Dermatology practical & conceptual最新文献

Introduction: The underlying mechanisms behind the development of psoriasis have become better understood in recent years. Key factors involved include the heightened reactivity of certain T cell subsets (Th1 and Th17 cells) as well as dysregulation of regulatory T cell (T-reg) function. Additionally, the complex interplay between immune cells, skin cells (keratinocytes), and the blood vessel endothelium has been shown to play an important role in the pathogenesis of psoriasis.

Objectives: A more thorough investigation of these mechanisms could present an opportunity to devise novel therapeutic approaches.

Methods: In this study, we reviewed the evidence regarding the role played by stem cells in the pathogenesis of psoriasis as well as initial attempts at leveraging stem cells as a treatment modality.

Results: Investigations uncovered the impact that epidermal stem cells and their interactions with T cells have in psoriasis. Importantly, malfunctions across diverse stem cell types may constitute a central mechanism underlying the dysregulated inflammatory processes that characterize this condition.

Conclusions: Nonetheless, a more thorough investigation of these mechanisms could present an opportunity to devise novel therapeutic approaches.

Introduction: The full range of cutaneous comorbidities associated with keratinocyte skin cancers remains to be elucidated.

Objectives: We aimed to examine other skin diseases in patients with keratinocyte cancer (KC) and to reveal potential associations between them.

Methods: Included in the study were 200 patients with KC and 200 disease-free controls. To identify any additional concomitant dermatological conditions, all study groups underwent examination by two dermatologists.

Results: In patients with KC, 87.5% were diagnosed with basal cell carcinoma and 13.5% were diagnosed with squamous cell carcinoma. There was no statistically significant difference between the two groups regarding sunscreen use habits (P =0.284). Patients with KC exhibited a significantly elevated odds ratio (OR) for the presence of rosacea (OR 5.13, 95% CI: 3.2-8.3, P=0.000) and especially erythematotelangiectatic rosacea (ETR) subtype (OR 5.03, 95% CI: 3.1-8.2, P=0.000). An Receiver Operating Characteristic (ROC) curve analysis was conducted to assess the efficacy of rosacea in differentiating between the control group and patients with KC. The sensitivity, specificity, negative predictive value, and positive predictive value for rosacea were 45.5%, 86%, 61.2%, and 76.5%, respectively (AUC 0.658, 95% CI: 0.604-0.711, P=0.000), while for ETR it was 44%, 86.5%, 60.7%, and 76.5%, respectively (AUC 0.653, 95% CI: 0.599-0.706, P=0.000). The presence of rosacea demonstrated a significant efficacy in differentiating patients with KC from the control group in all localizations (P< 0.05).

Conclusion: The risk of rosacea in patients with KC, particularly those with the ETR subtype, was found to be significantly elevated, irrespective of age, sex, or localization.

Introduction: Vascular patterns play a crucial role in the diagnosis and differentiation of skin lesions by providing insight into underlying pathology and aid in distinguishing between benign and malignant lesions. While dermoscopy has proven valuable for visualizing these vascular structures, line-field confocal optical coherence tomography (LC-OCT) offers high-resolution, 3-dimensional (3D) imaging of the skin, potentially providing detailed visualization of vascular architecture and new insights into their projection in dermoscopy.

Objectives: This pilot study aimed to investigate the correlation between vascular patterns in skin lesions with LC-OCT and dermoscopy and explored tridimensional imaging in assessing microvascular architecture.

Methods: A cohort of patients with 14 diverse skin lesions showing typical dermoscopic vascular patterns were examined using dermoscopy and LC-OCT. LC-OCT images were analyzed, and manual segmentation with tridimensional reconstruction of the vascular structures was performed. The correlation between these vascular structures and their dermoscopic projection was then assessed qualitatively.

Results: LC-OCT demonstrated a strong visual correlation with dermoscopy in identifying vascular patterns, offering additional depth and 3D details of the intricate relationship between skin micro-architecture and the development of specific vascular patterns in skin lesions.

Conclusions: LC-OCT correlates with dermoscopy in vascular pattern analysis in skin lesions. The added advantage of 3D imaging helped us understand the way vascular structures are formed in skin lesions depending on their micro-architecture. LC-OCT could potentially play a significant role in precisely assessing the vascular environment of skin lesions. Further studies are necessary to assess how this could provide clinical value for diagnosing or monitoring skin lesions.

Introduction: Psoriasis is a chronic inflammatory disease that significantly impacts psychosocial well-being. This study compared the clinical and psychosocial characteristics of early-onset (<40 years) and late-onset (≥40 years) psoriasis.

Methods: This cross-sectional study included 190 patients with psoriasis categorized as early-onset (n=135) and late-onset (n=55). Data on demographics, clinical features, comorbidities, and psychosocial factors were collected. The Hospital Anxiety and Depression Scale (HADS) and the Dermatology Life Quality Index (DLQI) assessed psychological impact and quality of life. Statistical analyses included chi-squared tests, t-tests, and correlation analyses.

Results: Early-onset patients were more likely to have a family history of psoriasis (43.7% vs. 16.4%, P<0.001), while pustular psoriasis was more common in the late-onset group (27.3% vs. 11.1%, P=0.006). A significant positive correlation was observed between DLQI scores and HADS-Total, HADS-Anxiety, and HADS-Depression scores (P<0.001). Psychological stress was reported as a disease trigger by 63.1% of patients, with a higher proportion in the early-onset group (P=0.025). Although initial comparisons revealed no significant difference in DLQI or HAD scores between groups, an additional analysis limited to chronic plaque psoriasis revealed significantly higher anxiety and total HADS scores in the early-onset group (P=0.002 and P=0.035, respectively), suggesting a stronger psychological burden when clinical subtype is controlled.

Conclusions: Early-onset psoriasis patients are more likely to report stress as a trigger and have a family history, while late-onset patients exhibit higher rates of pustular psoriasis and increased body mass index. Early-onset patients with chronic plaque psoriasis experience greater psychological burden, particularly anxiety. These findings highlight the importance of age of onset in tailoring psychosocial support and treatment strategies in psoriasis care.

Introduction: Atopic dermatitis (AD) is a chronic inflammatory condition associated with a significant physical, psychological, and economic burden. This study aimed to determine the multidimensional impact of AD on patients and the Spanish healthcare system.

Methods: The present multicenter descriptive cross-sectional study was conducted at 12 Spanish sites to detect clinical practice assessments and validated patient-reported measures.

Results: A total of 62 patients were included (54.8% males; mean age: 33.1 years). According to the validated Investigator Global Assessment scale for AD, 61.3% and 38.7% of patients had moderate and severe AD, respectively. AD involved a mean of 43.3% body surface area, with patients reporting a median of 4.0 flares in the past year. The mean Patient-Oriented Eczema Measure (POEM) questionnaire score was 19.8, indicating severe eczema. In addition, 57.1% of patients reported daily pain from scratching or skin inflammation. The mean Dermatology Life Quality Index (DLQI) was 14.3, showing a strong AD impact on patients' quality of life, positively correlated with severity, pruritus, and pain. AD also affected work productivity and sleep, with over 50% of patients reporting impairments in daily activities. Treatment patterns showed predominant use of topical corticosteroids (81.5%). Although no patient required hospitalization in the previous year, 25% resorted to alternative therapies/unlicensed products.

Conclusions: AD profoundly impacts patients' quality of life and entails high economic costs. This study emphasizes the need for more effective treatment strategies and an improved understanding of the AD burden to utilize public healthcare resources more efficiently.

Introduction: Trichorhinophalangeal syndrome (TRPS) is a rare autosomal dominant genetic disorder characterized by trichological, craniofacial, and skeletal abnormalities. To date, limited data are available on hair involvement in TRPS, especially those focusing on trichoscopy.

Objective: We aimed to describe the epidemiology and the clinical and trichoscopy features of TRPS.

Methods: We performed a retrospective multicenter study using chart review and images from six patients with a confirmed diagnosis of TRPS. Hair density (hair/field; field 13×1.4 mm) was classified as high (>30), medium (21-30), low (11-20), very low (5-10), or hairless (<4). The distance between follicular units, ranging from 1.0 mm to 1.4 mm, was considered normal.

Results: Most patients were females, with a median age of 12 at diagnosis. Hair density ranged from very low to medium. All female patients presented a high occipital hairline. Our patients had exclusively non-terminal hairs and no case with high hair density, following the literature, which describes thin and sparse hairs. Hair density was related to a higher proportion of single hair units, while the distance between follicles was within normal limits.

Conclusion: TRPS is notably uncommon, with hair alterations being important for diagnosis, where trichoscopy serves as a valuable tool. Our study found a normal hair diameter relationship (frontal ≥ occipital) in females, while the male patient exhibited frontal-occipital inversion. Low hair density may result from an increased number of single hair units rather than from follicular distance. The high occipital hairline is proposed as a diagnostic pearl, warranting further studies to validate our findings.

Introduction: Pemphigus vulgaris is an autoimmune disorder characterized by blistering of the skin and mucous membranes due to the loss of cohesion between keratinocytes. Oxidative stress, a condition caused by an excess of reactive oxygen species that overwhelms the body's antioxidant defenses, has been implicated in various autoimmune diseases, including pemphigus vulgaris.

Objectives: This study aimed to evaluate serum levels of advanced glycation end products and advanced oxidation protein products as novel biomarkers of oxidative stress in pemphigus vulgaris patients and to correlate these levels with disease activity.

Methods: Sixty participants were included, divided into three equal groups: 20 patients with active mucocutaneous pemphigus vulgaris not on systemic treatment, 20 patients in remission on minimal therapy, and 20 healthy controls. Serum levels of advanced glycation end products and advanced oxidation protein products were measured using the enzyme-linked immunosorbent assay.

Results: Serum levels of advanced glycation end products and advanced oxidation protein products were significantly higher in the active pemphigus vulgaris patient group compared to both the remission group and healthy controls (P<0.001). No significant correlation was found between the oxidative stress markers, desmoglein 3, and the Pemphigus Disease Activity Index.

Conclusions: The findings of the present study demonstrate that oxidative stress may not play a primary role in the pathogenesis or severity of pemphigus vulgaris but could instead be a secondary effect associated with tissue damage. Factors such as diet and ethnicity could have influenced the results, indicating the need for larger scale, population-specific studies.