Clinical, Cosmetic and Investigational Dermatology最新文献

A fixed drug eruption (FDE) is a recurring adverse drug reaction that manifests as lesions on the same cutaneous or mucosal sites after exposure to the causative drug. It is characterized by erythematous or violaceous, round-to-oval patches with a dusky center. With each recurrence, the number and size of lesions can increase, raising the risk for generalized bullous fixed drug eruption (GBFDE). GBFDE, a rare and severe variant, presents with widespread bullae accompanied by characteristic FDE lesions. Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the primary causes of FDE. Although cross-reactivity between different groups of NSAIDs has been rarely reported in FDE cases, in this report we present a case of paracetamol-induced GBFDE followed by FDE triggered by cross-reactivity with dipyrone (metamizole).

This case presenting a rare occurrence of Molluscum contagiosum (MC) on the nipple of a nineteen-month-old toddler. Clinical and dermoscopy examination revealed yellowish papule consistent with Molluscum contagiosum (MC). The lesion was extracted using a 30-gauge syringe needle. After two months, a follow-up dermoscopy revealed total clearing. This case illustrates how uncommon MC is in unusual places, like toddler's nipple, and shows how useful dermoscopy is for making diagnosis and treatment easier.

Background: Antibiotic resistance is growing globally, with multiple countries reporting resistance in >50% of Cutibacterium acnes (C. acnes) strains. Combination formulations of an antibiotic and the antimicrobial benzoyl peroxide (BPO) may reduce this resistance risk, especially with prolonged use. This 4-part study tested susceptibility of 31 C. acnes clinical strains and development of resistance to antibiotics alone or combined with BPO.

Methods: C. acnes susceptibility to single-drug antibiotics was assessed via minimum inhibitory concentration (MIC) values obtained from epsilometer tests, with lower MIC indicating higher susceptibility. Susceptibility to fixed-dose antibiotic/BPO combination products was determined by measuring the zone of inhibition using the agar diffusion method, with larger diameter indicating increased bacterial inhibition. The effect (synergistic, additive, antagonistic, or indifferent [no interaction]) of combining clindamycin with BPO on C. acnes inhibition was evaluated using a checkerboard assay, wherein 2 test compounds are combined in varying concentrations. Resistance development was assessed using serial passage of bacterial cultures in increasing concentrations of clindamycin alone or in combination with BPO.

Results: All tested antibiotics (clindamycin, doxycycline, erythromycin, and minocycline) exhibited similar activity. C. acnes susceptibility was variable, with some strains having elevated MIC values-an indication of resistance-against different antibiotics. For 6 strains resistant to clindamycin alone (inhibitory zone=0 cm), formulations with BPO enhanced activity against the same isolates (range: 0.8-2.2 cm). Of 7 acne-associated strains, combining clindamycin and BPO had an additive effect against 4, and no interaction against 3. Bacterial cultures repeatedly exposed to the combination of clindamycin and BPO did not develop antibiotic resistance, which occurred with exposure to clindamycin alone.

Conclusion: Overall, antibiotic susceptibility was highly dependent on the C. acnes strain, and antibiotic formulations with BPO exhibited enhanced activity against less susceptible strains. Fixed combinations of BPO with an antibiotic may improve antimicrobial activity and protect against resistance development.

Background: It has been shown that the Basal cell carcinoma (BCC) is associated with chronic inflammation of skin conditions, the circulating inflammatory protein levels may be a more intuitive index in response to inflammation, however, the cause-and-effect relationship between circulating inflammatory proteins and BCC is currently unknown.

Methods: This study performed a Mendelian randomization (MR) analysis using the plasma inflammatory protein levels from a large genome-wide protein quantitative trait loci study as the exposure data, and the outcome data from a GWAS for BCC. Inverse variance weighed, MR-Egger, maximum likelihood ratio, and weighted median for assessing causality between inflammatory proteins and BCC. MR-Egger regression and Cochran's Q statistic were applied for sensitivity analysis and MRPRESSO was applied to exclude outliers. Inverse MR analysis was performed on inflammatory proteins found to be causally associated with BCC.

Results: Six circulating inflammatory proteins with a causal relationship with BCC were obtained, including CCL4, was of a significant protective effect on BCC development. IL-18 and CCL28, were of suggestive protective effects on BCC development. CX3CL1, IL-17A, and CSF-1 were potential risk factors in the development of BCC. According to the results of reverse MR analysis, there is no significant causal relationship between BCC and the above-mentioned inflammatory proteins.

Conclusion: This two-sample MR study revealed a strong association between circulating inflammatory proteins and the development of BCC. Specifically, CCL4, CCL28, IL-18, CX3CL1, IL-17A, and CSF-1 emerged as potential targets for prognostic evaluation and treatment of BCC. However, further experimental studies are needed to elucidate the specific mechanisms.

Psoriasis is genetically influenced and can be triggered by factors such as infections, stress, and lifestyle. Chronic plaque psoriasis, the most prevalent form, involves key roles for IL-17 and IL-23 in its pathogenesis. Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder characterized by the degeneration of motor neurons, resulting in muscle weakness and atrophy. Currently, there is no cure for ALS, and treatment is symptomatic, aimed at improving quality of life. The combination of psoriasis and ALS is relatively rare. Although biologic agents have shown remarkable efficacy in the treatment of chronic plaque psoriasis, we have not found any case reports regarding the use of biologic agents for treating psoriasis accompanied by ALS. Our study presents a patient with severe plaque psoriasis and ALS who exhibited a positive response to Guselkumab, without worsening of ALS symptoms, suggesting a promising therapeutic strategy. This could provide a treatment option for patients with psoriasis combined with ALS.We conducted a comprehensive review of the literature on the comorbidity of neurodegenerative diseases, including Alzheimer's disease (AD), Parkinson's disease (PD), multiple sclerosis (MS), and ALS, with plaque psoriasis. This review highlights the differential impact of treatment modalities. Specifically, we found that TNF-α inhibitors may have adverse effects in MS but could provide protective benefits in AD and PD. In ALS patients with psoriasis, IL-17A and IL-23 inhibitors, exemplified by Guselkumab, are suggested as a more suitable alternative due to their lower risk of worsening ALS symptoms.

Purpose: Recent advances in epidemiological and genetic studies have provided some insights regarding the pathophysiology of rosacea, but the majority of its underlying mechanisms are still poorly understood. In particular, more data are needed to fully understand the role of micronutrients in rosacea development. This study aimed to explore the causality of associations between Calcium, Copper, Selenium, Zinc, Iron, Potassium and Magnesium with the risk of rosacea.

Patients and methods: This was a two-sample Mendelian Randomization (MR) study that used data from genome-wide association studies (GWAS) on serum levels of selected micronutrients as exposure and rosacea as the outcome. The analysis primarily employed the Inverse Variance Weighted (IVW) method. Additional methods included weighted median, weighted mode, and MR-Egger regression. Sensitivity analysis included MR-Egger, MR-PRESSO, Cochran's Q, and leave-one-out methods. A total of 301 Instrumental Variables were selected for analysis.

Results: The genetic prediction indicated a statistically significant association between serum Calcium levels and higher rosacea risk (Odds Ratio (OR) = 2.27, 95% Confidence Interval (CI): 2.02-2.55, P < 0.001), further confirmed by all supplementary MR methods. Significant association was also found between serum Potassium levels and lower rosacea risk (OR = 0.36, 95% CI: 0.14-0.93, P = 0.0354), further confirmed by the weighted-median method. Sensitivity analyses showed that the results were robust and not driven by any single factor, with low probability of horizontal pleiotropy.

Conclusion: This study found an evidence of a causal association between genetically predicted serum levels of Calcium and Potassium with the risk of rosacea. The roles of these micronutrients should be further studied in rosacea, especially as a link to neurovascular dysregulation and oxidative stress.

Pseudocellulitis is a non-necrotizing inflammation of the dermis and hypodermis with a non-infectious etiology. One of the variants of pseudocellulitis is acute inflammatory edema (AIE), characterized by bilateral, erythematous, and edematous plaques, often found in critically ill patients. AIE is a rarely reported and frequently overlooked case of pseudocellulitis. Therefore, it needs to be differentiated from classic cellulitis, which has different management and prognosis. This case report aimed to present a case of AIE in a critically ill patient. A 71-year-old woman was admitted to intensive care with reddish swelling on four extremities. She was suffering from sepsis caused by pneumonia, congestive heart failure, tubulointerstitial disease, and hypoalbuminemia. A physical examination showed bilateral erythematous and edematous plaques that palpably felt warm. ALT-70 score was 4, indicating not likely true cellulitis. The patient was diagnosed with AIE and treated with a compression bandage, diuretics, and medications for underlying diseases. The lesions improved significantly on the second day of evaluation; unfortunately, respiratory failure caused the patient's death. Critically ill patients may have AIE misdiagnosed as cellulitis. Therefore, clinicians need to be well-versed in pseudocellulitis, especially AIE, to improve patient outcomes.

Background: Cosmetic Botulinum toxin (BoTx) injection has become a popular trend. There is evidence that beauty seekers improve their self-esteem and psychological state through BoTx injection. However, the personality traits in Chinese patients with cosmetic injections have not yet been investigated.

Objective: This study aimed to investigate the motivations and personality profiles of patients seeking cosmetic BoTx injections using the Eysenck Personality Questionnaire (EPQ).

Methods: The present study used a cross-sectional design, and was conducted with a sample of 195 randomly selected patients seeking BoTx treatment. All participants completed the EPQ. We also provide options listed to explore patients' motivations for seeking treatment. The demographic information was collected and analysed.

Results: A total of 195 patients were enrolled, with a mean age of 33.09 ± 8.70 years. Of the 195 participants, 177 (90.77%) were women and 18 (9.23%) were men. The mean age of the participants was 33.09 ± 8.70 years, and the majority (74.36%) had a bachelor's degree or higher. We investigated three injection options, including lower facial contour treatment, anti-aging wrinkle injection, and body slimming injection. The EPQ of all participants showed higher E and N scores, but lower P and L scores compared to the norms. The participants age below 30 of lower facial contour injection had significantly higher P scores (p=0.048) and N scores (p=0.004), while N scores of anti-aging wrinkle treatments were significantly lower (p=0.013).

Conclusion: Our study was the first using EPQ to depict the personality traits of Chinese adults seeking cosmetic BoTx injection. Initially, we questioned the purpose of aesthetic treatment in the Chinese population, which were more affected by psychological factors. Identifying personality traits before injection will assist physicians in providing a psychologically matched treatment plan while improving treatment satisfaction. These findings suggest that understanding patients' personality traits can help physicians better predict treatment expectations and preferences. For example, patients with high neuroticism scores may be more anxious about treatment outcomes, so physicians can provide more detailed pre-treatment counseling and postoperative follow-up, which is crucial for improving treatment satisfaction and reducing potential medical disputes.

Background: Seborrheic keratosis (SK), the most common benign epithelial tumor, frequently presents with cosmetic concerns despite its benign nature. The clinicopathological features of SK may demonstrate notable geographical variability. Diagnosis remains challenging due to varied clinical presentations.

Objective: This study aimed to investigate the clinicopathological characteristics of SK through a comprehensive analysis of a large patient cohort.

Methods: We conducted a retrospective analysis of clinical and pathological data from 1,169 patients diagnosed with SK between 1 January 2009 and 31 December 2023. Histopathological subtypes were categorized, and a descriptive analysis of demographic and clinical characteristics was performed.

Results: A total of 1,169 SK specimens were identified. The most frequent histopathological subtype was the acanthotic type (79.86%, 960 cases), followed by melanoacanthoma (7.98%, 92 cases), adenoid (5.32%, 64 cases), hyperkeratotic (4.90%, 59 cases), irritated (1.74%, 21 cases), and clonal (0.004%, 6 cases). The male-to-female ratio was 1.3:1, with a higher prevalence in men. SK most commonly affected the head, face, and neck, which accounted for 54.58% of cases (656/1,169), followed by the trunk (28.87%, 347 cases) and extremities (11.48%, 138 cases). The perineal area accounted for 4.48% (54 cases), while mucosal and plantar lesions were rare. The acanthotic subtype predominated across all anatomical sites, including mucosal and plantar regions. The age group most frequently diagnosed with SK was 40-59 years, with the acanthotic, melanoacanthoma, and adenoid types being particularly prevalent in this cohort. The clinical-pathological diagnostic concordance rate was 55.69%, indicating a relatively high rate of diagnostic discrepancy based on visual examination alone.

Conclusion: Our study confirms the acanthotic subtype as the most common histological type of SK, predominantly observed in patients aged 40-59 years. The head, face, and neck emerged as the most frequently involved sites. Ultraviolet radiation may play a significant role in SK pathogenesis.

Penile cancer is a rare malignant tumor with a poor prognosis in advanced stages. Immune checkpoint inhibitors (ICIs) have demonstrated promising efficacy in patients with advanced penile cancer, but it can also induce immune-related adverse events (irAEs). This article reports a patient who achieved almost a complete response to the PD-1 inhibitor sintilimab as third-line treatment for advanced penile squamous cell cancer with massive ulceration of chemoradiotherapy-resistant, and successful treatment by immunotherapy. One year into maintenance therapy with sintilimab, skin toxicity in the form or grade-2 skin rashes and grade-3 pruritus occurred. Sintilimab was permanently discontinued. The skin toxicity was effectively controlled by oral prednisone at a daily dosage of 15 mg. At the last follow-up of 16 months after sintilimab discontinuation, the patient remained in partial response, with total progression-free survival exceeding 30 months. We also conducted a comprehensive literature search, and summarized skin toxicity of ICIs administration. These articles suggested that immune-related skin toxicity may be indicative of good treatment response.