Dermatology practical & conceptual最新文献

Introduction: Few studies have explored the intricate connections between vitamin D receptor (VDR) gene polymorphisms, VDR, tight junction (TJ) protein expression and clinical features of atopic dermatitis (AD).

Methods: From 43 adult AD patients, VDR polymorphisms were genotyped from peripheral blood samples using polymerase chain reaction-restriction fragment length polymorphism. VDR, occludin, claudin-1 and ZO-1 protein expression from skin lesion biopsies were assessed by immunohistochemistry.

Results: The A1012G heterozygous VDR polymorphism exhibited a lower odds ratio (OR) for juvenile AD onset (OR: 0.046, 95% CI 0.004-0.51, p=0.012). In contrast, the presence of ≥2 homozygous VDR polymorphisms were significantly associated with positive skin prick test (SPT) (10/20, 50%) vs. negative SPT (1/23, 4.3%; p=0.0003). The most highly expressed TJ proteins in lesions of AD patients were claudin-1 and zonulin-1 (ZO-1), while VDR and occludin were less prevalent. A significant correlation was observed between ZO-1 expression and a body mass index ≥30 kg/m² (OR: 12.1, 95% CI 1.06-137.9, p=0.045). Claudin-1 expression was associated with a positive SPT (OR: 8.23, 95% CI 1.04-65.5, p=0.046) and serum 25(OH)D levels were negatively correlated with ZO-1 expression (rho= -0.43, p=0.0058).

Conclusion: This study provides novel insights into the relationship between VDR gene polymorphisms, VDR, TJ protein expression, and clinical features in adult AD patients, highlighting a significant role of vitamin D in the pathophysiology of this disease.

Introduction: Oral antifungals are the treatment choice for onychomycosis, and topical therapies are favored in cases of limited nail involvement. Recently, carbon dioxide (CO₂) laser treatment has emerged as an option to enhance the effectiveness of topical therapies.

Objectives: Our objective was to compare the efficacy of fractional ablative and fully ablative CO₂ laser treatments for distolateral subungual onychomycosis affecting a single toenail and caused by dermatophytes.

Methods: The records of 10 patients treated with a single fully ablative CO₂ session were matched with those of 10 patients who underwent a single CO₂ fractional treatment. All had previously failed topical antifungal lacquers and were discharged with the prescription of topical ciclopirox nail lacquer (8%) for 3 months.

Results: The clinical response rates were 80% for the fully ablative group and 60% for the fractional group. Additionally, the mean reduction in Onychomycosis Severity Index from baseline to 8.6±1.6 weeks after treatment completion was 6.9±5.4 in the fully ablative group and 3.6±6.6 in the fractional group. The relapse rate among responders was 12.5% in the fully ablative and 33.3% in the fractional group after a mean follow-up time of 29.4±2.3 weeks.

Conclusions: Fractional and fully ablative CO₂ laser in combination with ciclopirox lacquer could increase the response rate in onychomycosis resistant to topical antifungals when systemic therapy is contraindicated or not yet pursued. Fully ablative mode therapy is significantly more effective than fractional (P < 0.05). Further studies are needed to identify prognostic response factors and assess the long-term effectiveness of CO₂ laser treatment.

Introduction: Alopecia areata is a type of non-scarring alopecia which is thought to be associated with T-cell mediated immune response.

Objective: This study aimed to compare the levels of serum inflammatory markers before and after treatment in patients with alopecia areata. The study explored the utility of the systemic immune-inflammation index (SII) in assessing the severity and treatment response in alopecia areata patients.

Methods: The study included 60 alopecia areata patients and 40 control patients diagnosed with tinea unguium, aged between 18 and 65 years. Sociodemographic characteristics such as age, sex, and medical history were recorded for both groups. For alopecia areata patients, serum inflammatory markers were recorded before and at the third month of treatment. Serum inflammatory markers for the control group were also recorded. Furthermore, the Severity of Alopecia Tool (SALT) score was calculated for alopecia areata patients before and at the third month of treatment.

Results: The alopecia areata group had a significantly higher neutrophil-lymphocyte ratio, mean platelet volume, and SII values compared to the control group, while high-density lipoprotein (HDL) values were significantly lower. Serum inflammatory markers, assessed at the third month of treatment in the alopecia areata group, were lower, and HDL values were significantly higher compared to pre-treatment levels. A statistically significant correlation was observed between disease severity and the SII.

Conclusion: The SII is a cost-effective marker that can be utilized in assessing the severity of alopecia areata and treatment response.

Introduction: Telogen effluvium (TE) is a common type of non-cicatricial alopecia, and it is reported frequently in patients with SARS-CoV-2 infection.

Objectives: Herein, we aimed to examine the demographic, dermoscopic, and laboratory features of the patients with SARS-CoV-2 associated TE (CATE) and compare them with TE due to other causes (TEDOC) according to these features.

Methods: In this retrospective case-control study we evaluated the patients who were diagnosed with TE and were above 18 years of age between April and June 2022. The patients were divided into two groups based on their medical history and SARS-CoV-2 PCR positivity. The first group included patients with CATE and positive SARS-CoV-2 PCR test results in the last 3 months. The second group consisted of patients with TEDOC. Patients gender, age, disease duration, additional systemic disease, dermoscopic findings, and laboratory results were recorded.

Results: A total of 92 patients, 86 (93.5%) females, and 6 (6.5%) males, were included in the study. CATE was detected in 52 (56.5%) patients whereas 40 (44.5%) patients had TEDOC. The mean time between the onset of SARS-CoV-2 infection and hair loss complaint was calculated as 64.8 + 25.6 days, and this time was significantly shorter than patients with TEDOC (P = 0.003). The dermoscopic evaluation showed that empty follicular openings and yellow dots were statistically higher in patients with CATE, whereas short regrowing hair were markedly higher in patients with TEDOC (P = 0.001, P = 0.001,and P = 0.001, respectively) CONCLUSIONS: CATE is characterized by excessive hair-shedding that begins sooner after infection than classic TE. Dermoscopic findings can assist clinicians in diagnosis.

Introduction: Data regarding quality of life (QoL) of oncologic patients experiencing dermatologic immune-related adverse events (dirAEs) and their course after dermatologic intervention are scarce.

Objectives: To assess the impact of dirAEs on patients QoL and to investigate the correlation between dermatologic and oncologic indexes used for estimating QoL.

Methods: We enrolled oncologic patients with dirAEs managed in two supportive onco-dermatology outpatient clinics in Greece. Patient-reported outcomes included DLQI, EORTC-QLQ-C30 and Numerical Rating Scale for pruritus (pNRS).

Results: Overall, 110 patients were enrolled in the study. Mean (standard deviation) DLQI and pNRS scores were 15.54 (5.44) and 7.25 (2.95), correspondingly, while functional, symptom and summary scores of EORTC-C30 were 79.17 (2.11), 17.66 (3.60) and 80.67 (3.08), respectively. After therapeutic interventions, there was a statistically significant decrease in DLQI scores after first intervention compared to baseline, and second intervention compared to first (mean decrease 4.38 (2.91), P < 0.001 and 5.16 (3.99), P < 0.001, respectively). DLQI showed no correlation with global health status/QoLs (rho 0.01, P = 0.90) of EORTC-C30.

Conclusions: DirAEs negatively affect QoL. Dermatologic intervention improves patients QoL, facilitating an unimpaired oncologic treatment. Poor correlation between DLQI and EORTC-QLQ-30 highlights the need for adapted QoL measurement tools in the context of immune checkpoint inhibitors treatment.