Dermatology practical & conceptual最新文献

Introduction: Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are primary scarring alopecias that few authors consider the same entity, and some consider them different. Only a few reviews focus on trichoscopic findings in delineating these two alopecias.

Objective: We describe and summarize the trichoscopic features of both conditions.

Methods: We performed an extensive literature search using the PubMed and Google Scholar databases. The Chi-square test was applied to compare the trichoscopic features in LPP and FFA. P-values less than 0.05 were considered statistically significant.

Results: Out of 60 articles, 33 (16 LPP, 17 FFA) were considered for quantitative analysis due to availability in English literature with full text. We found that peripilar cylindrical casts and perifollicular erythema with arborizing vessels were predominant features suggesting early LPP. In contrast, yellow dots, perifollicular erythema, and scattered pigmentation suggested active FFA. Shiny-white area was seen in both groups in the inactive stages. The target arrangement of blue-grey dots, milky-red areas, and irregularly arranged white fibrotic dots were seen in late LPP, and black dots, lonely hairs, and loss of vellus hairs were detected in the later stages of FFA. Features such as blue-grey structureless areas, blue-white veil, and variability in morphologies of hair shafts were not significantly different between the two groups.

Conclusion: This article provides a comprehensive literature review on the trichoscopic features of LPP and FFA, including comparing the similarities, differences, and peculiarities of both conditions.

Introduction: Actinic keratosis (AK) is a common precancerous skin lesion that arises on chronically UV-exposed skin and that can progress to keratinocyte carcinoma.

Objective: The aim of this study was to compare the efficacy, safety, local skin reaction, time to wound healing, and patient preference of imiquimod (IMQ) 3.75% vs 5-fluorouracil (5-FU) 4% cream treatment for AKs.

Methods: Two symmetrical contralateral areas of approximately 25 cm² harboring a similar (≥5) number of AKs were selected and randomly assigned to IMQ 3.75% or 5-FU 4% cream treatment. The total number of AKs for each patient was evaluated at baseline (T0) and 90 days after the end of treatments (T1). Local skin reaction (LSR) score was registered the day after the end of both treatments. Complete remission rate of lesions, cosmetic outcome, and patient preference of treatment were assessed after 90 days (T1).

Results: The mean variation (ΔT0-T1) of AKs was not significantly different in patients treated with IMQ 3.75% vs 5-FU 4% (P = 0.35). The mean LSR was not significantly different between patients treated with IMQ 3.75% and those with 5-FU 4% (p=0.63). No difference in cosmetic outcome was observed in the two groups. Patient preference was equally distributed between the treatments. The mean time to wound healing after the end of the treatment was similar with IMQ 3.75% and with 5-FU 4% (P = 0.83).

Conclusions: This study reports a non-superiority of efficacy, tolerability, wound-healing time, and cosmetic outcome of topical IMQ 3.75% treatment compared to topical 5-FU 4% treatment in AK management.

Introduction: Genodermatoses refer to a group of heterogenous rare genetic diseases with cutaneous expression. Several genodermatoses present with multisystem involvement that can range from mild to life-threatening conditions leading to increased morbidity and mortality.

Objective: Given the paucity in the literature in the field of genodermatoses, especially in the Middle East and North Africa (MENA) region, and building upon the first established genodermatoses database based in Lebanon, this study aimed to decipher the genetic basis of two different types of skin-inherited diseases (androgenic alopecia and vitiligo).

Methods: We conducted a pilot study on two subjects with androgenic alopecia and vitiligo to investigate the possibility of a digenic inheritance model as a potential underlying mechanism for these conditions. Whole exome sequencing (WES) and Gene Expression Omnibus (GEO) DataSets were employed to validate the methodology and provide a foundation for future, larger-scale studies.

Results: We identified two gene variants FOXC1(p.His484Tyr) and SMARCD1 (p.Arg351Cys) responsible for androgenic alopecia and HPS1(p.Ser566Ter) and ITK (p.Pro521Leu) responsible for vitiligo. Further analysis using GEO DataSets confirmed the association between the genes involved in each each disease.

Conclusion: This study identified novel candidate disease genes and inheritance model that could explain the underlying phenotypes that could open the door for a better-guided genomic approach for personalized treatment and early diagnosis.

Introduction: Actinic keratosis (AKs) is a precancerous skin lesion that can progress to keratinocyte carcinoma.

Objective: The objective of the study was to evaluate the efficacy of a dermocosmetic (DC) formulation containing prebiotic active ingredients (Aqua Posae Filiformis, a complex made of ferments, sugars, plant extracts, panthenol, madecassoside, and zinc) on healing time and local skin reactions (LSR) following cryotherapy of AKs and to compare the application of DC and boric acid 3% solution soaks (BA) vs. BA alone.

Methods: Seventy-five adult patients presenting with a maximum of five isolated AKs on the face and/or scalp and who underwent cryotherapy (T0) were enrolled. Post-treatment, patients initiated the application of BA only or BA followed by DC once daily for 30 days (unblinded 1:1 randomization). The evaluation of efficacy in healing time and cosmetic outcomes was assessed 30 days post-treatment (T2); LSR was evaluated three days post-treatment (T1).

Results: There was a gain of 4.5 days (40%) in healing time in the BA+DC group compared to the BA group, with a median time of seven days versus 11.5 days (P <0.0005). Additionally, 50% of lesions in complete response had an excellent cosmetic outcome with BA+DC vs. 20% with BA only. The majority of patients treated with BA+DC had mild LSR vs. moderate LSR with BA, with a median value of two vs three, respectively (P <0.0001).

Conclusion: The addition of a prebiotic DC significantly reduced healing time, improved cosmetic outcomes, and minimized LSR post-cryotherapy. No adverse event was reported with this treatment.

Introduction: Nasal involvement may happen infrequently, and some lesions may not respond to conventional treatments.

Objectives: The current case series report aimed to describe the characteristics of 10 confirmed pemphigus vulgaris (PV) and pemphigus foliaceus (PF) patients with nasal skin lesions who did not respond to conventional treatment options or relapsed after a while and to evaluate the role of methotrexate in treatment.

Methods: Data regarding patient demographics, disease type and severity, nasal lesion characteristics, and treatment response were obtained from medical records and direct communication with patients between 2019 and 2023.

Results: Eight patients had received intravenous rituximab (RTX) and three had received methotrexate (MTX). Out of the eight pemphigus vulgaris (PV) patients who had undergone RTX treatment, a total of eighteen treatment sessions were carried out. Following RTX therapy, significant improvements were observed in the nasal lesions after eleven (61.1%) sessions, with eight (44.4%) achieving complete resolution within six months. Additionally, three patients who did not have satisfactory results after RTX treatment, received methotrexate, and all experienced complete recovery of their nasal lesions within the same timeframe.

Conclusions: All the patients who benefited from methotrexate had never experienced complete remission of their nasal lesions before. It seems methotrexate can be an eligible choice for recalcitrant cases.