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Climate change is the greatest threat to global health. As climate change worsens, heat waves will be longer, more intense, and more frequent. Increased health risks from climate change and heat waves include heat-related illness (HRI). HRI increases ED visits, hospitalizations, and mortality. Healthcare providers should be aware of the impact of medications on risk for HRI. This article elucidates signs and symptoms, populations at risk, drugs and mechanisms that increase risk, and patient education to reduce risk. [ABSTRACT FROM AUTHOR]

The article describes the case of a 23-year-old gentleman with progressively increasing paraparesis over the past two years and an active smoker for the past four years. Topics discussed include findings on medical examination, a presumptive diagnosis of non-compressive dorsal myelopathy made, and a targeted biopsy of the spinal cord he underwent which revealed granulomatous vasculitis.

The physiological role of α‐melanocyte stimulating hormone in regulating integumental pigmentation of many vertebrate species has been recognized since the 1960's. However, its physiological significance for human pigmentation remained enigmatic until the 1990's. α‐Melanocyte stimulating hormone and related melanocortins are synthesized locally in the skin, primarily by keratinocytes, in addition to the pituitary gland, and therefore act as paracrine factors for melanocytes. Human melanocytes express the melanocortin 1 receptor, which recognizes α‐melanocyte stimulating hormone and the related adrenocorticotropic hormone as agonists. This review summarizes the current knowledge of the pleotropic effects of the activated melanocortin 1 receptor that maintain human melanocyte homeostasis by regulating melanogenesis and the response to environmental stressors, mainly solar radiation. Certain allelic variants of the melanocortin 1 receptor gene are associated with specific pigmentary phenotypes in various human populations. Variants associated with red hair phenotype compromise the function of the encoded receptor. Activation of the human melanocortin 1 receptor regulates eumelanin synthesis and enhances DNA damage response of melanocytes to solar radiation and oxidative stressors. We describe how synthetic selective melanocortin 1 receptor agonists can be efficacious as sunless tanning agents, for treatment of vitiligo and photosensitivity disorders, and for prevention of skin cancer, including melanoma. [ABSTRACT FROM AUTHOR]

Mogamulizumab is a first‐in‐class IgG1k monoclonal antibody that selectively targets the chemokine receptor type 4. The drug has received Food and Drug administration authorisation for mycosis fungoides and Sézary syndrome following failure of at least one previous course of systemic therapy and now is available in Europe. One of the most common treatment‐related side effects observed has been the mogamulizumab‐associated rash (MAR), which affects up to a quarter of patients and is the most frequent adverse event leading to drug discontinuation. The aim of this study is to perform a systematic review of the literature on patients diagnosed with MAR and other mogamulizumab‐related cutaneous events to describe the clinical and histological characteristics, the management in clinical practice and to assess whether these events have prognostic implications. In total, 2073 records were initially identified through a literature search, 843 of which were duplicates. After screening for eligibility and inclusion criteria, 49 articles reporting mogamulizumab‐associated cutaneous events were included. Totally, 1516 patients were retrieved, with a slight male prevalence as for the available data (639 males and 570 females, i.e. 52.9% vs. 47.1%). Regarding the reported clinicopathological findings of the cutaneous reactions, the five most common patterns were spongiotic/psoriasiform dermatitis (22%), eruptions characterized by the presence of papules and/or plaques (16.1%), cutaneous granulomatosis (11.4%), morbilliform or erythrodermic dermatitis (9.4%) and photodermatitis (7.1%). Our results highlight how the majority of the reported cutaneous adverse events on mogamulizumab are of mild‐to‐moderate entity and generally manageable in clinical practice, though prompt recognition is essential and case‐by‐case assessment should be recommended. Future research will need to focus on the MAR prognostic implications and to identify genomic and molecular markers for a more rapid and accurate diagnosis. [ABSTRACT FROM AUTHOR]

Protoporphyria is a subtype of porphyria characterized primarily by painful phototoxic skin reactions after light exposure at specific wavelengths. Historically, phototherapy is not contraindicated in patients with protoporphyria since there have not been any reports of phototoxic reactions. However, patients with protoporphyria are advised to avoid direct sunlight. In this case report, we describe a neonate not known to have X-linked protoporphyria who received phototherapy for 1 to 2 hours. Within hours after initiation of phototherapy, this neonate developed a life-threatening reaction consisting of rash over the distribution of phototherapy, acute liver failure with coagulopathy, diffuse hypotonia with diaphragmatic failure, and subsequent acute respiratory failure that required mechanical ventilation. As in this case, patients with protoporphyria-related acute liver failure can have signs and symptoms similar to that of an acute hepatic porphyria attack. Neither neonatal reactions to phototherapy nor liver failure temporally associated with phototherapy have been reported in patients with X-linked protoporphyria. Early recognition of this entity is crucial in light of potential life-threatening complications. Therefore, providers must react quickly when neonates have abnormal reactions to phototherapy and consider protoporphyria in the differential diagnosis. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to assess the prevalence and characteristics of, and knowledge about, photosensitivity and the use of photoprotective measures in an international cohort of cutaneous lupus erythematosus and SLE patients. Methods We conducted an international, cross-sectional study based on a 46-question web-based survey, including patients with medically confirmed lupus erythematosus, conducted between November 2021 and April 2022. Results A total of 600 patients with lupus erythematosus [94% female, median age: 41 years, interquartile range (IQR): 33–51] from 50 countries were included. A history of photosensitivity was reported by 389/600 (64.8%) patients. Photosensitivity was associated with the presence of other cutaneous involvement [odds ratio (OR) = 3.8; 95% CI 2.5–5.7; P  < 0.001] and differed according to the area of residence and level of education (P  < 0.001, for all). Photosensitivity was characterized by a wide range of clinical manifestations (both cutaneous and systemic symptoms in 56.1% and systemic symptoms only in 29.8% of patients). Fatigue was the most frequently reported systemic manifestation (82.3%). Overall, 559/600 (93%) patients were aware of the detrimental role of ultraviolet radiation exposure in lupus erythematosus, but 160/480 (33.3%) were unaware of the importance of photoprotective measures, including 90/310 (29%) among those with photosensitivity. Conclusion A high rate of self-reported photosensitivity characterizes lupus erythematosus patients. Photosensitivity frequently includes subjective features, which makes it difficult to evaluate in clinical practice. As fatigue is frequent in lupus erythematosus, further study is needed to clarify the causal link with ultraviolet radiation exposure. About one-third of lupus erythematosus patients are unaware of the importance of photoprotective measures. This should be improved through more frequent and targeted awareness interventions. [ABSTRACT FROM AUTHOR]

Simple Summary: Many cancer treatments, including chemotherapy, targeted therapy, immunotherapy, and radiotherapy, can cause skin side effects. These are called 'dermatologic toxicities' or 'skin toxicities'. There are many different types of skin toxicities, some of which can not only affect the quality of life but also lead to cancer treatment being stopped or slowed down. This paper gives an overview of 12 of the most common skin toxicities experienced by people receiving cancer treatment. These include rashes, dry skin, skin irritation, hair loss, changes in skin colouring, and itching. We have provided Australia/New Zealand-specific recommendations on how skin toxicities can be prevented and managed, including the role of dermocosmetic solutions. Cancer systemic therapeutics and radiotherapy are often associated with dermatological toxicities that may reduce patients' quality of life and impact their course of cancer treatment. These toxicities cover a wide range of conditions that can be complex to manage with increasing severity. This review provides details on twelve common dermatological toxicities encountered during cancer treatment and offers measures for their prevention and management, particularly in the Australian/New Zealand context where skincare requirements may differ to other regions due to higher cumulative sun damage caused by high ambient ultraviolet (UV) light exposure. Given the frequency of these dermatological toxicities, a proactive phase is envisaged where patients can actively try to prevent skin toxicities. [ABSTRACT FROM AUTHOR]

Background: With the rise in cosmetic usage, adverse reactions related to cosmetics have also risen. Photocontact dermatitis to cosmetics is a challenging entity to diagnose and manage. Objectives: To evaluate the clinical features and photocontact sensitivity patterns in patients with cosmetic dermatitis and establish their association based on patch and photopatch test results. Methods: A prospective observational study, where 80 patients with a clinical diagnosis of cosmetic dermatitis were patch or photopatch tested (as per indication) with the Indian standard series, Indian cosmetic and fragrance series, and the patient’s personal product(s). Results: A total of 104 positive reactions were observed in 57/80 patients, of which 50 were relevant to cosmetics usage. Sixty-five patients underwent a photopatch test, and 17 tested positive. Photosensitivity in patients was significantly associated with a positive photopatch test (p-value < 0.001). Various new photo-allergens were discovered, including propylene glycol, triethanolamine, chloroacetamide, isopropyl myristate, cetrimide and hexamine. Facial melanosis was a predominant clinical finding in 44 patients, with pigmented contact dermatitis detected in 19 (43.2%) of these cases. Limitations: Patients’ personal products could not be tested on every patient. Chemical analysis of indigenous products and the individual chemical ingredients of the patient’s personal products could not be patch-tested separately. Phototesting was not performed in patients with photosensitivity. Conclusion: In patients with suspected cosmetic dermatitis with history of photosensitivity or those with facial melanosis of unknown origin, a photopatch test is crucial to detect potentially hidden photo allergens. Many new photo allergens have emerged in the present study. Cosmetic companies should provide detailed information regarding each constituent of the cosmetic products. [ABSTRACT FROM AUTHOR]

Purpose: The skin and mucous membrane of cancer patients can be directly or indirectly impaired during the treatment of cancers, bringing about not physical but also psychological damages to cancer patients. A practical guideline is of great significance to improve the quality of life for patients suffered from cutaneous adverse events. Methods: This guideline was generated based on up-to-date evidence and the consensus of experts specialized in dermatology. Results: The current guideline include the baseline screening of skin and mucosal membranes, the manifestations of injuries on skin, mucosa and appendages, along with the treatment of them. The causal anti-tumor management include chemotherapy, radiotherapy, immune therapy and surgery. Conclusion: This guideline can be helpful to reduce the risk of cutaneous adverse events during anti-cancer treatment and improve the quality of life of patients suffered from these adverse events. [ABSTRACT FROM AUTHOR]

Cutaneous lupus erythematous (CLE) is an autoimmune dermatological disorder that typically presents with photosensitivity. CLE in older patients is characterised by more drug-induced and other subacute CLE, and a generally milder and shorter disease course. This is balanced by an increased susceptibility to adverse drug events such as skin atrophy. Eliminating possible precipitating medications (e.g. thiazide diuretics, antifungals) and sun avoidance with vitamin D monitoring are key preventative strategies. Topical corticosteroids and calcineurin inhibitors are first-line therapies, then systemic agents such as the antimalarial hydroxychloroquine, short-term corticosteroids and immune modulators. Renal and hepatic compromise may limit options. [ABSTRACT FROM AUTHOR]

Introduction: As a result of genetically being deficient of melanin, albinos are particularly susceptible to skin damage from ultraviolet rays leading to photodermatoses such as sunburns, dermatoheliosis, and cutaneous cancers. These negatively affects quality of life and cause premature death. Little is known of the photoprotective measures available to and dermatological profile of persons with albinism in Plateau state, North Central Nigeria. Objective: To describe the dermatological profile of albinos in Plateau state, Nigeria, photo exposure levels, photoprotection strategies, and factors associated with presence of photodermatoses. Patients and methods: Consenting individuals with albinism attending the sensitization event hosted by the Centre for Albinism Right and Empowerment Network were recruited. Demographic information, occupational history, solar exposure, photoprotective practices, and perceived sun exposure were all documented using semistructured questionnaires. Physical and dermatological examination, dermoscopy, and laboratory investigations were used to make diagnosis. Statistical package for social sciences, version 26, was used to carry out univariate and bivariate analysis. Results: While a wide spectrum of skin diseases was observed among the 59 albinos that participated. Photodermatoses were three times more than nonphotodermatoses. The commonest photodermatoses were solar elastosis (55.9%), solar lentigines (44.1%), actinic keratosis (27.1%), and sunburn (25.4%). Skin cancers affected 10.2% of all patients and 16.6% of persons more than or equal to 20 years. Generally, the presence of photodermatoses was associated with age and occupation while actinic keratotic changes specifically was associated with living in rural areas (P=0.035). Despite this, only seven (11.9%) owned sunscreen at the time of study with more than a third (35.2%) being ignorant of existence of sunscreen lotions. Conclusion: Continuous multifaceted programs that involve tracking, education, prevention, early detection, and treatment of photodermatoses will be planned to be targeted towards persons with albinism living in Plateau state. [ABSTRACT FROM AUTHOR]

The congenital photosensitivity disorders present as cutaneous signs and symptoms secondary to photosensitivity, extracutaneous manifestations, and a predisposition to malignancy. Diagnosis of these conditions mainly depend on clinical findings as the molecular analysis is not always feasible. A review of all the related articles collected after a thorough literature search using keywords, "congenital AND photosensitivity NOT acquired" and the individual diseases was done. A total of 264 articles were included in the review. An algorithm for diagnosis of the different congenital photosensitivity disorders based on the various clinical presentations has been proposed. An early suspicion and diagnosis of the different congenital photosensitivity disorders is the cornerstone behind prompt institution of prevention and treatment, and decreasing the associated morbidity. [ABSTRACT FROM AUTHOR]

Macrolides and tetracyclines are antibiotics that have a range of anti‐inflammatory properties beyond their microbial capabilities. Although these antibiotics have been in widespread use, the long‐term safety profiles are limited. We performed a systematic review and meta‐analysis of randomized clinical trials that compared macrolides or tetracyclines with placeboes to provide long‐term safety information. We searched Medline and EMBASE from inception to October 2022 and identified studies that reported study drug‐related death, serious adverse events (SAEs), or withdrawal rates, and common adverse effects of each drug. Relative risk (RR) and number needed to harm were calculated. Of the 52 randomized clinical trials included, there are 3151 participants on doxycycline, 2519 participants on minocycline, 3049 participants on azithromycin, 763 participants on clarithromycin, 262 participants on erythromycin, and 100 participants on roxithromycin. There was no death related to any study drugs and rates of SAE were not significantly different from placebo in any drug. Overall withdrawal rates were slightly higher than placebo in doxycycline (RR, 1.30; 95% CI, 1.12‐1.52) and minocycline (RR, 1.29; 95% CI, 1.15‐1.46). Withdrawal rates due to adverse events were higher in doxycycline (RR, 2.82; 95% CI, 1.88‐4.22), minocycline (RR, 1.48; 95% CI, 1.09‐1.98), and azithromycin (RR, 1.53; 95% CI, 1.13‐2.08). Gastrointestinal disturbances are the most common tolerable adverse effects for every drug. Photosensitivity and rash are the second most common adverse effects for doxycycline and minocycline. We found no evidence that long‐term use up to 2 years of macrolides or tetracyclines was associated with increased risk of SAEs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Congenital erythropoietic porphyria, or Günther's disease, is a non-acute cutaneous porphyria that is characterized as a rare autosomal recessive disorder, currently approximately 200 cases have been reported in the world with a prevalence of 0.9 per 1,000,000 habitants. CLINICAL CASE: A 38-year-old female patient who consulted for a 12-hour clinical presentation of epigastralgia associated with hematemesis and multiple diarrheal episodes without mucus; additionally she presented dyspnea, cough, edema and thickening of the skin that predominated in the legs, spontaneous ulceration of the skin of the hands and face. History of hirsutism, virilization, and sclerodactyly. On physical examination she had icteric scleras, subconjunctival hemorrhages, atrophic scars on the nasal dorsum and accentuation of barcode lines, erythrodontia, jugular engorgement, occasional rales on the right base, sclerodactyly, calcinosis in hands and face, marked hirsutism, ichthyosis in the lower limbs, lenticular macules, deformity on the back of the hands and pigmentary changes on the outside of the forearms. The paraclinic studies confirmed the diagnosis of congenital erythropoietic porphyria. CONCLUSIONS: Congenital erythropoietic porphyria is an infrequent disease, which occurs mainly in people with a family history, and is due to a deficiency of the enzyme uroporphyrinogen III. The most relevant clinical manifestations are cutaneous photosensitivity, erythrodontia, corneal lesion, chronic hemolytic anemia, and changes in the color of the urine from pink to dark red. [ABSTRACT FROM AUTHOR]

Phytophotodermatitis is a cutaneous phototoxic inflammatory eruption caused after the skin is exposed to photosensitizing compounds in plants, also known as furanocoumarins, and ul-traviolet A radiation. The skin lesions are limited to the areas in contact with the phototoxic agent a sun-exposed, usually appear 24 hours after exposure and peaks at 48- 72 hours. The affected area usually peels and develops permanent hyper or hypopigmentation, which may take months or years to fade. Treatment is essentially symptomatic with topical steroids and application of cold patches, as well as avoidance of sunlight to allow the dermatitis to self-resolve. However, this phenomenon is a chemical burn and should be managed according to the impact. With appropriate identification and removal of the offending agent the prognosis is usually good. This condition may be misdiagnosed as other skin disorders, as allergic contact dermatitis, cellulitis, physical abuse, and it should always be considered in differential diagnosis in sum-mer months.

Background: Erythropoietic protoporphyria is a rare disorder which represents an important health problem in children, causing painful photosensitivity. Little is known on the correlation between genetic profile and clinical manifestations. The standard of care for Erythropoietic protoporphyria is based on avoiding sun and using sun protections, but recent literature has suggested that cimetidine may have a role in improving sun sensitivity. Herein we report our case series describing the successful use of cimetidine and analyzing potential phenotype-genotype correlations. Case presentation: This case series describes five patients presented to our Rheumatology Service complaining sun sensitivity. Blood exams and genetic analysis were consistent with the diagnosis of erythropoietic protoporphyria. Four of 5 patients received cimetidine in addition to standard therapies and the effect of treatment was evaluated by Erythropoietic Protoporphyria - Quality of Life questionnaire. Conclusions: Erythropoietic protoporphyria usually manifests in early childhood after a short sun exposure. Skin manifestations are the main reason for investigations, although sometimes they can be more subtle, leading to a significant diagnostic delay. Skin diseases in children can have profound effects on their family and social relationships. A treatment with cimetidine appears to be an excellent therapeutic option in children with Erythropoietic protoporphyria. [ABSTRACT FROM AUTHOR]

Photodermatoses represent a broad spectrum of skin diseases caused because of exposure to ultraviolet radiation. It is categorized mainly as idiopathic photosensitive disorders, drug or chemical induced photosensitivity reactions, DNA repair-deficiency photodermatoses and photoaggravated dermatoses. Despite being under the photodermatoses umbrella, the pathophysiology of each type of photodermatoses varies. We reported 4 cases of photodermatoses including azathioprine induced pellagra, adult onset actinic prurigo, and photoallergic contact dermatitis due to NSAIDs and cutting fluids. Photoprotection with the usage of photoprotective clothing, broad-spectrum sunscreen application and avoidance of photosensitizing drugs and chemicals are crucial. [ABSTRACT FROM AUTHOR]

This document is a case study titled "Actinic comedonal plaque sine elastosis: a rare presentation or a hitherto unexplored variant of comedonal plaque in skin of color?" published in the Dermatology Online Journal by authors Hilts, Alexis, Ghosh, Kisalay, Behera, Biswanath, et al. The study explores a rare presentation of actinic comedonal plaque in individuals with skin of color. The authors discuss the clinical features, histopathology, and treatment options for this condition. The article is available on the eScholarship website and is copyrighted by the authors under a Creative Commons Attribution-NonCommercial-NoDerivatives License. [Extracted from the article]

The International Journal of Molecular Sciences has published a special issue titled "Molecular Studies of Dermatitis: From Mechanism to Therapy." The issue explores various types of dermatitis, including contact, atopic, seborrheic, and stasis dermatitis, as well as hand eczema. The articles discuss the pathogenesis and treatment of these conditions, highlighting the role of the innate immune system and the involvement of cytokines and chemokines. The issue also covers the prevalence of atopic dermatitis in different populations and the development of new treatments, such as monoclonal antibodies and Janus kinase inhibitors. Overall, the special issue provides valuable insights into the complex nature of dermatitis and its molecular mechanisms. [Extracted from the article]

Objective: Photosensitivity is one of the most common manifestations of systemic lupus erythematosus (SLE), yet its pathogenesis is not well understood. The normal‐appearing epidermis of patients with SLE exhibits increased ultraviolet B (UVB)–driven cell death that persists in cell culture. Here, we investigated the role of epigenetic modification and Hippo signaling in enhanced UVB‐induced apoptosis seen in SLE keratinocytes. Methods: We analyzed DNA methylation in cultured keratinocytes from SLE patients compared to keratinocytes from healthy controls (n = 6/group). Protein expression was validated in cultured keratinocytes using immunoblotting and immunofluorescence. An immortalized keratinocyte line overexpressing WWC1 was generated via lentiviral vector. WWC1‐driven changes were inhibited using a large tumor suppressor kinase 1/2 (LATS1/2) inhibitor (TRULI) and small interfering RNA (siRNA). The interaction between the Yes‐associated protein (YAP) and the transcriptional enhancer associate domain (TEAD) was inhibited by overexpression of an N/TERT cell line expressing a tetracycline‐inducible green fluorescent protein–tagged protein that inhibits YAP–TEAD binding (TEADi). Apoptosis was assessed using cleaved caspase 3/7 and TUNEL staining. Results: Hippo signaling was the top differentially methylated pathway in SLE versus control keratinocytes. SLE keratinocytes (n = 6) showed significant hypomethylation (Δβ = −0.153) and thus overexpression of the Hippo regulator WWC1 (P = 0.002). WWC1 overexpression increased LATS1/2 kinase activation, leading to YAP cytoplasmic retention and altered proapoptotic transcription in SLE keratinocytes. Accordingly, UVB‐mediated apoptosis in keratinocytes could be enhanced by WWC1 overexpression or YAP–TEAD inhibition, mimicking SLE keratinocytes. Importantly, inhibition of LATS1/2 with either the chemical inhibitor TRULI or siRNA effectively eliminated enhanced UVB‐apoptosis in SLE keratinocytes. Conclusion: Our work unravels a novel driver of photosensitivity in SLE: overactive Hippo signaling in SLE keratinocytes restricts YAP transcriptional activity, leading to shifts that promote UVB apoptosis. [ABSTRACT FROM AUTHOR]

Porphyrias are a rare group of inborn errors of metabolism due to defects in the heme biosynthetic pathway. The biochemical hallmark is the overproduction of porphyrin precursors and porphyrin species. Afflicted patients present with a myriad of symptoms causing a diagnostic odyssey. Symptoms often overlap with those of common diseases and may be overlooked unless there is heightened clinical suspicion. We are reporting clinical features and diagnostic challenges in four pediatric patients having variegate porphyria, congenital erythropoietic porphyria, acute intermittent porphyria, and erythropoietic protoporphyria (EPP), who presented with diverse multisystem manifestations. This case series illustrates a logical analysis of symptoms and judicious selection of investigations and the role of genotyping in successfully diagnosing porphyrias. [ABSTRACT FROM AUTHOR]

Kindler syndrome is a rare autosomal recessive disorder belonging to the group of Epidermolysis Bullosa (EB), which encompasses genetic disorders affecting the skin and mucous membranes. This case report aims to contribute to the limited literature on Kindler syndrome by presenting two cases observed at a district hospital in Gujranwala, Pakistan. The cases involve a brother and sister displaying typical symptoms and having a family history of the disease. The objective is to enhance clinicians' awareness of this rare disorder and emphasize the significance of clinical diagnosisdriven management strategies. [ABSTRACT FROM AUTHOR]

Age-related macular degeneration (AMD) is a chronic, multifactorial disorder and a leading cause of blindness in the elderly. Characterized by progressive photoreceptor degeneration in the central retina, disease progression involves epigenetic changes in chromatin accessibility resulting from environmental exposures and chronic stress. Here, we report that a photosensitive mouse model of acute stress-induced photoreceptor degeneration recapitulates the epigenetic hallmarks of human AMD. Global epigenomic profiling was accomplished by employing an Assay for Transposase-Accessible Chromatin using Sequencing (ATAC-Seq), which revealed an association between decreased chromatin accessibility and stress-induced photoreceptor cell death in our mouse model. The epigenomic changes induced by light damage include reduced euchromatin and increased heterochromatin abundance, resulting in transcriptional and translational dysregulation that ultimately drives photoreceptor apoptosis and an inflammatory reactive gliosis in the retina. Of particular interest, pharmacological inhibition of histone deacetylase 11 (HDAC11) and suppressor of variegation 3-9 homolog 2 (SUV39H2), key histone-modifying enzymes involved in promoting reduced chromatin accessibility, ameliorated light damage in our mouse model, supporting a causal link between decreased chromatin accessibility and photoreceptor degeneration, thereby elucidating a potential new therapeutic strategy to combat AMD.

Rosacea is a chronic skin disease characterized by photosensitivity, abnormal dermal vascular behavior, inflammation, and enhanced expression of the antimicrobial peptide LL-37. We observed that dermal endothelial cells in rosacea had an increased expression of VCAM1 and hypothesized that LL-37 could be responsible for this response. The digestion of double-stranded RNA from keratinocytes exposed to UVB blocked the capacity of these cells to induce adhesion molecules on dermal microvascular endothelial cells. However, a synthetic noncoding snoU1RNA was only capable of increasing adhesion molecules on endothelial cells in the presence of LL-37, suggesting that the capacity of UVB exposure to promote both double-stranded RNA and LL-37 was responsible for the endothelial response to keratinocytes. Sequencing of RNA from the endothelial cells uncovered the activation of Gene Ontology (GO) pathways relevant to the human disease, such as type I and II interferon signaling, cell-cell adhesion, leukocyte chemotaxis, and angiogenesis. Functional relevance was demonstrated as double-stranded RNA and LL-37 promoted adhesion and transmigration of monocytes across the endothelial cell monolayers. Gene knockdown of TLR3, RIGI, or IRF1 decreased monocyte adhesion in endothelial cells, confirming the role of the double-stranded RNA recognition pathways. These observations show how the expression of LL-37 can lead to enhanced sensitivity to UVB radiation in rosacea.

Gefitinib (GFT) is a selective epidermal growth factor receptor (EGFR) inhibitor clinically used for the treatment of patients with non-small cell lung cancer. Bioactivation by mainly Phase I hepatic metabolism leads to chemically reactive metabolites such as O-Demethyl gefitinib (DMT-GFT), 4-Defluoro-4-hydroxy gefitinib (DF-GFT), and O-Demorpholinopropyl gefitinib (DMOR-GFT), which display an enhanced UV-light absorption. In this context, the aim of the present study is to investigate the capability of gefitinib metabolites to induce photosensitivity disorders and to elucidate the involved mechanisms. According to the neutral red uptake (NRU) phototoxicity test, only DF-GFT metabolite can be considered non-phototoxic to cells with a photoirritation factor (PIF) close to 1. Moreover, DMOR-GFT is markedly more phototoxic than the parent drug (PIF = 48), whereas DMT-GFT is much less phototoxic (PIF = 7). Using the thiobarbituric acid reactive substances (TBARS) method as an indicator of lipid photoperoxidation, only DMOR-GFT has demonstrated the ability to photosensitize this process, resulting in a significant amount of TBARS (similar to ketoprofen, which was used as the positive control). Protein photooxidation monitored by 2,4-dinitrophenylhydrazine (DNPH) derivatization method is mainly mediated by GFT and, to a lesser extent, by DMOR-GFT; in contrast, protein oxidation associated with DMT-GFT is nearly negligible. Interestingly, the damage to cellular DNA as revealed by the comet assay, indicates that DMT-GFT has the highest photogenotoxic potential; moreover, the DNA damage induced by this metabolite is hardly repaired by the cells after a time recovery of 18 h. This could ultimately result in mutagenic and carcinogenic effects. These results could aid oncologists when prescribing TKIs to cancer patients and, thus, establish the conditions of use and recommend photoprotection guidelines. [ABSTRACT FROM AUTHOR]

Background/Purpose: Chronic actinic dermatitis (CAD) is a spectrum of diseases with chronic photosensitivity occurring mostly among middle‐aged and older men. We seek to explore the characteristics and pathogenesis of CAD among the Chinese population. Methods: The medical records of 488 CAD cases diagnosed by phototesting at Huashan Hospital, Fudan University from January 2014 to December 2018 were analyzed retrospectively. Results: Among the 488 patients, 344 were male and 144 were female. 84.8% of the cases were over 40 years old at the age of onset, while the remaining with an early age of onset had a prevalence of atopic history of 21.6%. Up to 45.0% of the patients reported excessive sun exposure and outdoor activities before the initiation of symptoms. The typical skin lesions were erythema, papules and plaques laid predominantly in sun‐exposed areas. 42.8% of the cases showed sensitivity to UVB only, 20.7% were both sensitive to UVA and UVB, and 18.2% had UVA sensitivity only. The most predominant photoallergens were chlorpromazine (80.1%), thimerosal (17.2%), potassium dichromate (12.7%), etc. The most prevalent patch test allergens were potassium dichromate (24.4%), thimerosal (20.5%), formaldehyde (16.8%), etc. Conclusions: CAD was more commonly seen in males over 40 years old. The action spectrum of Chinese patients is primarily in the UVB range. Exposure to excessive sunlight or contact allergens and photoallergens are important risk factors. Photobiology tests are essential in detecting photosensitivity and recognizing potential photosensitizers. Early avoidance of confirmed photoallergens and sun exposure may prevent photosensitive reactions from progressing into persistent photosensitivity. [ABSTRACT FROM AUTHOR]

Photoprotection is a critical health prevention strategy to reduce the deleterious effects of ultraviolet radiation (UVR) and visible light (VL). Methods of photoprotection are reviewed in this paper, with an emphasis on sunscreen. The most appropriate sunscreen formulation for personal use depends on several factors. Active sunscreen ingredients vary in their protective effect over the UVR and VL spectrum. There are dermatologic diseases that cause photosensitivity or that are aggravated by a particular action spectrum. In these situations, sunscreen suggestions can address the specific concern. Sunscreen does not represent a single entity. Appropriate personalized sunscreen selection is critical to improve compliance and clinical outcomes. Health care providers can facilitate informed product selection with awareness of evolving sunscreen formulations and counseling patients on appropriate use. This review aims to summarize different forms of photoprotection, discuss absorption of sunscreen ingredients, possible adverse effects, and disease-specific preferences for chemical, physical or oral agents that may decrease UVR and VL harmful effects. [ABSTRACT FROM AUTHOR]

Pemphigus foliaceus is a benign variety of pemphigus group. It is a rare autoimmune blistering disease that affects the skin without mucosal involvement. It can present in endemic and sporadic form; whereby endemic form is common in Brazil and Tunisia, known as fogo selvagem. There was no previous case reported in Malaysia. We report a case of a 43-year-old man, who presented with generalized extensive blisters and vesicles that form crust and scale. The full evaluation established the diagnosis of pemphigus foliaceous. Delay in diagnosis can lead to poor outcomes. Primary care practitioners should be aware of this since the condition can mimic eczema, specifically photodermatitis. [ABSTRACT FROM AUTHOR]

Cockayne syndrome (CS, OMIM #216400 and OMIM #133540) is a rare, progressive, multisystemic disorder that results in premature aging and cachectic dwarfism. It is an autosomal recessive disorder with a prevalence of 2-2.5 per million. Pathogenic variants detected in the ERCC excision repair 6 (ERCC6) and ERCC excision repair 8 (ERCC8) genes are responsible for molecular pathogenesis. In this case report, an 11-year-old boy with severe microcephaly, growth retardation, loss of subcutaneous fat tissue, neuromotor developmental delay, bilateral cataracts, and facial dysmorphism but without dermal photosensitivity, who had a novel missense variant in trans configuration with a nonsense variant is presented. [ABSTRACT FROM AUTHOR]

Light responses are initiated in photoreceptors, processed by interneurons, and synaptically transmitted to retinal ganglion cells (RGCs), which send information to the brain. Retinitis pigmentosa (RP) is a blinding disease caused by photoreceptor degeneration, depriving downstream neurons of light-sensitive input. Photoreceptor degeneration also triggers hyperactive firing of RGCs, obscuring light responses initiated by surviving photoreceptors. Here we show that retinoic acid (RA), signaling through its receptor (RAR), is the trigger for hyperactivity. A genetically encoded reporter shows elevated RAR signaling in degenerated retinas from murine RP models. Enhancing RAR signaling in healthy retinas mimics the pathophysiology of degenerating retinas. Drug inhibition of RAR reduces hyperactivity in degenerating retinas and unmasks light responses in RGCs. Gene therapy inhibition of RAR increases innate and learned light-elicited behaviors in vision-impaired mice. Identification of RAR as the trigger for hyperactivity presents a degeneration-dependent therapeutic target for enhancing low vision in RP and other blinding disorders.

Statement of the Problem: Staphylococcus aureus (S.A) can colonize in the skin, nasal cavity, and oral cavity. In the oral cavity, it can cause dental caries and periodontal disease. Mouthwashes can be used as an adjunct to mechanical plaque control methods to decrease the load of oral microorganisms. Chlorhexidine (CHX) is a commonly used antimicrobial mouthwash with side effects such as changing the sense of taste, tooth discoloration, oral mucosal burning, allergy, and xerostomia. It also has adverse systemic effects, if swallowed. Purpose: This study aimed to assess the effect of photodynamic therapy (PDT) with curcumin and methylene blue (MB) photosensitizers and different laser parameters on S.A colony count. Materials and Method: In this in vitro experimental study, 99 samples of standard-strain S.A were subjected to PDT with curcumin and MB photosensitizers with/without irradiation of 660 and 445 nm laser with different exposure parameters, and CHX in 9 groups (n=11). The samples were cultured in microplates containing Mueller-Hinton agar, and the number of colony forming units (CFUs) was counted after 24 h of incubation at 37°C. Data were analyzed by the Kruskal-Wallis and Dunn tests. Results: The minimum colony count was noted in CHX group (CFUs=0) followed by MB and 660nm diode laser group irradiated for 100 s (CFUs=147.2727±169.35707). The difference in this respect was significant between MB+660nm diode laser for 100 s and other groups (p< 0.05) except for the MB + 660 nm diode laser for 60 s group. Conclusion: CHX is superior to laser for elimination of S.A. However, PDT with 660 nm diode laser + MB has considerable antimicrobial efficacy against S.A; increasing the duration of laser irradiation enhances the antimicrobial effect.

This article presents a case report of a 75-year-old Japanese male who developed depigmented contact dermatitis after using a skin lotion containing phenylbenzimidazole sulfonic acid. The patient experienced discomfort and skin symptoms after using the lotion, which subsided but left behind depigmented spots. Patch tests confirmed an allergic contact dermatitis reaction to phenylbenzimidazole sulfonic acid. The article highlights the possibility of depigmentation due to inflammation at the epidermal-dermal interface and emphasizes the importance of considering this phenomenon in cases of contact allergy to this substance. [Extracted from the article]

Objective: Photodermatoses are a group of cutaneous disorders with abnormal reactions triggered by exposure to sunlight. Previous studies reported varying photodermatoses prevalence in Caucasians and African-Americans; however, it was seldom reported in the Asian population. The aim of our study was to determine the prevalence, clinical characteristics and trend of photodermatoses in Thailand. Materials and Methods: A retrospective chart review was performed at the Faculty of Medicine Siriraj Hospital, Mahidol University using diagnoses from the International Classification of Disease (ICD), Tenth Revisions codes, between January 2005 and September 2021. Results: A total of 561 patients with definite diagnoses of photodermatoses were identified. The prevalence of photodermatoses in the outpatient dermatology clinic was 3 cases per 1,000. The most common photodermatoses were chemical and drug-induced photosensitivity (39.4%), followed by immunologically-mediated photodermatoses (30.1%), photo-aggravated dermatoses (29.4%) and genophotodermatoses (1.1%). Overall phototesting was performed in 276 cases (49.2%). In our study, some photodermatoses had unique clinical characteristics including a pinpoint popular variant of polymorphous light eruption and adult-onset actinic prurigo. Over 16 years, the trend of patients being diagnosed with photodermatoses has continued to rise gradually with an increment of 1.67 times. Conclusion: Photodermatoses are uncommon in Thailand. Some photodermatoses have distinctive clinical features in Asian populations. The trend of photodermatoses in Thailand is continually rising, reflecting an increase in physicians' awareness and knowledge of these cutaneous conditions. [ABSTRACT FROM AUTHOR]

Photosensitization, also known as photodermatitis, is an abnormal reaction of the skin when exposed to light and is caused by accumulation of photosensitizing substances in the skin, resulting in a severe dermatitis of the skin unprotected by unpigmented. There are three types of photosensitization: (a) primary, in which photodynamic chemicals, or plant toxins, reach the skin through the circulation, (b) congenital porphyria, in which there is a metabolic, congenital defect in porphyrin metabolism, and (c) secondary (hepatogenous), which occurs when the capacity of the liver to excrete derived from the catabolism of alimentary chlorophyll is impaired. We consider that liver pathologies are the most important in animals from Romania. [ABSTRACT FROM AUTHOR]

Phytophotodermatitis is a condition caused by contamination of the skin with phototoxic plant substances, followed by exposure to ultraviolet rays. Ficus carica L 1753, belonging to the Moraceae family, can be responsible for acute photodermatitis. We present five cases of photodermatitis caused by contact with Ficus carica L and subsequent exposure to sunlight. A histopathologic study and review of the literature are included. [ABSTRACT FROM AUTHOR]