Dermatology practical & conceptual最新文献

Introduction: Approximately half of patients affected by psoriasis are women, and the management of female patients of childbearing age is an under-investigated topic. Some studies have shown a significant decrease in births in psoriatic patients due to intimacy and pregnancy avoidance and to potential birth complications.

Objectives: We sought to evaluate data on reproductive health in a cohort of female patients, to compare them with similar data in the general population and to assess the impact of psoriasis, especially genital psoriasis, on pregnancy desire and the prevalence of psoriasis in the children of patients with psoriasis.

Methods: This retrospective observational study involved adult female patients with a diagnosis of psoriasis made during or before childbearing age. The enrolled patients were asked questions concerning fertility and previous pregnancies in relation to their dermatologic disease.

Results: Of 100 women enrolled, 73 reported a history of pregnancy, for a total of 170 pregnancies. The average number of pregnancies to term and the average number of children per woman (1.2 ± 1) were lower than the national average. The percentage of miscarriages was 18.2%, higher than the national average; in particular, women with psoriatic arthritis had a greater percentage of miscarriages (27.4%). During the pregnancies, psoriasis was mainly stable (36.1%) or improved (29.2%), even though most patients (91.5%) did not follow any treatment.

Conclusions: Psoriasis impacts pregnancy desire and course. The management of psoriasis in women of childbearing age is crucial to minimize its burden on this vulnerable population.

Background: Parkinson's disease (PD) is primarily characterized by motor symptoms, but non-motor symptoms, including skin manifestations, are increasingly recognized. These remain underexplored despite their potential impact on quality of life.

Objectives: This study aimed to evaluate the prevalence and clinical features of skin findings in PD patients, with a focus on identifying potential pathogenetic links between dermatological conditions and PD.

Methods: A total of 215 PD patients were included. Comprehensive dermatological examinations were performed, and demographic and clinical data were collected. Statistical analysis was conducted using SPSS 23.0, with significance set at P < 0.05.

Results: Skin conditions were found in 92.1% of PD patients. Xerosis, seborrheic dermatitis, and hyperhidrosis were the most common findings. Pre-PD xerosis was associated with an earlier stage of PD (P = 0.001). Use of PD medications, such as levodopa/carbidopa/entacapone, was linked to a lower incidence of seborrheic dermatitis (P = 0.040). A significant correlation was also noted between rosacea and cherry angioma (P = 0.01).

Conclusion: Dermatological conditions are prevalent in PD and may precede its motor symptoms. Skin assessments could aid early diagnosis and management of PD, highlighting the need for further research on their pathogenetic mechanisms.

Introduction: Short-term teledermoscopic monitoring helps to distinguish early melanomas from nevi. As the incidence of melanoma is increasing, there are several benefits of patients' taking their own dermoscopic images, but only a few previous studies have investigated the feasibility of this approach.

Objectives: To examine patients' ability to take evaluable dermoscopic images of atypical melanocytic lesions in need of short-term monitoring.

Methods: Patients were asked to take follow-up images in their homes using a borrowed dermoscope and their own smartphone. It was investigated whether the management decision differed when assessing follow-up images taken by patients compared to follow-up images taken by hospital staff. Lesions were rated as either changed, unchanged, or in need of further monitoring. In addition, image quality and patients' attitudes towards taking dermoscopic follow-up images were studied.

Results: Ninety-five patients with 132 lesions completed the study. Images taken by hospital staff were of better quality than images taken by patients (P<0.001). A total of 24 dermoscopic images taken by patients (18.2%) were of poor quality and considered unsuitable for assessment at follow-up. In the remaining 108 lesions, the management decision was concordant in 95 cases (88.0%). Most patients found the procedure to be easy to perform, and 76.0% of patients answered that they preferred self-photography.

Conclusions: Self-photography for teledermoscopic evaluation of atypical melanocytic lesions is feasible, but it results in worse image quality, which may lead to discordant evaluations. Dermoscopes used for this purpose need to be more user-friendly and maintain a higher technical standard.

Introduction: Rosacea, a chronic inflammatory disease primarily affecting the central area of the face, is a complex condition whose mechanisms are still not fully understood. However, research has indicated a positive correlation between two molecules: hypoxia-inducible factor-1α (HIF-1α) and interleukin-6 (IL-6). The levels of HIF-1α in rosacea patients have yet to be assessed.

Objectives: The aim of this study was to assess the levels of HIF-1α and IL-6 in patients with rosacea in relation to both the severity of the disease and the primary and secondary clinical manifestations of the condition.

Methods: The study included patients diagnosed with rosacea and sex-and age-matched healthy controls (N=40, N=40). Serum HIF-1α and IL-6 levels were quantified using enzyme-linked immunosorbent assay (ELISA).

Results: Compared to the control group, the patient group had significantly elevated serum levels of HIF-1α and IL-6. A positive correlation was found between the level of HIF-1α and the severity of the disease (r=0.374, P=0.017); furthermore, a significant association was observed between the presence of telangiectasia, one of the primary manifestations, and HIF-1α (z=2.401, P=0.016).

Conclusion: The significantly elevated levels of IL-6 and HIF-1α in patients with rosacea compared to the control group support the hypothesis that these molecules play a role in the pathogenesis of the disease. The correlation between HIF-1α and the severity of the disease, and its significant elevation in patients with telangiectasia, suggest its potential involvement in the pathogenesis of the disease, particularly in the formation of telangiectasia.

Introduction: Irritant contact dermatitis (ICD) is characterized by direct injury to the epidermal cells, activating the innate immune response. Allergic contact dermatitis (ACD), in contrast, is delineated by a delayed hypersensitivity reaction of type IV. Despite the distinct etiopathogenic mechanisms under-pinning each condition, the differentiation between them presents a significant diagnostic challenge.

Objective: This study aimed to determine whether a combination of clinical evaluation and noninvasive measurements-encompassing oxidative stress, erythema, hydration, melanin content, transepidermal water loss (TEWL), hemoglobin concentration, and skin texture and volume-could distinguish ICD from ACD.

Methods: Two cohorts, each comprising 21 patients, were evaluated: one diagnosed with ICD and the other with ACD. All participants underwent biophysical and clinical assessments, along with Antera^® 3D evaluations. Tape strips were utilized for skin sampling, and oxidative stress levels were measured via fluorescence assessments.

Results: ICD prompted an almost immediate inflammatory reaction (peaking at 24 hours), whereas ACD incited a delayed response (72 hours). Noninvasive evaluated parameters such as hemoglobin concentration, skin texture and volume, melanin content, erythema, and TEWL showed significant differences between the ICD and ACD cohorts (P < 0.05). The allergens amcinonide, nickel sulphate, cobalt chloride, budesonide, PPD, and thiuram mix were found to induce elevated levels of oxidative stress.

Conclusions: The evaluation of patients with noninvasive parameters, including transepidermal water loss (TEWL), hemoglobin concentration, and skin texture and volume, could markedly aid in distinguishing irritant contact dermatitis from allergic contact dermatitis (ACD). Nevertheless, the study was constrained by a limited sample size.

Introduction: Pemphigus, an autoimmune disorder, significantly impacts the quality of life for those affected.

Objective: This study examined the sleep quality in patients with pemphigus, a domain for which the existing literature provides limited data without a focused analysis.

Methods: A total of 156 individuals, 52 in the case and 104 in the control group, completed several questionnaires (Pittsburgh Sleep Quality Index [PSQI], General Health Questionnaire-12 [GHQ-12], and ABQOL [Autoimmune Bullous Disease Quality of Life]). Disease severity was evaluated using the Pemphigus disease area index (PDAI index).

Results: The case group exhibited significantly higher levels of psychological distress, reflected in GHQ-12 scores (P = 0.00), and notably poorer sleep quality compared to controls across various parameters (sleep latency [SL], disturbances [SDi], medication [SM], daytime sleep dysfunction [DSD]), and the global PSQI score (GS)] (P = 0.00)). Significant correlations were observed between PDAI scores and sleep duration (SDu) (P = 0.01), SM (P=0.03), SL (P =0.03), and GS (P=0.00). An association was found between the equivalent steroid intake and SDu (P=0.00) as well as GS (P=0.02). No statistically significant correlation emerged between disease duration and PSQI scores. Our findings indicated a correlation between poor sleep quality and cutaneous rather than mucosal manifestations (p=0.01). Pemphigus affects sleep quality. Severe disease showed heightened SDi, correlating with higher steroid doses, and in the chronic phase, the impact seems to have been more influenced by the pro-inflammatory stage of the disease. Patients with cutaneous pemphigus exhibited reduced sleep quality compared to those with oral pemphigus.

Conclusion: Understanding that pemphigus worsens sleep quality can be beneficial for the holistic management of individuals with this condition.