Clinical and Experimental Dermatology最新文献

Cutaneous myiasis is an infestation of the tissues and organs of living vertebrates and humans by fly larvae, usually those belonging to the Calliphoridae family. The larvae feed on the host's necrotic or living tissue. Pre-existing dermatological conditions and poor hygiene are predisposing factors for cutaneous myiasis, which is especially common among neglected, dependent patients. Our literature search revealed only a few case reports of cutaneous myiasis in autoimmune bullous disorders (AIBDs). Cutaneous myiasis is more common in the population of the South Indian state of Tamil Nadu because AIBDs, such as pemphigus and bullous pemphigoid, are erroneously considered to be chickenpox and are treated with neem and turmeric preparations, alongside poor hygiene practices. We report a case series of eight patients with AIBDs and cutaneous myiasis.

Background: Porokeratosis variants are relatively rare and can be clinically misdiagnosed with several common papulokeratotic mimickers. Line-field confocal optical coherence tomography (LC-OCT) is a new technology able to explore the skin in vivo up to a depth of 500 µm.

Objectives: To investigate the role of LC-OCT in the diagnosis of many porokeratosis variants in a preliminary study.

Method: In total, 130 LC-OCT images were obtained from 98 patients, 45 affected by a porokeratosis variant (69 images) and 53 with a mimicker condition (61 images).

Results: We found almost perfect interobserver agreement for LC-OCT image interpretation and perfect correspondence with the findings from histological slides. In addition, a series of morphological in vivo and three-dimensional features related to the cornoid lamella were detected by LC-OCT that were not visible from the histology.

Conclusions: This device can be proposed to assist with rapid bedside noninvasive differentiation of porokeratosis variants from their mimickers, possibly sparing incisional biopsy in patients where the diagnosis is uncertain.

Background: Cutaneous malignant melanoma (CMM) represents a global public health problem. Epidemiological studies about CMM trends tend to focus on single indicators or lack information about tumor characteristics that can help gain a more thorough understanding of CMM epidemiology.

Objectives: To fill this gap, we studied CMM trends in incidence, mortality, and survival over three decades and considering sex, age, and tumor characteristics.

Methods: Data were obtained for all new cases of CMM diagnosed 1985-2017 from the population-based cancer registry in Granada (Southern Spain) and for deaths due to CMM by the Ministry of Health of the Spanish government. Incidence, mortality, and survival estimates were obtained according to sex, age group, anatomical site, histological type, Breslow index, and Clark level. Observed and net survival were calculated for 1, 3, and 5 years using the Kaplan-Meier and Pohar-Perme methods, respectively. Log-linear jointpoint regression was used to assess temporal trends in age-standardized rates of incidence and mortality.

Results: Between 1985-2017, 2,446 patients aged 15 years and older were newly diagnosed with CMM. There was a significant increase in incidence, both in men and women (APC 4.4% and 3.7% respectively), mainly in superficial spreading and nodular melanomas, and more pronounced among those with <1mm Breslow index. Mortality rates increased, mainly driven by increases among men and individuals ≥65 years old. Nodular melanoma had the worst prognosis, with a 5-year observed survival of 67.1% compared to survival greater than 90% for the other subtypes. 5-year net survival improved from 78.3% in 1985-1997 to 88.6% in 2008-2017, with a clear trend by Breslow index.

Conclusions: The incidence of melanoma in early stages in Southern Spain has increased over the past decades. This has been accompanied by noticeable improvements in mortality and survival, especially among younger age groups, suggesting the potential effectiveness of prevention strategies, and new treatment regimens.

Melasma is a skin pigmentation disorder that lacks consistent treatment success, despite various methods used. Tranexamic acid (TXA) has shown hypopigmentation properties, but whether its administration should be combined with standard treatment has yet to be clarified. We aimed to perform an investigation of the effectiveness and safety of oral TXA as an adjuvant to triple combination cream (TCC) treatment in melasma. We searched PubMed, Embase and Cochrane (CENTRAL) for studies that compared TCC + adjuvant TXA to TCC treatment alone in patients with melasma. Outcomes of interest included change from the baseline Melasma Area and Severity Index (MASI) score, recurrence of melasma and adverse events. Statistical analysis was performed using R Studio 4.3.2. Four trials involving 490 patients were included. In the pooled analysis, the decrease from baseline in MASI score [mean difference -3.10, 95% confidence interval (CI) -5.85 to -0.35] was significantly higher in patients treated with oral TXA as an adjuvant to TCC compared with TCC alone. Melasma recurrence [risk ratio (RR) 0.28; 95% CI 0.16-0.49] was significantly lower in the group treated with TCC and TXA. Regarding erythema (RR 0.63, 95% CI 0.34-1.17) and burning (RR 0.59, 95% CI 0.30-1.17), no statistically significant difference was found. This meta-analysis demonstrated statistically significant benefits of TCC + TXA combination treatment compared with TCC alone. Furthermore, the results suggest that the addition of TXA to TCC treatment may reduce melasma recurrence.

Background: Severe keloids are difficult to treat. Corticosteroid injections with needles are painful and associated with frequent recurrences. Therefore, more effective, safe and patient-friendly alternative treatments are urgently needed.

Objectives: To assess the efficacy, tolerability and patient satisfaction of intralesional bleomycin treatment using a needle-free electronic pneumatic jet injector (EPI) in severe keloids.

Methods: Patients with severe keloids were included in this double-blind, randomized, placebo-controlled trial with split-lesion design. Three EPI treatments with bleomycin or saline were administered every 4 weeks in the intervention and control sides. Outcome measures were change in scar volume assessed by three-dimensional imaging, Patient and Observer Scar Assessment Scale (POSAS), skin perfusion with laser speckle contrast imaging (LSCI), spilled volume, procedure-related pain, adverse events and patient satisfaction.

Results: Fourteen patients (nine female, five male) were included. The estimated mean keloid volume was significantly reduced by 20% after EPI-assisted bleomycin, compared with a slight increase of 3% in the control side (P < 0.01). The estimated mean POSAS patient and observer scores decreased by respectively 28% and 20% (P = 0.03 and P = 0.001). LSCI showed no significant change in perfusion. EPI treatment was preferred over previous needle injections in 85% of patients. The estimated mean spilled volume after EPI was around 50%, and numerical rating scale pain scores were moderate. Adverse events included bruising, hyperpigmentation and transient superficial necrosis.

Conclusions: A course of three EPI-assisted bleomycin injections is efficacious and well tolerated in severe keloids. Moreover, EPI was preferred by most patients and may serve as a patient-friendly alternative treatment.