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Background Chronic illnesses belong to suicide risk factors. The goal of the current study was to estimate the rate of suicide-related behaviors in patients with atopic dermatitis, psoriasis, or acne from a third-person perspective (namely, Austrian dermatologists). Methods A link to a questionnaire specially developed for this study was emailed to 450 self-employed dermatologists in Austria, from which a total of 45 participated. Results Three dermatologists reported more than five patients with atopic dermatitis, psoriasis, or acne who committed suicide in 2017. Seven doctors treated between 1 and 10 such patients suffering from suicidal ideation. These results are suggestive for a low rate of suicidal ideations in Austrian dermatology ordinations. The majority of dermatologists in the sample (82%) knew that these patients are at higher suicide risk. 60% of participants also believed that it rather would not be a problem for them to recognize suicidal ideation. When facing patients in a suicide crisis, reported intervention steps were: referring them to a specialist in psychiatry, or having a conversation about it. In the sample, most challenging about suicide was lack of time and lack of knowledge. Dermatologists were also interested in cooperating with mental health professionals and in the implementation of new prevention strategies (e.g., suicide-related training programs). Analysis revealed that private specialists, as compared with contract physicians, had fewer patients, but spent more time with them. Yet, these differences did not appear to influence the quality of treatment they provided. Treatment quality was defined as the extent to which doctors tell their patients that additional psychological treatments could be helpful and asking them about their emotional state. Female gender and a professional background in psychology impacted positively on treatment quality. Conclusions Possible explanations for the low rate of suicidal ideations reported include the advanced Austrian health care system and dermatologists’ underestimation of the problem. Implications of the study are to promote cooperation between dermatologists and mental health professionals and to address patient suicidality from a first-person perspective (i.e., the patients).

Targeted therapy and immunotherapy have markedly improved prognosis of advanced melanoma patients. With expanded use of these drugs, a range of cutaneous adverse events has emerged. Although the vast majority of adverse events are low-grade, they many cause significant morbidity and can affect patients' quality of life. Early diagnosis and prompt intervention may prevent unnecessary discontinuation of life-saving anticancer therapies. In this article, we review the cutaneous adverse events of small molecules and monoclonal antibodies used for the therapy of melanoma and discuss their pathophysiology and recommendations for prevention and management of these adverse events.

Celulite dissecante e foliculite decalvante podem apresentar, em estágios iniciais, quadro clínico semelhante. Este artigo apresenta os achados ecográficos da celulite dissecante que auxiliam no diagnóstico e na abordagem terapêutica. A ecografia não se substitui à observação, tricoscopia e histopatologia mas pode ajudar ao diagnóstico. Em fase activa, observam-se lesões ovóides de bordos relativamente bem definidos, não encapsuladas, com conteúdo hipoecogénico que comunica com a derme através dos bulbos dilatados de folículos pilosos. Permite distinção com foliculite decalvante, com quisto de triquilema (no caso de lesão única ou poucas lesões) e ao permitir avaliar a inflamação quando combinado com Doppler a cores, poderia servir para monitorizar o controlo da inflamação e a resposta terapêutica. Os autores compartilham 2 casos clínicos ilustrativos, sendo apresentada uma revisão da literatura sobre o tema.

Introdução: A dermatite atópica (DA) é uma doença inflamatória crônica e multifatorial. Casos graves afetam a qualidade de vida. A patogénese é complexa, marcada por resposta imune celular defeituosa, exacerbação da resposta inflamatória Th2 e comprometimento da função de barreira da pele. Evidências sugerem que a vitamina D atua na regulação da resposta imune inata e adaptativa, na redução do processo inflamatório e na melhora da barreira cutânea. O nosso objectivo foi correlacionar os níveis séricos de vitamina D com a gravidade da DA. Material e Métodos: Foram analisados prontuários de 30 pacientes assistidos em um ambulatório de Dermatologia, entre 2015 e 2018. Os pacientes foram divididos em 2 grupos: doença leve (terapia tópica) e doença moderada a grave (usuários de imunossupressores). Resultados: Foram selecionados 10 casos com DA leve e 20 com DA moderada a grave. Entre os pacientes com doença leve, 20% apresentaram deficiência de vitamina D. Quanto aos pacientes com doença moderada a grave, 40% apresentaram vitamina D deficiente. Comparando a média de vitamina D nos dois grupos, não houve diferença estatística entre o valor médio. Conclusão: Estudos sobre associação entre os níveis de vitamina D e gravidade da DA permanecem controversos. Alguns trabalhos reforçam essa associação. Neste estudo, apesar da proporção de pacientes com deficiência de vitamina D ser duas vezes maior entre os pacientes com DA moderada a grave, não houve significância estatística entre os dois grupos, corroborando estudos já publicados. Mais estudos relacionando a dermatite atópica à vitamina D são desejáveis, tendo em vista a sua possível aplicabilidade como terapêutica auxiliar.

Introduction: Atopic dermatitis (AD) is a chronic inflammatory disease that affects both children and adults. The main symptom is pruritus, which has an important impact on quality of life (QoL). The objective of our study was to assess the impact of AD on the quality of life of children through the CDLQI score. Population and Methods: We performed a cross-sectional survey, with descriptive and analytical aims, carried out on the basis of prospective recruitment, carried out over a period of 7 months from December 2017 to June 2018. The study included children (5-16 years) with AD selected during dermatology consultations at the Centre Hospitalier Universitaire of Treichville. Data collected included the socio-demographic characteristics of patients and their AD and the results of a questionnaire on the severity score (SCORAD) and the quality of life index in these children (CDLQI). Results: We included 60 children, mainly within the group from 05 to 09 years (57%). CDLQI average score was 9.9 and mean SCORAD 24. Pruritus, insomnia and sadness had more impact on QoL. We found a strong association between the severity of AD objectified by SCORAD and the CDLQI. Conclusion: The study reveals a high impact of AD on the QoL of children in Abidjan mainly through pruritus, insomnia and sadness. It opens up reflection on the need for education for AD management and the prospect of creating an atopy school in Côte d’Ivoire.

Introdução: As doenças de pele apresentam alta prevalência em ambientes hospitalares. Pacientes hospitalizados com dermatoses associadas apresentam maior risco de mortalidade do que indivíduos sem doenças de pele, reforçando a importância do diagnóstico e tratamento precoces. Métodos: Foi realizada uma revisão sistemática em cinco bases de dados Medline, SciELO, LILACS, Web of Science e Scopus, utilizando as palavras- chave “Inpatients” AND “Dermatology”, abrangendo o período de 2010 a 2020. Em seguida, foi realizada uma revisão narrativa por meio dos autores 'seleção de referências relevantes sobre dermatologia hospitalar, incluindo artigos de revisão, livros e outras publicações. Resultados: Com base na estratégia de busca, foram encontradas 166 publicações, das quais 26 estudos foram elegíveis para inclusão no estudo. A partir desta revisão da literatura, analisamos as frequências de dermatoses em pacientes hospitalizados e os tipos de cuidados dermatológicos. As doenças dermatológicas constituem patologias importantes nos hospitais, sendo as erupções infecciosas e medicamentosas as dermatoses mais prevalentes. Conclusão: Este estudo demonstra que as doenças dermatológicas são altamente frequentes entre os pacientes hospitalizados. A maioria dos estudos corrobora a contribuição da dermatologia para a assistência hospitalar.

Pleomorphic hyalinizing angiectatic tumor (PHAT) is a very rare entity of soft tissue considered a “neoplasm of uncertain behaviour of connective or other soft tissue” by the World Health Organization (2020). It develops in subcutaneous tissue of the lower extremities, more frequently in the region of the ankle and foot, and rarely as a deep-seated soft tissue mass in locations such as the perineum, buttock, arms, head and neck, and viscera. Although inconsistent cytogenetic data have been reported on PHAT so far, there are potential morphological and genetic overlaps with hemosiderotic fibrolipomatous tumor (HFLT) and myxoinflammatory fibroblastic sarcoma (MIFS). Here we report a case of PHAT at the level of the upper third of the right thigh in a 48-year-old patient and we also focus on the differential diagnoses of these entities and conduct a literature review of reported cases.

Antonello Tateo,1 Gabriel Siquier-Dameto,2– 4 Ofir Artzi,5 Dalvi Humzah,6 Beatriz Molina,7 Ravi Jain,6 Arturo Lanzarotti,8 Malika Laouedj,9 Nicolas Dapis,10 Gilberto Bellia11 1Private Practice, Milan, Italy; 2Private Practice, Amsterdam, the Netherlands; 3Private Practice, Mallorca, Spain; 4Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, Universitat de Girona (UdG), Girona, Spain; 5Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 6Private Practice, London, UK; 7Private Practice, Bristol, UK; 8Research & Development, IBSA Institut Biochimique SA, Lugano, Switzerland; 9Clinical Operations, Quantificare SA, Valbonne, France; 10Business Development, Quantificare SA, Valbonne, France; 11Medical Affair, IBSA Farmaceutici Italia, Lodi, ItalyCorrespondence: Gilberto BelliaIBSA Farmaceutici Italia, Lodi, LO, ItalyEmail gilberto.bellia@ibsa.itObjective: To describe the development and validation of the 5-grade photographic IBSA Neck Laxity Scale.Methods: The scale was developed from 2 real images, which led to the creation of 5 morphed images, representing different degrees of severity of laxity of the neck. For validation, a set of 50 images (25 real and 25 morphed) was created and sent for evaluation to 6 trained raters (physicians) in 2 rounds, 1 month apart. Raters had to assess each image according to the 5-image scale. Inter-rater and intra-rater reliability in both rounds was evaluated.Results: As to intra-rater reliability, single rater kappa scores between 0.69 and 0.87, and a global kappa score of 0.78 were observed. Inter-rater agreement was measured by means of the intra-class correlation coefficient and scores higher than 0.85 were reported, indicating excellent reliability.Conclusion: IBSA Neck Laxity Scale is a validated and reliable scale.Keywords: photographic scale, neck, laxity, aesthetic medicine, scale validation, scale development

Shunqing Su, Rurong Xie, Xiumei Ding, Yuechun Lin Department of Burn & Plastic Surgery, Dalang Hospital of Dongguan, Dongguan, 523770, People’s Republic of ChinaCorrespondence: Shunqing SuDepartment of Burn & Plastic Surgery, Dalang Hospital of Dongguan, No. 85 of Jinlang Middle Street, Dalang Town, Dongguan, 523770, People’s Republic of ChinaTel +86 769 83009512Fax +86 769 83009171Email sushunqing_dr88@163.comObjective: This study aims to analyze three cases of bilateral breast absence associated with congenital ectodermal defects in the same family to identify a suitable clinical treatment plan.Methods: Three patients (case 1 and case 2 are a brother–sister relationship; case 3 is their father) complained of the absence of breasts, nipples, and areolas, accompanied by deformity of facial features and fingers; all other clinical indexes were normal. Case 1 first underwent bilateral papillary reconstruction, with areola embroidery carried out six months later. Case 2 first underwent prosthetic breast augmentation, and after ten months, she underwent nipple reconstruction and auricular cartilage, silica gel prosthesis rhinoplasty, epicanthus correction, and areola embroidery. Gene tests were carried out for both cases. Case 3 did not undergo any surgical procedures.Results: The operations achieved good results, although in case 2, the reconstructed nipples retracted and became smaller. Neither of the subjects had adverse reactions after the procedures. A heterozygous mutation of the KCTD1 gene c.2020A>T (p.i674f), a mutation inherited from case 3 (their father), was detected through gene analysis. Copy number analysis and single-nucleotide polymorphism (SNP) analysis were carried out, but no copy number variation possibly related to clinical manifestations was detected.Conclusion: The bilateral breast absence associated with familial congenital ectodermal defects in cases 1 and 2 were found to be induced by a heterozygous mutation of the KCTD1 gene c.2020A>T (p.i674f) inherited from case 3 (their father). Two of the three cases underwent surgical treatment, and good clinical results were achieved.Keywords: bilateral breast absence associated with congenital ectodermal defects, familial inheritance, breast reconstruction, nipple reconstruction, case report

Robert English Jnr, Sophia Ruiz Perfect Hair Health, San Francisco, CA, 94115, USACorrespondence: Robert English JnrPerfect Hair Health, 2021 Fillmore Ste # 98, San Francisco, CA, 94115, USAEmail Rob@perfecthairhealth.comAbstract: Despite decades of study, debate persists over the role of inflammation, fibrosis, and prostaglandins in the histopathology of androgenic alopecia (AGA). This brief review proposes that inconsistent findings across histological studies are a consequence of three inadequately controlled variables: 1) biopsy location, 2) hair diameter diversity (HDD), and 3) relative hair follicle miniaturization (HFM) within and across subjects. We suggest new methodological considerations to improve AGA histopathological research, as well as a novel classification system to quantify HFM by its stages. Finally, we hypothesize a dynamic relationship between inflammation, fibrosis, and prostaglandin activity dependent on relative HFM.Keywords: androgenic alopecia, hair diameter diversity, inflammation, fibrosis, prostaglandins

Nigusie Selomon Tibebu,1 Tigabu Desie,1 Chalie Marew,1 Moges Wubneh,2 Adane Birhanu,2 Agimasie Tigabu2 1Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia; 2Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, EthiopiaCorrespondence: Tigabu DesiePediatrics and Child Health Nursing @ Debre Tabor University, P.O.Box:272, Debre Tabor, EthiopiaEmail tigabud05@gmail.comIntroduction: Burns can have a considerable negative impact on physical and psychosocial functioning that affects the quality of life. The physical and psychological manifestations may compromise the quality of life of burned patients. The aim is to assess health-related quality of life and associated factors among burn patients at Amhara regional state governmental referral hospitals, Northwest Ethiopia, 2020.Methods: Institution-based cross-sectional study was conducted from June 01 to July 15, 2020, in Amhara National regional state governmental referral hospitals. Systematic random sampling technique was used, and data were collected using structured Burn Specific Health Scale Brief Questionnaire through face-to-face interview and document review from patients time since burn 15 days and above. Data were entered into Epidata, and analysis was done by SPSS version 25. Descriptive statistics were computed, and binary logistic regression analysis was used to determine the association between the dependent and independent variables. Variables with a p-value of ≤ 0.05 in the multivariable analysis were considered statistically significant.Results: Of 423 study participants, 95.7% responded completely. Among the respondents, 58.8% (group mean and median of 18.38 and 21) for physical domain and 57% (group mean and median of 44.73 and 53) for generic domains had a poor health-related quality of life. Overall poor health-related quality of life was 57.5% with a mean of 63.12. Third-degree burn, exposed burnt body part, total body surface area burned ≥ 20%, having an amputation and having a co-morbid illness with (P = 0.001) were associated with poor health-related quality of life.Conclusion and Recommendation: This study revealed that more than half of the burn survivors had poor health-related quality of life. There shall be strengthened long-term physical and psychosocial domains (generic) intervention for burn survivors by giving more concern for those with the identified risk factors.Keywords: Amhara, burn injury, Ethiopia, quality of life

Oral lichen planus (OLP) and oral lichenoid lesions (OLL) can both present with histological dysplasia. Despite the presence of WHO-defined criteria for the evaluation of epithelial dysplasia, its assessment is frequently subjective (inter-observer variability). The lack of reproducibility in the evaluation of dysplasia is even more complex in the presence of a lichenoid inflammation. We evaluated dysplasia in 112 oral biopsies with lichenoid inflammation in order to study the inter-observer and the intra-observer variability.

Bullous pemphigoid (BP) is an autoimmune blistering disease resulting from autoantibodies directed against BP180 and/or BP230 proteins. BP is traditionally diagnosed based on clinical features, histologic assessment of cutaneous biopsies, direct (DIF) and indirect immunofluorescence (IIF) studies, and/or enzyme-linked immunoassay (ELISA) analysis. We here report, 6 elderly patients who presented with multiple tense bullae, clinically mimicking BP in the absence of detectable autoantibodies by DIF, IIF, and ELISA for BP-180, BP-230, and type VII collagen autoantibodies. All patients in this case series had histological overlap between BP and eczema, potentially representing a unique form of bullous eczema. Patient demographics are listed in Table I along with clinical images (Fig 1). Patients were evaluated in the Autoimmune Blistering Disease Clinic at Emory University. All patients had at least 2 negative DIFs on 2 separate occasions. Only 1 patient was subject to systemic immune suppression at the time of biopsy, and no history of diabetes, peripheral edema, or arthropod assault was noted. Table I Clinical summary of patients 1 to 6

Granulomatous skin disorders are a heterogeneous group of disorders characterized by granuloma formation on histopathology. They may be triggered by various stimuli, including infectious and non-infectious stimuli (foreign bodies, malignancy, metabolites, and chemicals), of different etiological origins. Although pathophysiological mechanisms are still poorly understood, infectious granuloma formation may occur if the patient’s immune system could not eliminate an agent. Clinically, localized or disseminated infectious granuloma formation can be related to the infectious agent’s pathogenicity or the patient’s immunity. Typical infectious agents causing infectious granulomatous reactions are mycobacteria, fungal infections, or parasites, such as leishmaniasis. This review aims to summarize granulomatous skin diseases encountered more frequently in our clinical experience because of infectious causes.

Background and Design: Type 1 diabetes mellitus (T1DM) can cause significant changes in the skin. However, there are limited studies examining the skin findings in children with T1DM. The objective of this study is to determine the frequency of skin lesions in children with T1DM. Additionally, this study also evaluates the relationship of skin lesions with disease duration and hemoglobin A1c (HbA1c) levels. Materials and Methods: This cross-sectional study enrolled 65 children with T1DM and 78 age- and sex-matched healthy children. Importantly, detailed skin examinations of the cases were conducted. Results: The mean age at the onset of disease was 7.1±3.7 years, and the mean duration of T1DM was 45.9±40.4 months. The mean level of HbA1c in children with T1DM was determined as 8.0±1.6%. In total, 9 (13.8%) of the patients were using insulin infusion pump, whereas 56 of them were using multiple insulin injections therapy. At least one skin lesion related to insulin treatment was recorded in 54 patients (83%). Bruises (50.8%), lipohypertrophy (44.6%), and post-inflammatory hyperpigmentation (26.2%) were among the most observed skin reactions related to the insulin treatment. However, hypopigmented scar was the most frequently observed skin reaction related to the insulin treatment among the patients using insulin infusion pump (5/9, 55%). Only xerosis and rubeosis faciei diabeticorum were found to be significantly higher in the T1DM group, as compared to healthy controls. Xerosis was observed in 19 (29%) patients with DM and 8 (10.2%) healthy controls, whereas rubeosis faciei was observed in 6 (9.2%) patients with DM and 1 (1.3%) healthy control. Although not statistically significant, it was found that the disease duration was longer and HbA1c levels were higher in T1DM patients with rubeosis faciei or xerosis. Conclusion: We believe that significant benefits can be provided for the management and prevention of skin findings in children with T1DM through the training of the patients and caregivers as well as by increasing the awareness of physicians.

Background and Design: This study aimed to compare neutrophil-lymphocyte ratio (NLR), carotid intima-media thickness (CIMT), epicardial fat tissue (EFT), and arterial stiffness values of psoriatic patients with healthy subjects and to determine the relation of these parameters with the severity of psoriasis. Materials and Methods: This study included 102 patients with psoriasis and 102 control subjects matched according to age and gender. CIMT, echocardiographic EFT, arterial stiffness [aortic stiffness index (ASI) and aortic distensibility], anthropometric measurements, psoriasis area and severity index (PASI) score, and metabolic parameters were measured in all patients. Results: The mean NLR in the psoriasis group were significantly higher than in the healthy group (2.3±0.74 vs 1.49±0.36; p

Mal de Meleda (MDM), also called keratoderma palmoplantaris transgrediens, is a rare autosomal recessive palmoplantar keratoderma with an estimated prevalence of 1: 100,000. Genetic mutations affecting SLURP-1 play a role in MDM. It typically starts shortly after birth and is characterized by hyperkeratosis extending from the palmoplantar region to the dorsal surfaces that worsens with age. MDM can lead to severe functional limitations involving the hands and feet and psychosocial problems. The rarity of the condition can lead to misdiagnoses and unsuitable treatments, with MDM commonly mistaken for psoriasis due to the involvement of the elbows and knees. This report presents the case of a family affected by MDM who had a pathogenic variant previously not reported in Turkey, been followed up with the diagnosis of psoriasis for several years, and received a late diagnosis where systemic acitretin achieved satisfactory clinical improvement.

Atopic dermatitis is a multifactorial pathology that includes perturbations of gene expression and increased adhesion of Staphylococcus aureus. Fucoidans are seaweed-derived sulfated fucose-rich polysaccharides that are known to be anti-inflammatory and may inhibit adhesion of pathogens. Fucoidan was assessed for effects on gene expression of an in vitro 3D model of atopic dermatitis. It was also assessed for inhibitory effects on the adhesion of bacteria onto 3D reconstructed skin. Fucoidan significantly altered gene expression in the atopic dermatitis model, and there was a trend to reduce periostin levels. Fucoidan significantly inhibited the adhesion of Staphylococcus aureus and Cutibacterium acnes but did not affect the adhesion of Staphylococcus epidermidis. Fucoidan may be a useful topical agent to assist in the management of atopic dermatitis.

Extramammary Paget’s disease (EMPD) is a rare intraepithelial neoplasm that occurs in apocrine-bearing areas of skin. Most EMPD patients initially present with chronic pruritic eczematous lesions involving genitalia, perineum and perianal area. Familial form of EMPD is extremely rare. Several genetic mutations have been proposed but specific modes of inheritance are still unknown. This article reports two cases of familial extramammary Paget’s disease in female siblings.

The coexistence of epidermal cysts and lipomas at the same site is extremely rare, although epidermal cysts and lipomas are both common benign skin tumors. We present a rare case of an epidermal cyst with underlying lipoma on the back. This case report may simply be a result of coincidence, but the possibility of underlying subcutaneous tumors should be considered before epidermal cyst surgery.

Petrified ears is an uncommon clinical entity. It describes auricular cartilage hardening, due usually to ectopic calcification or, less commonly, ossification. The most common causes are frostbite and mechanical trauma. However, endocrinopathies have also been reported to cause ectopic calcium deposition through an unknown mechanism. Addison’s disease is the systemic disease most frequently associated, but the exact pathogenesis remains unclear. Patients are usually asymptomatic, and the diagnosis is made incidentally when rigid helices are noted on palpation and can be confirmed by radiological imaging. A biopsy can also help to differentiate between calcification and ossification. The presence of this condition may be a useful clinical sign, which in some cases precedes the development of endocrinopathies by many years. We report on a case, and we review the current literature.

Background: Evidence of factors associated with psoriasis from large population-based cohort studies is scarce. Objective: We aimed to explore the risk factors of late-onset psoriasis. Methods: This study included 487,835 Japanese participants aged 40-107 years, who were followed prospectively from 2012 to 2018 using individually linked databases between annual health checkups and medical claims. Results: During the study period, 2793 patients (0.57%) newly developed psoriasis; 13.8% had moderate-to-severe psoriasis. In the multivariate analysis, factors associated with psoriasis onset were age (hazard ratio [HR] 1.11 {95% confidence interval [CI]: 1.06-1.16}), male sex (HR: 1.11 [95% CI: 1.02-1.21]), body mass index (HR: 1.09 [95% CI: 1.05-1.14]), smoking (HR: 1.46 [95% CI: 1.31-1.63]), not exercising ≥1 hour per week (HR: 1.13 [95% CI: 1.05-1.22]), and gamma-glutamyl transpeptidase (HR: 1.04 [95% CI: 1.01-1.06]). When we used weight increment of ≥10 kg since the age of 20 years instead of body mass index in the multivariate model, this was also a risk factor (HR: 1.12 [95% CI: 1.04-1.21]). Limitations: This study targeted people aged >40 years, thereby narrowing the search to the risk factors of late-onset psoriasis. Conclusion: We showed that increasing age, male sex, body mass index, smoking, low physical activity, weight gain, and gamma-glutamyl transpeptidase are associated with late-onset development of psoriasis and revealed a relationship between liver dysfunction and psoriasis development.

Background: Oculocutaneous albinism is disproportionately prevalent in Africa; however, the medical and psychosocial characteristics of people living with albinism (PWA) in Botswana have not been studied. Objective: To characterize the demographics, health-related factors, sun-protective behaviors, and psychosocial challenges of PWA in Botswana. Methods: Overall, 50 PWA and 99 patients without albinism (non-PWA) were recruited and surveyed. Results: Higher proportions of PWA lived in rural villages compared with non-PWA (odds ratio [OR], 2.59; 95% confidence interval [CI], 1.26-5.34). PWA reported limited access to health care more frequently compared with non-PWA (OR, 2.72; 95% CI, 1.11-6.62). High proportions of PWA adopted sun-protective measures, including sunscreen, clothing, and sunlight avoidance. Despite high rates of feeling accepted by family and peers, PWA had increased odds of feeling unaccepted by their community (OR, 15.16; 95% CI, 5.25-31.81), stigmatized by society (OR, 9.37; 95% CI, 3.43-35.62), and affected by stigma in social interactions (OR, 2.21; 95% CI, 1.08-4.54) compared with non-PWA. Three-quarters of PWA had witnessed mistreatment of PWA. Limitations: Study limitations include the small sample size, convenience sampling, and a non-validated survey instrument. Conclusion: PWA faced increased medical and psychosocial challenges compared with non-PWA in Botswana. Our findings can begin to inform public health strategies aimed at promoting improved health care, education, and social inclusion for this population in Botswana and other regions in Africa.

Background: Little is known about the effectiveness and drug survival associated with apremilast under real-world conditions. Objective: To investigate the influence of patient and disease characteristics on drug survival associated with apremilast and to elucidate clinical effectiveness with regard to the psoriasis area and severity index (PASI) reduction. Methods: This was an observational, retrospective, multicenter analysis from the Austrian Psoriasis Registry. Results: Data from 367 patients were eligible for analysis. The 12-month drug survival rate associated with apremilast (ie, the proportion of patients on the drug) was 57.3% and decreased significantly in patients younger than 40 years (relative hazard ratio = 1.49, P = .007918). Sex; concomitant arthritis; previous biologic therapy; obesity; and palmoplantar, scalp, nail, and intertriginous involvement did not significantly affect drug survival. At 12 months, the response rates in patients receiving apremilast per protocol with a PASI of 50, 75, 90, and 100 were 80.0%, 56.4%, 38.2%, and 22.7%, respectively. Limitations: Inclusion of a substantial number of patients with no record of absolute PASI at study entry and lack of PASI reduction follow-up data of 103 patients (28.1%) after starting apremilast treatment. Conclusion: Apremilast is a robust antipsoriatic drug for which the drug survival is not strongly influenced by most patient- or disease-related factors except age. Drug survival is significantly shorter in patients younger than 40 years.

Objective: Because of the increasing emergence of skin manifestations of COVID-19 worldwide, we investigated the published reports of these lesions. Methods: We conducted a literature search for original and review articles published from November 11, 2019 to September 30, 2020. Results: We identified 5 skin lesions common in patients with COVID-19: pseudo-chilblains, rashes containing macules and papules, and urticarial, vesicular, and vaso-occlusive lesions. These lesions manifested at various times in relation to the COVID-19 symptoms, which may indicate whether the lesions are virus-induced or are delayed immunological responses to the infection. Skin lesions were more prevalent among Europeans and United States residents than among Asians, as was pseudo-chilblain, and the morphology of the skin lesions varied among continents. Pseudo-chilblains were the most common COVID-19 skin manifestation in Europe and the United States, but there was only 1 reported case from Asian populations. Additionally, patients with vaso-occlusive lesions were more likely than those with pseudo-chilblains to be admitted to the intensive care unit and to die. Conclusion: Different cutaneous manifestations in patients with COVID-19 could reflect a wide spectrum of viral interactions with the skin, though reporting bias may play a role as well.

Joanna Narbutt,1 Janusz Krzyścin,2 Piotr Sobolewski,2 Małgorzata Skibińska,1 Marcin Noweta,1 Witold Owczarek,3 Bonawentura Rajewska-Więch,2 Aleksandra Lesiak1 1Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Łódź, Łódź, Poland; 2Institute of Geophysics, Polish Academy of Sciences, Warsaw, Poland; 3Department of Dermatology, Military Institute of Medicine, Warsaw, PolandCorrespondence: Janusz KrzyścinInstitute of Geophysics, Polish Academy of Sciences, Warsaw, 01-452, PolandTel +48-2269-15950Email jkrzys@igf.edu.plBackground: Nowadays, patients with moderate-to-severe psoriasis are treated with conventional immunosuppressants or with new biological agents. Phototherapy is the first-line treatment for patients in whom topical therapy is insufficient. Although numerous studies have been carried out, it is still difficult to predict the outcome of phototherapy in individual patients.Methods: Prior to standard narrow band (NB) ultraviolet B (UVB) phototherapy, the patients filled out a questionnaire about personal life and health status. Several standard blood tests, including selected cytokine levels, were performed before and after a course of 20 NB-UVB treatments. The questionnaire answers, results of the blood tests, and treatment outcomes were analyzed using an artificial intelligence approach—the random forest (RF) classification tool.Results: A total of 82 participants with moderate-to-severe psoriasis were enrolled. Prior to starting phototherapy, the patients with expected good outcome from the phototherapy, shorter remission, and quitting a possible second course of the NB-UVB treatment could be identified by the RF classifier with sensitivity over 84%, and accuracy of 75%, 85%, and 79%, respectively. The inclusion of cytokine data did not improve the performance of the RF classifier.Conclusion: This approach offers help in making clinical decisions by identifying psoriatic patients in whom phototherapy will significantly improve their skin, or those in whom other therapies should be recommended beforehand.Keywords: psoriasis, phototherapy, outcome prediction, artificial intelligence

Epidermolysis bullosa acquisita (EBA) is a rare autoimmune blistering disorder, with

Schwannoma is a benign neoplasm that originates from the neural sheath of Schwann cells. Although extracranial schwannomas are commonly observed in the head and neck region, only 1% are found in the intraoral cavity. This article describes the first case in the Eastern Mediterranean region of a lower lip schwannoma in a 17-year-old male patient.

Generalized bullous fixed drug eruptions (GBFDEs) are rare in the paediatric population. We present the case of a 7-year-old girl with GBFDE believed to be secondary to oral ibuprofen, who experienced rapid resolution of lesions and cessation of blistering with a 3-week course of oral cyclosporine. To the best of our knowledge, this is the first report of a paediatric case of GBFDE treated with cyclosporine. In our report, we review published cases of GBFDE in children, and all adult cases managed with cyclosporine.

Ming Lei,1 Guang-Yuan Yu,2 Yong-Gang Zhao,3 Ji-Ping Wang,1 Su-Yun Feng1 1Center of Hair Transplantation, Department of Burn and Plastic Surgery, The Fourth Medical Center of the General Hospital of PLA, Beijing, People’s Republic of China; 2Department of Dermatology, The Fourth Medical Center of the General Hospital of PLA, Beijing, People’s Republic of China; 3First Department of Surgery, Beijing Armed Police Corps Hospital, Beijing, People’s Republic of ChinaCorrespondence: Ji-Ping WangCenter of Hair Transplantation, Department of Burn and Plastic Surgery, The Fourth Medical Center of the General Hospital of PLA, No. 51 of Fucheng Road, Haidian District, Beijing, 100048, People’s Republic of ChinaTel +86 10-66867304Email wangjp693587@163.comObjective: This study aims to establish the concept of invalid extraction rates in follicular unit extraction and evaluate its clinical value.Methods: The present study involved 30 patients with alopecia. Three young surgeons (nominated A, B, and C) each performed follicular unit extraction on a randomly selected portion of the donor site of each patient for ten minutes. The outcomes were separately recorded and calculated, and converted to an invalid extraction rate for each surgeon using the formula, “invalid extraction rate = 1 − successfully extracted follicular units/actually extracted units × 100%.”Results: The follicular unit invalid extraction efficiency of each surgeon gradually declined. The average efficiency level of surgeon B was evaluated as excellent, while the levels of surgeons A and C were evaluated as good.Conclusion: With experience, surgeons can speed up the process of follicular unit extraction and gradually increase performance quality through both extraction speed and success rate.Keywords: follicular unit extraction, operating level, evaluation

Andrea Ronchi,1 Antonello Sica,2 Paola Vitiello,3 Renato Franco1 1Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, 80138, Italy; 2Oncology and Haematology Unit, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, 80131, Italy; 3Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, 80131, ItalyCorrespondence: Renato FrancoPathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Via Luciano Armanni 5, Naples, 80138, ItalyTel +390815664084Email renato.franco@unicampania.itAbstract: Primary cutaneous marginal zone lymphoma (PC-MZL) is a B-cell lymphoma arising in the skin. Although it is a rare disease, PC-MZL accounts for 20– 40% of all primary cutaneous B-cell lymphoma in Western Countries. The aetiology and the pathogenesis of PC-MZL are poorly understood, as it generally lacks the chromosomal translocations most typically present in marginal zone lymphomas of other sites. The diagnosis of PC-MZL may be challenging, due to the rarity of the disease, and needs the competence of different professional figures, including the dermatologist and the pathologist. Furthermore, the management of the patient after the diagnosis is complex and involves the dermatologist, the haematologist, the surgeon, the radiotherapist and the radiologist. The aim of this review is to describe the clinical and histological findings for the diagnosis of PC-MZL, and the state of art for the management of the patient.Keywords: marginal zone lymphoma, cutaneous lymphoma, Borrelia burgdorferi, immunohistochemistry, dermoscopy

Ting Yang,1,2 Wen-Juan Wu,1 Li-Ming Tian,3 Deng-Feng Zhang,4 Xiao-Yan Yang,1 Jue Qi,1 Ying Tu,1 Li He1 1Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650023, People’s Republic of China; 2Department of Dermatology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, Hubei, 435000, People’s Republic of China; 3Department of Dermatology, First Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, People’s Republic of China; 4Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Kunming, Yunnan, 650223, People’s Republic of ChinaCorrespondence: Li HeDepartment of Dermatology, First Affiliated Hospital of Kunming Medical University, No. 295 Xichang Road, Wuhua District, Kunming, Yunnan, 650023, People’s Republic of ChinaTel/Fax +86 0871-65317895Email lihe_4785@163.comObjective: Androgens acting through the androgen receptor play a crucial role in the pathogenesis of acne. This study aimed to identify whether two key genes (CYP21A2 and CYP19A1) involved in the synthesis and metabolism of androgens were associated with Pillsbury III-IV severe acne vulgaris.Methods: We carried out a standard questionnaire survey about acne and enlisted 600 Pillsbury III-IV severe acne vulgaris patients and 652 healthy controls of Han Chinese descent from Yunnan, China in the study. Twenty-two single nucleotide polymorphisms (SNPs) were genotyped by SNaPshot assay and analyzed for association with severe acne.Results: There was no significant difference in gender between the two groups (P = 0.085), and the age of the acne case group was significantly lower than that of the control group (P < 0.001). Our results revealed that only two SNPs, rs6474 (p.Arg102Lys) (P = 0.001) and rs6465 (P = 0.025) of the CYP21A2 gene were significantly associated with severe acne among the Han Chinese. When subjects were divided into males and females, significant associations were observed only in male patients with severe acne vulgaris for four variants: CYP21A2 rs6474 (p.Arg102Lys) (P = 0.002); CYP21A2 rs6465 (P = 0.012); CYP19A1 rs8023263 (P = 0.037); and CYP19A1 rs2470152 (P = 0.007). Haplotype analyses showed that the distribution of CYP21A2 haplotypes was significantly associated with male patients, while no association of CYP19A1 haplotypes was observed. The structure of the human CYP21A2 consists of two substrate binding sites and one substrate access channel.Conclusion: This study shed a light on a potentially important effect of CYP21A2 and CYP19A1 genes in severe acne vulgaris in the Han Chinese, especially for male patients. Future studies using independently verified datasets from a broader geographical spectrum will be valuable in identifying the causal and functional variants responsible for severe acne vulgaris within the CYP19A1 and CYP21A2 genes.Keywords: androgen receptor, severe acne, synthesis, metabolism, genetic risk

Griscelli syndrome (GS) is a rare disease that is characterized by silvery hair and fair skin. It is included in congenital grey hair syndromes, a rare group of autosomal recessive disorders characterized by silvery grey hair and severe multisystem disorders, such as immune system impairment, defects in immunological function, ocular and skeletal alterations, and nervous system defects. Herein, we report a rare case of GS type 1 and highlight the importance of a dermatological and hair examination to make an early diagnosis of these life-threatening diseases.

Li-Li Yang,1,2,* Ping Peng,1,3,* Yun-Hong Lin,3 Ting Zhou,4 Xiao-Xue Ren,1,3 Wei-Qi Wang,1 Xing-Xing Li1,3 1Department of Dental Research, The Affiliated Stomatological Hospital of Kunming Medical University, Kunming, Yunnan, 650100, People’s Republic of China; 2Department of Periodontics, The Affiliated Stomatological Hospital of Kunming Medical University, Kunming, Yunnan, 650100, People’s Republic of China; 3Department of Prosthodontics, The Affiliated Stomatological Hospital of Kunming Medical University, Kunming, Yunnan, 650100, People’s Republic of China; 4Department of Orthodontics, The Affiliated Stomatological Hospital of Kunming Medical University, Kunming, Yunnan, 650100, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xing-Xing LiDepartment of Prosthodontics, The Affiliated Stomatological Hospital of Kunming Medical University, No. 1088 Haiyuan Road, Wuhua District, Kunming, Yunnan, 650100, People’s Republic of ChinaTel +86 13759581696Fax +86 87165330099Email lxx_drli1862@163.comObjective: This study aims to measure and analyze the lip and tooth dynamic esthetic characteristics at rest and during speech in order to provide a reference for its esthetic design and restoration among the Hani and Han populations in Yunnan Province, China.Methods: Subjects of Hani and Han ethnicity in Yunnan were selected using multistage stratified sampling and inclusive criteria. The lip and tooth dynamic esthetic characteristics of the subjects at rest and during the pinyin pronunciation of “me”, “yi”, “fu”, and “si” were recorded using digital photography and analyzed with computer software.Results: No statistical difference was detected between the Hani and Han groups in the upper central-incisor display, when pronouncing the pinyin “yi”. Furthermore, there were no statistical differences in lip dynamic esthetic parameters between the Hani and Han groups, except for the distance between the upper and lower lips when pronouncing “si”. There were three kinds of correlation between the upper central-incisor edge and lower lip: separation, contact, and overlap.Conclusion: The display of upper central incisors and the mouth width of Hani people are larger than those of Han people when at rest. When the pinyin “si” is pronounced, the display of upper central incisors and the upper–lower lip distance of Hani people is less than that of Han people due to labial muscle movement.Keywords: Hani, Han, pronunciation, lip and tooth aesthetics, digital videography

Background and Design: Melanoma is a serious type of cancer. Patients previously diagnosed with melanoma are at an increased risk of a second melanoma. Therefore, it is important to know and apply preventive measures. This study aimed to examine melanoma patients’ behaviors of sun protection and skin self-examination (SSE), knowledge on risk factors, and communication with their physicians about the disease. Materials and Methods: A questionnaire-based cross-sectional study was conducted in 65 melanoma patients to assess knowledge of melanoma and sun protection and determine SSE attitudes and patient-physician communication. Results: Sun exposure was a well-known melanoma risk factor (67.7%), but the knowledge level on other risk factors, especially regarding skin, hair, and eye color phenotypes, was low (between, 21.5% and 36.9%). Sunscreen use practice was insufficient (33.8%) and mostly inadequate. The most commonly reported reason for not using sunscreen was not having a habit of sunscreen use (83.7%). Compliance with other sun protection behaviors was variable. Half (50.8%) of the melanoma patients reported that they perform SSE. The most commonly reported reasons for not performing SSE was not knowing its necessity (71.8%). More than one-third (35%) of patients stated that they did not receive information about melanoma from their physicians. Almost all patients who received information from their physicians were informed verbally, and only 4% received written information. Conclusion: Our study highlights the need for a comprehensive education for patients about all aspects of melanoma and strategies to improve patient-physician communication. Barriers to preventive behaviors in melanoma patients may be determined in more detail in larger future studies and the content of education may be planned accordingly.

Seong Sung Kwak,1,2 Kwang Ho Yoon,1 Jin Hee Kwon,1 Won-Ho Kang,1 Chang-Hoon Rhee,3 Gi-Hyeok Yang,1 Deu John M Cruz,1 Woo-Chan Son2 1Gwanggyo R&D Center, Medytox Inc., Suwon-si, Gyeonggi-do, Korea; 2Department of Pathology, Asan Medical Center, Seoul, Korea; 3Osong R&D Center, Medytox Inc., Cheongju-si, Chungcheongbuk-do, KoreaCorrespondence: Woo-Chan SonDepartment of Pathology, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-Gil, Songpa-gu, Seoul, Republic of KoreaTel +82 2 3010 4051Fax +82 2 3010 4099Email wcson@amc.seoul.krDeu John M CruzNon-Clinical Development Department, Medytox Gwanggyo R&D Center, 114 Central town-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, Republic of KoreaTel +82 31 8065 8254Fax +82 31 8065 8232Email deujohn.cruz@medytox.comPurpose: Hyaluronic acid (HA) is the most common injectable dermal filler used for soft-tissue augmentation, and can be removed non-surgically by directly injecting hyaluronidase. In this study, the hyaluronidase-mediated degradation of different types of HA fillers implanted subcutaneously at the back of hairless mice having filler residence time of four days or three months were compared.Methods: Two sites at the back of female hairless mice were subcutaneously implanted with 0.1-mL of one of the seven HA fillers (NLL, NL, NDL, NVL, and ND, JUVX+, and RESLYFT) and injected with 30 IU or 60 IU hyaluronidase per 0.1-mL filler after reaching a filler residence time of 4 or 91 days, respectively. Filler bolus projection was measured using three-dimensional optical imaging over a 72 h period, and the implantation sites were histologically examined 2 weeks after hyaluronidase injection.Results: Following hyaluronidase injection, all seven HA fillers showed a rapid decrease of filler volume within 24 h, and complete degradation was confirmed by histological examination after 2 weeks. There was no significant difference in filler volume reduction rate among the seven HA fillers, and no evidence of macroscopic or microscopic adverse effects were observed at the implantation sites.Conclusion: All seven HA fillers show comparable susceptibility to hyaluronidase-mediated degradation. HA fillers with prolonged filler residence time may require a higher dose of hyaluronidase to achieve efficient degradation owing to tissue integration.Keywords: soft tissue augmentation, HA filler volume, 3D optical imaging, filler residence time, tissue integration

Maria Grazia Ferraro,1 Marialuisa Piccolo,1 Alessandro Pezzella,2 Fabrizia Guerra,1 Francesco Maione,1 Gian Carlo Tenore,1 Rita Santamaria,1 Carlo Irace,1 Ettore Novellino1 1Department of Pharmacy, School of Medicine and Surgery, University of Naples “Federico II”, Naples, 80131, Italy; 2Department of Chemical Sciences, University of Naples “Federico II”, Naples, 80126, ItalyCorrespondence: Carlo Irace;Rita SantamariaDepartment of Pharmacy, School of Medicine and Surgery, University of Naples “Federico II”, Via D. Montesano 49, Naples, 80131, ItalyTel +39 081 678416; +39 081 678421Fax +39 081 678403Email carlo.irace@unina.it; rita.santamaria@unina.itIntroduction: Melanocytes are engaged in synthesis, transport, and release of pigments at the epidermal-melanin units in response to the finely regulated melanogenic pathway. A multifaceted combination of both intrinsic and extrinsic factors – from endocrine and paracrine dynamics to exogenous stimuli such as sunlight and xenobiotics – modulates expression and activity of proteins involved in pigmentation, including the rate-limiting enzyme tyrosinase. As well as playing critical physiological functions comprising skin photoprotection, melanins define hair and skin pigmentation which in turn have impacted considerably to human social communication since time immemorial. Additionally, numerous skin diseases based on pigmentation alterations can have serious public influence. While several melanogenesis inhibitors are already available, the number of melanin activators and tyrosinase stimulators as drug-like agents is still limited.Methods: To explore the biological effects of an Annurca Apple-based nutraceutical preparation (AMS) on melanin production, experiments in cellular models of human skin were performed. Both primary cultures and co-cultures of epidermal melanocytes (HEMa) and follicular keratinocytes (HHFK) were used.Results: We show that AMS, by now branded for its cutaneous beneficial effects, induces in total biocompatibility a significant promelanogenic effect in human primary melanocytes. In line, we found melanin cytosolic accumulation consistent with tyrosinase up-regulation.Conclusion: Disposal of skin pigmenting agents would be attractive for the treatment of hypopigmentation disorders, to postpone skin photoaging or simply for fashion, so that discovery and development of melanogenesis stimulators, especially from natural sources, is nowadays a dynamic area of research.Keywords: melanins, skin pigmentation, tyrosinase, skin pigmenting agents, natural bioactive molecules

Diana Prieto-Peña,1 Santos Castañeda,2,3 Belén Atienza-Mateo,1 Ricardo Blanco,1 Miguel Ángel González-Gay1,4,5 1Department of Rheumatology, Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain; 2Department of Rheumatology, H. Universitario de La Princesa, IIS-Princesa, Madrid, Spain; 3Cátedra UAM-ROCHE, EPID-Future, Universidad Autónoma Madrid (UAM), Madrid, Spain; 4School of Medicine, Universidad de Cantabria, Santander, Spain; 5Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaCorrespondence: Miguel Ángel González-GayDepartment of Rheumatology, Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Hospital Universitario Marqués de Valdecilla, Avenida Valdecilla s/n, Santander, 39008, SpainEmail miguelaggay@hotmail.comAbstract: Giant cell arteritis (GCA) is characterized by granulomatous inflammation of large and medium-sized vessels. It is the most common vasculitis among elderly people in Europe and North America. GCA usually presents with ischemic cranial manifestations such as headache, scalp tenderness, visual manifestations, and claudication of the tongue and jaw. Thickness and tenderness of temporal arteries are the most recognizable signs of GCA on physical examination. Laboratory tests usually show raised acute phase reactants. Skin manifestations are uncommon in GCA and are rarely found as a presenting symptom of GCA. Necrosis of the scalp and tongue is the most common ischemic cutaneous manifestation of GCA. Although infrequent, when present it reflects severe affection and poor prognosis of GCA. Panniculitis-like lesions have been reported in the setting of GCA, with nodules being the most common finding. Other entities, such as generalized granuloma annulare or basal cell carcinoma have been occasionally described in GCA patients. Prompt recognition and initiation of therapy are crucial to prevent serious complications of GCA. When high suspicion of GCA exists, immediate administration of glucocorticoids is recommended. It is advisable to refer the patient to a specialist GCA team for further multidisciplinary assessment.Keywords: giant cell arteritis, cutaneous manifestations, skin, vasculitis

Background: Despite efforts toward the earlier detection and prevention of skin cancer, the prevalence of skin cancers continues to increase. Identifying trends in skin cancer burdens among populations can lead to impactful and sustainable interventions. Methods: We assessed the global trends in skin cancer from 1990 to 2017 in 195 countries worldwide through the Global Burden of Disease Study (GBD) 2017 database. Results: The rate of change in skin cancers between 1990 to 2017 varied among countries. Squamous cell carcinomas increased by 310% during this time, the highest among any neoplasm tracked by the GBD. Men experienced greater age-specific prevalence rates of keratinocyte carcinoma across all ages (P

Background: Skin diseases, such as psoriasis, hidradenitis suppurativa, acne, and alopecia areata, have increasingly been linked to systemic and mental health comorbidities, such as depression. Although identification and management of these comorbidities is typically a part of primary care, some patients might not have an established relationship with a primary care provider and may only be seeing their dermatologist. Objective: To examine the frequency with which dermatologists are the main contact within a health care system for patients with these chronic skin conditions. Methods: We performed a retrospective cohort study using Optum's deidentified Clinformatics Data Mart Database. The primary outcome was the proportion of patients who established care with a dermatologist and had no encounters with a primary care provider during the subsequent year after this dermatology encounter. Results: Across each of the skin diseases evaluated, 21.6%-31.2% of men and 16.9%-26.2% of women had no primary care visits in the subsequent year after establishing care with their dermatologist. Conclusion and Relevance: For many patients with chronic skin diseases, their dermatologist might be their only source of contact with the health care system. There may be an opportunity for dermatologists to improve the quality of care for our patients by screening for associated comorbidities.

Background: Complementary and alternative medicine (CAM) treatments are growing in popularity as alternative treatments for common skin conditions. Objectives: To perform a systematic review and meta-analysis to determine the tolerability and treatment response to CAM treatments in acne, atopic dermatitis (AD), and psoriasis. Methods: PubMed/Medline and Embase databases were searched to identify eligible studies measuring the effects of CAM in acne, AD, and psoriasis. Effect size with 95% confidence interval (CI) was estimated using the random-effect model. Results: The search yielded 417 articles; 40 studies met the inclusion criteria. The quantitative results of CAM treatment showed a standard mean difference (SMD) of 3.78 (95% CI [−0.01, 7.57]) and 0.58 (95% CI [−6.99, 8.15]) in the acne total lesion count, a SMD of −0.70 (95% CI [−1.19, −0.21]) in the eczema area and severity index score and a SMD of 0.94 (95% CI [−0.83, 2.71]) in the scoring of atopic dermatitis score for AD, and a SMD of 3.04 (95% CI [−0.35, 6.43]) and 5.16 (95% CI [−0.52, 10.85]) in the Psoriasis Area Severity Index score for psoriasis. Limitations: Differences between the study designs, sample sizes, outcome measures, and treatment durations limit the generalizability of data. Conclusions: Based on our quantitative findings we conclude that there is insufficient evidence to support the efficacy and the recommendation of CAM for acne, AD, and psoriasis.

Maysoon Algain Department of Dermatology, King Abdulaziz University, Jeddah, Saudi ArabiaCorrespondence: Maysoon Algain Department of DermatologyKing Abdulaziz University, Jeddah, Saudi ArabiaTel +966 503000301Email maysoonalgain@gmail.comAbstract: Yellow nail syndrome (YNS) is a rare disease of unknown etiology that is characterized by varying degrees of pulmonary manifestations, lymphedema, and yellow discoloration of the nails. Herein, we report the efficacy of oral terbinafine and topical minoxidil in treating the associated nail abnormalities of YNS in a 66-year-old woman. The patient presented with yellow, brittle, slow-growing nails, which had developed progressively over the past 8 months; left ankle edema; a chronic, purulent, productive cough; and exertional dyspnea. Based on these symptoms, she was diagnosed with YNS. She failed to respond to treatment with fluconazole and vitamin E; however, she was successfully treated with oral terbinafine and topical minoxidil. The treatment was well tolerated, and we speculate that its mode of action includes promoting lymphatic formation and barrier enhancement, thereby improving the distal lymphedema, in addition to distal vasodilation that accelerates the nail growth. To our knowledge, this is the first report of successful treatment of YNS using these agents.Keywords: exertional dyspnea, lymphedema, productive cough, case report

SARS-CoV2 pandemic has affected dermatologypractice greatly. In view of the risk of transmission, physicians need to devise methods to perform procedures in a safer way. Our institute has adopted a number of innovative safety precautions steps, which are being outlined here.

Sylvia PB Ramirez,1 Gunther Scherz,1 Helen Smith2 1Cutis Medical Laser Clinics Pte Ltd, Singapore; 2Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, SingaporeCorrespondence: Sylvia PB RamirezCutis Medical Laser Clinics Pte Ltd, 9 Scotts Road, Scotts Medical Center #08-07, 228210, SingaporeTel +65 90400113Email ramirezs224@gmail.comPurpose: Identifying predictors for patients’ readiness to receive non-surgical facial aesthetic treatments facilitates the physician’s understanding of the patient’s goals and expectations. This paper aims to identify clinical and demographic characteristics of patients who proceed with non-surgical facial aesthetic procedures in Singapore.Patients and Methods: Using data from electronic patient health records, authors examined clinical and demographic characteristics of 624 Asian and Caucasian patients who sought treatment in a 12-month period and who had minimum follow-up of 1 year. Variables examined included age, race/ethnicity, gender, prior treatment, and attitudes and motivation for seeking treatment. Univariate and multivariate analyses of factors associated with proceeding with the treatment plan were evaluated using chi-square and logistic regression analyses.Results: Approximately 88% of patients who sought consultation proceeded with treatment. The majority were older than 40 years of age, were female and received prior treatments. Notable is the high frequency of rejuvenation rather than correction as the clinical outcome goal. There were slightly more Caucasians than Chinese patients but the racial distribution allowed the identification of differences between the two groups. Chinese patients were younger and more likely to seek correction or more obvious changes as compared to Caucasian patients. On multivariate analyses, powerful predictors for proceeding with non-invasive facial treatments included a treatment goal of rejuvenation rather than correction, an expectation of an immediate result, and prior aesthetic treatments.Conclusion: This study is the first to compare race/ethnic differences in factors that influence treatment with non-invasive aesthetic procedures. This is also the first to identify demographic, clinical and motivational characteristics associated with actual treatment with non-invasive facial procedures. Further research on a systematic approach to defining a patient’s motivation for receiving treatment, as well as research identifying which patients are more likely to have positive clinical outcomes are warranted.Keywords: predictors, motivations, non-invasive, rejuvenation, race, ethnicity