Clinics in dermatology最新文献

Nutrition is essential for skin care, whether for its rejuvenation, recovery, or regeneration after trauma or surgery; yet it is often overlooked. Although many nutrients have well-demonstrated benefits, others, such as vitamin E, a liposoluble antioxidant used for over 50 years in dermatology, lack research and proof of their photoprotective and anti-tumorigenic properties. "Vitamin E" is the collective term for tocopherol (TP) and tocotrienol (T3), with the main differences being their aliphatic tails and T3 having a higher antioxidant effect when compared to TP due to its unsaturated and isoprenoid side-chain. With the ongoing exposure of individuals to physical, biologic, chemical and psychologic stressors throughout their lives, recent studies have shown that vitamin E provides stress protection or resistance, normalizes cellular homeostasis, and increases resistance to toxic stimuli that cause cellular damage. We discuss the relationship between oral and topical vitamin E and its improvement in many dermatologic and systemic conditions.

Before the eighteenth century, many authorities expressed their individual opinions on how food helps maintain health. By the end of this century, the First Chemical Revolution will have examined all existing and new ideas from a fresh perspective. They were scientifically subjected to chemical analysis. Among the various scientists, Jean Baptiste André Dumas voiced his doubts about the nutritional value of artificially made milk to counter the shortage during the Siege of Paris (1870-1871). The traditional idea of five essential factors-namely carbohydrates, proteins, fats, salts (or minerals), and water-was subjected to analysis. Josef Forster was the first to test the significance of minerals in nutrition and concluded that a certain critical amount of inorganic salts is needed to maintain nutrition. Augustus von Bunge, an influential scientist, criticized Forster's observations and instructed his student Nikolai Ivanovich Lunin to investigate the idea. Lunin conducted methodical research and found that even if the artificial combination of all the nutritive factors present in the milk was insufficient for complete nutrition, there must be some indispensable substance necessary to complete the matter. This was the first experiment that initiated vitamin research. This work was not pursued further, and Nikolai Lunin's groundbreaking contribution went unnoticed for decades.

We explore the pivotal role of vitamin C or ascorbic acid (AA), in skin health, emphasizing its antioxidant properties, collagen synthesis cofactor role, and tyrosinase inhibition capabilities. The mechanisms of action reveal its protective effects against environmental stressors, particularly UV radiation-induced damage. Clinical studies underscore the effectiveness of topical L-AA in preventing photoaging, reducing wrinkles, and mitigating hyperpigmentation. Formulation strategies, including pH adjustment and encapsulation, are explored to address the intrinsic instability of L-AA. While L-AA continues to be widely used, promising derivatives exhibit enhanced stability, though limited skin penetration is a challenge. Ongoing research aims to optimize formulations and investigate new derivatives, striving for maximal efficacy and safety in skincare applications.

Pellagra is a non-hereditary disorder of the niacin and tryptophan metabolism. Cutaneous and gastrointestinal symptoms are early signs of the disease, but neuropsychiatric symptoms follow, if the disease is not recognized and treated soon enough. Although Pellagra has not been identified as a separate entity before 1735, artists have noticed the characteristic cutaneous manifestations. An example is Pietro Bellotti's masterpiece Vecchia popolana con un ragazzo (Old Peasant Woman with a Boy; ca. 1680-1690) with a most realistic style. In 1786, the German writer and scientist Goethe traveled to Northern Italy. In his book Italienische Reise (Italian Journey) he made remarks about cutaneous findings in the rural population suggesting pellagra. He missed the scaling and fissuring of skin since he traveled in autumn and not spring, when the disease has its seasonal peak. The association of pellagra to art is further illustrated by two examples of the early 20th century - painter John Wesley Carroll from Kansas and medical illustrator Amedeo John Engel Terzi from Sicily. Their multicolored illustrations supported education about the disease before high-quality color photography became available.

Psychodermatology is an interdisciplinary field of medicine that examines the interrelationships between mental state and skin function. This contribution presents the biologic and theoretic foundations of these relationships, with particular emphasis on the role of stress, the brain-skin axis, and neuroimmunologic mechanisms. The historic development of psychodermatology is discussed, including the evolution of terminology and classification of disorders, as well as the emergence of structures facilitating interdisciplinary collaboration. Attention is drawn to the clinical and psychosocial consequences of chronic skin diseases, including reduced quality of life, anxiety and depressive symptoms, and patient stigmatization. Current challenges facing psychodermatology include the lack of diagnostic standardization and the need for further development of integrated models of care. Psychodermatology is presented as an essential component of a holistic approach to the treatment of skin diseases.

The Limberg rhomboid flap, first described in 1928 by the Russian surgeon Alexander Alexandrovich Limberg (1894-1974), represents a milestone in reconstructive plastic surgery. Based on precise geometric principles, the flap has become one of the most versatile and widely used techniques for closing skin defects in different body regions, particularly in the treatment of the pilonidal sinus. This contribution revisits the history of its creation, its mathematic planning .and its technical and scientific principles, as well as its contemporary relevance in surgical and reconstructive practice.

The painting of Cosmas and Damian appears to depict these Saints working with Angels to transplant a leg in the 3^rd century CE. This would be the first composite tissue allotransplantation. There has been much written about this painting, describing what it might have represented in the 3^rd century and when it was painted in the 16^th century. This manuscript discusses how this painting has additional meaning in our current time, when the stresses of medical practice are more pronounced, and how contemplating it can be helpful to us today.

Menopause transition or perimenopause is the transitional period preceding menopause, marked by hormonal variability and menstrual irregularity. This period is associated with a wide range of clinical symptoms due to reduced levels of estrogen. The skin, in particular, is affected by the decline in estrogen, specifically 17β-estradiol and dehydroepiandrosterone, along with an increase in cortisol. The sudden onset of various menopause symptoms can be distressing for many women and significantly impacts their quality of life. The genitourinary syndrome of menopause, a typical result of hypoestrogenism, is characterized by signs and symptoms relevant to urogenital atrophy. In this discussion, we focus on the aesthetically relevant symptoms of perimenopause and the approach to management. Most of these findings, including hot flushes, rosacea flares, worsening skin quality with dryness, sagging, and increased wrinkling, dyschromia, hair thinning, and cellulite, can be effectively managed. The provider should be aware of the emotional changes that occur during perimenopause and ensure that patients have a healthy and balanced motivation for seeking treatment. We discuss valid treatment options such as hormonal replacement therapy, minimally invasive procedures, and topical products, including the new dermocosmetic regimens. Because many of these treatments are geared toward maintaining results, consistency is paramount for achieving successful outcomes.

Jugular venous distention, which implies the presence of a superior vena cava syndrome, has been described in Hellenistic sculpture and early modern painting. This is unusual and remarkable considering this was done before the discovery of the true nature of the human circulatory system (1628) or the discovery of superior vena cava syndrome (1757). One has to wonder whether these artists only expressed what they saw or were aware of what they were depicting in their work. Caravaggio is the only artist who demonstrated this condition in his paintings and about whom we know enough to comment. This contribution discusses the influence of Michelangelo, who had anatomic training, on Caravaggio's work. It also discusses Caravaggio's knowledge and his use of messages in his work, as well as what was known about human circulation during his lifetime. This discussion is intended to help us appreciate what Caravaggio could have known and been trying to convey through his art, and in doing so, aid us in the practice of medicine by improving our awareness of life's mysteries.