Cutaneous and Ocular Toxicology最新文献

Objective: In this study, we aimed to examine the responses given by ChatGPT (OpenAI), Copilot (Microsoft), and Gemini (Bard) artificial intelligence applications to questions about the active ingredient isotretinoin in terms of accuracy, readability, applicability, and understandability.

Material and methods: The readability of the answers given by the artificial intelligence programs was evaluated using the Flesch-Kincaid ease score, and the applicability and understandability levels were evaluated using the Patient Education Materials Evaluation Tool scales. The accuracy of the answers was compared by two dermatologists who scored them between 1 and 5.

Results: No significant difference was found between the groups in terms of Flesch Kincaid reading ease scores (p = 0.671), and all three programs were found to be at a difficult level of reading. In the Patient Education Materials Evaluation Tool scales, it was observed that Gemini and ChatGPT rates were >70% and there was a significant difference in favor of these programs between the groups (p < 0.001). In the accuracy scores of the answers, Gemini (4.90 ± 0.31) and ChatGPT (4.60 ± 0.69) had high scores and there was a significant difference between the groups (p < 0.001).

Conclusion: While the AI chatbots we used in the study demonstrated reasonable accuracy in answering questions about isotretinoin, they performed limited in terms of readability and usability. These findings suggest that AI programs alone are not sufficient for patient education and need to be improved to simplify responses.

Background: Existing research lacks a systematic investigation of the complete gene expression profile in hypertrophic scars (HS). This study aimed to systematically explore the differences in mRNA expression profiles between human HS and normal skin tissues using bioinformatics analysis methods.

Methods: GSE236983 and GSE229848 were downloaded from Gene Expression Omnibus (GEO) to screen differentially expressed genes (DEGs). Protein-protein interaction (PPI) network was constructed using STRING (search tool for recurring instances of neighboring genes), followed by gene ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis of the DEGs. Three surgical samples of HSs and adjacent normal skin tissues were selected from 3 HS patients for comparative analysis of DEGs.

Results: Venn diagram of two datasets showed an intersection, revealing 31 DEGs. GO enrichment results unveiled that DEGs were mainly involved in keratinization, keratinization cell differentiation, epidermal cell differentiation (ECD), and skin development. Cellular components (CCs) were mainly enriched in cell desmosomes, intermediate filament cytoskeleton (IFC), keratin filament (KF), and intermediate filament (IF). KEGG analysis signified that the main involved pathways encompassed tight junctions, extracellular matrix-receptor interaction, arachidonic acid metabolism, and terpenoid backbone biosynthesis. mRNA levels of 10 core genes (MVD, ACAT2, HMGCS1, HMGCR, FASN, MSMO1, DHCR7, DHCR24, and AACS) in HS and normal skin tissues were different (P < 0.05), with MVK showing non-significant differences (P > 0.05).

Conclusion: this study identified ten core DEGs associated with HS through systematic bioinformatics analysis. These genes are involved in biological processes and cellular components such as keratinization, cell differentiation, lipid metabolism, cholesterol biosynthesis, and cell adhesion.

Background: Rosacea is a chronic inflammatory skin disorder involving dysregulated innate immunity and microbial interactions. Procalcitonin (PCT) is a serum biomarker of bacterial inflammation but its role in rosacea remains unclear.

Objectives: To assess serum PCT levels in rosacea patients compared to healthy controls and explore associations with treatment modalities and clinical parameters.

Methods: This case-control study included 60 rosacea patients and 20 age- and sex-matched healthy individuals. Patients were grouped as untreated, topically treated with metronidazole, or systemically treated with doxycycline plus metronidazole. Serum PCT levels were measured by fluorescence immunoassay. Statistical analyses included Kruskal-Wallis, Mann-Whitney U, and multivariate linear regression.

Results: Rosacea patients had significantly higher PCT levels than controls (0.18 ± 0.06 vs. 0.12 ± 0.04 ng/mL; p < 0.001). Elevated PCT was observed in untreated and topical-only groups, while systemic treatment was associated with reduced levels (0.10 ± 0.004 ng/mL; p < 0.001), comparable to controls. No differences were found based on sex, smoking, or alcohol use. Multivariate analysis identified systemic therapy as a negative predictor (β = -0.55, p < 0.001) and papulopustular subtype as a positive predictor of elevated PCT (β = 0.23, p = 0.039).

Conclusions: PCT may reflect underlying subclinical inflammation in rosacea and decrease with systemic therapy. These findings support further investigation of PCT as a biomarker in rosacea.

Objective: Topical anesthetic eye drops are widely used in ophthalmology; however, improper use may result in serious complications, including blindness.

Materials and methods: This descriptive, cross-sectional study examined patients presenting with foreign body sensation, exposure to ultraviolet (UV) radiation, or misuse of topical anesthetic drops at Sina Hospital's Ophthalmology Emergency Department from September 2019 to September 2020. After obtaining informed consent, participants completed questionnaires under the supervision of an ophthalmologist. Patients with anesthetic-related complications received appropriate treatment and were followed up for one month. Data were analyzed using SPSS version 21.

Results: Of 192 patients (185 men and 7 women; mean age: 42.69 ± 12.45 years), 76.56% reported foreign body sensation. The most common symptoms were lacrimation (84.37%) and photophobia (73.95%). Many patients used non-medical remedies such as closing their eyes (63.15%) and applying tea (45.31%). Pharmacy staff (38.27%) and colleagues (33.33%) were the most frequent sources of advice. Tetracaine misuse was significantly more common among patients with a prior history of use (P < 0.001) and was significantly associated with ocular complications, including keratopathy and vision loss (P = 0.011).

Conclusion: Arbitrary use of topical anesthetic drops-often based on non-specialist recommendations-significantly increases the risk of ocular complications. Awareness of potential side effects does not appear to prevent misuse, underscoring the need for stronger educational efforts regarding the risks of topical anesthetics.

Introduction: The global incidence of skin cancer is rising, emphasizing the need for early detection tools. Artificial intelligence (AI) models, including multimodal systems like ChatGPT-4o, can analyze visual data to assist clinicians in diagnosis. This study evaluated ChatGPT-4o's diagnostic accuracy in detecting melanoma and non-melanoma skin cancers from macroscopic and dermoscopic images.

Methods: Ninety patients with histopathologically confirmed lesions were included. For each patient, macroscopic images were first uploaded to ChatGPT-4o, followed by combined upload of macroscopic and dermoscopic images. ChatGPT-4o was instructed to provide a preliminary diagnosis and three differential diagnoses for each lesion. Accuracy was assessed at four levels: Level 1: preliminary diagnosis using macroscopic images; Level 2: preliminary diagnosis using macroscopic and dermoscopic images; Level 3: three differential diagnoses using macroscopic images; Level 4: three differential diagnoses using macroscopic and dermoscopic images.

Results: Overall Level 1 accuracy was 73.3%, with Level 2, Level 3, and Level 4 accuracies of 66.6%, 75%, and 76.6%, respectively. Dermoscopic images improved accuracy for squamous cell carcinoma (72.7% vs 81.8%, p = 1.00), reduced overall and basal cell carcinoma accuracy (73.3% vs 66.6%, p = 0.180 and 79.6% vs 67.8%, p = 0.065, respectively), and did not affect malignant melanoma (84.6% vs 84.6%) or lentigo maligna (0% vs 0%). Statistical analysis revealed that the addition of dermoscopic images did not significantly influence diagnostic accuracy, either overall or within individual diagnostic categories. The model recommended biopsy for all lesions, suggesting potential as a supportive diagnostic tool.

Conclusion: ChatGPT-4o showed variable diagnostic accuracy for melanoma and non-melanoma skin cancers. Dermoscopic images reduced performance for certain diagnostic categories. These misclassifications highlight the potential for unnecessary interventions and patient anxiety underscoring that AI-based systems should serve as supportive aids rather than standalone diagnostic tools.

Purpose of the article: Snail mucin (SM) has garnered significant attention in dermatology, particularly for its potential in scar therapy and wound healing, due to its bioactive compounds, like allantoin, glycolic acid, and hyaluronic acid. These compounds are known to promote tissue regeneration, enhance skin hydration, and reduce scarring.

Materials and methods: However, despite growing interest, significant gaps remain in the clinical understanding of SM's therapeutic potential, including a lack of standardised formulations and limited clinical trials. There is a urgent need for more extensive human clinical trials to fully explore SM's potential in scar therapy, particularly given the potential safety concerns, such as skin irritation, sensitisation, and allergic reactions, these issues highlight the importance of toxicological evaluations and regulatory scrutiny.

Result and conclusion: While current regulatory frameworks, such as from FDA and CIR, emphasise the importance of safety substantiation for SM-based products, no formal toxicological monographs exist. This review discusses the therapeutic relevance of SM, identifies research gaps, and emphasises the need for rigorous safety testing and clinical validation to support its use in dermatology.

Background: Combination of targeted therapy and immune checkpoint inhibitors (ICIs) is a leading approach in the treatment of advanced hepatocellular carcinoma (HCC). However, an increased incidence of skin rashes poses a clinical challenge. Understanding the acute cutaneous adverse drug reactions (CADRs) during the early stage of the combination treatment is crucial.

Objective: To investigate the clinical characteristics of acute CADRs in HCC patients undergoing combined targeted agents and ICIs and identify potential risk factors contributing to the development of severe CADRs phenotypes.

Methods: A retrospective analysis of 33 HCC patients with acute CADRs following combination therapy was conducted. Patients were categorized into maculopapular eruption (MPE) group and atypical targetoid eruption (ATE) group based on the rash phenotypes. Clinical characteristics were compared between the subgroups, and the administration pattern of the combination therapy was analyzed.

Results: 16 MPE cases and 17 ATE cases were identified. No other types of acute skin eruptions were documented. Patients with ATE developed rashes with a shorter time latency, experienced more systemic symptoms, showed higher severity grades, had longer disease courses, and demonstrated a lower rate of successful rechallenge compared to patients with MPE. The ATE group displayed a significantly higher percentage receiving full-dose targeted agents and a shorter interval between targeted agents and ICIs upon initiation of combination therapy.

Conclusions: In HCC patients receiving combined regimens, atypical targetoid rashes indicate a more severe CADR. Full-dose targeted agents and shorter intervals between targeted agents and ICIs may contribute to the more severe CADR phenotype.

Objective: This study aimed to assess the potential risk of Bullous pemphigoid (BP) associated with antidiabetic agents, antimicrobials, diuretics, immune checkpoint inhibitors, and biological agents.

Research design and methods: A retrospective pharmacovigilance data analysis was conducted using the FDA Adverse Event Reporting System (FAERS) between Q1/2004 and Q3/2024. Disproportionality analyses, viz. Proportional Reporting Ratio (PRR), Reporting Odds Ratio (ROR), and Information Component (IC) were performed to identify signals of BP. Additionally, a literature review of case reports of BP was conducted in PubMed, Google Scholar, and Scopus.

Results: Disproportionality analysis identified 61 signals, and the following drugs exhibited the highest number of BP case associations: metformin (596 cases), vildagliptin (406 cases), nivolumab (376 cases), and furosemide (301 cases). Strong statistical correlation for signals was observed for vildagliptin [PRR = 295.8, LB (lower bound) ROR = 287.2, IC₀₂₅ = 7.5], dapsone [PRR = 20.7, LBROR = 14.4, IC₀₂₅ = 3.4], furosemide [PRR = 7.2, LBROR = 6.4, IC₀₂₅ = 2.6], and nivolumab [PRR = 31.5, LBROR = 28.5, IC₀₂₅ = 4.6]. These findings were supported by 106 identified case reports of BP.

Conclusion: This study suggests a strong statistical correlation between vildagliptin, dapsone, furosemide, nivolumab, and the development of BP.

Objective: Scarring alopecias are chronic inflammatory disorders characterised by irreversible hair follicle destruction. In this study, we aimed to evaluate the potential roles of serum ferritin, folate, vitamin B12, vitamin D levels and thyroid function markers in the pathogenesis of scarring alopecias.

Aterials and methods: Between 2020 and 2025, a total of 68 patients over the age of 18 who were diagnosed with scarring alopecia based on clinical and/or histopathological findings and whose medical records were accessible retrospectively were included in the study, along with 68 healthy control subjects. Serum levels of ferritin, folate, vitamin B12, vitamin D, and thyroid function markers were recorded and statistically compared between groups.

Results: Among patients with scarring alopecia, 91.2% were female (n = 62), with a mean age of 47.25 ± 12.98 years. The average disease duration was 34.37 ± 24.22 months (min: 3, max: 144). The distribution of diagnoses among patients was as follows; lichen planopilaris in 45.6% (n = 21), frontal fibrosing alopecia in 29.4% (n = 20), pseudopelade in 16.2% (n = 11), discoid lupus erythematosus in 7.4% (n = 5), and folliculitis decalvans in 1.5% (n = 1). There were no statistically significant differences between patients with scarring alopecia and the control group regarding serum vitamin B12 (340.19 ± 107.950 vs. 357.04 ± 107.549 ng/L, p = 0.373), folate (11.89 ± 6.11 vs. 12.23 ± 6.53 ng/mL, p = 0.767), ferritin (34.75 ± 38.05 vs. 39.89 ± 66.74 µg/L, p = 0.593), and vitamin D (54.3 ± 26.57 vs. 58.59 ± 37.38 nmol/L, p = 0.434) levels. Thyroid function tests (TSH and free T4) were also similar between the two groups (p > 0.05).

Conclusion: Our study demonstrated that serum ferritin, folate, vitamin B12, vitamin D levels and thyroid function in patients with scarring alopecia were similar to those in the healthy control group.

Purpose: Some preservatives in eye drops induce corneal epithelial damage. Diquafosol sodium, a dry eye treatment drug released in 2022, contains silver nitrate as a preservative. This study examined the effects of diquafosol sodium ophthalmic solution and silver nitrate solution on the barrier function of corneal epithelial cells in rabbit eyes.

Patients and methods: The 14 rabbits included in the study were divided into 7 eye drop treatment groups (4 eyes per group): (1) 3% diquafosol (Diquas) without silver nitrate; (2) 3% Diquas LX containing silver nitrate; (3) 3% Diquas LX without silver nitrate; (4) 0.01% silver nitrate; (5) 0.1% silver nitrate; (6) 1% silver nitrate; and (7) saline. Electrical corneal resistance (CR) was measured using a CR-measuring device (CRD) at 30, 60, and 120 minutes after the final instillation, and CR% was calculated. Corneal epithelial damage was evaluated using fluorescein staining 120 minutes after the final instillation.Corneal tissue obtained 120 minutes post-instillation was fixed in 4% paraformaldehyde, permeabilized, and blocked. Zonula occludens-1 protein, which constitutes tight junctions between epithelial cells, was visualized using whole-mount immunohistochemical staining. To examine the expression of ZO-1 in corneal epithelial cells, photographs of the outermost layer of the cornea were taken.

Results: CR in the Diquas LX group 1 (containing silver nitrate) reached its peak value (114.2 ± 7.1%) 60 minutes after the final instillation, which was comparable to that in the 0.1% silver nitrate group (117.2 ± 17.6%) and significantly higher than that in the Diquas group 3 (without silver nitrate) (98.8 ± 5.8%; P < 0.05). Zonular occludens-1 protein was localized in a continuous linear pattern at the boundary between epithelial cells in all three Diquas groups.

Conclusions: Diquas LX eye drops containing silver nitrate significantly increased CR compared to Diquas eye drops without silver nitrate and improved corneal barrier function. Silver nitrate as a preservative may have contributed to this effect.