Dermatology practical & conceptual最新文献

Introduction: Psoriasis is a chronic inflammatory autoimmune skin disease. Several treatment options are available including topical and systemic options. Methotrexate was the main systemic medication in treating severe psoriasis, yet adverse events can limit its use. Leflunomide is an isoxazole derivative that inhibits the synthesis of pyrimidines, and subsequently inhibits RNA and DNA synthesis.

Objectives: As available data directly comparing MTX to leflunomide in psoriasis are lacking, this double blinded study was designed to compare the efficacy of methotrexate versus leflunomide in the treatment of moderate to severe psoriasis.

Methods: The study included 40 patients (25 males and 15 females) with chronic plaque psoriasis. s. Patients were randomly assigned to one of two equal groups, group A for subcutaneous methotrexate injections and group B for leflunomide (loading dose 100mg daily for the first 3 days, then 20 mg daily for 3 months. Disease severity was determined by psoriasis area and severity index (PASI) score before and at the end of treatment The treatment response was evaluated at the baseline and weeks 4, 8 and 12 PASI score.

Results: Both groups were matching at the baseline in aspects of gender, age, disease duration and PASI scores Both medications yielded comparable results with no significant difference between both groups in PASI score neither in side effects.

Conclusions: Leflunomide can be as effective as methotrexate in treatment of moderate to severe psoriasis.

Introduction: Data about the demographic and clinical characteristics of melanoma patients in Turkey is limited.

Objectives: Data about the demographic and clinical characteristics of melanoma patients in Turkey is limited. We aimed to review the features of patients with primary cutaneous melanoma (PCM) diagnosed and treated in a tertiary referral center.

Methods: The medical records of melanoma patients followed up by the Departments of Dermatology and Medical Oncology were retrospectively reviewed.

Results: Within a 5-year period, 180 patients had been diagnosed with melanoma. Of all, 158 (87.8%) had PCM, 9 (5%) had mucosal melanoma, 9 (5%) had unknown primary melanoma, and 4 (2.2%) had ocular melanoma. Of 146 patients with PCM, 32.9% had stage I, 28.8% had stage II, 17.8% had stage III, and 20.5% had stage IV disease. The most common subtype was superficial spreading melanoma (38.8%). A statistically significant correlation was found between the patients Breslow thickness and lymph node involvement, histopathological subtype, and tumor ulceration (P < 0.001). Among all PCM patients, those in stage IV had the lowest 5-year survival rate when compared to the other disease stages (P < 0.001).

Conclusions: Relatively younger age at melanoma diagnosis, frequent presence of thick (> 4 mm) tumor, and frequent acral lentiginous subtype are the most remarkable features that suggest the low awareness and knowledge of melanoma in our population.

Introduction: Post-acne scars are a prevalent cosmetic complaint that usually require multi-modality treatment to achieve accepted results.

Objectives: The target of this research was to evaluate and compare the efficacy and safety of microneedling with topical insulin versus microneedling with non-cross-linked hyaluronic acid in atrophic post-acne scar treatment.

Methods: The current comparative split-face research included 30 patients with atrophic facial acne scars. Each patient received six sessions of microneedling with topical insulin on one side of the face and microneedling with non-cross-linked hyaluronic acid on the other side. Sessions were done three weeks apart, and digital photographs were taken before and three months after the last treatment session. Goodman and Baron qualitative and quantitative grading system was used to evaluate the improvement across both sides of the face, along with patient satisfaction.

Results: Three months after the last session, a statistically significant improvement in qualitative acne scar grading on both sides of the face (P < 0.001) was reported, with non-significant difference between the two sides (P = 0.864). Moreover, the mean percentage of improvement in quantitative acne scar grading was 49.18 ± 13.22 on the insulin side and 47.72 ± 15.08 on the hyaluronic acid side, with non-significant difference between the two sides after treatment (P = 0.235).

Conclusion: Both microneedling with topical insulin and with non-cross-linked hyaluronic acid achieved comparable significant improvement of atrophic post-acne scars.

Introduction: Vitiligo is characterized as melanocyte loss in skin and mucous membranes, the pathogenesis of which has not yet been clarified. Calprotectin is a protein secreted from neutrophils, monocytes, and dendritic cells which has an effect on cytokine receptor regulation and the production of reactive oxygen radicals. It has been the subject of research in various inflammatory and autoimmune diseases, yet not investigated in vitiligo.

Objective: The aim of our study was to investigate the role of calprotectin in the etiopathogenesis of vitiligo and its relationship with clinical subtypes and disease scores.

Methods: Forty-four vitiligo patients with lack of autoimmune disease and 36 age- and sex-matched healthy controls were involved in the study. Serum calprotectin levels were measured by ELISA. The results were compared with the control group, and the relationship between patients' demographic characteristics, skin phototypes, disease type, disease scores (Vitiligo Area Scoring Index and Vitiligo Disease Activity Score), disease duration, and age at onset were evaluated.

Results: The median serum calprotectin level was 454.08 pg/ml (41.19-873.41) in the patient group, and the median serum calprotectin level was 223.17 pg/ml (44.88-1044.43) in the control group. Serum calprotectin level was significantly higher in the patient group than in the control group (P = 0.016). No correlation was found between serum calprotectin level and disease scores, disease duration, age, or age of onset of disease (P > 0.05).

Conclusions: In our study, serum calprotectin levels in the patient group were found to be significantly higher than in the control group. Our findings and the existing literature on calprotectin suggest its potential involvement in the pathogenesis of vitiligo, independent of disease progression and patient characteristics.

Introduction: Psoriasis is a chronic inflammatory skin disease that can pose challenges for histopathological diagnosis. Recent research has emphasized the importance of necrotic keratinocytes, meaning keratinocytes undergoing programmed cell death, for diagnosing psoriasis. It has also become increasingly evident that programmed cell death pathways play a significant role in psoriasis's pathogenesis, development, and progression, including via a recently identified programmed cell death mechanism called "PANoptosis."

Objectives: In our study, we aimed to investigate the significance of necrotic keratinocytes in both the diagnosis and pathogenesis of psoriasis.

Methods: We analyzed the number of necrotic keratinocytes in 135 samples of psoriasis, 57 samples of psoriasiform spongiotic dermatitis, and 71 samples of normal skin. We additionally assessed the distribution of necrotic keratinocytes in the upper, middle, and lower thirds of the epidermis.

Results: Our findings revealed a significant difference in the total number of necrotic keratinocytes and their distribution within epidermal regions between patients with psoriasis and both the psoriasiform spongiotic dermatitis and control groups (p < .001). In particular, necrotic keratinocytes were predominantly found in the upper epidermis (77.5%) in patients with psoriasis. We also observed a strong correlation between Psoriasis Area and Severity Index scores and the total count of necrotic keratinocytes in patients with psoriasis (r = .72).

Conclusions: Our results highlight the role of necrotic keratinocytes, resulting from programmed cell death, as important marker cells in both the diagnosis and pathogenesis of psoriasis.