Search

Aims: The aim of the study was to study the pattern of dermatoses in children up to 5 years of age. Settings and Design: It is an observational study done in a tertiary care hospital. Subjects and Methods: A total of 505 patients, aged up to 5 years, attending the department of dermatology, venereology, and leprosy for a duration of 18 months from January 2017 to June 2018 were included in the study. Statistical Analysis Used: All results were statistically analyzed by IBM SPSS software and Chi-square test was used to compare the associations. Results: Preschoolchildren (75.44%) formed the majority. Males (54.65%) outnumbered females. Infections constituted the most (45.94%) followed by eczema (21.98%), hypersensitivity disorders (14.25%), nevi (4.55%), papulosquamous (3.76%), pigmentary (3.76%), physiological and transient noninfective neonatal conditions (3.56%), sweat gland (2.97%), hair disorders (0.59%), and other dermatoses (2.97%). Conclusions: Infections/infestations constituted the most among the dermatoses in children up to 5 years of age. As they are preventable, educating the parents, guardian, care takers, and teachers in the preschool about communicable diseases can limit their transmission and improve the well-being of children.

Yue Zheng,* Zijian Gong,* Jian Chen, Yao Lin, Yufang Liu Dermatology Department, Third Affiliated Hospital of Sun-Yat Sen University, Guangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yue ZhengDermatology Department, Third Affiliated Hospital of Sun-Yat Sen University, Guangzhou 510630, People’s Republic of ChinaEmail benbenzhu-11@163.comBackground: COVID-19 can affect various organ systems including the skin. Cutaneous manifestations of COVID-19 in infected patients are poorly characterized.Objective: To summarize retrospectively the skin features of COVID-19 infection and to analyze the skin rash incidence rate, clinical onset time, cutaneous manifestations, pathological characteristics and relationship with the novel coronavirus pneumonia severity.Methods: The literature up to Sep 20, 2020, were searched and analyzed. Information on clinical features including skin manifestations, disease severity, stage and onset day, and cutaneous pathological characteristics was extracted. Data were analyzed using descriptive non-parametric statistics. For categorical data, the number and percentage of patients are presented. A Spearman correlation test was used to analyze the associations between rash type, rash onset and severity of COVID-19. All statistical analysis was performed with IBM SPSS software (version 20) using two-tailed tests. P values < 0.05 were considered statistically significant.Results: Twenty-three cases of COVID-19 patients with cutaneous manifestations from seven reports were collected. Inflammatory dermatosis, skin vasculitis and vascular dermatosis were the main lesion types of COVID-19 patients. Microvascular and endothelial cell injury, perivascular lymphocytic infiltrate, thrombosis, extremely dilated vessels and prominent deposits of C5b-9 were the main dermatologic pathological changes. The onset day analysis showed that out of 19 patients, 63.2% of cutaneous manifestations were within 10 days, 21.1% in 10– 20 days and 15.8% were 20 days after the time the patient presented with COVID-19 main symptoms. Spearman rho analysis found no correlation between skin rash type, onset day and COVID-19 severity.Conclusion: COVID-19 induced skin changes are one of the manifestations of immune responses to the novel coronavirus. Clinical and pathological characteristics were identified as dermal inflammatory reactions and/or skin vascular injury. External or systematic use of anti-inflammatories, protection of blood vessels and circulation-improving medicines should be considered in the skin treatments for novel coronavirus pneumonia patients.Keywords: COVID-19, skin manifestations, diagnosis, treatment

Background: Acute kidney injury (AKI) is a severe clinical syndrome, causing a profound medical and socioeconomic burden worldwide. This study aimed to explore underlying molecular targets related to the progression of AKI. Methods: A public database originated from the NCBI GEO database (serial number: GSE121190) and a well-established and unbiased method of weighted gene co-expression network analysis (WGCNA) to identify hub genes and potential pathways were used. Furthermore, the unbiased hub genes were validated in 2 classic models of AKI in a rodent model: chemically established AKI by cisplatin- and ischemia reperfusion-induced AKI. Results: A total of 17 modules were finally obtained by the unbiased method of WGCNA, where the genes in turquoise module displayed strong correlation with the development of AKI. In addition, the results of gene ontology revealed that the genes in turquoise module were involved in renal injury and renal fibrosis. Thus, the hub genes were further validated by experimental methods and primarily obtained Rplp1 and Lgals1 as key candidate genes related to the progression of AKI by the advantage of quantitative PCR, Western blotting, and in situ tissue fluorescence. Importantly, the expression of Rplp1 and Lgals1 at the protein level showed positive correlation with renal function, including serum Cr and BUN. Conclusions: By the advantage of unbiased bioinformatic method and consequent experimental verification, this study lays the foundation basis for the pathogenesis and therapeutic agent development of AKI.

Background and Design: Urticaria is a very common skin disease which is characterized by itchy, erythematous and edematous plaques. Angioedema can also be seen in half of the cases in addition to skin findings. In most cases of chronic urticaria, the underlying factor is not known. Omalizumab, a recombinant human monoclonal immunoglobulin G (IgG) antibody against IgE, is a safe treatment option in chronic urticaria cases which are resistant to treatment with antihistamines. This study aimed to evaluate the treatment responses of chronic urticaria patients taking omalizumab treatment with an urticaria control test (UCT). Materials and Methods: One hundred fifty-four patients diagnosed with chronic urticaria taking omalizumab treatment attended our evaluation between January 1, 2017 and December 31, 2018. These patients were evaluated with an UCT every four weeks. Sixty-six patients who were evaluated with an UCT during the course of the following 12 weeks were statistically analyzed. Thirty-nine of the patients received a treatment shorter than 12 months (the first group), and the remaining 27 patients received treatment for longer than 12 months (the second group). The patients were analyzed according to the duration of their treatment. Results: The first, second, and third average UCT scores of the 3 sequential applications for the first group were 9.16; 11.57; and 12.73; respectively. There was a statistically significant difference in the UCT scores between the 3 successive applications in the first group (p

Background and Design: Psoriasis is a chronic inflammatory skin condition associated with several systemic comorbidities including cardiovascular diseases (CVD). Epicardial fat pad (EFP) is defined as a visceral fat tissue surrounding the heart and coronary vessels. Recent studies revealed epicardial fat thickness, which is also increased in psoriasis, as an early sign of CVD. The aim of this study was to evaluate EFP prevalence and its associations in psoriasis patients. Materials and Methods: Two hundred thirty-seven psoriasis and 113 control patients were assessed for CVD risk factors, Psoriasis Area Severity Index, body composition parameters and laboratory work-up. Controls were chosen from outpatients who lack any chronic inflammatory skin disease and/or systemic inflammatory disease. Evaluation of chest X-rays were performed by a radiologist who was unaware of clinical data. Results: 42.2% of psoriasis patients (n=100) and 31% of controls (n=35) had EFP detected on chest X-ray revealing psoriasis patients had significantly more prevalent EFP than the controls (p=0.047). Prevalence of major CVD risk factors was statistically higher in psoriasis patients (60%, n=142) compared to controls (32%, n=36), (p

A endometriose ocorre em cerca de 10% das mulheres em idade reprodutiva, é histopatologicamente definida pela presença de tecido glandular endometrial e/ou estroma fora da cavidade uterina. A principal localização cutânea é o umbigo. A endometriose cutânea primária é rara e subdiagnosticada. Deve ser suspeitada na presença de nódulo eritemato-violáceo com tendência a sangramento, especialmente durante o período menstrual, mesmo na ausência de cirurgia abdominal anterior ou história de endometriose pélvica. A ressecção cirúrgica é o tratamento de escolha. A avaliação ginecológica é recomendada, visto que a associação com a doença pélvica ocorre em 26% dos casos de endometriose cutânea. Relatamos caso de paciente sem história de cirurgias abdominais e/ou endometriose, com nódulo violáceo em cicatriz umbilical com um ano de evolução, com sangramento durante o período menstrual e após traumas.

A urticária multiforme é uma reação de hipersensibilidade aguda, sendo um subtipo morfológico de urticária. É mais comum em crianças e, uma vez que sua apresentação clínica se assemelha a outras dermatoses, como o eritema multiforme, a vasculite urticariana e a doença do soro-like, tem sido subdiagnosticada. Relatamos assim, um caso de uma criança de 1 ano e 9 meses com lesões cutâneas exuberantes associado a manifestações sistêmicas, com recuperação completa do quadro após tratamento com anti-histamínicos e corticosteróides endovenoso em unidade de medicina intensiva.

O angiohistiocitoma de células multinucleadas (ACM) é uma entidade rara, cuja patogenia não está completamente compreendida. É mais comum em mulheres de meia-idade e caracteriza-se por pápulas ou nódulos eritematovioláceos, habitualmente assintomáticos e localizados predominantemente nas extremidades. O diagnóstico é fundamentalmente histopatológico, consistindo em alterações típicas na derme, nomeadamente na proliferação de pequenos vasos e na presença de células gigantes multinucleadas. A sua evolução é benigna, embora persistente, havendo poucos casos relatados de remissão espontânea. Apresenta-se o caso de um homem de 48 anos com diagnóstico de ACM, manifestando-se por pápulas e nódulos assintomáticos, agrupados no dorso de ambas as mãos, com um ano de evolução. O diagnóstico foi determinado pelo exame histopatológico, excluindo-se outros diagnósticos diferenciais. Com este relato de caso pretende-se contribuir para o conhecimento sobre esta patologia e destacar a complementaridade entre a observação clínica e a análise histopatológica.

Background/Aims: Renal vascular injury accounts for the poor outcomes of patients with IgA nephropathy (IgAN). In this study, we investigated whether endostatin, a potent inhibitor of angiogenesis, is associated with IgAN. Methods: Serum endostatin levels were detected in patients with IgAN, disease controls, and healthy controls, and the correlation among endostatin and clinicopathologic manifestations, as well as prognosis in patients with IgAN, was analyzed. In addition, serum endostatin levels were compared in patients “before” and “after” treatment. Data on endostatin expression in the renal interstitium of patients with IgAN were downloaded and analyzed from the GSE35489 array in the GEO database. The poly-IgA1 (pIgA) immune complex is widely recognized as the “trigger” of IgAN initiation. pIgA in the plasma of patients was extracted and used to stimulate human glomerular endothelial cells (GECs). Endostatin, IL-6, and CXCL1 in the cell supernatant were detected by ELISA kits. Results: We found that serum endostatin levels were significantly increased in patients with IgAN, as was endostatin expression in the renal interstitium. Patients with IgAN were divided into 2 groups according to the median value. The high endostatin expression group had significantly higher levels of serum creatinine and BUN and more severe tubular/interstitial damage. Moreover, patients with arteriolar injury and endothelial cell proliferation had higher serum endostatin levels. Patients with high serum endostatin levels had poor prognosis. According to the in vitro experiment, the GEC apoptosis rate and the supernatant levels of endostatin, IL-6, and CXCL1 were significantly increased following pIgA stimulation. Conclusion: Our study found that elevated endostatin expression was associated with disease severity and poor prognosis in patients with IgAN and can be upregulated by pIgA, but how it participates in the pathogenesis of IgAN deserves further exploration.

Background/Aims: Arterial stenosis activates the renin-angiotensin-aldosterone system subsequently resulting in renovascular hypertension (RVHT) and renal oxidative injury. We explored the effect of sodium thiosulfate (STS, Na2S2O3), a developed antioxidant in clinical trial, on RVHT-induced hypertension and renal oxidative injury in rats. Methods: We induced RVHT in male Wistar rats with bilaterally partial ligation of renal arteries in the 2-kidney 2-clip model. We evaluated the STS effect on RVHT-induced oxidative injury and apoptosis by a chemiluminescence amplification method, Western blot, and immunohistochemistry. Results: We found STS displayed a dose-dependent antioxidant H2O2 activity and adapted the maximal scavenging H2O2 activity of STS at the dosage of 0.1 g/kg intraperitoneally 3 times/week for 4 weeks in RVHT rats. RVHT induced a significant elevation of arterial blood pressure, blood reactive oxygen species amount, neutrophil infiltration, 4-HNE and NADPH oxidase gp91 expression, Bax/Bcl-2/poly(ADP-ribose) polymerase (PARP)-mediated apoptosis formation, blue Masson-stained fibrosis, and urinary protein level. STS treatment significantly reduced hypertension, oxidative stress, neutrophil infiltration, fibrosis, and Bax/Bcl-2/PARP-mediated apoptosis formation and depressed the urinary protein level in the RVHT models. Conclusion: Our results suggest that STS treatment could ameliorate RVHT hypertension and renal oxidative injury through antioxidant, antifibrotic, and antiapoptotic mechanisms.

Introduction: Various viruses including a novel coronavirus (SARS-CoV-2) can infect the kidney. When viruses invade the glomeruli from the bloodstream, glomerular endothelial cells (GECs) initiate the innate immune reactions. We investigated the expression of interferon (IFN)-induced protein with tetratricopeptide repeats (IFIT) 1/2/3, antiviral molecules, in human GECs treated with a toll-like receptor (TLR) 3 agonist. Role of IFIT1/2/3 in the expression of C-X-C motif chemokine ligand 10 (CXCL10) was also examined. Methods: Human GECs were cultured and stimulated with polyinosinic-polycytidylic acid (poly IC), a synthetic TLR3 agonist. Real-time qPCR, Western blotting, and ELISA were used to examine the expression of IFIT1/2/3, IFN-β, and CXCL10. RNA interference against IFN-β or IFIT1/2/3 was also performed. Results: Expression of IFIT1/2/3 and CXCL10 was induced by poly IC in GECs. The inductions were inhibited by RNA interfering of IFN-β. Knockdown of IFIT1/2/3 decreased the CXCL10 expression. Knockdown of IFIT3 decreased the expression of IFIT1 and IFIT2 proteins. Conclusion: IFIT1/2/3 and CXCL10 were induced by poly IC via IFN-β in GECs. IFIT1/2/3 may increase the expression of CXCL10 which induces lymphocyte chemotaxis and may inhibit the replication of infected viruses. These molecules may play a role in GEC innate immune reactions in response to viruses.

Stevens–Johnson syndrome and toxic epidermal necrolysis are well-known severe cutaneous adverse reactions, with >100 medications previously implicated, most frequently sulfonamide antibiotics. Ursodeoxycholic acid (UDCA), normally present in human bile at a low concentration, is used for the treatment of various cholestatic disorders. Reports of UDCA causing cutaneous complications are, however, rare. The present report describes a suspected case of UDCA-induced Stevens–Johnson syndrome–toxic epidermal necrolysis overlap in a 24-year-old female, admitted with a whole-body maculopapular rash with oromucocutaneous ulceration and skin desquamation. The patient was managed with supportive care, including fluid and electrolyte replacement, corticosteroids, antibiotics, antihistamines, and intravenous Ig. Early identification, prompt intervention with effective care, and support are the key action points in these severe cutaneous adverse reactions.

Background: Recessive dystrophic epidermolysis bullosa (RDEB) and junctional EB (JEB) are inherited disorders characterised by fragility and blistering of epithelial tissues leading to pain, pruritus, and adherent scarring. The severity and chronic nature of the resultant skin wounds significantly reduces quality and length of life. Current therapies primarily consist of protective bandaging and nutritional supplementation; there is no cure for these disorders. Although the skin fragility results from a lack of C7 protein (RDEB) and laminin-332 (JEB), other serious aspects of these disorders, such as inflammation that interferes with healing and aggressive squamous cell carcinoma, have not been completely elucidated. Recent research has suggested that mitochondrial function plays a significant role in skin healing. Objective: To evaluate how mitochondrial function differs in patients with RDEB and JEB. Method: The energy status of RDEB and JEB patient-derived fibroblasts was determined by Seahorse analysis and metabolite production. The energetics and overall morphology of RDEB and JEB patient-derived fibroblasts were assayed as a measure of metabolic stress. Results: EB patient-derived fibroblasts showed impaired oxidative phosphorylation with concomitant compensation by glycolysis. Morphological parameters were altered in RDEB and JEB fibroblasts compared with controls. Conclusion: This is the first study to describe changes in mitochondrial energy metabolism, metabolic profile, and mitochondrial morphology of EB patients.

Chronic urticaria (CU) is one of the most commonly diagnosed skin conditions. CU is characterised by the presence of recurrent wheals and/or angioedema and intense pruritus persisting for at least 6 weeks. Subtypes of CU include chronic spontaneous urticaria and chronic inducible urticaria. Following diagnosis, adequate trigger identification and appropriate treatment can significantly reduce disease activity and improve the patient’s quality of life and disease outcomes. Current guidelines recommend a stepwise approach in the management of CU, including non-sedating oral antihistamines, administered in up to four times the conventional dose, the monoclonal antibody omalizumab (anti-IgE), and eventually cyclosporine as an add-on therapy for patients with antihistamine-refractory CU. Potential disease-related biomarkers are needed to predict the therapeutic response that would lead to establishment of personalised regimens and treatment plans. This paper reviews the current perspectives and guidelines for classification, diagnosis, and management of CU.

Trichoblastomas (TBs) are extremely rare, benign hair germ tumors that can mimic basal cell carcinoma (BCC). They usually arise on the head or neck and have a potential for malignant transformation, albeit it is rare. We report a case of giant TB on the forehead of a 75-year-old otherwise healthy woman. Since the age of 20 she reported a bulge on her forehead, in which a superficial-looking wound had now developed. Initially a dermatologist biopsied the tumor suspecting a BCC, which the histological analyses confirmed. The patient was then referred to the Department of Plastic Surgery for complete excision of the carcinoma, including the large frontal bulge. Surprisingly, the concluding pathology report changed the diagnosis from a BCC to a TB. Current management of most skin lesions relies on the histopathological subtype of a single punch biopsy. Many benign and malignant dermatological entities may mimic BCC, and therefore misdiagnosis can lead to either unnecessary excision or delayed treatment of metastatic disease. Mimics may include various types of nonneoplastic processes, benign adnexal tumors, including TB, or cutaneous carcinomas with basaloid features. A single punch biopsy is not always adequate in making the correct diagnosis. Although it is considered the gold standard, the clinical assessment is just as important. Due to its potential for malignant transformation, it is recommended to excise TB with negative margins.

Keloids are a difficult-to-treat disease characterized by an imbalance in mechanisms of tissue reparation. We present the case of a middle-aged woman with spontaneous keloids which histologically and clinically improved after UVA-1 phototherapy treatment. There are few reported cases of keloids treated with high doses of UVA-1 phototherapy. We used a low-dosage regimen with a good response in only one cycle, which could diminish the risk of skin cancer development.

Background: Patient decision aids are tools that facilitate shared decision making when clinical evidence and patient values and preferences inform the process. Evidence-based guidelines have been developed for clinicians in hidradenitis suppurativa management. To address treatment decision-making needs of hidradenitis suppurativa patients, we developed a hidradenitis suppurativa patient decision aid. Objective: To assess the efficacy of the hidradenitis suppurativa patient decision aid during treatment decision making. Methods: An online, participant-blinded, parallel-group, randomized controlled trial of the hidradenitis suppurativa patient decision aid versus Mayo Clinic hidradenitis suppurativa website content (Mayo) was conducted with hidradenitis suppurativa patients. Outcomes were knowledge, decisional conflict, and preparation for decision making. Results: Forty participants fulfilled inclusion criteria and were randomized to hidradenitis suppurativa patient decision aid or Mayo. In the hidradenitis suppurativa patient decision aid group, data from 16 and 15 participants were analyzed at phases 1 and 2, respectively. In the Mayo group, data from 15 and 13 participants were analyzed at phases 1 and 2, respectively. Increased knowledge (P

Introduction: Dermatoses contribute to a large burden of global disease, but the relationship between socioeconomic status and the effect of dermatologic conditions in Europe is not well understood. Methods: We selected Global Burden of Disease Study data sets to analyze disability-adjusted life-years (DALYs) and the annual rate of change of dermatoses between 1990 and 2017 in 43 European countries. The principal country-level economic factor used was gross domestic product per capita from the World Bank. Statistical analysis was performed with Spearman ρ correlation. Results: Wealthier European countries had higher DALYs for melanoma, basal cell carcinoma, psoriasis, atopic dermatitis, acne, seborrheic dermatitis, alopecia, asthma, contact dermatitis, and viral skin disease. Poorer countries had higher DALYs of squamous cell carcinoma, urticaria, decubitus ulcers, pruritus, scabies, tuberculosis, and syphilis. Thirteen European countries were in the top 10th percentile globally for annual increase in skin and subcutaneous disease burden. Conclusion: The majority of European countries have experienced an increase in skin and subcutaneous diseases in recent decades relative to the rest of the world, but the burden of individual dermatoses in Europe varies by country and socioeconomic status. DALYs can potentially serve as a purposeful measure for directing resources to improve the burden of skin disease in Europe.

Angioimmunoblastic T-cell lymphoma (AITL) is an aggressive lymphoma that accounts for approximately 18% of natural killer/T-cell lymphomas.1 AITL typically affects older men and manifests at nodal and extranodal sites with B symptoms, lymphadenopathy, hematologic abnormalities, and, in up to 50% of cases, cutaneous manifestations.1, 2, 3 We report a case of AITL with a severe skin eruption developing during checkpoint inhibitor therapy.

Elise Cabout,1 Sebastien Eymere,1 Robert Launois,1 Flavia Aslanian,2 Charles Taïeb,3,4 Sophie Seité5 1Réseau d’évaluation en Économie de la Santé (REES), Paris, France; 2Epsom and St Helier University Hospitals NHS Trust, London, UK; 3EMMA, Fontenay-sous-Bois, France; 4Hôpital Necker Enfants-Malades, Santé Publique, Paris, France; 5La Roche-Posay Dermatological Laboratories, Levallois-Perret, FranceCorrespondence: Sophie SeitéLa Roche-Posay Dermatological Laboratories, 62 Quai Charles Pasqua, Levallois-Perret 92300, FranceTel +33 1 49 64 33 40Email sophie.seite@loreal.comIntroduction: Atopic dermatitis (AD) is chronic inflammatory skin condition, characterized by its remission-relapse cycles. This predominantly pediatric disease is becoming more and more prevalent. Emollients are part of the therapeutic management and particularly a way to increase time between relapses. The follow-up of AD and relapses have a great impact on patient’s quality of life, expenditures and society costs. The aim of this study is to assess the cost-effectiveness of different emollients prescribed to AD patients.Methods: A three-state Markov simulation model was developed over a six-year period with 28 days cycles. Two perspectives were adopted, a health care system perspective and a societal perspective. Four different emollients (A, B, C, D) were compared with no emollient use. Time without flare-up was the key endpoint of the study. quality adjusted life-years (QALYs) were assessed as a secondary outcome. Cost and effectiveness data were derived from (i) randomized clinical trials and literature review for the efficacy of treatments, (ii) resource utilization and quality of life data, and (iii) unit prices from official price lists.Results: The six-year health care costs associated with emollient A amount to £ 1844.23 and generate 4.58 years-without flare-up. Compared to emollient B, emollient A is costlier (Δ £ 41) but more effective (0.097 years). The ICER is £ 428.30 per year without flare-up. Emollient A is the dominant strategy compared to no treatment (£ 2,251.01; 3.99 years without flare-ups). When accounting for the societal costs, emollient A is the dominant strategy.Discussion: According to the analysis, treatment with preventive emollient was a cost-effective option compared with no treatment in adult AD patients. In this comparative study, emollient A is the most efficient strategy from a willingness to pay £ 200 with a probability of 49%.Keywords: atopic dermatitis, cost-effectiveness, Markov model

Wojciech Danysz,1 Bartosch Nowag,1 Thomas Hengl,1 Peter Kreymerman,2 Céline Furne,3 Elise Madeuf,4 Christoph Höennscheidt,1 Deanne Mraz Robinson5,6 1R&D, Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany; 2Medical Affairs, Merz North America, Raleigh, NC, USA; 3NAMSA, Chasse sur Rhône, France; 4Preclinical Studies, Voxcan, Marcy L´Etoile, France; 5Modern Dermatology of Connecticut, Westport, CT, USA; 6Yale-New Haven Hospital, New Haven, CT, USACorrespondence: Wojciech DanyszMerz Pharmaceuticals GmbH, Eckenheimer Landstrasse 100, Frankfurt am Main 60318, GermanyEmail Wojciech.danysz@merz.deIntroduction: Calcium hydroxylapatite microspheres suspended in a gel carrier of sodium carboxymethylcellulose (CaHA; Radiesse®) has demonstrated safe and effective restoration of facial volume in clinical trials, as well as collagen biostimulation leading to skin quality improvement. The potential with CaHA, as with any filler, to produce overcorrection and subsequent complications has led to the search for a reversal agent. Sodium thiosulfate (STS) was proposed based on experience with it as a chelating agent to treat calciphylaxis. Previous pilot studies with small sample sizes have suggested its efficacy in the reduction of CaHA volume and nodule formation. The present study focuses on the verification of this effect using various readout methods in preclinical experiments.Methods: We use both in vitro (co-incubation of STS with CaHA) and in vivo (injections in farm pig) methods with readout techniques such as 3D camera analysis, micro-computed tomography ex vivo (μCT), computed tomography in vivo (CT), histopathology and scanning electron microscopy.Results: We did not obtain any indications of CaHA degradation by STS, either in vitro or in vivo. 3D-camera analysis also did not show any decreasing effect of STS on CaHA. However, histology, μCT ex vivo, and CT in vivo indicated a decrease of Radiesse amount/volume after STS treatment, which could be attributed to dispersion effect. It should be noted that necrosis and haemorrhages were observed after STS treatment.Discussion: Results suggest no indication of CaHA microspheres degradation with STS and that the STS mechanism of action on CaHA is consistent with a dispersion effect. Observed necrosis is a further obstacle in the use of STS.Keywords: calcium hydroxylapatite, sodium thiosulfate, dispersion effect, computed tomography, histology, 3D camera

Background and Design: Lichen planus (LP) is a chronic inflammatory disease of unknown etiology that most commonly affects the skin and oral mucosa. Vitamin D is a steroid hormone with immunomodulatory, anti-inflammatory and antioxidant effects. The purpose of this study was to evaluate serum vitamin D levels in patients with LP and to compare these with those of healthy control subjects. Materials and Methods: Forty-eight patients with a diagnosis of LP and 46 healthy controls were enrolled in the study. The serum levels of 25-hydroxy vitamin D, calcium, phosphate and parathyroid hormone were studied from blood samples collected from all subjects. Results: The serum levels of vitamin D were lower in the LP patients compared to the controls and in the oral erosive LP patients compared to the other LP patients, although the difference was not statistically significant. There were no statistically significant differences in other laboratory parameters between the patient and the control groups. Conclusion: Our study revealed no clear relation between LP and vitamin D levels. The results of our study suggest that other factors except vitamin D, particularly probable triggers, play a more dominant role in the immunopathogenesis of LP. Further studies with larger patient populations assessing serum vitamin D levels in different types of LP and vitamin D-related gene polymorphisms are now needed in order to reveal the relation between LP and Vitamin D more clearly.

Acute generalized exanthematous pustulosis (AGEP) is a toxic cutaneous reaction pattern that is mostly caused by drug intake and rarely associated with spider bites. We report a case of a female patient, 47 years old, with febrile pustular lesions on an erythematous base at the abdominal region. She had three violaceous erythematous and edematous plaques on the interscapular region, one of which had a necrotic crust at its center. The lesions were compatible with spider bites. By considering histopathological and clinical findings, the patient was diagnosed with AGEP. Since she had no history of drug intake, viral infection or other triggers, a spider bite was thought to have caused the AGEP.

Background: Despite warnings about its harmful adverse effects and the implementation of regulatory bans, anecdotal reports suggest high use of skin-lightening agents in Kumasi, Ghana. Objective: To estimate the prevalence and motivation for skin-lightening agent use and nonuse among shoppers in Kumasi, Ghana. Methods: This is a cross-sectional survey of a convenience sample of shoppers in 3 of Kumasi's largest markets. Results: Of the 350 shoppers who were approached, 334 consented, for a response rate of 95%. Data were analyzed on 331 completed surveys. A total of 40.4% of individuals reported current or past use of skin-lightening products, and 26.6% of men reported history of product use compared with 56.5% of women. Female sex was significantly associated with skin-lightening product use (odds ratio 3.59; 95% confidence interval 2.26-5.70). Users of skin-lightening agents were more likely to agree with statements that associated lighter skin with beauty, self-esteem, attractiveness, and wealth. Limitations: Using a nonrandomized convenience sampling method on a single city limits the generalizability of the results. Response, recall, and social desirability biases may have skewed the results, especially given the stigma associated with skin-lightening agent use. Conclusion: The practice of skin lightening among all participants is high and is associated with perceptions of increased beauty, attractiveness, self-esteem, and wealth.

Contemporarily to the new SARS-CoV-2 mediated COVID-19 pandemic, a rise in patients with acral chilblain lesions has been described. They manifest late after mild disease or asymptomatic exposure to SARS-CoV-2. Their pathogenic evolution is currently unknown. In biopsies from three patients with acral partially ulcerating chilblain lesions that occurred associated to the COVID-19 pandemic, we analysed the expression of type I interferon induced proteins and signal transduction kinases. Histology demonstrated perivascular and periadnexal lymphohistiocytic infiltrates and endothelial dominated MxA-staining, as well as pJAK1 activation. Our findings demonstrate induction of the type I IFN pathway in lesional sections of COVID-19-associated chilblain-like lesions. This may indicate a local antiviral immune activation status associated with preceding exposure to SARS-CoV-2.

Yao Pan,1,2 Xue Ma,1,2 Jinfeng Zhao,1,2 Shiyu Yan,1,2 Qi Liu,3 Hua Zhao1,2 1Department of Cosmetics, College of Chemistry and Materials Engineering, Beijing Technology and Business University, Beijing 100048, People’s Republic of China; 2Beijing Key Laboratory of Plant Research and Development, Beijing 100048, People’s Republic of China; 3Beijing EWISH Testing Technology Co., Ltd, Beijing 100142, People’s Republic of ChinaCorrespondence: Yao PanDepartment of Cosmetics, College of Chemistry and Materials Engineering, Beijing Technology and Business University, 11 Fu Cheng Road, Hai Dian District, Beijing 10048, People’s Republic of ChinaEmail panyao@btbu.edu.cnBackground: Ageing is an inevitable physiology process of humans, and skin biophysical parameters change owing to genetic and environmental factors in different ethnic populations.Aim: To gain comprehensive data on the skin biophysical parameters of different anatomical regions and to explore the change trend of the skin characteristics associated with age for the indicated regions by generalized additive model.Methods: We measured various skin biophysical parameters on forehead, cheek, chin and inner forearm of 178 Chinese women aged between 20 and 64 years living in Beijing. These parameters comprised skin hydration, transepidermal water loss (TEWL), sebum content, erythema index (EI), melanin index (MI), L*a*b* values, individual typology angle (ITA) and pH, which were quantified by non-invasive instruments.Results: Comparing the skin parameters among the four test areas, we observed that the hydration, TEWL, EI and a* values were significantly higher for the face than for the forearm, but the L* and ITA values were just the opposite. The cheek was the lightest and brightest region with lowest sebum content, while the chin was much darker and the forehead was yellowish. Considering the change of the skin parameters with age, TEWL, sebum content and melanin and erythema indices had a linear relationship with age, whereas skin hydration, L, a, b, ITA and pH values exhibited a non-monotonic relationship. The turning points of these curves appeared almost at the thirties, showing the lightest and evenest skin color and more hydration, with lower pH values.Conclusion: This study indicates that the skin biophysical characteristics of Chinese women were significantly affected by age and body regions.Keywords: ageing, hydration, skin barrier function, skin color, regional variation

A região nasal é frequentemente acometida por neoplasias cutâneas, especialmente em indivíduos de fototipos baixos, em quem a incidência de carcinoma basocelular é elevada. Defeitos cirúrgicos na asa nasal e região perinasal constituem desafio à sua reconstrução, uma vez que envolve várias unidades cosméticas e preservação do sulco nasal. A preservação dos limites entre essas unidades mostra-se fundamental, portanto, para o bom resultado funcional e estético. Este artigo tem como objetivo mostrar a aplicação do retalho de pedículo subcutâneo em formato de tubarão para correção de defeitos em asa nasal e região perinasal.

Essam A Nada,1 Eman MS Muhammad,2 Sheren FM Ahmed,2 Asmaa MS Tamam,1 Amr Abdelhamed1 1Dermatology, Venereology and Andrology Department, Faculty of Medicine, Sohag University, Sohag, Egypt; 2Pathology Department, Faculty of Medicine, Sohag University, Sohag, EgyptCorrespondence: Amr AbdelhamedDepartment of Dermatology, Venereology, and Andrology, Faculty of Medicine, Sohag University, Sohag 82524, EgyptTel +20 1005825574Email dramr80@yahoo.comPurpose: Psoriasis vulgaris, one of the most prevalent chronic inflammatory skin diseases, is associated with metabolic syndrome (MetS). Autophagy, an intracellular degradation system is essential for cell survival and differentiation, and its dysfunction may contribute to metabolic diseases. A cross-sectional study was conducted on 38 psoriasis vulgaris patients and 16 healthy control subjects to 1) Assess immunohistochemical (IHC) expression of microtubule-associated protein light chain 3 (LC3); 2) Evaluate the relationship between Psoriasis Area Severity Index (PASI) score, and LC3 expression.Patients and Methods: PASI score was evaluated for all psoriasis patients. Lipid profile, blood sugar, and CRP were done for all patients and controls. A punch biopsy was taken from lesional and perilesional skin of psoriasis patients and normal skin of the controls. Tissue sections were prepared. IHC LC3 staining was done and evaluated.Results: LC3 was nearly absent, in the epidermis of the lesional skin of psoriasis while it was strong among control (p=0.001). LC3 expression in the lesional skin of psoriasis vulgaris was lower than its expression in perilesional (p=0.001). However, LC3 expression was not significantly changed with PASI or the presence/absence of MetS.Conclusion: A potential link between psoriasis vulgaris and autophagy as assessed by LC3 could be present. LC3 was down-regulated in psoriasis lesions than in normal skin. However, its expression did not change with PASI or MetS. An autophagy enhancer might be used as a possible therapeutic target in psoriasis vulgaris patients.Keywords: psoriasis vulgaris, Psoriasis Area Severity Index score, PASI score, metabolic syndrome, autophagy, microtubule-associated protein light chain 3, LC3

O condiloma acuminado é causado pelo DNA-vírus, que pertence ao grupo papovavírus. Em menores de três anos, a transmissão tende a não ser por abuso sexual, mas, sim, de maneira vertical. Não existe consenso para o tratamento das verrugas anogenitais em crianças. O método escolhido é individualizado para o paciente, sendo a preferência por tratamentos menos traumáticos, com menor sequela. Embora ainda existam algumas restrições ao uso do imiquimode em menores de 12 anos, estudos já mostram o sucesso desta terapêutica nesta faixa etária. Será descrito um caso tratado com imiquimode creme a 5%, com resolução das lesões preexistentes.

With the recent advancements of biologic therapies that block IL-23, there is increasing need for analysis of which biologics are most efficacious in treatment of plaque psoriasis. Guselkumab and risankizumab have each individually been compared to adalimumab in head-to-head trials, but no prior clinical trials have directly compared them to each other. The authors performed a literature review of guselkumab and risankizumab to determine which treatment is more efficacious in the management of plaque psoriasis. Using PubMed, a literature review was conducted using the terms “adalimumab psoriasis”, “risankizumab psoriasis”, and “guselkumab psoriasis”. Fifteen studies resulted, and all were nonduplicate clinical trials written in English that were conducted within the past 5 years and included plaque psoriasis in the title. The data supports that risankizumab is more effective in improving Dermatology Life Quality Index (DLQI), static Physician’s Global Assessment (sPGA), and Psoriasis Area and Severity Index (PASI) 90 scores. However, risankizumab may be associated with more adverse events than guselkumab. Major limitations of this review include that only one prior head-to-head trial comparing risankizumab to adalimumab has been conducted and there are no Phase II studies comparing the two biologics. Furthermore, risankizumab is a recently approved treatment and data regarding long-term efficacy and side effects are limited. Risankizumab and guselkumab are both highly effective, very safe, and very convenient psoriasis treatments that can be considered first-line treatment options for patients with moderate-to-severe plaque psoriasis.

Background: Racial variation exists in the incidence of orofacial granulomatosis (OFG). The epidemiology and clinical characteristics of OFG in Asian countries are poorly described. Objective: To describe the epidemiologic and clinical features of OFG in China from data collected on chronic odontogenic infection and studied in actual practice regarding the long-term outcome of OFG patients receiving different treatments. Methods: Data on demographics, medical history, chronic odontogenic infection, and the extent of disease were collected, and long-term outcomes after the end of treatments were evaluated. Results: Of the 165 OFG patients, 118 (71.5%; 95% CI 64.6%-78.5%) had a chronic odontogenic infection. There was a variety of difference between OFG with and without chronic odontogenic infection. Approximately 98.3% (95% confidence interval 94.8%-100%) of OFG patients with chronic odontogenic infection who received dental treatment showed a marked response, of whom 31 patients (53.4%; 95% confidence interval 40.2%-66.7%) had complete remission. Limitations: Endoscopic investigations were not performed for most of the patients, and more detailed data were not collected, which might have demonstrated additional systemic problems. Conclusions: OFG with chronic odontogenic infection is the major clinical pattern of OFG in China, which may be a subtype of OFG. Dental treatment should necessarily be the preferred first-line therapy for such patients.

Guoxiu Cao,1 Bei Chen,2 Xian Zhang,3 Hongyun Chen1 1Department of Dermatology, The Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, Guizhou 563000, People’s Republic of China; 2Department of Pharmacy, The Third People’s Hospital of Zunyi, Zunyi, Guizhou 563000, People’s Republic of China; 3Department of Project, MDL Biotech. Co.Ltd, Beijing 100080, People’s Republic of ChinaCorrespondence: Hongyun Chen Email Chenhongyuan4242@163.comIntroduction: Human adipose-derived mesenchymal stem cells (ADMSCs) with their secretory factors are able to induce collagen synthesis and fibroblast migration in the wound healing process. This study is launched to figure out the effect of human ADMSCs-derived exosomes on skin wound healing.Methods: ADMSCs were extracted and ADMSCs-derived exosomes were identified. Skin damage models were established by treating HaCaT cells and human skin fibroblasts with H2O2. Next, the roles of ADMSCs and their derived exosomes were investigated. The exosomal miRNA then was analyzed, and the function of miRNA on the H2O2-induced cells was studied by miRNA suppression. Bioinformatics analysis, luciferase activity and RIP assays were implemented to find the target genes ofthe miRNA and the modulated pathways. A mouse skin damage model was induced to elucidate the effects of exosomes in vivo by injecting exosomes.Results: H2O2 treatment significantly reduced the viability of HaCaT cells and increased their apoptosis rate. Co-culture with ADMSCs or their derived exosomes could improve the cell damage caused by H2O2. Meanwhile, H2O2 treatment promoted the internalization of exosomes. ADMSCs and their derived exosomes significantly increased miR-19b expression in the recipient cells, while inhibiting miR-19b resulted in a reduction in the therapeutic effect of ADMSCs-derived exosomes. Besides, miR-19b regulated the TGF-β pathway by targeting CCL1. The therapeutic effect of exosomes was further confirmed by a mouse model of skin damage.Conclusion: Our study indicates that exosomal miR-19b derived from ADMSCs regulates the TGF-β pathway by targeting CCL1, thereby promoting the healing of skin wounds.Keywords: human adipose-derived mesenchymal stem cells, exosome, microRNA-19b, healing of skin wounds, CCL1, TGF-β signaling pathway

Apremilast (Otezla®) is a relatively novel orally administered non-biologic disease-modifying anti-rheumatic drug (DMARD) extensively used in the management of psoriasis and psoriasis arthritis, lately approved for treating oral ulcerations in Behçets disease. Its advantageous side effect profile together with its uncomplicated follow-up and monitoring when compared to other DMARDs facilitates even a broad off-label prescribing. Here, the first case of laryngeal pseudotumor in a patient treated with apremilast for plaque psoriasis is presented.

The skin is an ecosystem composed of specialized cell types that work together to serve as a physical protective barrier. Single-cell resolution is therefore essential to deconvolve skin's heterogeneity by identifying novel, distinct cell subsets in health and disease. Single-cell RNA sequencing is a highly meticulous methodology used to study the distinct transcriptional profiles of each cell within large tissue libraries at uniquely high resolution. The investigative capabilities achieved by this methodology allow previously unattainable analyses, including identification of rare cell populations, evaluation of cell-to-cell variation, and the ability to track trajectories of distinct cell lineages through development. In the past decade, application of transcriptomic analysis to skin biology and dermatology has greatly advanced understanding of homeostatic physiology in the skin, as well as a multitude of dermatologic diseases. Single-cell RNA sequencing offers tremendous promise for identification of novel therapeutic targets in dermatologic diseases, with broad implications of improving therapeutic interventions.

Background: Identification of epidemiologic and phenotypic variations of psoriasis among different ethnic groups can further our understanding of this perplexing disease, aiming at better management of patients worldwide. Objective: To provide a descriptive analysis of psoriasis patients registered at Kasr Al-Ainy Psoriasis Unit Disease Registry. Methods: This retrospective single-center registry study included patient records between November 2015 and November 2018 (2534 patients). Sociodemographic and phenotypic data were analyzed. Results: The mean age of the registered patients was 39.3 years and 56.3% were men. Stress was the main precipitating factor (48.3%), whereas the most common symptom reported was itching (82.4%). The median body mass index was 27.5, and the median percentage of body surface area involved was 10.0. The mean Psoriasis Area Severity Index score was 8.7, and the mean Psoriasis Disability Index score was 13.0. Both parameters correlated positively, and both showed significantly higher means in smokers. Limitations: Despite that the study was performed at a highly specialized tertiary care center with a high flow of patients, this was still a single-center registry. Conclusions: This work shows that the characteristics of Egyptian patients with psoriasis are comparable to those of other studied ethnic groups, with minor differences.

Embora várias técnicas tenham sido descritas para a reconstrução do lábio superior, a reconstrução funcional dos defeitos totais do lábio superior permanece um desafio. Neste caso, realizou-se a exérese de um carcinoma espinocelular de tamanho significante, em região labial superior, por meio da técnica de duplo avanço, com resultados funcional e estético positivos.

A doença de Dowling-Degos (DDD) é uma genodermatose rara, caracterizada principalmente por hiperpigmentação reticular progressiva de áreas flexurais, que pode estar associada a um grande espectro de lesões benignas e neoplasias cutâneas. Pode ocasionar prejuízo psicossocial devido ao potencial de deformidade das lesões e dano estético significativo. Apresentamos dois casos de pacientes, ambos do sexo masculino, com máculas hipercrômicas, múltiplos comedões, cistos epidérmicos, cicatrizes cribriformes em: face, região cervical, dorso, tórax anterior, axilas e região genital, além de tumorações desfigurantes, características da DDD.

The COVID-19 pandemic has spurred healthcare systems across the world to rapidly redesign their models of care delivery. As such, this pandemic has accelerated the adoption of teledermatology in the United States. However, it remains unknown whether this momentum will be maintained after the pandemic. The future of teledermatology in the United States will be significantly influenced by a complex set of policy, legal, and regulatory frameworks. An understanding of these frameworks will help dermatologists more effectively adopt and implement teledermatology platforms. In this article, we review the current state of teledermatology in the United States, including policy dimensions, the regulatory landscape, market characteristics, and future directions.

Dermatologists stand at the gateway of individualization of classification, treatment, and outcomes of acral melanoma patients. The acral melanoma genetic landscape differs in vital ways from that of other cutaneous melanomas. These differences have important implications in understanding pathogenesis, treatment, and prognosis. The selection of molecularly targeted therapy must be adapted for acral melanoma. It is also critical to recognize that tumor development is far more complex than an isolated event, reliably treated by a medication acting on a single target. Tumors exhibit intratumor genetic heterogeneity, metastasis may have different genetic or epigenetic features than primary tumors, and tumor resistance may develop because of the activation of alternative genetic pathways. Microenvironmental, immune, and epigenetic events contribute and sustain tumors in complex ways. Treatment strategies with multiple targets are required to effectively disrupt the tumor ecosystem. This review attempts to translate the current molecular understanding of acral melanoma into digestible concepts relevant to the practice of dermatology. The focus is tumor genetics defining potentially treatable cancer pathways, contextualized within the relevant pathologic and molecular features.

A infecção genital pelo papilomavírus humano ocorre em 65% das vezes após contato com pele e mucosa contaminadas. A maioria das pessoas elimina o vírus através do sistema imune. Fatores individuais, como tabagismo, idade, multiparidade, uso prolongado de contraceptivos hormonais, comportamento sexual e infecção por outras doenças sexualmente transmissíveis, ocasionam perpetuação viral e lesões genitais, em sua maior parte, assintomáticas. As regiões mais afetadas são anogenitais. O tratamento deve ser individualizado. O tratamento agressivo pode ocasionar distúrbios cicatriciais. Relatamos um caso de múltiplos tratamentos para retirada de condiloma genital com consequente formação de extenso queloide vulvar.

Background and Design: The harmful ultraviolet radiation of sunlight can damage skin cells and affect the skin’s normal appearance. The short term effects associated with sun exposure include acute skin damage associated changes such as sunburn, suntan and the long term effects are delayed pigmentation, impaired vitamin D synthesis, altered immunological responses of the skin, photodamage and photocarcinogenesis. The majority of these photodermatoses are preventable with the implementation of appropriate sun protection measures and behavioral changes. Materials and Methods: Data collection was done with the help of a structured questionnaire which was distributed among 339 undergraduate medical students in their 4th, 7th, 8th and 9th term attending dermatology postings at a medical college attached to a tertiary hospital from January 2018 to July 2018. Results: The majority of the students in this study were 4th term undergraduates representing 35.3% of the population. The mean ± standard deviation scores of knowledge, behaviour and awareness were 11.67±3.31, 12.32±5.004, 24±6.282, respectively. Only 26.8% of the above population always used sunscreen during daily activities, 32.1% sometimes, 25.6% rarely used and 15.3% never used sunscreen during daily activities. One-Way ANOVA tests depicted a statistically significant difference among the various term students with respect to variables of knowledge, behaviour and awareness score with a p

Background An estimated 50% of children in the US are Medicaid-insured. Some of these patients have poor health literacy and limited access to medications and specialty care. These factors affect treatment utilization for pediatric patients with atopic dermatitis (AD), the most common inflammatory skin disease in children. This study assesses and compares treatment patterns and healthcare resource utilization (HCRU) between large cohorts of Medicaid and commercially insured children with AD. Methods Pediatric patients with AD were identified from 2 large US healthcare claims databases (2011–2016). Included patients had continuous health plan eligibility for ≥6 months before and ≥12 months after the first AD diagnosis (index date). Patients with an autoimmune disease diagnosis within 6 months of the index date were excluded. Treatment patterns and all-cause and AD-related HCRU during the observation period were compared between commercially and Medicaid-insured children. Results A minority of children were evaluated by a dermatology or allergy/immunology specialist. Several significant differences were observed between commercially and Medicaid-insured children with AD. Disparities detected for Medicaid-insured children included: comparatively fewer received specialist care, emergency department and urgent care center utilization was higher, a greater proportion had asthma and non-atopic morbidities, high- potency topical corticosteroids and calcineurin inhibitors were less often prescribed, and prescriptions for antihistamines were more than three times higher, despite similar rates of comorbid asthma and allergies among antihistamine users. Treatment patterns also varied substantially across physician specialties. Conclusions Results suggest barriers in accessing specialty care for all children with AD and significant differences in management between commercially and Medicaid-insured children. These disparities in treatment and access to specialty care may contribute to poor AD control, especially in Medicaid-insured patients.

Ran Xie,1,* Suwei Dong,2,* Jie Jiang,3 Conghui Yang,1 Lanjiang Li,4 Sheng Zhao,1 Yunlei Li,3 Chun Wang,1 Shujuan Li,1 Yanbin Xiao,2 Long Chen1 1PET/CT Center, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Cancer Center of Yunnan Province, Kunming, Yunnan, People’s Republic of China; 2Second Orthopedic Ward, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Cancer Center of Yunnan Province, Kunming, Yunnan, People’s Republic of China; 3Graduate School, Kunming Medical University, Kunming, Yunnan, People’s Republic of China; 4Department of Forensic Medicine, Kunming Medical University, Kunming, Yunnan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yanbin XiaoSecond Orthopedic Ward, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Cancer Center of Yunnan Province, Kunming 650118, Yunnan, People’s Republic of ChinaEmail xiaoybbt@163.comLong ChenPET/CT Center, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Cancer Center of Yunnan Province, Kunming 650118, Yunnan, People’s Republic of ChinaEmail Lonechen1983@hotmail.comIntroduction: Skin cutaneous melanoma (SKCM) is a common skin malignancy worldwide, and its metastasis and mortality rates are high. The molecular characteristics exhibited by tumor–immune interactions have drawn the attention from researchers. Therefore, increased knowledge and new strategies to identify effective immune-related biomarkers may improve the clinical management of SKCM by providing more accurate prognostic information.Patients and Methods: In this study, we established a prognostic immune-related gene pair (IRGP) signature for predicting the survival of SKCM patients. The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases provided gene expression profiles together with clinical information, and the samples were randomly divided into three groups including the training, testing, and validation datasets. The regression model of least absolute shrinkage and selection operator (LASSO) helped to identify a 13-IRGP signature with a significant relation to the survival of SKCM patients.Results: The training, TCGA, and independent sets have an average value of area under the curve of 0.79, 0.76, and 0.82, respectively. In addition, this 13-IRGP signature can noticeably divide SKCM patients into high-risk group and low-risk group with significantly different prognoses. Many biological activities such as gene family were enriched among the genes in our IRGP signature. While analyzing the risk signature and clinical characteristics, there was a large difference in the risk score between T stage and tumor stage grouping. Finally, we constructed a nomogram and forest plots of the risk score and clinical features.Conclusion: In summary, we developed a robust 13-IRGP prognostic signature in SKCM, which can identify and provide new insights into immunological biomarkers.Keywords: skin cutaneous melanoma, TCGA, immune-related gene pair, signature, bioinformatic

Background: Telemedicine provides accurate diagnoses for skin disorders and has gained emphasis. It may be used for the triage and management of common skin diseases in primary care, improving patients’ access and reducing time to treatment. Objective: To evaluate the proportion of atopic dermatitis patients who could be managed with the support of telemedicine and its accuracy. Second, we aimed to assess the frequency of atopic dermatitis, demographics, clinical features, and therapies dispensed in relation to the disease. Methods: Retrospective study in a population of 30,976 individuals, assisted by telemedicine. We assessed patients with the diagnosis of atopic dermatitis and evaluated the proportion of cases referred to biopsy, in-person dermatologists, or to be managed by primary care; the treatments suggested; and telemedicine accuracy to diagnose atopic dermatitis. Results: Atopic dermatitis was diagnosed in 1648 patients (5.3%), the sixth most common dermatosis, with 2058 lesions (3.7%) analyzed. Primary care physicians were able to manage 72% of the atopic dermatitis patients, whereas 28% of them were referred to in-person dermatologists. Accuracy for atopic dermatitis diagnosis was 84.4%. Conclusion: Telemedicine was an accurate method and helped primary care physicians to treat 72% of the atopic dermatitis lesions, thereby optimizing the availability of in-person appointments with dermatologists for more severe cases.

Reese Imhof,1 Stanislav N Tolkachjov2 1Mayo Clinic Alix School of Medicine, Rochester, MN, USA; 2Epiphany Dermatology, Dallas, TX, USACorrespondence: Stanislav N Tolkachjov Email stan.tolkachjov@gmail.comAbstract: Frontal fibrosing alopecia (FFA) is a primary lymphocytic cicatricial alopecia that is often considered a clinical variant of lichen planopilaris (LPP) due to their shared histopathologic features. FFA is characterized by the recession of the frontal, temporal, or frontotemporal hairline; the clinical pattern is distinct and usually includes eyebrow hair loss, as well as other associated symptoms. Pruritus, facial papules, eyelash loss, body hair involvement, and trichodynia may also occur in addition to the frontotemporal recession and eyebrow loss classically seen. Early diagnosis and prompt treatment are critical as FFA is a progressive disorder that can result in permanent hair loss. FFA is challenging as patients may not present or be recognized until the disease has progressed. Additionally, there is currently no consensus or standard treatment regimen for FFA. While many different therapies have been reported as beneficial, there are a limited number of published guidelines for the treatment of FFA. This article is a review of the literature on treatment modalities for FFA and the objective is to offer a practical guide for clinicians on the evidence-based management options currently available in the literature.Keywords: alopecia, frontal fibrosing alopecia, hair loss, scarring alopecia, treatment, management, hair, inflammatory hair disorder, lichen planopilaris, primary lymphocytic cicatricial alopecia, scarring

Ashraf Badawi,1,2 Mai Osman,1 Ahmed Kassab1 1Department of Medical Laser Applications, National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt; 2Department of Dermatology and Allergology, Faculty of Medicine, University of Szeged, Szeged, HungaryCorrespondence: Ashraf Badawi 2147 Mayflower Boulevard, Oakville, Ontario L6H4E6, CanadaEmail ashrafbadawi@hotmail.comIntroduction: Rhinophyma is a cosmetic disorder that causes emotional distress if the symptoms are extensive or obvious enough. Treatment options range from topical antibiotics or isotretinoin, surgical resection, cryosurgery, electrocautery, dermabrasion and more recently laser therapy. With the limitations of surgical techniques, lasers gained popularity for treating rhinophyma. However, laser ablation is invasive and can lead to side effects and prolonged downtime. Fractional photothermolysis (FP) was introduced to overcome the limitations posed by conventional ablative lasers. To the best of our knowledge, there are no previous studies to evaluate the use of Er:YAG in an ablative mode with a fractional handpiece for the treatment of rhinophyma.Aim of the Work: The goal of this study was to evaluate the efficacy and safety of fractional ablative 2940 nm Er:YAG laser for the treatment of mild to moderate rhinophyma.Patients and Methods: Sixteen patients having mild to moderate rhinophyma were treated with fractional ablative 2940 nm Er:YAG laser. All patients received 4 laser treatments and were followed up over the following 3 months. An additional follow-up appointment 6 months after the last session was arranged to detect any signs of recurrence.Outcome Measures: Patient questionnaire was used to evaluate patient subjective satisfaction. Objective evaluation was performed by a blind assessment of clinical photographs that were taken before and 3 months after the final treatment by two independent blinded evaluators.Results: Patient questionnaire taken 3 months after last treatment revealed that 8 patients (50%) were “very satisfied”, 4 patients (25%) were satisfied, and 4 patients (25%) were somewhat satisfied. None of the patients assessed their results as not satisfying.Conclusion: In conclusion, the use of patterned ablative Er:YAG laser with a PS01 handpiece and parameters used in this study comprise an effective tool for treatment of mild to moderate rhinophyma with rapid postoperative recovery compared with conventional surgical procedures and other ablative lasers.Keywords: rhinophyma, fractional lasers, ablative lasers, Er:YAG laser