Clinical, Cosmetic and Investigational Dermatology最新文献

Purpose: To explore antimicrobial resistance profiles and mupA gene characterization of Staphylococcus epidermidis recovered from facial skin of healthy females in Shanghai, China.

Patients and methods: In this study, we collected facial skin samples from 107 healthy females in Shanghai, China, and S. epidermidis isolation was performed. The minimal inhibitory concentrations of 10 antibiotics were determined for the S. epidermidis isolates using the agar dilution method. High-level mupirocin-resistant isolates were subjected to whole-genome sequencing and bioinformatics analysis. A total of 94 un-duplicated S. epidermidis isolates were obtained from 107 facial skin samples.

Results: Antimicrobial susceptibility tests revealed that 23.4% of the 94 S. epidermidis isolates were resistant to oxacillin and positive for the mecA gene, which could be cauterized as methicillin-resistant S. epidermidis (MRSE). Resistance rates for erythromycin, clindamycin, tetracycline, ciprofloxacin, and gentamicin were 8.5%, 11.7%, 10.6%, 12.8%, and 1.1%, respectively. For mupirocin, the rates of low- and high-level resistance were 3.2% (3/94) and 11.7% (11/94), respectively. Resistance to vancomycin or linezolid was not observed. High-level mupirocin resistance in facial skin isolates is mediated by mupA. WGS and SNP-based phylogenetic analyses revealed diverse phylogenies among the 11 mupA-positive S. epidermidis isolates. Additionally, various resistance and virulence genes were identified in mupA-positive isolates. A new hybrid plasmid carrying mupA genes was found in two S. epidermidis isolates.

Conclusion: We observed a considerable level of antimicrobial resistance to several antibiotics and the prevalence of abundant and diverse resistance and virulence genes in the facial skin-origin S. epidermidis isolates. This may pose a potential risk for both public health and S. epidermidis infection.

Objective: In this single-centre, retrospective, pragmatic, longitudinal case-series clinical study triple-frequency LDM (TF-LDM) technology with frequencies of 1/3/10 MHz and 3/10/19 MHz was applied for treatment of cellulite to reveal the effect of these waves on the cellulite skin and assess the sustainability of treatment outcomes during the long-term follow-up controls.

Methods: Twenty Caucasian females with mild-to-severe gynoid lipodystrophy aged 27-53 years who received cellulite monotherapy with TF-LDM were included in this study. All participants were evaluated at three time points: baseline (T1), on the day of the last treatment (T2), and during the last follow-up (T3). Cellulite severity was assessed by six independent clinicians using the five-grade Clinician-Reported Photonumeric Cellulite Severity Scale (CR-PCSS). Patient satisfaction was evaluated using a 10-grade GAIS scale, ranging from 0 to 10 (0 - dissatisfied; 10 - fully satisfied). To objectify the treatment outcomes, 17 subjects were investigated using B-mode ultrasonography and real-time compression elastography at baseline and during follow-up.

Results: The average values of CR-PCSS (T1), CR-PCSS (T2) and CR-PCSS (T3) over all participants were 2.22±0.82, 1.18±0.77, and 0.84±0.77, respectively, which corresponded to the skin improvement between T1 and T2 of 0.93±0.27 (p < 0.0001) as well as between T1 and T3 of 1.38±0.47 (p < 0.0001). Assessment of elasticity of the dermis and adipose tissue on the basis of the 5-grade coloration scale revealed significant reinforcement of both tissues as well as of the superficial fascia at follow-up as compared to their baseline values. The obtained treatment outcomes were long-lasting and could be clearly observed even in individuals with a long-term follow-ups. Assessment of the satisfaction of participants with the treatment results revealed a high satisfaction of 8.95 ± 1.49. The method demonstrated no side effects, was pain-free, well-tolerated, and highly accepted by patients.

Background: Dermatofibroma (DF) is one of the common dermatosis, which is so challenging to diagnose that its misdiagnostic incidence is quite high. The very-high-frequency (VHF) ultrasound is particularly relevant to the diagnosis of DF. Herein, we analyze the sonographic features and application value of VHF ultrasound in the diagnosis of DF.

Methods: Clinical data from 153 patients with pathologically confirmed DF from January 2019 to December 2023 were retrospectively analyzed using high-resolution VHF ultrasound, including size, location, shape, edge, boundary, interior echo, blood supply and so on.

Results: The VHF sonographic features of DF showed that the maximum diameter of the lesions was about 7.29 ±2.85 mm (mean ± standard deviation). In addition, most lesions were located in the middle and lower part of dermis (49%), with ill-defined (84%) and irregular shape (51%), 19% of which were serrated. Forty-four percent of lesions were hypo-echoic and heterogeneous, and 8% were complicated with calcifications. Nineteen percent of lesions presented as thickened dermal epidermal junction. Dermatofibroma are mostly hypovascular on color Doppler ultrasound. Forty-three percent of lesions were detected with punctate dotted blood flow signals. The correlation analysis showed blood flow classification and maximum diameter were not relevant.

Conclusion: The DF based on VHF ultrasonographic findings is characteristic, such as <10mm, ill-defined, located in the dermis, thickened DEJ, serrated shape, punctute or no flow on Doppler, which provide crucial indicators for differential diagnosis, potentially reducing the rate of DF misdiagnosis.

Background: Previous studies have indicated that human flora may affect the development of scabies, however, no studies have proven a causal relationship between human flora and scabies, which would be detrimental to future in-depth studies on human flora and scabies.

Methods: Mendelian randomization (MR) was used to analyze the causal effect between human microbiota and scabies, with data on intestinal flora and skin flora from two large published studies and data on scabies from the FinnGen database. Five MR analysis methods were used to increase the reliability of the results, and sensitivity analyses were conducted to increase the robustness of the results.

Results: Our results suggest that 13 intestinal flora as well as 7 skin flora can have a causal effect on scabies.

Conclusion: Overall, our results demonstrate a causal relationship between intestinal and skin flora and scabies and are consistent with previous observational findings. This will contribute to the future development of probiotic agents for the prevention or treatment of scabies.

Darier's disease (DD) is a rare chronic keratinizing skin disease characterized by dyskeratosis of epidermal cells. We report a case of DD with a medical history spanning over 20 years and recurring symptoms. Pathologically confirmed DD was treated with a combination of abrocitinib and acitretin, resulting in rapid symptom resolution within 2 weeks. No recurrence was noted in an 11-week follow-up. The mechanism may involve acitretin's inhibition of proliferation and anti-inflammation, while abrocitinib acts on IL-6 implicated in DD pathogenesis, exerting an immunomodulatory and anti-inflammatory effect, leading to rapid symptom relief. The combination of abrocitinib and acitretin is an effective therapy for DD, offering a promising new option for refractory patients.

Poly-D,L-lactic acid (PDLLA) microspheres, marketed globally as Aesthefill^® (Regen Biotech, Seoul, South Korea), are recognized for their biocompatible and biostimulatory properties, positioning them as a preferred option in aesthetic medicine. This article presents consensus recommendations from Brazilian experts on the reconstitution and clinical application of PDLLA for facial and non-facial treatments. Developed using a modified Delphi method with contributions from leading dermatologists and plastic surgeons, the consensus outlines protocols for reconstitution, injection techniques, and patient management. Key recommendations include reconstitution with 7-8 mL of sterile water for injection, the addition of lidocaine to improve patient comfort, and a preference for targeting the superficial subcutaneous layer. Dosing guidelines are specifically tailored to each treatment area and the desired degree of correction, underscoring the importance of personalized treatment plans. Maintenance treatments are advised at biennial intervals or at shorter intervals for patients exhibiting accelerated collagen degradation. The consensus also highlights the need for proper training and patient screening to minimize adverse effects, such as nodules and granulomas. This comprehensive guide aims to standardize the use of PDLLA, prioritizing patient safety and optimizing outcomes. While clinical trials evaluating PDLLA's aesthetic indications remain limited, these evidence-based guidelines bridge the gap by offering practical protocols grounded in clinical expertise. Further research is encouraged to validate these recommendations and explore new applications for PDLLA in aesthetic medicine.

Papular acantholytic dyskeratosis (PAD), often found to occur in the vulvar or anogenital area, is an exceedingly rare skin condition that usually presents in adulthood and features multiple smooth skin-colored or grayish-white papules with or without pruritus. Although the pathogenesis of PAD is unknown, PAD may be associated with mutations in ATP2C1 and ATP2A2 genes. Here, we report on an 18-year-old female patient with multiple gray-white flat papules in the anogenital area. Skin biopsy revealed hyperkeratosis of the epidermis, acantholysis, formation of fissures or lacunae, and disappearance of desmosomes. Whole exon sequencing (WES) of the patient indicated mutations in the ATP2C1 gene.

Background: Tuberous sclerosis complex (TSC) is a rare autosomal-dominant disorder involving multiple organs including skin, brain, heart, lung, kidney and liver. It usually occurs as early as birth or even in utero, with rare cases diagnosed in their adulthood. Here, we present a rare adult case of TSC presenting as periungual fibromas (PF).

Case presentation: A 67-year-old gentleman showed recurrence of multiple periungual polypoid tumors on all the toes of the right foot when presenting to our department. On physical examination, there were polypoid and verrucous protrusions on the nail fold side of the proximal toe. Computed tomography scan indicated multiple subependymal nodules and renal cyst. Pathological analysis for the polypoid tissues showed fibroepithelial-like lesions, epidermal hyperkeratosis, and acanthosis. Therefore, the patient was diagnosed with TSC presenting as PF.

Conclusion: We reported a rare case of TSC diagnosed in the adulthood based on the presence of PF, subependymal nodules, and renal cyst.

Background: Dyschromatosis symmetrica hereditaria (DSH) is a rare genetic skin condition characterized by pigmented macules on the hands, feet, and sometimes the face. The ADAR1 gene is responsible for this autosomal dominant disorder.

Objective: This study aimed to analyze a three-generation Chinese family with DSH, identify a novel ADAR1 gene mutation, and conduct a comprehensive literature review of Chinese DSH families to enhance understanding of the genetic basis and clinical manifestations.

Methods: Clinical reports, mutation analysis, and literature reviews were conducted. A literature search was performed using PubMed.

Results: A novel heterozygous nonsense mutation, c.763C>T (p.Q255X), in the ADAR1 gene was identified in the proband and five other affected individuals. Literature review findings revealed prevalent mutation sites and clinical data in Chinese DSH families over the past two decades.

Limitations: The number of databases searched was limited, and the treatment outcomes for patients were not deemed satisfactory.

Conclusion: This study provides valuable insights into the genetic basis and clinical features of DSH in Chinese families, shedding light on prevalent mutation sites and clinical data. Further research is needed to explore the relationship between gene mutations and clinical phenotypes and advance therapeutic interventions for DSH.