Dermatology最新文献

Background: Vitiligo is a condition characterized by the loss of pigmentation in certain areas of the body. It occurs when pigment-producing cells, called melanocytes, die or stop producing melanin, the pigment responsible for skin color. This loss of pigmentation can affect any part of the body, including the lips, hair, and eyes. In the eyes, individuals with vitiligo may present a reduction or absence of pigmentation in the protective pigmentary layer, thereby increasing their susceptibility to light exposure, which raises the question of how does light pollution may affect the vision of individuals with vitiligo.

Summary: This review examines the intersection between light pollution from light-emitting diode (LED) sources and vitiligo, highlighting experimental findings from adult albino rats as a model of ocular depigmentation, exposed to white LED light.

Key messages: We discuss the biological mechanisms of retinal vulnerability in the absence of melanin and the implications for understanding subclinical retinal changes in individuals with vitiligo.

Introduction: Assessing the risk of incontinence-associated dermatitis (IAD) in clinical settings can be subjective, which makes early detection difficult. We aim to verify the ability of skin barrier monitoring technology (SBMT) in predicting IAD.

Methods: This was a cohort study. Using a convenience sampling method, 282 patients who were admitted to adult intensive care units were included in the study and were monitored for 7 days or until the day of IAD (less than 7 days). The risk of IAD was assessed with the perineal assessment tool (PAT), and skin barrier indicators of the perianal area were measured with a skin barrier instrument once a day.

Results: SBMT was better at predicting early IAD than the perineal assessment tool. Relative transepidermal water loss (R-TEWL) was positively correlated with the risk of IAD. Based on the optimal cutoff value for R-TEWL (47.5 g/m2h), the Kaplan-Meier survival curve showed that the incidence of IAD in the high-risk group was 9.701-fold higher than that in the low-risk group (hazard ratio: 9.701, 95% confidence interval: 4.560-20.640; p < 0.001).

Conclusion: SBMT can objectively and accurately predict IAD.

Introduction: The Psoriasis Area and Severity Index (PASI) score is widely used to assess psoriasis severity; however, manual PASI scoring is susceptible to environmental variability and subjective interpretation. This study leverages artificial intelligence to improve the consistency and objectivity of psoriasis severity classification based on features extracted from 2D clinical images.

Methods: This study employed the YOLOv8 deep learning model to classify psoriatic lesions according to the severity of erythema, thickness, and scaling - key subcomponents of the PASI scoring system. Severity was assessed as follows: (0), mild (1), moderate (2), severe (3), or very severe (4). Model training and analysis were conducted in a cloud-based environment (Google Colab) using three different datasets. Stratified k-fold cross-validation was employed to ensure robustness by preserving the distribution of PASI scores across folds. Model performance was assessed using a confusion matrix and accuracy metrics.

Results: In experiments, the YOLOv8 model proved highly effective in classifying psoriasis images based on PASI scores. Stratified k-fold cross-validation was shown to enhance model reliability across diverse datasets.

Conclusions: This study represents a significant advancement in the application of AI to the automated classification of lesion severity based on erythema, thickness, and scaling - key subcomponents of PASI.

Introduction: Cutaneous squamous cell carcinoma (cSCC) is the second most common type of skin cancer. While most tumors have a positive prognosis, poorly differentiated tumors increase the risk of negative outcomes. Few studies are available on noninvasive methods to determine the level of differentiation of cSCC before surgery. The objective of this study was to determine the degree of differentiation of cSCC using high-frequency ultrasound (HFUS).

Methods: This study included 117 lesions from 117 patients, of which 68 were well-differentiated, 30 were moderately differentiated, and 19 were poorly differentiated cSCC. We analyzed the clinical, appearance, histopathological, and HFUS characteristics of cSCC. The thickness characteristics measured by HFUS included the overall thickness of the tumor, the thickness of the tumor's endophytic part, and the proportion of endophytic thickness to the overall thickness.

Results: The three groups did not show significant differences in their clinical and appearance features (all p > 0.017). However, on HFUS, the lesion total thickness, endophytic proportion, and surface keratinization were the significant features for identifying poorly differentiated cSCC. While a single indicator is not as effective as the combination of all three (all p > 0.05), the diagnostic accuracy of any two or all three indicators together did not show significant differences (p < 0.05).

Conclusions: HFUS can reveal internal morphological details of cSCC lesions, identifying poorly differentiated cSCC by analyzing total lesion thickness, endophytic proportion, and surface hyperkeratinization. Any two of these features can be as effective as using all three to diagnose poorly differentiated cSCC.

Background: Rosacea is a prevalent, chronic inflammatory skin disorder increasingly affecting middle-aged individuals worldwide. Characterized by facial erythema, flushing, papules, pustules, and telangiectasia, rosacea arises from complex, dysregulated immune responses with chronic inflammation and vascular instability. Given its multifactorial nature, treatment approaches focus on managing symptoms and often require a multidisciplinary strategy that integrates targeted skincare, topical and systemic therapies, and physical modalities to address the condition's diverse clinical manifestations, subtypes, and severity effectively. Validated conventional treatments, like metronidazole and azelaic acid, offer symptom relief to varying extents; however, many patients find these therapies insufficient, leading to a growing interest in alternative therapies.

Summary: Dermocosmetic products containing natural ingredients, particularly botanicals, are gaining in popularity, driven not only by their reported anti-inflammatory properties and perceived favorable tolerability, but also because they often appear to align with the personal values and beliefs of many individuals, and offer a more holistic approach to care. This review provides an up-to-date summary of advancements in the use of botanical ingredients for the management of rosacea. By exploring both well-studied botanicals and emerging plant extracts, this review highlights the growing role of natural adjunctive treatments in rosacea care.

Key messages: Emerging clinical evidence suggests that plant-based ingredients may help alleviate rosacea symptoms by modulating inflammation, regulating keratinization, and supporting vascular health, thereby promoting skin restoration, vessel stability, and reduced sensitivity.

Background: Maintaining homeostasis in the upper pilosebaceous unit in acne-prone skin has emerged as the primary goal for effective and long-term acne management.

Summary: In this review, we describe advances in acne research that have helped redefine the strategic targets for new topical acne treatments, providing the basis for new therapeutic strategies that may allow this goal to be achieved.

Key messages: First, we describe the results of studies analyzing apparently uninvolved skin from individuals with acne, using sequential skin surface biopsies. These studies led to the identification of subclinical lesions, referred to as microcomedones, as the root of all subsequent acne lesions, and thus clinically non-lesional acne skin as the strategic target for new acne therapies. We then describe the concept of the comedo switch, in which exposure of progenitor cells in the pilosebaceous unit to comedogenic factors in acne-prone skin leads to the formation of microcomedones. Previously considered as an "inert plug", the microcomedone rather appears to be "an egg" that can grow into acne lesions.

Introduction: Non-transient erythema (NTE) is a major feature of rosacea, but its clinical evaluation is subject to human investigator variability. The angiopoietin-TIE2 receptor tyrosine kinase pathway plays a key role in regulating vascular homeostasis, but was previously overlooked as a target for rosacea therapy. Angiopausin® is a patented plant-based ingredient identified through a molecular phytotherapy screening program as a positive inducer of the angiopoietin-TIE2 pathway, which is the "gatekeeper of vascular quiescence." The objective of this preliminary study was to compare traditional clinical NTE scoring methods with a novel algorithm-assisted approach (AAREA®) aimed at both assessing erythema and exploring the potential scientific interest of analyzing erythema regression patterns in patients with rosacea treated with topical Angiopausin.

Methods: Data were obtained from the regular follow-up of patients with mild-to-moderate rosacea, monitored as part of the real-world "homeostasis in chronic facial dermatosis" registry cohort. Patients were managed exclusively with Angiopausin (applied twice daily) for up to 64 weeks. Facial redness was evaluated clinically using the global investigator erythema assessment (IEA) score and compared to data generated using the algorithm-assisted approach using an ANOVA with post hoc Tukey tests.

Results: Forty-four patients (9 men, 35 women) were included (average follow-up: 29 ± 3 weeks per patient). Reductions in total IEA scores were observed at week 4 (W4; p < 0.05) and through W8 to W64 (p < 0.001). Decreases in individual scores were also observed for flushing, NTE and edema (W4 to W64: p < 0.001), and telangiectasia (W8 to W32; p < 0.001). A high level of agreement (R2 = 0.9566) was observed between the clinical IEA scores and the algorithm-assisted approach. The algorithm-assisted approach also provided quantitative data on redness area and intensity, detected early reductions in NTE, and identified distinctive NTE regression patterns.

Conclusion: This study demonstrated the real-world effectiveness of targeting the angiopoietin-TIE2 pathway for managing rosacea, with topical Angiopausin resulting in significant and long-lasting reductions in NTE and other vascular manifestations. It also highlighted how advances in rosacea therapy can be studied by profiling the clinical effects of treatments using artificial intelligence. The AAREA tool provided valuable data for clinical scoring and research into understanding rosacea pathogenesis.

Background: Acne is a chronic inflammatory skin disease associated with impaired pilosebaceous unit function, leading to the development of noninflammatory and inflammatory lesions and, in some cases, persistent post-inflammatory erythema, hyperpigmentation, and scarring. Acne pathophysiology is complex, involving altered sebum production and composition, abnormal keratinization, microbiome dysbiosis, and skin inflammation. Conventional therapies, such as topical retinoids, antibiotics, and benzoyl peroxide, are the first-line treatments for mild-to-moderate acne, but antibiotic resistance and local adverse effects can have a negative impact on therapeutic outcomes, leading to a growing interest in alternative strategies for disease management. The use of dermocosmetics is increasingly being recognized as a useful strategy to improve treatment outcomes and patient adherence. In particular, there has been a recent increase in research aiming to identify natural plant-based ingredients with properties that target the multiple pathogenic mechanisms involved in acne but which have less impact on skin barrier function.

Summary: This review provides a summary of the anti-acne properties of the most well-characterized plant extracts and phytocompounds used in dermocosmetic anti-acne products, based on insights gained from in vitro, ex vivo, and in vivo studies. Evidence gained from clinical trials evaluating the effectiveness and safety of topical formulations containing these herbal ingredients is also presented. Finally, several less well-characterized herbal extracts and phytocompounds with promising anti-acne properties are described.

Key messages: Although research is ongoing for many of the anti-acne herbal ingredients identified so far, this review highlights the effectiveness of topical plant-based formulations for reducing lesion counts and disease severity in acne patients, as well as the rebalancing effects of herbal ingredients on sebum composition, microbial diversity, and pilosebaceous unit cell differentiation. Taken together with the antibiofilm, anti-inflammatory, antioxidant, and skin barrier repair properties demonstrated for many of these extracts, current evidence suggests that dermocosmetics with plant-based ingredients show great promise for acne management, either as monotherapies, maintenance treatments, or in combination with conventional drugs.

Introduction: Ehlers-Danlos syndromes (EDS) represent a group of heritable connective tissue disorders characterized by skin hyperelasticity, joint hypermobility and generalized tissue fragility. Many patients remain undiagnosed years after initial symptoms and an accurate diagnosis is difficult despite all efforts. Currently, Germany lacks a patient registry and a specialized EDS centre.

Methods: In early 2020, a dermatological-orthopaedic EDS outpatient service was established at the University Hospital of Cologne. Medical records of all patients presenting in 2020 were retrospectively analysed.

Results: Forty-three adults were examined. Fifteen patients were diagnosed with EDS (different types), 13 with hypermobility spectrum disorder, and 1 with likely Loeys-Dietz syndrome (LDS) based on patient history and a suspicious variant in the gene TGFBR1. Excluding hypermobile EDS (6 patients), molecular confirmation was achieved in a total of 4 of 9 patients. The combination of symptomatic generalized hypermobility and skin manifestations was diagnostic in more than two-thirds of the EDS patients. Arterial involvement (aneurysms, dissection and rupture) and distinctive cutaneous signs (thin translucent skin with haematomas) indicated vascular EDS and LDS in altogether 3 patients.

Conclusion: With the present analysis, we discuss our diagnostic approach in patients with a suspected diagnosis of EDS in order to raise awareness of this rare group of genodermatoses and review recent developments in EDS nosology.

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common cause of chronic liver disease. Patients suffering from psoriasis are at an increased risk of developing MASLD. Psoriasis and MASLD share a pro-inflammatory cytokine milieu; however, it is still unclear whether these conditions are related through shared metainflammatory processes or shared comorbidities such as obesity, diabetes, insulin resistance, and metabolic syndrome. The aim of our study was to better characterize the anthropometric and metabolic profile of psoriatic patients with MASLD.

Methods: We conducted a prospective, single-center, cross-sectional study between June 2014 and August 2017. Recruitment was restricted to adult patients with psoriasis. Blood analysis, liver ultrasonography, and a FibroScan were performed. Blood investigations, baseline anthropometric measurements, and components of fatty liver disease (hepatic ultrasound, FibroScan) were assessed.

Results: A total of 100 patients were recruited, of which, 43% (65.1% men, n = 28) were diagnosed with MASLD. The mean BMI was significantly higher in MASLD than in non-MASLD (27.7 kg/m2 vs. 30.1 kg/m2, p =< 0.001). The mean waist circumference in MASLD patients was significantly higher than in non-MASLD patients (105.6 cm vs. 97.2 cm, p = 0.005). There was no significant difference between the mean age of both patient groups (50.4 vs. 47.3 years, p = 0.26). Psoriatic arthritis was more prevalent in MASLD than in the non-MASLD group (14.3% vs. 1.8%, p = 0.004). Biochemical analysis revealed significantly higher C-peptide level in patients with MASLD compared with patients without MASLD (2.5 vs. 1.6 ng/mL, p = 0.036). Moreover, MASLD patients were found to have a lower HDL level and higher glycemia, triglyceridemia, cholesterol, and LDL levels than non-MASLD patients. A total of 16.3% of patients with MASLD had fibrosis stage ranging from F2 to F4 based on liver stiffness measurement compared with only 10.6% of patients without MASLD.

Discussion: We identified parameters which were more prevalent in patients with psoriasis having MASLD, specifically a high BMI, elevated triglyceride levels, decreased HDL levels, and an elevated level of C-peptide. Patients with psoriasis and MASLD were more likely to suffer from comorbid psoriatic arthritis, despite having similar psoriasis disease severity as measured by PASI.

Conclusion: This study highlights the importance of screening patients with psoriasis for MASLD to prevent the progression to liver fibrosis.