions. However, this approach usually leads to image collections containing contaminations such as irrelevant samples, duplicates and label errors since this is in stark contrast to prior practice where experts collected samples in standardised conditions.This thesis aims to contribute to the research landscape of deep learning in combination with digital dermatology by producing three scientific articles in the domains of self-supervised learning and dataset cleaning. The first subproject, termed Self-supervised pre-training for dermatological imaging, investigated the possible benefits of using domain-specific self-supervised pre-training for digital dermatology by comparing them against supervised and self-supervised general-purpose pre-training. The second subproject, termed Data-centric approach to medical imaging, introduced a novel semi-automatic data cleaning strategy which can detect various dataset contaminations.The results of the first subproject indicated a clear benefit in using domain-specific self-supervised pre-trained features in terms of reducing the need for annotated samples and increasing linear, kNN and fine-tuning performance for classification and segmentation tasks. Further, a qualitative evaluation revealed that domain-specific pre-training learned more favourable properties for applications in dermatology since it included bot, + ID der Publikation: hslu_100438 + Art des Beitrages: Master-/Lizentiats-/Diplomarbeit + Name der Universität / Institution inkl. Ort: Lucerne University of Applied Sciences and Arts, Rotkreuz + Land der Universität / Institution: Switzerland + Sprache: Englisch + Letzte Aktualisierung: 2024-07-30 13:11:58

Polarimetry is a powerful tool for the analysis of the optical properties of materials and systems, such as human skin. However, in many polarimetric setups, the field of view is limited to a few square centimeters. In these cases, it is possible to resort to stitching techniques, which involve combining multiple Mueller matrix measurements obtained from different overlapping regions of the sample. In this paper, we propose a stitching technique for polarimetric data and discuss its advantages and limitations. We also describe the potential of image stitching for improving the accuracy and robustness of in vivo polarimetry in the presence of random patient movement. We conducted our research using a diverse set of samples which included porcine skin, human skin from arms and fingers, cold cuts of chicken and gelatine, alongside synthetically created sample data. Our results demonstrate the effectiveness of this technique for the application in dermatology. Each additional in vivo measurement enhances the field of view by approximately one third, thereby considerably augmenting the total observation area. We show that stitching enables for the polarimetric assessment of large skin patches which is useful for the diagnosis of inflammatory skin diseases.

[Importance] Transient neonatal zinc deficiency (TNZD) occurs in breastfed infants due to abnormally low breast milk zinc levels. Mutations in the solute carrier family 30 member 2 (SLC30A2) gene, which encodes the zinc transporter ZNT2, cause low zinc concentration in breast milk. [Objective] This study aimed to provide further insights into TNZD pathophysiology. [Methods] SLC30A2 sequencing was performed in three unrelated Japanese mothers, whose infants developed TNZD due to low-zinc milk consumption. The effects of the identified mutations were examined using cell-based assays and luciferase reporter analysis. [Results] Novel SLC30A2 mutations were identified in each mother. One harbored a heterozygous missense mutation in the ZNT2 zinc-binding site, which resulted in defective zinc transport. The other two mothers exhibited multiple heterozygous mutations in the SLC30A2 promoter, the first mutations in the SLC30A2 regulatory region reported to date. [Interpretation] This report provides new genetic insights into TNZD pathogenesis in breastfed infants.

The presence of dermatological information on the internet has grown exponentially over the last two decades. In recent years, that growth has mostly occurred in social media platforms. This has risen concerns about the quality of this information, which many studies have proven to be misleading or even harmful. The reason is mainly that most content is produced by individuals without any dermatological training. Although social media use is becoming increasingly prevalent amongst dermatologists, it is still a controversial practice. The main concerns are patient confidentiality, and legal and ethical issues. This background raises the following questions: What are all the advantages of social media use by dermatologists? What are the drawbacks of these platforms? How can we optimize the performance of a real-life dermatologist profiles on social media? Gaining deeper insights on all these matters is critical for developing a successful approach for dermatological presence on social media. The aim of this thesis is to provide answers to these research questions. As an initial theoretical approximation to the problem, the first part of this thesis consists on a systematic review of the literature that assembles the benefits, drawbacks and challenges that social media platforms present for dermatologists. A comprehensive systematic review was performed, dating from inception to July 2021. Fifteen benefits, eleven drawbacks and ten challenges of social media use in dermatology were identified and discussed. Suggested strategies to address the identified drawbacks were provided. The remaining issues were addressed empirically. An educational dermatological YouTube channel was launched, designed to avoid the risks and ethical challenges that social media involves for dermatologists. After a three-year period, the channel has reached over 355,000 subscribers and 21 million views. As the limited presence of dermatologists on social media has been criticized for focusing on, La presencia de información dermatológica en internet ha crecido exponencialmente en las últimas décadas. En los últimos años, ese crecimiento se ha producido sobre todo en las redes sociales. Esto ha suscitado preocupación sobre la calidad de esta información, que muchos estudios han demostrado que puede ser engañosa o incluso perjudicial. La razón principal es que la mayoría de los contenidos son elaborados por personas sin formación dermatológica. Aunque el uso de las redes sociales es cada vez más frecuente entre los dermatólogos, sigue siendo una práctica controvertida. Las principales preocupaciones son la confidencialidad del paciente y las cuestiones legales y éticas. Estos antecedentes plantean las siguientes preguntas: ¿Cuáles son las ventajas del uso de las redes sociales por los dermatólogos? ¿Cuáles son los inconvenientes? ¿Cómo podemos optimizar el éxito de los perfiles de los dermatólogos en las redes sociales? Conocer a fondo estas cuestiones es fundamental para desarrollar un enfoque exitoso de la presencia de los dermatólogos en las redes sociales. El objetivo de esta tesis es dar respuesta a estas preguntas de investigación. Como aproximación teórica inicial, la primera parte de esta tesis consiste en una revisión sistemática de la literatura que recoge los beneficios, inconvenientes y retos que las redes sociales presentan para los dermatólogos. Se identificaron y analizaron quince beneficios, once inconvenientes y diez retos del uso de las redes sociales en dermatología. Se sugirieron estrategias para abordar los inconvenientes identificados. Las cuestiones restantes se abordaron empíricamente. Se desarrolló un canal dermatológico educativo en YouTube. Tras un periodo de tres años, el canal ha alcanzado más de 355.000 suscriptores y 21 millones de visitas. El primer experimento de esta tesis se diseñó para averiguar si existía alguna diferencia en la visibilidad de los temas relacionados con la dermatología cosmética y los temas relacionados con, Escuela de Doctorado, Doctorado en Investigación en Ciencias de la Salud

Producción Científica, Scleroderma or systemic sclerosis (SSc) is an autoimmune disease affecting the connective tissue, characterized by fibrosis of the skin and internal organs. There is currently no curative treatment available, so therapeutic action is aimed at a symptomatic treatment of the affected organs. The development of biotechnology has made it possible to implement certain biological drugs that could represent a window of opportunity to modulate the evolution and symptomatology of scleroderma with greater efficacy and less toxicity than conventional treatments. This study aimed to review the current evidence critically and systematically on the effects of biological drugs on the pulmonary function, skin disease, and health status of patients afflicted by diffuse cutaneous systemic sclerosis (dcSSc). Three electronic databases (Pubmed, Dialnet, and Cochrane Library Plus) were systematically searched until the cut-off date of October 2022. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included original articles in English and Spanish with a controlled trial design, comparing biological drug treatments (tocilizumab, belimumab, riociguat, abatacept, and romilkimab) with a control group. The methodological quality of the studies was assessed using the McMaster quantitative form and the PEDro scale. A total of 383 studies were identified, 6 of them met the established criteria and were included in the present systematic review. A total of 426 patients treated with tocilizumab, belimumab, riociguat, abatacept, and romilkimab were included. The results showed substantial non-significant (p < 0.05) improvement trends after treatment with the biological drugs included in this review for the modified Rodnan Scale Value, Forced Vital Capacity, and Carbon Monoxide Diffusion Test; however, no benefits were shown on the Health Assessment Questionnaire–Disability Index when compared to the control group. Biol, Caja Rural de Soria - (project SO-12-2022)

OBJECTIVES This study aimed to determine the frequency of mucocutaneous manifestations in patients with COVID-19. METHODOLOGY This prospective cross-sectional study was conducted in the isolation ward of Hayatabad Medical Complex, Peshawar, for COVID-19-positive patients from 20th June to 30th July 2020. One hundred and twenty COVID-19-positive patients were included in our study. Patients fulfilling the inclusion criteria were subjected to a detailed clinical history and mucocutaneous and systemic examination. Relevant investigations were done. Data was recorded in predesigned proforma and analyzed for various statistical variables. RESULTS Among 120 patients included in our study, 87 were male and 33 female. Most patients belonged to the age group 21-40 years. A total of 17 patients showed mucocutaneous manifestations. Generalized pruritus and petechial rash were the most common, and the maculopapular rash were the least common. Mucosal involvement was seen in 2 patients. CONCLUSION Mucocutaneous manifestations are essential clues in the diagnosis of COVID-19. Early recognition may help in the effective management of patients

Artificial intelligence (AI) and machine learning (ML) have occupied the center stage in healthcare as research groups and institutions investigate their capabilities and risks. Dermatology is often cited as one of the medical specialties most ripe for disruption with AI technology due to the heavy incorporation of visual information into clinical decisions and treatments. Although the literature on AI in dermatology is rapidly growing, there has been a noticeable absence of mature AI solutions utilized by dermatology departments or patients. This commentary provides insight into the regulatory challenges facing AI solutions for the specialty of dermatology and the unique considerations that should be factored into AI development and deployment.

A 75-year-old man with a three-year history of metastatic lung adenocarcinoma was diagnosed with cutaneous lymphangitic carcinomatosa of unique morphology. He was admitted to our hospital for right neck swelling, erythema, and failure to thrive. Skin examination demonstrated an indurated, thickened, firm, hyperpigmented plaque extending from the right neck and chest to the right ear, cheek, and eyelids. Skin biopsy demonstrated poorly differentiated adenocarcinoma, morphologically consistent with metastasis from the patient's known pulmonary adenocarcinoma and showed dermal invasion, perineural invasion, and involvement of dermal lymphatics. The diagnosis was an atypical presentation of cutaneous lymphangitis carcinomatosa from metastatic lung adenocarcinoma. This case presentation affirms that cutaneous lymphangitis carcinomatosa has a variety of atypical presentations, so physicians must maintain a high index of suspicion when evaluating cutaneous lesions in patients with known or suspected internal malignancy.

Wound healing is a general response of the body to injury. All organs share in commonthree response elements to wound healing: inflammation to prevent infection andstimulate the removal of dead cells, active anti-inflammatory signalling to turn off theinflammatory response, and a repair phase characterized by extracellular matrix scarformation. The extent of scar formed depends on the ability of endogenous cells thatpopulate each organ to regenerate. The skin has keratinocytes that have regenerativecapacity, and in general, wounds are fully re-epithelialized. Heart, in contrast, hascardiac myocytes that have little to no regenerative capacity, and necrotic myocytesare entirely replaced by scars. Despite differences in tissue regeneration, the skin andheart share many wound-healing properties that can be exploited to predict the cardiacresponse to pathology. We summarize in this review article our current understandingof how the response of the skin to a wounding event can inform us about the ability ofthe myocardium to respond to a myocardial infarction.

Wound healing is a general response of the body to injury. All organs share in commonthree response elements to wound healing: inflammation to prevent infection andstimulate the removal of dead cells, active anti-inflammatory signalling to turn off theinflammatory response, and a repair phase characterized by extracellular matrix scarformation. The extent of scar formed depends on the ability of endogenous cells thatpopulate each organ to regenerate. The skin has keratinocytes that have regenerativecapacity, and in general, wounds are fully re-epithelialized. Heart, in contrast, hascardiac myocytes that have little to no regenerative capacity, and necrotic myocytesare entirely replaced by scars. Despite differences in tissue regeneration, the skin andheart share many wound-healing properties that can be exploited to predict the cardiacresponse to pathology. We summarize in this review article our current understandingof how the response of the skin to a wounding event can inform us about the ability ofthe myocardium to respond to a myocardial infarction.

Wound healing is a general response of the body to injury. All organs share in commonthree response elements to wound healing: inflammation to prevent infection andstimulate the removal of dead cells, active anti-inflammatory signalling to turn off theinflammatory response, and a repair phase characterized by extracellular matrix scarformation. The extent of scar formed depends on the ability of endogenous cells thatpopulate each organ to regenerate. The skin has keratinocytes that have regenerativecapacity, and in general, wounds are fully re-epithelialized. Heart, in contrast, hascardiac myocytes that have little to no regenerative capacity, and necrotic myocytesare entirely replaced by scars. Despite differences in tissue regeneration, the skin andheart share many wound-healing properties that can be exploited to predict the cardiacresponse to pathology. We summarize in this review article our current understandingof how the response of the skin to a wounding event can inform us about the ability ofthe myocardium to respond to a myocardial infarction.

BACKGROUND: In-hospital dermatological care has shifted from dedicated dermatology wards to consultation services, and some consulted patients may require postdischarge follow-up in outpatient dermatology. Safe and timely care transitions from inpatient-to-outpatient specialty care are critical for patient health, but communication around these transitions can be disjointed, and workflows can be complex. OBJECTIVE: In this 3-phase quality improvement effort, we developed and evaluated an intervention that leveraged an electronic health record (EHR) feature, known as SmartPhrase, to enable a new workflow to improve transitions from inpatient care to outpatient dermatology. METHODS: Phase 1 (February-March 2021) included interviews with patients and process mapping with key stakeholders to identify gaps and inform an intervention: a SmartPhrase table and associated workflow to promote collection of patient information needed for scheduling follow-up and closed-loop communication between dermatology and scheduling teams. In phase 2 (April-May 2021), semistructured interviews-with dermatologists (n=5), dermatology residents (n=5), and schedulers (n=6)-identified pain points and refinements. In phase 3, the intervention was evaluated by triangulating data from these interviews with measured changes in scheduling efficiency, visit completion, and messaging volume preimplementation (January-February 2021) and postimplementation (April-May 2021). RESULTS: Preintervention pain points included unclear workflow for care transitions, limited patient input in follow-up planning, multiple messaging channels (eg, EHR based, email, and phone messages), and time-inefficient patient tracking. The intervention addressed most pain points; interviewees reported the intervention was easy to adopt and improved scheduling efficiency, workload, and patient involvement. More visits were completed within the desired timeframe of 14 days after discharge during the postimplementation period (21

Bacteriophages, also known as phages, are viruses that selectively target and infect bacteria. In addition to bacterial dysbiosis, dermatologic conditions such as acne, psoriasis, and atopic dermatitis are characterized by a relative reduction in the abundance of phages and the overgrowth of the corresponding bacteria. Phages often exhibit high specificity for their targeted bacteria, making phage-replacement therapy a promising therapeutic strategy for the control of pathogenic bacteria in dermatologic disease. Novel therapeutic strategies regulating pathogenic bacteria are especially necessary in light of growing antibiotic resistance. In this review, we aimed to review the medical literature assessing phage dysbiosis and therapeutic trials in dermatology. Ultimately, studies have depicted promising results for the treatment of acne, psoriasis, and atopic dermatitis but are limited by low sample sizes and the omission of control groups in some trials. Additional work is necessary to validate the efficacy depicted in proof-of-concept trials and to further determine optimal treatment vehicles, administration mechanisms, and dosing schedules. This review provides the necessary framework for the assessment of phage efficacy in future trials.

With more disease- and symptom-specific measures available and research pointing to increased usefulness, patient-reported outcome measures (PROMs) can be routinely used in clinical care. PROMs increase efficiency in healthcare, improve the clinician-patient relationship, and increase patient satisfaction with their care. PROMs can be administered before, during, and after clinic visits using paper-and-pencil, mobile phones, tablets, and computers. Herein, we combine available literature with expert views to discuss overcoming barriers and helping dermatologists incorporate PROMs into routine patient-centered care. We believe dermatology patients will benefit from broader PROM implementation and routine clinical use. However, a few major barriers exist: (1) cost to implement the technology, (2) selecting the right PROMs for each disease, and (3) helping both patients and clinicians understand how PROMs add to and complement their current clinical experience. We provide recommendations to assist dermatologists when considering whether to implement PROMs in their practices.

BackgroundChronic hand eczema (CHE) significantly impacts quality of life. Published literature on pediatric CHE (P-CHE) in North America including knowledge on epidemiology and standard evaluation and management is limited.ObjectiveOur objective was to assess diagnostic practices when evaluating patients with P-CHE in the US and Canada, produce data on therapeutic agent prescribing practices for the disorder, and lay the foundation for future studies.MethodsWe surveyed pediatric dermatologists to collect data on clinician and patient population demographics, diagnostic methods, therapeutic agent selection, among other statistics. From June 2021 to January 2022, a survey was distributed to members of the Pediatric Dermatology Research Alliance (PeDRA).ResultsFifty PeDRA members responded stating that they would be interested in participating, and 21 surveys were completed. For patients with P-CHE, providers most often utilize the diagnoses of irritant contact dermatitis, allergic contact dermatitis, dyshidrotic hand eczema, and atopic dermatitis. Contact allergy patch testing and bacterial hand culture are the most used tests for workup. Nearly all utilize topical corticosteroids as first line therapy. Most responders report that they have treated fewer than six patients with systemic agents and prefer dupilumab as first-line systemic therapy.ConclusionsThis is the first characterization of P-CHE among pediatric dermatologists in the United States and Canada. This assessment may prove useful in designing further investigations including prospective studies of P-CHE epidemiology, morphology, nomenclature, and management.

Spontaneously arisen hereditary diseases in domestic animals provide an excellent opportunity to study the physiological functions of the altered genes. We investigated two 4-month-old sibling domestic short haired kittens with dry dark debris around the eyes, nose, and ears, dark crusting on the legs and a thin poor hair coat. Skin biopsies revealed abnormal sebaceous gland morphology with lack of normal sebocyte arrangement and differentiation. Hair follicles had a distorted silhouette, interpreted as a change secondary to the observed sebaceous gland dysplasia. Whole genome sequencing on both affected kittens and 65 genetically diverse feline genomes was performed. Filtering for variants that were present in both kittens but absent from the control genomes revealed a homozygous missense variant in SOAT1, encoding sterol O-acyltransferase 1. The protein is localized in the endoplasmic reticulum and catalyzes the formation of cholesteryl esters, an essential component of sebum and meibum. The identified SOAT1:c.1531G > A variant is predicted to change a highly conserved glycine residue within the last transmembrane domain of SOAT1, p.Gly511Arg. In mice, variants in Soat1 or complete knockout of the gene lead to the "hair interior defect" (hid) or abnormal Meibomian glands, respectively. SOAT1:c.1531G > A represents a plausible candidate variant for the observed sebaceous gland dysplasia in both kittens of this study. The variant was not present in 10 additional cats with a similar clinical and histopathological phenotype suggesting genetic heterogeneity. SOAT1 variants should be considered as potential cause in hereditary sebaceous gland dysplasias of humans and domestic animals.

Biosimilars are beginning to gain regulatory approval in the United States. Biosimilars are structurally near identical to the innovator and must demonstrate identical pharmacokinetics via the same binding affinity and biological function on assays. However, biologics are so complex that even the innovator company cannot produce exact duplicates; there is batch-to-batch variation. The International Psoriasis Council has outlined a biosimilarity index, which aims to standardize preclinical definitions of biosimilarity. Such an index, paired with post-approval monitoring, could provide a transparent, quantitative definition of biosimilarity. Such an index could increase trust in biosimilar medicines and the preclinical assessment process without increasing costs. As preclinical analyses are critical to biosimilar approval, manufacturers should devote proportionate resources to completing them. Dermatologists, who might reflexively look for indication-specific clinical data, might also shift their focus to preclinical variables. Finally, it should be noted that biosimilars provide more evidence of similarity than we have for different batches of the innovator product. Thus, any clinical testing standards, or lack thereof, for different batches of innovator products should also apply to biosimilars.

Combined internal medicine and dermatology (med-derm) training programs were created to advance complex medical dermatology and inpatient dermatology care. A prior study demonstrated that compared to categorical dermatology residents, med-derm residents had less program satisfaction, yet indicated a stronger desire to pursue careers in academia. No follow-up data on practice patterns after training has been reported. We aimed to characterize differences in residency program satisfaction and practice patterns between physicians trained in categorical dermatology compared to med-derm residency programs. We surveyed physicians who graduated from combined med-derm programs along with their counterparts, from six institutions, that either currently or historically had a combined med-derm training, from 2008-2017. Fifty-five percent of med-derm and forty-one percent of categorical-trained physicians responded. The practice patterns between the two groups were similar. A quarter of med-derm physicians continued to provide general internal medicine services. Categorical trained physicians were significantly more satisfied with their training (P=0.03) and performed more excisions on the head/neck (P=0.02). The combined graduates had significantly greater confidence in multidisciplinary care (P=0.003), prescribed more biologic (P<0.001) and non-biologic immunosuppressive agents (P=0.002), and volunteered more for the underserved patients in their communities (P=0.04). Although few differences in overall practice patterns between categorical and med-derm trained graduates were appreciated, med-derm graduates seem more comfortable with multidisciplinary care and may care for more medically complex patients requiring immunosuppression.

La dermatose nodulaire contagieuse représente un problème majeur de la santé des bovins à Madagascar. La présente étude a pour objectif de décrire la situation épidemio-clinique de la dermatose nodulaire contagieuse bovine dans le district de Mananjary. Il s’agit d’une étude descriptive et transversale a été réalisée du mois d’octobre 2015 au mois de février 2016 dans le district de Mananjary. En termes de résultats, la prévalence globale de la dermatose nodulaire contagieuse est de 20,96%. L’étude des facteurs de risque montre que la persistance de ces maladies est significativement liée à la race, au sexe et à l’état d’embonpoint. En conclusion, la dermatose nodulaire des bovins reste encore une menace pour le bétail dans notre pays. Le diagnostic étiologique précis et les traitements efficaces à long terme sont indispensables pour pouvoir les maitriser et les éradiquer.

La dermatose nodulaire contagieuse représente un problème majeur de la santé des bovins à Madagascar. La présente étude a pour objectif de décrire la situation épidemio-clinique de la dermatose nodulaire contagieuse bovine dans le district de Mananjary. Il s’agit d’une étude descriptive et transversale a été réalisée du mois d’octobre 2015 au mois de février 2016 dans le district de Mananjary. En termes de résultats, la prévalence globale de la dermatose nodulaire contagieuse est de 20,96%. L’étude des facteurs de risque montre que la persistance de ces maladies est significativement liée à la race, au sexe et à l’état d’embonpoint. En conclusion, la dermatose nodulaire des bovins reste encore une menace pour le bétail dans notre pays. Le diagnostic étiologique précis et les traitements efficaces à long terme sont indispensables pour pouvoir les maitriser et les éradiquer.

Wound healing is a general response of the body to injury. All organs share in commonthree response elements to wound healing: inflammation to prevent infection andstimulate the removal of dead cells, active anti-inflammatory signalling to turn off theinflammatory response, and a repair phase characterized by extracellular matrix scarformation. The extent of scar formed depends on the ability of endogenous cells thatpopulate each organ to regenerate. The skin has keratinocytes that have regenerativecapacity, and in general, wounds are fully re-epithelialized. Heart, in contrast, hascardiac myocytes that have little to no regenerative capacity, and necrotic myocytesare entirely replaced by scars. Despite differences in tissue regeneration, the skin andheart share many wound-healing properties that can be exploited to predict the cardiacresponse to pathology. We summarize in this review article our current understandingof how the response of the skin to a wounding event can inform us about the ability ofthe myocardium to respond to a myocardial infarction.

Case presentation: We describe the case of a 38-year-old female patient with a history of lupus presenting with atraumatic abdominal pain and ecchymosis. The ultimate diagnosis of abdominal lupus erythematous panniculitis was determined based on physical exam and imaging findings.Discussion: Lupus erythematous panniculitis is a rare diagnosis, but consideration is important as early recognition and treatment is important to reduce pain and lessen the possibility of irreversible disfigurement and unnecessary costs to affected patients.

Producción Científica, Scleroderma or systemic sclerosis (SSc) is an autoimmune disease affecting the connective tissue, characterized by fibrosis of the skin and internal organs. There is currently no curative treatment available, so therapeutic action is aimed at a symptomatic treatment of the affected organs. The development of biotechnology has made it possible to implement certain biological drugs that could represent a window of opportunity to modulate the evolution and symptomatology of scleroderma with greater efficacy and less toxicity than conventional treatments. This study aimed to review the current evidence critically and systematically on the effects of biological drugs on the pulmonary function, skin disease, and health status of patients afflicted by diffuse cutaneous systemic sclerosis (dcSSc). Three electronic databases (Pubmed, Dialnet, and Cochrane Library Plus) were systematically searched until the cut-off date of October 2022. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included original articles in English and Spanish with a controlled trial design, comparing biological drug treatments (tocilizumab, belimumab, riociguat, abatacept, and romilkimab) with a control group. The methodological quality of the studies was assessed using the McMaster quantitative form and the PEDro scale. A total of 383 studies were identified, 6 of them met the established criteria and were included in the present systematic review. A total of 426 patients treated with tocilizumab, belimumab, riociguat, abatacept, and romilkimab were included. The results showed substantial non-significant (p < 0.05) improvement trends after treatment with the biological drugs included in this review for the modified Rodnan Scale Value, Forced Vital Capacity, and Carbon Monoxide Diffusion Test; however, no benefits were shown on the Health Assessment Questionnaire–Disability Index when compared to the control group. Biol, Caja Rural de Soria - (project SO-12-2022)