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People all over the world, independent of their culture or background, touch their faces up to 800 times per day. No other part of the body is touched as often as the face. Forehead, nose, and chin-the so-called T-zone of the face-are touched particularly frequently during spontaneous facial self-touches (sFST). It is hypothesized that there is a relationship between the density of mechanoreceptors (inferred from facial hair distribution) and the frequency of spontaneous self-touching. In order to indirectly measure the density of mechanoreceptors (cutaneous end organ complexes), the number of vellus and terminal hairs at 40 different measuring points on the face of 30 (15f/15m) healthy volunteers in study A is determined. In study B, the frequency of sFST at the same 40 measuring points in 66 (32f/34m) healthy persons is determined. Study A reveals that the number of facial hairs-in both sexes-is higher in the T-zone than in other areas of the face. Study B reveals that the T-zone is touched more frequently than other areas of the face. Skin areas of the face with a higher number of vellus hairs (and presumably higher innervation density) are touched particularly frequently during sFST., (© 2024 The Author(s). Advanced Biology published by Wiley‐VCH GmbH.)

Chronic pruritus is a highly prevalent disease associated with high psychosocial and economic burdens. In addition to pharmacological treatments, device-based physical therapies also offer antipruritic effects. Phototherapy, laser, electrical neurostimulation technologies, acupuncture, cryotherapy, and cold atmospheric plasma are, in part, still experimental but emerging treatment options that augment our repertoire to treat patients with chronic pruritus. In this narrative review, we provided an overview of these physical modalities and their role in itch management., Competing Interests: Conflicts of interest None disclosed., (Copyright © 2024 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Vulvar lichen sclerosus (VLS) is a chronic inflammatory skin condition associated with significant impairment of quality of life and potential risk of malignant transformation. However, diagnosis of VLS is often delayed due to its variable clinical presentation and shame-related late consultation. Machine learning (ML)-trained image recognition software could potentially facilitate early diagnosis of VLS., Objective: To develop a ML-trained image-based model for the detection of VLS., Methods: Images of both VLS and non-VLS anogenital skin were collected, anonymized, and selected. In the VLS images, 10 typical skin signs (whitening, hyperkeratosis, purpura/ecchymosis, erosion/ulcers/excoriation, erythema, labial fusion, narrowing of the introitus, labia minora resorption, posterior commissure (fourchette) band formation and atrophic shiny skin) were manually labelled. A deep convolutional neural network was built using the training set as input data and then evaluated using the test set, where the developed algorithm was run three times and the results were then averaged., Results: A total of 684 VLS images and 403 non-VLS images (70% healthy vulva and 30% with other vulvar diseases) were included after the selection process. A deep learning algorithm was developed by training on 775 images (469 VLS and 306 non-VLS) and testing on 312 images (215 VLS and 97 non-VLS). This algorithm performed accurately in discriminating between VLS and non-VLS cases (including healthy individuals and non-VLS dermatoses), with mean values of 0.94, 0.99 and 0.95 for recall, precision and accuracy, respectively., Conclusion: This pilot project demonstrated that our image-based deep learning model can effectively discriminate between VLS and non-VLS skin, representing a promising tool for future use by clinicians and possibly patients. However, prospective studies are needed to validate the applicability and accuracy of our model in a real-world setting., (© 2024 European Academy of Dermatology and Venereology.)

Porokeratoses are a heterogenous group of autoinflammatory keratinization disorders all characterized by the presence of a cornoid lamella. In addition to gene mutations affecting the mevalonate pathway, environmental factors such as UV radiation, immunosuppression, trauma, and infection are also thought to contribute to porokeratoses. To date, there are no management guidelines or levels of evidence for commonly used pharmacologic and non-pharmacologic treatment options for porokeratoses. Conventional treatment strategies encompass topical and systemic drugs (e.g., salicylic acid, topical glucocorticoids, and retinoids), phototherapy, laser, and surgical interventions. Better insights into the pathogenesis of porokeratoses have paved the way for the development of novel therapeutic approaches, such as topical statins or the use of monoclonal antibodies. This narrative review aims to summarize both conventional and novel treatment options, including their level of evidence, advantages, and disadvantages., (© 2024 Deutsche Dermatologische Gesellschaft (DDG).)

Spontaneous touches of one's face (sFST) were suggested to serve cognitive-emotional regulation processes. During the pandemic, refraining from face-touching was recommended, yet, accompanying effects and the influence of personal attributes remain unclear. Ninety participants (45 female, 45 male) filled out a questionnaire concerning personality, anxiety screening and ADHD screening. Subsequently, they performed a delayed verbal memory recall task four times. After two times, sixty participants were instructed to refrain from face-touching (experimental group). Thirty participants did not receive behavioral instructions (control group). To identify face-touches and conduct further analysis, Video, EMG, and EEG data were recorded. Two samples were formed, depending on the adherence to completely refrain from face-touching (adherent, non-adherent sample) and compared to each other and the control group. EEG analyses uncovered that refraining from face-touching is accompanied by increased beta-power at sensorimotor sites and, exclusively in the non-adherent sample, at frontal sites. Decreased memory performance was found exclusively in subsamples, who non-adherently touched their face while retaining words. In terms of questionnaire results, lower Conscientiousness and higher ADHD screening scores were revealed by the non-adherent compared to the adherent sample. No differences were found among the subsamples. The presented results indicate that refraining from face-touching is related to personal attributes, accompanied by neurophysiological shifts and for a portion of humans by lower memory performance, supporting the notion that sFST serve processes beyond sensorimotor., (© 2024. The Author(s).)

Aquaporin-4 (AQP4) is a water channel protein that links the astrocytic endfeet to the blood-brain barrier (BBB) and regulates water and potassium homeostasis in the brain, as well as the glymphatic clearance of waste products that would otherwise potentiate neurological diseases. Recently, translational readthrough was shown to generate a C-terminally extended variant of AQP4, known as AQP4x, which preferentially localizes around the BBB through interaction with the scaffolding protein α-syntrophin, and loss of AQP4x disrupts waste clearance from the brain. To investigate the function of AQP4x, we generated a novel AQP4 mouse line (AllX) to increase relative levels of the readthrough variant above the ~15% of AQP4 in the brain of wild-type (WT) mice. We validated the line and assessed characteristics that are affected by the presence of AQP4x, including AQP4 and α-syntrophin localization, integrity of the BBB, and neurovascular coupling. We compared AllX Hom and AllX Het mice to WT and to previously characterized AQP4 NoX Het and NoX Hom mice, which cannot produce AQP4x. An increased dose of AQP4x enhanced perivascular localization of α-syntrophin and AQP4, while total protein expression of the two was unchanged. However, at 100% readthrough, AQP4x localization and the formation of higher order complexes were disrupted. Electron microscopy showed that overall blood vessel morphology was unchanged except for an increased proportion of endothelial cells with budding vesicles in NoX Hom mice, which may correspond to a leakier BBB or altered efflux that was identified in NoX mice using MRI. These data demonstrate that AQP4x plays a small but measurable role in maintaining BBB integrity as well as recruiting structural and functional support proteins to the blood vessel. This also establishes a new set of genetic tools for quantitatively modulating AQP4x levels., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Mueller, McFarland White, Fass, Chen, Shi, Ge, Engelbach, Gaines, Bice, Vasek, Garbow, Culver, Martinez-Lozada, Cohen-Salmon, Dougherty and Sapkota.)

Neurons, astrocytes and oligodendrocytes locally regulate protein translation within distal processes. Here, we tested whether there is regulated local translation within peripheral microglial processes (PeMPs) from mouse brain. We show that PeMPs contain ribosomes that engage in de novo protein synthesis, and these are associated with transcripts involved in pathogen defense, motility and phagocytosis. Using a live slice preparation, we further show that acute translation blockade impairs the formation of PeMP phagocytic cups, the localization of lysosomal proteins within them, and phagocytosis of apoptotic cells and pathogen-like particles. Finally, PeMPs severed from their somata exhibit and require de novo local protein synthesis to effectively surround pathogen-like particles. Collectively, these data argue for regulated local translation in PeMPs and indicate a need for new translation to support dynamic microglial functions., (© 2023. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Pruritus is a common symptom of cutaneous graft-versus-host disease (GVHD) following haematopoietic stem cell transplantation (HSCT). However, little is known about its prevalence, pathophysiology, perceptual characteristics, impact on quality of life and response to antipruritic therapies. The aim of this review was to determine the current knowledge on pruritus in cutaneous GVHD. The review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. Of the 338 studies screened, 13 were included. The prevalence of pruritus in cutaneous GVHD was reported in three studies, ranging from 37.0% to 63.8%. Only four trials used pruritus assessment tools. There was little or no information on the intensity of pruritus, its qualitative perception, the location of pruritus and the impact of pruritus on quality of life. Antipruritic treatments for GVHD-associated pruritus were mentioned in five studies (38.5%), including topical ointments (steroids, tacrolimus and calcipotriene), broadband UVB, systemic antihistamines and oral ursodeoxycholic acid. In conclusion, pruritus in cutaneous GVHD appears to be common, but very little is known about the pathophysiology, impact on quality of life and effective treatment options. Basic research and controlled clinical trials are warranted to improve knowledge and management of this important issue., (© 2023 European Academy of Dermatology and Venereology.)

Puf3p regulates the stability of nuclear-encoded mRNAs acting in mitochondrial biogenesis and function in Saccharomyces cerevisiae. This work identifies the phosphorylation of Pop2p, a component of the deadenylase complex, as being critical for adapting Puf3p-mediated mRNA decay upon carbon source alterations. We demonstrate that the Puf3p-Pop2p association diminishes in mitochondria-reliant conditions and establish Yak1p, a kinase that phosphorylates Pop2p at threonine 97, as a new player in Puf3p-mediated regulation of mRNA decay. Yak1p deletion alters the half-life of Puf3p target mRNAs. Our findings outline a metabolism-driven regulatory switch, whereby, in mitochondria-independent conditions, Puf3p recruits Pop2p and the decay machinery to bound mRNAs for rapid decay. Conversely, in mitochondria-reliant conditions, the association of Puf3p with Yak1p increases, placing Yak1p proximal to neighboring Pop2p. Subsequent Pop2p phosphorylation reduces the Puf3p-Pop2p interaction and stabilizes Puf3p target mRNAs., (© 2023 Federation of European Biochemical Societies.)

Background: Despite humans frequently performing spontaneous facial self-touches (sFST), the function of this behavior remains speculative. sFST have been discussed in the context of self-regulation, emotional homeostasis, working memory processes, and attention focus. First evidence indicates that sFST and active facial self-touches (aFST) are neurobiologically different phenomena. The aim of the present analysis was to examine EEG-based connectivity in the course of sFST and aFST to test the hypotheses that sFST affect brain network interactions relevant for other than sensorimotor processes., Methods: To trigger spontaneous FST a previously successful setting was used: 60 healthy participants manually explored two haptic stimuli and held the shapes of the stimuli in memory for a 14 min retention interval. Afterwards the shapes were drawn on a sheet of paper. During the retention interval, artifact-free EEG-data of 97 sFST by 32 participants were recorded. At the end of the experiment, the participants performed aFST with both hands successively. For the EEG-data, connectivity was computed and compared between the phases before and after sFST and aFST and between the respective before-and the after-phases., Results: For the before-after comparison, brainwide distributed significant connectivity differences (p < .00079) were observed for sFST, but not for aFST. Additionally, comparing the before- and after-phases of sFST and aFST, respectively, revealed increased similarity between the after-phases than between the before-phases., Conclusion: The results support the assumption that sFST and aFST are neurobiologically different phenomena. Furthermore, the aligned network properties of the after-phases compared to the before-phases indicate that sFST serve self-regulatory functions that aFST do not serve., Competing Interests: Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: The prognosis of stroke patients can be improved by adherence to clinical guidelines., Objective: To analyse the current state of organisation of prehospital stroke treatment in Germany, Austria and Switzerland with a focus on guideline adherence., Materials and Methods: All medical directors of emergency medical services (MDEMS) in Germany ( n  = 178), Austria ( n  = 9) and Switzerland ( n  = 32) were invited to complete an anonymous online survey (unipark.com, Tivian XI GmbH, Cologne, Germany) which was available for 10 weeks from April-June 2020. Participants were asked for information regarding structural organisation, clinical treatment and strategic/tactical aspects., Results: The survey was completed 69 times and 65 datasets were analysed (4 participants without MDEMS status): 73.8% ( n  = 48) were MDEMS from Germany, 15.4% ( n  = 10) from Switzerland and 10.8% from Austria ( n  = 7). The survey results show relevant differences in the infrastructure of and the approach to prehospital stroke treatment. Standard operating procedures for stroke treatment were in place in 93.3% ( n  = 61) of the EMS areas. Furthermore, 37% ( n  = 24) of the EMS areas differentiated between stroke with mild and severe symptoms and 15.4% ( n  = 10) used specific scores for the prehospital prediction of large vessel occlusion strokes (LVOS)., Conclusions: Our data highlight the heterogeneity of prehospital stroke treatment in Germany, Austria and Switzerland. Consistent use of appropriate scores for LVOS prediction and a higher adherence to recent clinical guideline in general are measures that should be taken to optimise the prehospital treatment of stroke patients., (© The Author(s) 2023.)

Objectives: An increased frequency of intermittent hypoxemia (IH) is associated with a higher risk for poor developmental outcomes, disability, or death in extremely preterm infants. The objective of the prFesent study is to quantify the effect of hands-on medical and parental interventions on the incidence of IH in extremely preterm infants., Methods: An observational design with intraindividual comparisons was used. Blood oxygen saturation levels (SpO2) and time-lapse video were recorded. Frequency, duration, and time to occurrence of IH (SpO2 <80% for ≥10 s) were compared between nursing and medical care (NMC), health care by parents, skin-to-skin contact (SSC), touch in incubator, physiotherapy, and rest. Each infant was observed for six consecutive 24-h periods. Inclusion criteria were as follows: gestational age ≤28 weeks, birth weight <1500 g, postnatal age 0-6 weeks, gavage feeding, no severe illnesses or invasive procedures, no mechanical ventilation., Results: The highest proportion of time with IH occurred during NMC (2.49%) and incubator touch (1.32%), the lowest during SSC (0.74%) and health care by parents (0.67%). IH frequency per hour was highest during NMC (2.95, IQR 1.19-4.01) and lowest during SSC (0.88, IQR 0.37-2.32, p < 0.001). While an increase in IH during NMC was expected, the high incidence during incubator touch was surprising. Parental touch in the incubator is intended to be soothing, not stressful., Conclusions: Future studies need to clarify how preterm infants process touch, which attributes of touch are fundamental trigger mechanisms of IH, and which handling strategies are most effective in lowering the incidence of IH during hands-on medical care., (© 2022 The Author(s). Published by S. Karger AG, Basel.)

Spontaneously touching one's own face (sFST) is an everyday behavior that occurs in people of all ages, worldwide. It is-as opposed to actively touching the own face-performed without directing one's attention to the action, and it serves neither instrumental (scratching, nose picking) nor communicative purposes. These sFST have been discussed in the context of self-regulation, emotional homeostasis, working memory processes, and attention focus. Even though self-touch research dates back decades, neuroimaging studies of this spontaneous behavior are basically nonexistent. To date, there is only one electroencephalography study that analyzed spectral power changes before and after sFST in 14 participants. The present study replicates the previous study on a larger sample. Sixty participants completed a delayed memory task of complex haptic relief stimuli while distracting sounds were played. During the retention interval 44 of the participants exhibited spontaneous face touch. Spectral power analyses corroborated the results of the replicated study. Decreased power shortly before sFST and increased power right after sFST indicated an involvement of regulation of attentional, emotional, and working memory processes. Additional analyses of spectral power changes during the skin contact phase of sFST revealed that significant neurophysiological changes do not occur while skin contact is in progress but at the beginning of sFST (movement toward face and initial skin contact). The present findings clearly illustrate the complexity of sFST and that the specific trigger mechanisms and functions of this spontaneous behavior need to be further investigated in controlled, experimental studies., (© 2022. The Author(s).)

Spontaneous touching of one's own face (sFST) is an everyday behavior that occurs primarily in cognitively and emotionally demanding situations, regardless of a persons' age or gender. Recently, sFST have sparked scientific interest since they are associated with self-inoculation and transmission of respiratory diseases. Several studies addressed the need to reduce sFST behaviors without discussing the underlying functions of this spontaneous behavior. In addition, the question of why this behavior occurs very frequently in some individuals (high self-touching individuals, HT) but less frequently in others (low self-touching individuals, LT) has not yet been addressed. For the first time, we distinguished between HT and LT and investigated the behavioral consequences of sFST suppression in these two groups. For this purpose, we examined performance outcomes of 49 participants depending on sFST behaviors during a haptic working memory task. In addition, we assessed personality traits of HT and LT using the Freiburg Personality Inventory (FPI-R). The results of our study reveal that suppressing sFST in HT is negatively related to memory performance outcomes. Moreover, HT show tendencies to differ from LT in certain personality traits. Our results highlight the relevance of distinguishing between HT and LT in future studies of sFST., (© 2022. The Author(s).)

Introduction: Herpes zoster is the common reactivation of latent varicella zoster virus infection and is associated with substantial morbidity and costs. Age, immunosuppression, diabetes and active cancer are important risk factors for developing herpes zoster. The recombinant herpes zoster vaccine is highly effective in preventing this infection. To inform cost-effectiveness analyses of vaccination in risk groups, it is important to define the rates of complications, mortality, and hospitalisation and its costs., Methods: In this single-centre, investigator-initiated, retrospective study we analysed herpes zoster patients treated in our tertiary dermatology referral centre between 2005 and 2019. Case costs were calculated using health insurance invoices and by estimating the drug-related costs. The associations between patients' characteristics and complications were assessed using logistic regression models., Results: A total of 355 herpes zoster patients were analysed (mean age 61.5 ± 18.8 years; 56.6% women). The complication rate was 30.1% (n = 107) with post-herpetic neuralgia being the most frequent (37/355, 10.4%). The herpes zoster-related hospitalisation rate was 19.2% (n = 68), the herpes zoster-related mortality rate 0.85% (n = 3). Of all patients, 22.8% (n = 81) had herpes zoster risk factors. The odds ratio for complications (multivariate analysis) was 2.5 (95% confidence interval [CI] 1.12-5.72) in cancer patients and 1.04 (1.02-1.05) for each additional year of age (1.41 for 10 years). The cost ratio (median) of in- vs outpatient treatment was 26.9 (CHF/case 9029 vs 335), of all complicated vs non-complicated herpes zoster patients 6.6 (CHF/case 2203 vs 332) and of complicated vs non-complicated herpes zoster outpatients 4.3 (CHF/case 1331 vs 306)., Conclusion: In this herpes zoster population at a university hospital, one in three patients was affected by herpes zoster-related complications. Age and cancer were independently associated with a high complication rate, suggesting a need to vaccinate cancer patients. Herpes zoster-related complications and the need for inpatient treatment escalated the costs per case.

Background: Older adults sometimes shy away from using modern digital communication devices due to lacking experience and fear of failure. Within the present project, SmartCards were developed as analogous means to operate tablet computers for older adults with little previous computer experience. We investigated whether the SmartCards-Tablet-System would (a) increase use of digital communication and (b) affect loneliness, autonomy, cognitive ability and wellbeing of the users., Methods: The suitability and acceptance of the system was evaluated during a three month trial period with seniors in retirement homes, seniors with home assistance care and a waiting control group., Results: Acceptance, duration of use and frequency of use were high in both experimental groups. Cognitive ability significantly improved after three months' use in both experimental groups. Effects on loneliness, autonomy and wellbeing could not be observed., Discussion: Our results indicate that seniors are very much able and curious to use modern digital devices if the interface and hardware are adjusted to their needs and capabilities without being stigmatizing. The use of modern communication services and the World Wide Web can promote contact of seniors with their (younger) relatives.

Spontaneous face touching (sFST) is an ubiquitous behavior that occurs in people of all ages and all sexes, up to 800 times a day. Despite their high frequency, they have rarely been considered as an independent phenomenon. Recently, sFST have sparked scientific interest since they contribute to self-infection with pathogens. This raises questions about trigger mechanisms and functions of sFST and whether they can be prevented. This systematic comprehensive review compiles relevant evidence on these issues. Facial self-touches seem to increase in frequency and duration in socially, emotionally as well as cognitively challenging situations. They have been associated with attention focus, working memory processes and emotion regulating functions as well as the development and maintenance of a sense of self and body. The dominance of face touch over other body parts is discussed in light of the proximity of hand-face cortical representations and the peculiarities of facial innervations. The results show that underlying psychological and neuro-physiological mechanisms of sFST are still poorly understood and that various basic questions remain unanswered., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Healthcare professionals and expecting mothers frequently voice concerns that massages during pregnancy might cause complications or premature labor. This PRISMA review outlines current results on effects, side effects and contraindications of relaxation massage during pregnancy. Inclusion criteria: all randomized controlled trials (RCT) comparing relaxation massage during pregnancy with standard care or standard care plus another intervention (i.e., progressive muscle relaxation). Restrictions were full text availability and English language. Results: 12 RCT were included. Trials had good methodological quality but unknown risk of bias. All women were at least 12 weeks gestation at the start of the study. The main benefits of massage during pregnancy were: reduced stress, back and leg pain, depression and anxiety; increased immune response; increased serotonin and dopamine levels; higher fetal birth weight and reduced risk of preterm delivery. Only 2 RCT reported potential side effects of massage, which were minor and transient. Seven RCT excluded women with difficult pregnancies or preexisting complications, five studies did not report preexisting conditions. Those obstetric or postnatal complications that occurred were most likely unrelated to massage treatments. In healthy pregnant women without complications, relaxation massage has positive effects throughout pregnancy. Precautions for massage during pregnancy (i.e., to prevent pulmonary embolism) are discussed.

Psoriasis is polygenic, interleukin (IL)-17 and IL-23 driven chronic relapsing inflammatory multisystem disease caused by a complex interplay of endogenous and environmental factors. The most common and distressing symptom in psoriasis is itch, adding significantly to the burden of disease. Although histamine has historically not been considered a key itch mediator in psoriasis, there is some evidence from the literature that antihistamines may be effective to reduce itch in psoriasis. This review focuses on the role of antihistamines in the management of itch in psoriasis. The literature search included peer-reviewed articles published in English language (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) until January 2021 and by reference lists of respective articles. J Drugs Dermatol. 2021;20(8):844-847. doi:10.36849/JDD.5966.

In a previous proof-of-concept study we have demonstrated that visual exposure to specific colors results in pruritic or antipruritic effects. To determine the effect of "antipruritic" colors when using immersive virtual reality (VR) and to assess whether psychometric values correlate with the response to the color exposure. In this cross-sectional interventional single-center study, itch patients were exposed to their subjective "antipruritic color" (defined by the Manchester Color Wheel) in a virtual monochromatic room for 10 min using a head-mounted display. Itch intensity rating (0-10 numerical rating scale [NRS]) was repeated at 1-min intervals. Additionally, dermatology life quality index, itch-related quality of life and the Hospital Anxiety and Depression Scale questionnaires were completed. Twenty-two patients (mean age 51.9 ± 23 years, 13 females) participated in the study. Following color exposure for 10 min itch intensity was significantly reduced compared to baseline (exact Wilcoxon signed-rank test, mdn-NRS 4.5 vs 3.0; z = -3.025, p = 0.001), confirmed by the area under the curve (z = -3.118; p = 0.001). No significant correlation between itch reduction and questionnaire scores was found (Spearman's Rho for all questionnaires). Visual exposure to the "antipruritic color" using immersive VR resulted in a significant decrease in itch intensity. This aligns with previous findings on the influence of colors on itch perception. The response of the intervention appeared independent of psychometric values. Thus, color exposure using immersive VR is a promising, low-cost, rapidly-acting, easily-applicable, non-pharmacological experimental antipruritic method., (© 2021 Wiley Periodicals LLC.)

Background: In the past two centuries, generations of dermatologists around the world have created an enormous number of publications. To our knowledge, no bibliometric analysis of these publications has been performed so far, nor have registered trials been analysed to anticipate future publication trends., Objectives: To determine the global distribution of national publication productivity, most published topics, institutions and funding sources contributing most to publications and to anticipate future trends based on registered clinical trials., Methods: Following pre-assessment on PubMed, Embase, Web of Science and Scopus, the number of publications for 'dermatology' was determined for each of 195 countries, normalized per 1 Mio inhabitants and bibliometrically analysed. Dermatology-related trials registered at clinicaltrials.gov were specified by the top-10 diagnoses for the top-10 countries., Results: The search yielded 1 071 518 publications between 1832 and 2019 with the top-5 diagnoses being melanoma, basal cell carcinoma, psoriasis, pruritus/itch and atopic dermatitis. The top-3 countries with highest absolute numbers of publications were the USA (30.6%), Germany (8.1%) and the UK (8.1%), whereas Switzerland, Denmark and Sweden had the highest publication rates when normalized by inhabitants. The most productive affiliation was the Harvard Medical School, the leading funding source the National Institutes of Health. Currently, maximum number of trials are registered in the USA (8111), France (1543) and Canada (1368). The highest percentage of all dermatology-related trials in a specific country were as follows: Melanoma in the Netherlands (24.8%), psoriasis in Germany (21.7%) and atopic dermatitis in Japan (15.9%)., Conclusion: The top-10 countries including the USA, Canada, a few European and Asian countries contributed more than 3/4 of all publications. The USA hold the dominant leader position both in past publication productivity and currently registered trials. While most Western countries continue to focus their research on the top-10 topics, China and India appear to prioritize their scope towards other topics., (© 2021 European Academy of Dermatology and Venereology.)

We report scanning tunneling microscopy (STM) studies of individual adatoms deposited on an InSb(110) surface. The adatoms can be reproducibly dropped off from the STM tip by voltage pulses, and impact tunneling into the surface by up to ∼100×. The spatial extent and magnitude of the tunneling effect are widely tunable by imaging conditions such as bias voltage, set current and photoillumination. We attribute the effect to occupation of a (+/0) charge transition level, and switching of the associated adatom-induced band bending. The effect in STM topographic images is well reproduced by transport modeling of filling and emptying rates as a function of the tip position. STM atomic contrast and tunneling spectra are in good agreement with density functional theory calculations for In adatoms. The adatom ionization effect can extend to distances greater than 50 nm away, which we attribute to the low concentration and low binding energy of the residual donors in the undoped InSb crystal. These studies demonstrate how individual atoms can be used to sensitively control current flow in nanoscale devices., (© 2021 IOP Publishing Ltd.)

Slow-wave sleep (SWS) has been shown to promote long-term consolidation of episodic memories in hippocampo-neocortical networks. Previous research has aimed to modulate cortical sleep slow-waves and spindles to facilitate episodic memory consolidation. Here, we instead aimed to modulate hippocampal activity during slow-wave sleep using transcranial direct current stimulation in 18 healthy humans. A pair-associate episodic memory task was used to evaluate sleep-dependent memory consolidation with face-occupation stimuli. Pre- and post-nap retrieval was assessed as a measure of memory performance. Anodal stimulation with 2 mA was applied bilaterally over the lateral temporal cortex, motivated by its particularly extensive connections to the hippocampus. The participants slept in a magnetic resonance (MR)-simulator during the recordings to test the feasibility for a future MR-study. We used a sham-controlled, double-blind, counterbalanced randomized, within-subject crossover design. We show that stimulation vs. sham significantly increased slow-wave density and the temporal coupling of fast spindles and slow-waves. While retention of episodic memories across sleep was not affected across the entire sample of participants, it was impaired in participants with below-average pre-sleep memory performance. Hence, bi-temporal anodal direct current stimulation applied during sleep enhanced sleep parameters that are typically involved in memory consolidation, but it failed to improve memory consolidation and even tended to impair consolidation in poor learners. These findings suggest that artificially enhancing memory-related sleep parameters to improve memory consolidation can actually backfire in those participants who are in most need of memory improvement.

Vulvar lichen sclerosus (VLS) is a chronic inflammatory skin disease of the anogenitalarea leading to itch, burning, sexual dysfunction and impaired quality of life. An unmet need in the context of LS is a practical, easily assessable grading scale to classify disease severity and to allow intra- and interindividual comparisons. The objectives of this study were i) to assess the prevalence and severity of 23 items proposed by a recent Delphi consensus group in patients with adult VLS. ii) to develop a clinical severity scale and, iii) to test the interrater reliability of this novel severity scale. A retrospective assessment of the prevalence and severity of 23 items in 143 patients was performed by using patient records and photo documentation to develop a novel clinical severity scale (i.e. the "Clinical Lichen Sclerosus Score" = CLISSCO) for VLS. Thereafter, the CLISSCO was validated by 16 raters. We found that the items proposed by the consensus group vary markedly in frequency and severity. Following selection of the most relevant items, the CLISSCO was developed consisting of 3 "Symptoms", 3 "Signs" and 6 "Architectural changes" rated on a 0-4 point Likert-scale. The intraclass correlation coefficient was excellent for each item, the applicability of the CLISSCO considered user-friendly by the raters. We conclude that the CLISSCO proved to be a user-friendly, reliable tool to assess disease severity in VLS. However, further studies are needed to validate its applicability and value in daily practice and clinical research., (© 2021 Wiley Periodicals LLC.)

Imiquimod 5% is approved for topical treatment of actinic keratosis (AKs), superficial basal cell carcinoma and condylomata acuminata, the 3.75% formulation for the treatment of AKs and genital warts. Imiquimod has also been used off-label in various other skin conditions (eg, Bowen's disease, lentigo maligna, vulvar intraepithelial neoplasia). As a toll-like receptor 7/8 (TLR7/8) agonist imiquimod induces a local inflammatory response by increased production of cytokines, co-stimulatory molecules, activation of Nk-cells and antigen-specific T-cells. In addition to imiquimod-associated adverse effects at non-application sites such as fever, vertigo or myalgia there have been anecdotal reports of distant inflammatory mucosal reactions-a side effect not declared in the medicinal product information. In this scoping review we collected a total of seven cases of patients with lesions of the oral mucosa and lips and summarized pathophysiological hypotheses to explain this type of side effect. The review is complemented with an illustrated report of a 87-year-old female patient of ours suffering from chronic lymphocytic leukemia (CLL) who developed severe oral mucosal and labial reactions following application of imiquimod 3.75% for treatment of AKs. She denied accidental transfer of imiquimod and was tested negative for herpes simplex virus (PCR) and bacteria (culture) from lesional swabs., (© 2020 Wiley Periodicals LLC.)

The purpose of this study is to examine consumers' reactions to the introduction of nutrition and ingredient labelling for wine, a product that is so far still exempt from mandatory nutrition and ingredient labelling. It also analyses the effect of positive and negative information about the use of ingredients in wine on consumers' choice. Representative samples for wine consumers from three distinctly different countries representing old and new wine markets (Australia, n = 745; Germany, n = 716; Italy, n = 715) completed a discrete choice experiment (DCE) with graphically simulated wine back labels. For each country, respondents were randomly allocated to a reference group and two different treatment conditions where they received newspaper-like information (positive, negative) before making choices. Results for the reference condition show that consumers across all three countries have a significant positive utility for detailed nutrition information. Instead, ingredient information only receives a positive utility in Italy, whereas German and Australian respondents do not receive utility from ingredient labelling. When consumers in the treatment group are confronted with negative media information the attribute importance of ingredients significantly increases across all three countries, clean labelled products without ingredients are preferred, and a significantly higher share of consumers in Germany and Italy prefer not to buy any wine. The treatment effect of positive media information on consumers' wine choice is lower than that of negative information. The results of the study have implications for the pending new regulation of wine labelling and for communication strategies of the wine industry that should actively inform consumers about the necessity of ingredients in wine production., (Copyright © 2020. Published by Elsevier Ltd.)

Epidemiologic studies suggest that individuals with tattoos are more extroverted, aggressive, and more likely to take risks than individuals with no tattoos. Whether these personality traits affect athletic performance is uncertain. We compared behavioral patterns and rates of success of football players at the International Federation of Association Football (FIFA) World Cup 2018 by tattoo status. In this cross-sectional study, 32.7% of football players had visible tattoos (241 of 736), mostly on their arms (97.1%). Footballers with tattoos played longer on average (208 versus 160 minutes; P < .001), received more cards (.38 versus .27; P < .001), and committed more fouls per player (2.64 versus 2.2; P < .001). Players with tattoos attempted more shots at goal (P = .016), but without higher goal success (P = .204). The higher number of disciplinary events (being whistled for fouls and given yellow or red cards) and longer playing time of football players with tattoos may reflect personality traits reported in nonathletic individuals with tattoos, such as dominance, extroversion, aggressiveness, and willingness to take risks., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The traditional patient-physician relationship is being changed by the patients' searches for medical information on the Internet and in social media (SM). Freely available medical information online bears enormous potential but also holds dangers. In this cross-sectional, questionnaire-based study, the patients' motivation, preferences and unmet needs when searching for medical information online and the impact on the patient-physician relationship were assessed using Spearman's correlation coefficients, χ 2 -tests and paired t-tests. Among 460 participants, 82.4% had already used the Internet/SM to gain medical information, but in only 9.4% their dermatologists had raised this topic. Online search for medical information was associated with female gender (P = .048), a higher skin-related burden (P = .020), higher level of education (P = .072), higher income (P = .019), anxiety (P = .004), and adnexal skin diseases (P = .043). For 16.1% of patients, "the Internet/SM" was their most important source of medical information; 81.4% deemed the impact of their online searches on their patient-physician relationship as neutral, 16.0% as positive, 2.6% as negative. The patients' top three unmet needs were "Online consultations", "Professional content on YouTube" and "Chat opportunities". Online search for medical information is a very important topic for most dermatology patients but it may not be adequately addressed by dermatologists. Our results indicate that from the patients`perspective such online searches do not have a significant impact on patient-physician relationship., (© 2020 Wiley Periodicals LLC.)

(Audio-)visual itch transmission is referred to as "contagious itch" (CI) and has been linked to an evolutionarily ingrained ectoparasite defense system. Disgust is considered to be part of the behavioral immune system aimed to prevent the spreading of pathogens. Although they probably serve a similar purpose, the relationship between CI and disgust is unknown. We investigated their co-prevalence, correlation, and differences between the sexes and between skin-diseased and skin-healthy individuals. Medical students attending a lecture on ectoparasitic infestation indicated their change in itch and disgust compared to baseline on a 0 to 10 numerical rating scale (NRS) and specified which ectoparasitic infestation induced CI and disgust the most. Out of 132 participants, 87.9% reported CI, 84.1% disgust. The maximum intensity of CI was 3.68 ± 2.08 NRS (P < .0001), of disgust 3.80 ± 2.68 NRS (P < .0001), respectively. The CI and disgust correlated positively (rho 0.272; P = .002), but we also found that specific ectoparasitic infestations triggered rather itch than disgust and vice versa. Our results indicate that CI and disgust are coincident phenomena of distinct defense systems: CI is aimed to scrape off ectoparasites, disgust to prevent ingestion of pathogens. Furthermore, our data point to differences in CI and disgust between the sexes and skin-healthy vs skin-diseased participants., (© 2020 Wiley Periodicals LLC.)

The resistant and recalcitrant nature of severe allergic contact dermatitis (ACD) makes its management challenging. With advances in the understanding of the cellular and molecular pathogenesis of ACD, newer therapeutic targets are becoming apparent. In particular, the use of biologics has gained momentum, given the specificity of their action. This article aims to review the presently available data on the use of biologics in ACD. English-language-based literature available on the use of biological therapy was thoroughly probed in the following databases as on October 14, 2019: PubMed, Google Scholar, The Cochrane library, Embase, Scopus, and EBSCO. The following keywords were used: "contact dermatitis", "allergens", "delayed-type hypersensitivity reaction", "biologics", "biological therapy", "monoclonal antibodies", "patch testing", "TNF-α inhibitors", "infliximab", "adalimumab", "etanercept", "dupilumab", "omalizumab", "secukinumab", "ustekinumab", "rituximab"., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Dehydrated human amnion/chorion membrane allograft (dHACM) derived from placenta is increasingly used for skin and soft tissue repair in several medical specialties. Promising effects of dHACM were also reported in chronic venous and diabetic leg ulcers. However, dHACM is cost-intensive and its effect on chronic leg ulcers of other etiologies and pain reduction is unknown. Clinical predictors of a favorable response to dHACM during the early treatment period could help to limit unnecessary costs. In our case series with six patients suffering from chronic lower leg ulcers of various etiology, the effect of dHACM once per week on reduction of pain and wound size during a 5-week period was examined. dHACM resulted in effective pain reduction and improved wound healing in three patients with chronic leg ulcers due to calciphylaxis, chronic venous disease and reactive angioendotheliomatosis. Pain reduction after 1 to 2 applications of dHACM predicted a favorable healing response. Hence, our observation indicates that assessment of pain 3 weeks after initiation of dHACM may be a clinical predictor to justify dis-/continuation of dHACM and thereby may help to limit costs., (© 2020 Wiley Periodicals LLC.)

Itch is the commonest skin-related symptom, associated with a high psychosocial and economic burden. While the main focus of itch research lies on a few chronic skin diseases, only little is known about the perception of itch, itch-aggravating/-relieving factors and treatment preferences in patients with acute and chronic itch of various etiology. In this cross-sectional study, we assessed these aspects in 126 patients (mean age 61.7 ± 18.4 years, 67 females, median itch duration 3.9 years) using a 78-item questionnaire. The diseases were categorized into 11 diagnostic groups for descriptive analysis; the three most frequent groups ("atopic dermatitis," "nonatopic eczema," "inflammatory dermatoses") were statistically compared. Itch was most often perceived as localized 42.9%, burning (40.5%), and worrying (39.7%) with worsening in the evening (49.2%), due to warmth (42.1%) and sweating (26.2%). While itch perception, itch-aggravating factors and treatment preferences differed broadly among patients, the itch-relieving personal strategies were more uniform ("scratching by hand 70.6%, applying topicals 57.9%). Also, 69.8% of patients suffered from itch-related sleep disturbance, consequently affecting their relatives in 30.0%. Subgroup comparisons revealed significant differences regarding itch-aggravating factors (P = .0012) and itch duration (P = .0082). Patients rated the antipruritic effectiveness of phototherapy, "complementary and alternative medicine" and "other tablets" as high, but oral antihistamines, "cortisone tablets" and any topical as only moderately efficacious. The preferred administration of an ideal itch treatment was "creams/ointments" (51.6%) or "tablets" (35.7%), only few patients preferred "injections" or "patches." Consideration of such differences and similarities in itch characteristics and treatment preferences could help to better tailor treatment in itch patients., (© 2020 Wiley Periodicals LLC.)