Cutaneous and Ocular Toxicology最新文献

Study purpose: Botulinum toxin (BoNT) is commonly used for both cosmetic and medical purposes. However, improper use can lead to iatrogenic botulism. This scoping review aimed to evaluate the systemic and skin-related effects, identify risk factors, and highlight safety gaps in BoNT-related botulism.

Methods: We followed PRISMA-ScR guidelines to search for literature from 1997 to 2024 across PubMed, Scopus, EMBASE, and Google Scholar. Ten case reports (113 patient cases) met the inclusion criteria.

Results: Females accounted for 78.8% of cases. Systemic symptoms typically developed within four days after the injection. Notably, 46% of cases involved unlicensed BoNT products, raising safety concerns. Among the licensed formulations, Abobotulinum toxin A accounted for 33.6% of cases, Onabotulinum toxin A for 10.6%, and other or unspecified products for 9.7%. Doses ranged from 100 to 2000 units (average of 487±312 units). Intramuscular injection was the most common method at 60.2%. Common symptoms included dysphagia in 82.3% of cases, ptosis in 78.8%, and generalized weakness in 65.5%. Respiratory failure occurred in 12.4% of severe cases. Interestingly, there were no consistent reports of skin or injection-site reactions, suggesting potential underreporting of skin-related effects. Treatments included antitoxin in 59.3% of cases and pyridostigmine in 24.8%. The majority of patients, 86.7%, fully recovered, though six experienced symptoms lasting over six months.

Conclusion: Both licensed and unlicensed BoNT products can lead to iatrogenic botulism. Inconsistent reporting of skin complications highlights a gap in safety data. Adhering to proper injection protocols and thoroughly documenting adverse events is crucial for enhancing patient safety.

Introduction: Teledermatology, which utilizes communication technologies to remotely assess skin lesions, has become a vital tool in healthcare. This study aimed to compare the diagnostic accuracy of teledermatology versus face-to-face examination and explore factors influencing accuracy, such as teledermatoscopy use, dermatoscopy type, and clinical experience.

Methods: Fifty-seven cutaneous tumors were evaluated using handheld or digital dermatoscopy in face-to-face examinations, and preliminary diagnoses were recorded. A definitive diagnosis was established through histopathological examination, which served as the reference standard. Macro and dermatoscopic images were then sent to six teledermatologists for remote diagnosis, and findings were analyzed statistically.

Results: The preliminary diagnosis matched the histopathological diagnosis in 84.2% of face-to-face cases. Teledermatologists achieved 63.7% accuracy with macro images alone, increasing to 70.8% with dermatoscopic images. Teledermatology showed lower accuracy than face-to-face examination, regardless of whether teledermatoscopy was used (p < 0.05), but accuracy significantly improved with dermatoscopic images (p = 0.004). The teledermatology's accuracy for malignancy prediction was comparable to face-to-face examination (p > 0.05). Dermatoscopy type did not significantly impact accuracy (p > 0.05), while longer clinical experience correlated with higher accuracy (p < 0.05). Interrater reliability was poor for specific diagnoses but improved when categorizing lesions as malignant or benign (κ = 0.192, κ = 0.683).

Conclusion: Although teledermatology performed below face-to-face examination in terms of specific diagnoses, it remained effective in distinguishing between benign and malignant cutaneous tumors. The inclusion of teledermatoscopy and longer clinical experience enhanced diagnostic accuracy.

Objective: Wound repair remains a significant challenge in the field of regenerative medicine. Notably, while numerous studies have investigated the effects of isolated nicotine or chlorogenic acid, the systematic evaluation of tobacco ethanol extract (TEE) on cutaneous wound healing has remained uncharted territory. Therefore, this study aims to systematically explore TEE's multifaceted effect on wound healing.

Methods: The hepatorenal toxicity of 5% TEE was evaluated in 6-7-week-old ICR mice. Subsequently, full-thickness 6 mm wounds were created, and images were captured on days 0, 3, 6, 9, and 12. Tissues were collected for H&E staining, Masson trichrome staining, and immunohistochemistry to assess wound healing.

Results: The TEE we prepared showed little hepatorenal toxicity (p > 0.05). By day 12, the wound closure rate in the TEE group reached 95.26%, significantly higher than that in the vehicle group (89.20%, p < 0.05). Histopathological analysis demonstrated that TEE reduced neutrophil infiltration in the wound tissues, accelerated granulation tissue formation, and increased collagen content by 20.99% compared to the vehicle group (p < 0.05). Immunohistochemical staining revealed that on day 6, the positive areas of IL-6 and TNF-α in the TEE group were 5.91% and 4.87% lower than those in the vehicle group (p < 0.05), respectively. On day 9, CD31 expression in the TEE group (8.58%) was significantly higher than that in the vehicle group (5.54%) (p < 0.05).

Conclusion: This study reveals that TEE accelerates wound healing, providing new insights into effective topical therapies for skin wounds while highlighting the potential for tobacco waste valorization.

Kaposi sarcoma (KS) is a vascular tumour with four main clinical types-classic, endemic, iatrogenic, and epidemic-all linked to infection by human herpesvirus 8 (HHV-8). This retrospective cohort study assessed the relationship between demographic factors and clinical characteristics in 73 patients with biopsy-proven KS treated at a single dermatology centre between 2009 and 2023. Demographic and clinical data, including age, gender, birthplace, blood type, smoking, alcohol use, HIV status, tumour site, and disease stage, were collected and statistically analysed. Most patients were male (77%), with a mean age of 61 years, and the classic KS subtype predominated (86%). The majority (75%) had tumours localised to the extremities. HIV-positive status was diagnosed in 14% of cases and was strongly associated with non-extremity tumour location and increased visceral involvement. Notably, blood type showed a significant association with tumour localisation: 0Rh- and ARh- blood groups were less common in KS patients with extremity tumours. This is the first study to demonstrate a significant relationship between blood group and KS tumour site, introducing a novel epidemiological association. Smoking and alcohol consumption were each significantly linked to higher HIV positivity rates. Patients from the Mediterranean region had a higher frequency of HIV-positive KS, although birthplace did not correlate with disease stage. No associations were observed between gender and disease type. The study is limited by its retrospective design and missing data for certain variables, but it identifies potentially novel patterns-including a possible link between blood group and tumour location-and confirms known associations, such as HIV status with advanced disease. These findings underscore the complexity of KS presentation and suggest that demographic, clinical, and lifestyle factors may shape disease patterns. Prospective, multicentre studies are needed to validate these findings and guide personalised approaches to KS management.

Background: LUXTURNA^® (voretigene neparvovec-rzyl) is the first FDA-approved gene therapy for inherited retinal dystrophies caused by biallelic RPE65 mutations. While pivotal clinical trials established its safety and efficacy, there has been no formal analysis of real world data to date.

Methods: We reviewed published literature and regulatory safety databases, including the FDA Adverse Event Reporting System and EudraVigilance, to assess clinical outcomes and adverse event reporting associated with LUXTURNA^®.

Results: Clinical trials demonstrated durable functional vision improvements, with approximately 70% of patients maintaining gains up to four years post-treatment. Adverse events reported in trials were largely mild to moderate, such as conjunctival hyperemia, cataract, and transient intraocular pressure elevation. Post-marketing surveillance, however, revealed additional safety concerns, most notably chorioretinal atrophy (CRA), which has been reported in 13-50% of treated eyes, particularly in younger patients and often near the injection site. Disproportionality analyses confirmed CRA as the most prominent adverse event, alongside elevated risks for retinal tears or detachment, intraocular pressure changes, ocular hemorrhage, and inflammation. Despite these findings, central visual acuity was generally preserved, and no systemic toxicity was identified.

Conclusions: LUXTURNA^® provides meaningful and durable visual benefits for patients with RPE65-related disease, but long-term monitoring is essential to address its emerging ocular safety profile. Our data represent the first comprehensive pharmacovigilance review of LUXTURNA^®, providing critical insights for clinical practice and post-marketing surveillance.

Background: Anogenital warts (AGWs) are typically caused by low-risk HPV types. Coinfection with EBV and CMV may influence disease progression, especially under immunosuppression. This study aimed to detect HPV, EBV, and CMV in tissue samples from AGW patients. This descriptive, retrospective, single-center study aimed to detect HPV, EBV, and CMV DNA in paraffin-embedded tissue samples from patients with AGWs.

Material and methods: Paraffin-embedded tissues from 24 AGW patients were analyzed using real-time PCR and pyrosequencing for HPV, EBV, and CMV DNA. Demographic and viral data were statistically evaluated. Degraded or insufficient DNA samples were excluded following quality control assessment. Descriptive and comparative statistical analyses were performed using SPSS v22.0.

Results: HPV was detected in 62.5% of patients, most commonly type 6, followed by types 40, 87, and 16. EBV was found in 2 patients (8.3%), both with HPV coinfection. HPV. CMV was not detected in any samples. No statistically significant associations were found between demographic or clinical parameters and viral positivity.

Conclusion: The study identified rare EBV and HPV coinfections in AGWs but no CMV positivity. These findings are descriptive, and the small sample size limits generalization. The presence of EBV in immunosuppressed individuals may suggest immunotoxic mechanisms affecting viral persistence in the skin. Further studies with larger cohorts are warranted.

Objective: To prepare low-temperature extracted Portulaca oleracea L. (P. oleracea) and investigate the application of masks containing this extract in photorejuvenation for sensitive skin.

Methods: Eligible participants were randomly divided into two groups. Experimental group used the mask for 14 days prior to photorejuvenation. Both groups used the mask for 7 days post-treatment. Changes in physiological parameters and Dermatology Life Quality Index (DLQI) were observed.

Results: Immediately after photorejuvenation, control group showed a significant increase in skin red area and red blood cell concentration, while experimental group did not. At 7 days post-treatment, skin hydration and transepidermal water loss (TEWL) improved significantly in both groups, with greater improvement in the experimental group. Both groups' DLQI decreased, with a significant reduction in the experimental group.

Conclusion: Facial masks containing low-temperature extracted P. oleracea show promising potential in protecting sensitive skin from photothermal stimulation and improving skin barrier function during photorejuvenation therapy.

Objective: Diabetic wounds are slow to heal, causing pain and increasing medical burden. This study aims to develop a skin extracellular matrix (ECM) hydrogel containing ciprofloxacin (CIP) and S-nitrosoglutathione (GSNO) to evaluate its antimicrobial and wound healing effects.

Methods: Porcine skin was used to extract ECM hydrogel via decellularization, followed by loading with CIP and GSNO. Scanning Electron Microscopy (SEM) was used for microstructure and drug distribution characterization. In vitro antibacterial tests, along with human umbilical vein endothelial cell (HUVEC) proliferation and migration assays, were conducted. Animal studies on diabetic mice and histological analysis were performed.

Results: The ECM hydrogel with CIP and GSNO demonstrated uniform drug distribution and significant antibacterial effects, with a 99.2% antibacterial rate against Staphylococcus aureus. In vitro, the hydrogel enhanced HUVEC cell proliferation by 35% and migration by 51%. In diabetic mice, wound healing was accelerated, with a 95.2% healing rate at 14 days, 56.1% higher than the control group. Additionally, bacterial load was reduced by 77.6%, and angiogenesis and collagen fiber formation were promoted.

Conclusion: This study successfully developed a skin ECM hydrogel with dual antimicrobial and healing effects, offering a promising strategy for diabetic wound treatment.

Background: Abilar^® is a wound salve containing 10% medical-grade Norway spruce (Picea abies) resin, known for its antimicrobial and wound-healing properties. However, isolated reports of allergic contact dermatitis have raised concerns regarding its cutaneous safety profile. It is thus important to evaluate any potential for skin irritation and sensitisation.

Objectives: To evaluate the irritation and sensitisation potential of the resin salve using a modified Draize Human Repeat Insult Patch Test (HRIPT) in a healthy adult cohort, thereby providing toxicological insights relevant to both clinical applications and consumer safety.

Methods: A single-blind study was conducted with 215 healthy volunteers (207 completed the study). The resin salve was applied through cutaneous patches in an induction phase and a challenge phase. Skin reactions were evaluated using modified Draize scoring system.

Results: During the induction phase, only 7 of 207 subjects (3.38%) of participants exhibited mild erythema (Grade 1) attributed to the resin salve. Notably, no participant experienced moderate to severe reactions (Grades 2-5). In the subsequent challenge phase, no reactions were observed, and subjects with prior Grade 1 responses reverted to a non-reactive status.

Conclusions: The HRIPT findings demonstrate that medical-grade Picea abies resin salve has a low irritation and sensitisation potential under the conditions tested. Although rare allergic contact dermatitis cases have been reported, the data of this study suggests that the overall risk in the general population is low. These findings are also supported by clinical studies and extensive post-market surveillance of Abilar^® in wound care for both acute and chronic wounds.

Background: Actinic keratosis (AK) is a common premalignant skin condition linked to chronic ultraviolet (UV) exposure and oxidative stress. Systemic biomarkers of redox imbalance in AK remain underexplored.

Aims: To assess systemic oxidative stress in AK using plasma thiol-disulfide homeostasis (TDH) and ischemia-modified albumin (IMA).

Methods: This cross-sectional study included 42 patients with clinically diagnosed AK and 42 age- and sex-matched healthy controls. Native thiol, total thiol, disulfide concentrations, and derived redox indices (Index-1, -2, -3) were measured using a spectrophotometric assay. IMA levels were assessed via the albumin-cobalt binding test. Statistical comparisons and correlation analyses were performed.

Results: Native thiol, total thiol, and disulfide levels were significantly lower in the AK group (p = 0.001), whereas disulfide-based indices showed no significant differences. IMA concentrations were significantly elevated in AK patients (p = 0.001). IMA levels were negatively correlated with native (r = -0.312, p = 0.044) and total thiol (r = -0.309, p = 0.046) values. Patients with Fitzpatrick Type IV skin exhibited significantly higher lesion counts than those with Types II and III (p < 0.05).

Conclusion: AK patients show systemic oxidative imbalance, with reduced thiols and elevated IMA, reflecting persistent UV-induced redox stress and protein oxidation. TDH and IMA may have potential utility as systemic indicators of oxidative stress in AK. Limitations include cross-sectional design, modest sample size, and unmeasured confounders. Future longitudinal and interventional studies should assess causality and antioxidant-based therapies.