Clinics in dermatology最新文献

Before the 18th century, many authorities expressed their individual opinions on how food helps maintain health. By the end of the 18th century, the First Chemical Revolution had examined all existing and new ideas from a fresh perspective. Foods were subjected to chemical analysis. Among the various scientists, Jean Baptiste André Dumas voiced his doubts about the nutritional value of artificially milk made 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 also questioned. 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. Gustav 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 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.

The fundamental role of vitamin D in health and disease is constantly expanding. The major sources of the "sunshine vitamin" are sunlight exposure with subsequent cutaneous synthesis and oral intake in the form of supplementation or dietary consumption. Not only crucial for skeletal health, vitamin D is also linked to numerous disorders of cardiovascular, neurologic, reproductive, infectious, autoimmune, and dermatologic origins. It is a pleiotropic fat-soluble hormone that affects key factors in the pathogenesis of numerous cutaneous disorders because of its effects on the innate and adaptive immune systems and the physiology of the skin, including the integrity of the epidermal barrier. Thus, it is implicated in the development and severity of many dermatoses. Vitamin D status is dependent on numerous modifiable and nonmodifiable factors including Fitzpatrick skin type, sun exposure, sex, body mass index, physical activity, alcohol intake, season, and latitude, in addition to polymorphisms in the vitamin D receptor. In view of increasing knowledge about the overall benefits of vitamin D, it now seems necessary to focus on reaching and maintaining an optimal vitamin D status. This article will discuss the potential determinants as well as the advantages of adequate vitamin D levels, with a special focus on the skin.

There has been growing interest in supplements and hair care products beyond standard medical treatments to improve hair health. Vitamins are essential micronutrients required to maintain homeostasis in the body and are essential for hair growth. There is robust literature documenting vitamin deficiencies in patients with hair disorders such as alopecia areata and telogen effluvium; however, there is limited scientific backing to understand whether vitamin supplementation in healthy individuals has a tangible impact on hair health. We have reviewed the evidence given that clinical trials are limited. Vitamins appear to improve hair health in individuals with deficiencies; however, further evidence is needed to establish the benefits for those with healthy hair at baseline.

Lichen sclerosus (LS) is a chronic, relapsing, inflammatory skin condition that primarily affects the anogenital region. Treatment with potent topical corticosteroids (TCS) can help control symptoms for many patients, but complications such as atrophy and scarring often persist. Platelet-rich plasma (PRP) has emerged as a regenerative therapy with potential application in LS. We review the clinical evidence and highlight gaps and future research needs. We searched PubMed and Web of Science databases for studies of PRP in LS. The outcomes evaluated included symptom relief, quality of life (QoL), tissue repair, and safety. The evidence regarding PRP monotherapy includes one randomized controlled trial, 11 single-arm studies, one case series, and one case report. Four studies included PRP combined with other regenerative therapies such as adipose-derived stem cells. Most studies reported benefits in symptomatic relief, sexual function, vaginal health, tissue quality, and QoL after PRP therapy. PRP appeared to work effectively alongside other regenerative treatments. The evidence is limited due to small sample sizes, lack of control groups, short follow-up periods, inconsistent objective measures of treatment efficacy, variability in PRP preparation and injection protocols, limited use of objective endpoints, and a lack of standardized outcome measures. The safety profile of PRP appears favorable. In conclusion, PRP can serve as an adjuvant therapy for genital LS in patients who do not respond to TCS treatment or when such treatment is discontinued. More rigorous studies are needed nonetheless. The potential of combining PRP with other regenerative therapies warrants further investigation.

Vitamin A and analogs are widely used in dermatology, with retinoids being natural and synthetic vitamin A derivatives. Topical retinoids (especially tretinoin and tretinoin precursors) can diminish photoaging and contribute to the thickening and restoration of skin collagen. Retinoids used as therapeutic agents include oral retinoids (eg, isotretinoin, acitretin, alitretinoin, and bexarotene) and topical retinoids (eg, isotretinoin, tretinoin, adapalene, tazarotene, and trifarotene). Although retinoids have traditionally been used for skin disorders of keratinization, such as psoriasis, pityriasis rubra pilaris, Darier disease, and ichthyoses, there is a variety of indications of retinoids for the treatment of skin diseases, including diseases of the pilosebaceous unit such as acne vulgaris, pigmentary disorders such as melasma, or cutaneous malignancies such as cutaneous T-cell lymphoma. Other retinoids with distinct routes of administration (oral or topical) and distinct dosing or safety profiles are recommended for different skin disorders. We discuss the mode of action and indications of retinoids used as pharmacologic agents in dermatology and provide an update on their use, effectiveness, and tolerability.

Nails are specialized skin appendages. In addition to their physiologic, sensory, and protective functions, nails have great aesthetic appeal for women and men alike. Vitamins play an important enzymatic and catalytic role in the human body and are critical for its normal growth and functioning. Vitamin deficiencies can lead to nail manifestations, which can be recognized easily but are generally nonspecific. There is a lack of substantial and robust evidence for the role of vitamin supplementation in improving general nail health or improving the appearance of diseased nails. Biotin and vitamin E supplementation have been used in various nail disorders with variable outcomes. The use of injudicious nutritional and dietary supplements to achieve healthy nails is not uniformly beneficial and may be associated with many risks.

From the prehistoric period, the history and evolution of food and nutrition have witnessed a fascinating journey. Our early ancestors were dependent on naturally available food of plant and animal origin. Over time, they experienced the importance of food in maintaining health and also in the remedy of many ailments. These facts are available in the literature of various ancient civilizations across the globe. The scientific approach began with the works of François Magendie (1783-1855), Antoine Lavoisier (1743-1794), and others in the 18th century. The research continued and led to the discovery of some substances beyond carbohydrates, protein, fat, minerals, and water that are required in minute amounts but are vital for maintaining health and preventing diseases; hence, they were named vitamins.

We explore the pivotal role of vitamin C, or L-ascorbic acid, in skin health, emphasizing its antioxidant properties, collagen synthesis cofactor role, and tyrosinase inhibition capabilities. These mechanisms of action underlie its protective effects against environmental stressors, particularly UV radiation-induced damage. Clinical studies underscore the effectiveness of topical L-ascorbic acid in preventing photoaging, reducing wrinkles, and mitigating hyperpigmentation. Formulation strategies, including pH adjustment and encapsulation, are explored to address the intrinsic instability of L-ascorbic acid. Although L-ascorbic acid continues to be widely used, promising derivatives exhibit enhanced stability, but 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 signs and symptoms are early signs of the disease, but neuropsychiatric findings follow, if the disease is not recognized and treated soon enough. Although pellagra had not been identified as a separate entity before 1735, artists 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, as he traveled in the autumn and not spring, when the disease has its seasonal peak. The association of pellagra with 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.