Dermatology Research and Practice最新文献

Melasma, a pigmentary disorder that particularly affects Asian women, has been clinically proven to respond effectively to combination therapy of Q-switched lasers and tranexamic acid (TXA), especially with the advancements in laser aesthetics in recent years. However, treatment outcomes can be influenced by factors such as the wavelength and spot size of the Q-switched laser, the route of administration for TXA (including injectable, oral, or topical), as well as the dosage and duration of treatment. This article presents 13 different combination approaches from six randomized controlled trials, indicating that oral administration of TXA in combination with a 1064 nm Q-switched laser is currently the most widely used and effective treatment approach.

Background: Acrocyanosis is a functional peripheral vascular disorder, currently categorized under the canopy of acrosyndromes, i.e., a group of clinically similar and significantly overlapping vascular disorders involving the acral skin. The disorder might be primary or secondary, depending on the cause. Recently, there has been a remarkable surge in acrocyanosis prevalence along with the COVID-19 pandemic. Both COVID-19 infection and vaccines for COVID-19 have been affixed to the list of disorders instigating acrocyanosis. Objectives: The goal of this narrative review was to evaluate the existing literature, project acrocyanosis from the viewpoint of dermatologists in the face of the COVID-19 pandemic, and assess the need for targeted research, education, and/or clinical practice. Methods: An English literature search was conducted using PubMed and Google. All abstracts on acrocyanosis, irrespective of the article type and publication date, were retrieved and reviewed and those most relevant for the focus of this article were selected and summarized. Discussion/Results: A narrative review was carried out. There is paucity of randomized, double-blind, placebo-controlled studies on acrocyanosis in the English literature, implicating the need for targeted research. Pertinent information still relies on anecdotal observations, case reports, case series, or scarce reviews, which are dated rather old and published in vascular-oriented journals. The scarcity of published literature on acrocyanosis in dermatology-oriented journals points to the necessity of professional education and improvement of clinical diagnostic skills for dermatologists. Conclusions: Although acrocyanosis is the least known and the least studied acrosyndrome, it is increasingly more commonly confronted in the COVID-19 era. The diagnosis still largely relies on clinical findings. Accordingly, it has become a growing necessity for a dermatologist to remain updated on this peculiar disorder and be able to differentiate acrocyanosis from clinically similar cold-induced or cold-exacerbated acrosyndromes. Acrocyanosis is still misdiagnosed, underdiagnosed, underreported, and undertreated by the dermatology community.

SCORring atopic dermatitis (SCORAD) is widely used to assess the severity of atopic eczema, but score systems based on the entire body may be limited in effective monitoring and intervention. It is crucial to monitor moisture levels in each affected body part, but empirical research is still lacking. The objective of this study was to analyze the levels of stratum corneum hydration (SCH) and transepidermal water loss (TEWL) in atopic dermatitis (AD) patients, focusing on the presence and location of atopic lesions at different body sites. The levels of TEWL and SCH were measured using the AF200 AquaFlux and the Corneometer, respectively, at 15 body sites. 98 children under the age of 10 were measured, including 83 AD patients and 15 in the control group. Patients were also assessed with SCORAD and for the presence of atopic lesions at each body site. 58.7% of AD patients had lesions in the antecubital fossa and popliteal fossa, with corresponding low SCH levels and high TEWL in the upper body. The differences in TEWL between the control group and AD patients were confirmed significant in the neck and antecubital fossa regions, while differences in SCH were identified in the face, antecubital fossa, and popliteal fossa regions. A higher TEWL was found among AD patients with atopic lesions in the face and ankle. This study suggests that continuous monitoring of SCH and TEWL levels at specific body sites can provide insights into identifying vulnerable body areas to AD and supplement the SCORAD system for more effective clinical intervention and prevention strategies.

Atopic dermatitis (AD) is a chronic, inflammatory skin condition characterized by eczema lesions and dry, itchy skin. Recent guidelines for the management of AD emphasize the importance of using moisturizers in the management of AD. This study is a double-blind clinical trial to determine the effectiveness of moisturizers containing anti-inflammatory ingredients compared with moisturizers without anti-inflammatory ingredients for skin hydration in mild to moderate adult AD patients for 14 days at the Dermatology and Venereology Outpatient Clinic at Dr. Soetomo General Academic Hospital. There was a significant difference (p < 0.05) at the baseline and day 14 skin hydration values in the experiment group with anti-inflammatory ingredients (35.97 ± 6.04-66.06 ± 15.84) and the control group without anti-inflammatory ingredients (40.74 ± 10.94-56.12 ± 8.34). After comparison, there was a significant difference (p < 0.05) in the skin hydration value between the experiment group and the control group on the 14th day. There was also a significant difference in the improvement of skin hydration outcomes between both groups (p < 0.05). The severity of the disease using Scoring Atopic Dermatitis (SCORAD) showed a significant difference (p < 0.05) between the experiment group and the control group after 2 weeks of intervention. The addition of anti-inflammatory ingredients in the moisturizer, namely, shea butter, bacterial lysate, allantoin, bisabolol, Phragmites kharka extract, Poria cocos, and Mirabilis jalapa in a moisturizer containing occlusive (dimethicone), humectants (glycerin, saccharide, butylene glycol, and hyaluronic acid), and emollient (shea butter and squalane) was shown to be significantly better in improving skin hydration in patients with mild to moderate AD.

Background: Rosacea, a chronic facial dermatosis, poses a substantial global prevalence burden. Its impact extends beyond physical symptoms, affecting patient quality of life, self-esteem, and psychosocial functioning. This study aims to assess the health-related quality of life and emotional well-being in Jordanian rosacea patients in comparison to healthy controls. Methods: A case-control study, matching for age and sex, was conducted among rosacea patients attending the outpatient department at a governmental secondary hospital in the north of Jordan between September 2022 and November 2023. Adult patients with a confirmed rosacea diagnosis for a duration of ≥ 3 months were paired with healthy controls. Health-related quality of life, anxiety, and depression were evaluated using the Dermatology Life Quality Index (DLQI) and the Hospital Anxiety and Depression Scale (HADS), respectively. Disease severity was assessed using the Clinician's Erythema Assessment (CEA) grading system. Results: The study included 198 rosacea patients and 198 healthy controls. Rosacea patients exhibited significantly higher DLQI scores (mean 11.32 ± 5.4) compared to controls (mean 4.28 ± 2.3), indicating diminished quality of life. Subscale analysis revealed prominent differences in symptoms/feelings and daily activities. Additionally, rosacea patients reported elevated scores on the HADS anxiety (mean 9.38 ± 3.2) and depression (mean 8.19 ± 4.3) subscales in contrast to controls (mean 3.88 ± 2.18 and mean 3.41 ± 1.87, respectively). More than half (57%) of rosacea patients experienced moderate or severe anxiety, and nearly a third (31%) reported moderate or severe depression. Regression analyses revealed that higher disease severity significantly predicted worse quality of life (β = 0.384), anxiety (β = 0.352), and depression (β = 0.312). Conclusion: The study demonstrated that rosacea patients in Jordan experience significantly diminished quality of life and higher rates of anxiety and depression compared to healthy controls. Disease severity and multiple facial lesions emerged as strong predictors of poor psychological outcomes, while female gender increased vulnerability and longer disease duration showed a protective effect. These findings emphasize the need for routine psychological screening and a holistic treatment approach, particularly for newly diagnosed patients with severe disease manifestations.

Background: Cutaneous leishmaniasis (CL) is an endemic disease in Ethiopia, mainly caused by L. aethiopica. Limited reports are available related to histopathological features of the skin lesion caused by L. aethiopica. This study aimed to analyze the histopathological features of CL due to L. aethiopica. Materials and Methods: A similar cohort polymerase chain reaction (PCR) confirmed CL patients from a previous own study, who were prospectively enrolled from All Africa Leprosy, Tuberculosis and Rehabilitation Training (ALERT) Hospital Addis Ababa, Kela Health Center in Gurage Zone, Siliti Health Center in Silit zone of southern nations and nationalities, as well as Ankober Health Center in Amhara region was used for data analysis. The histopathology was analyzed by performing hematoxylin and eosin (H&E) staining to look for the presence of general and specific histopathology patterns of the disease. Descriptive statistics was utilized using SPSS version 26.0 (SPSS, Inc., Chicago, United States of America). Results: Amastigotes were observed in skin biopsies of 29% (n = 2) mucocutaneous leishmaniasis (MCL) and 58% (n = 6) localized cutaneous leishmaniasis (LCL) patients. Diffused inflammatory cell infiltrate was observed in the dermal compartment of 77% (n = 20) samples while the remaining 23% (n = 6) had patchy or nodular inflammatory cell infiltrate. The dominant type of inflammatory cell infiltrate in the dermal compartments is macrophages and lymphocytes with a similar proportion, 23/26 (88.5%), followed by plasma cells, 21/26 (80.8%). Among all cases, 38.5% (n = 10) of them were categorized under the Type I pattern while Types IV and V patterns were reported in 26.9% (n = 7) and 34.6% (n = 9) of the remaining samples, respectively. The study found statistically significant correlations between necrosis and MCL (p=0.01), unorganized granulomas and LCL (p=0.04), and the presence of eosinophils and giant cell Langerhans with MCL (p=0.002 and p < 0.001, respectively). Conclusion: In our study, the histopathological patterns of the CL caused by L. aethiopica were shown to have a dermal change that was characterized by a domination of diffused inflammatory cell infiltrate. Most of the cell types in the infiltrate were macrophages and lymphocytes. In addition, amastigote resided in the histiocyte with a varying degree of intensity, and both the organized and unorganized granulomas were shown with a considerable proportion.

Background: Fungal cultures are unavailable in many hospitals. The development of an effective sample storage solution for timely transportation would improve management of patients with superficial fungal skin and nail infections. Objectives: This study aimed to evaluate the efficacy of sample storage envelopes to preserve skin and nail samples for timely microscopic examination and culture for superficial fungal infections. Methods: Patients aged 18 years and above with suspected superficial fungal infections were enrolled. The samples were divided into four envelopes. The baseline 20% potassium hydroxide (KOH) examination and fungal culture served as reference points. The stored samples were reexamined on Days 3, 7, 14, and 28. Results: The study included 90 patients with suspected superficial fungal infections (45 skin and 45 nail lesions). Reference KOH examinations showed branching septate hyphae in 36 (80.0%) for skin and 35 (77.8%) for nail infections. Reference fungal cultures were positive for the growth of dermatophyte and nondermatophyte molds in 34 (75.6%) and 28 (62.2%) in skin and nail infections, respectively. Sample storage envelopes maintained 100% sensitivity and specificity for up to 28 days with KOH examination for both skin and nail samples. On Day 28, the fungal culture sensitivity was 70.6% for the skin and 64.3% for the nail samples, with specificities of 100.0% and 88.2%, respectively. Conclusions: Sample storage envelopes effectively maintained diagnostic accuracy for up to 28 days with KOH examination for both skin and nail samples. Given the high specificity even on Day 28 for fungal culture, transferring samples within 28 days remains a reliable practice.

Background: Cutaneous warts are epidermal proliferations caused by human papillomavirus. There are a variety of treatment options for warts with different success rates. Intralesional vitamin D₃ injection is an innovative treatment option for warts, and several studies have examined its efficacy. To the best of our knowledge, this is the first study to compare the two modalities of vitamin D₃ in wart treatment. Objective: To evaluate and compare the efficacy of topical vitamin D₃ derivative (calcipotriol) and intralesional vitamin D₃ in the treatment of warts. Patients and Methods: This is an open-label, therapeutic, comparative, clinical study involving 56 patients with warts. The patients were randomly divided into two equal groups (n = 28). Group A was treated with topical calcipotriol ointment (0.005%) twice daily for a period of 8 weeks, while Group B was treated with intralesional injection of 0.2-0.3 mL of vitamin D₃ (300,000 I.U. per ampule) for 4 sessions (2 weeks apart). The patients were followed every 2 weeks during treatment and then 3 months after the last visit. Results: The percentage of patients who showed a complete response in Group A was higher than that of Group B (95% vs. 59%). Furthermore, 9 patients out of 13 (69.2%) who showed a complete response in Group B required a period of 8 weeks, while only 2 patients out of 21 (9.5%) in Group A required the same period. In addition, side effects were more in Group B. Moreover, no recurrence was observed in Group A, while in Group B, it was seen in 2 (11%) patients. Conclusions: Both topical and intralesional vitamin D₃ are effective in the treatment of warts, with topical vitamin D₃ having better efficacy, faster, less side effects, and less risk of recurrence.

Background: Pemphigus is a rare autoimmune disease characterized by the formation of blisters on the skin and mucous membranes, caused by autoantibodies against desmoglein, a key protein in cell adhesion. This study aims to compare demographic and clinical criteria between male and female patients with pemphigus referred to a referral hospital, utilizing data from the pemphigus diseases registry. Method: This retrospective cross-sectional analysis focused on several key aspects age at disease onset, severity (measured by the Pemphigus Disease Area Index [PDAI]), types of pemphigus, duration of disease, and diagnostic criteria including the presence of antidesmoglein antibodies and findings from direct immunofluorescence (DIF). By examining these variables among a cohort selected based on their diagnosis of pemphigus, the study aimed to identify significant gender differences in disease manifestation, diagnosis, and progression. This approach is crucial for tailoring more effective gender-specific management and treatment strategies for this rare autoimmune condition. Results: In a comprehensive analysis of 1218 pemphigus patients in the year 2021 from the hospital's registry, comprising 543 males (44.6%) and 675 females (55.4%), significant gender differences were identified in 9 out of 44 variables examined. The study revealed that males had a higher age at disease onset, more frequent clinical manifestations in the head, neck, and trunk areas, and greater severity of disease as measured by the PDAI score compared to females. Conversely, females exhibited higher instances of mucosal manifestations and a higher PDAI score for mucosal erosion blister of the lower gingiva. No significant gender differences were found in 21 variables, including the overall age of patients, specific clinical manifestations across various mucous membranes, types of pemphigus, and PDAI scores for mucosal erosions in particular locations, indicating a nuanced gender impact on the presentation and severity of pemphigus that necessitates tailored clinical approaches. Conclusion: The study highlights significant gender differences in the presentation and severity of pemphigus, underscoring the importance of gender-specific approaches in the diagnosis and management of this condition. The findings contribute valuable insights into the complex nature of pemphigus and underline the necessity for further research to understand the underlying mechanisms driving these differences.

The dermatological manifestations of the coronavirus cause severe acute respiratory syndrome. The current study investigates the morphological and histopathological relationship between the emergence of skin lesions and the severity of COVID-19 across the course of the disease via a cross-sectional study. There were skin lesions (maculopapular rash, vesiculobullous lesions, urticarial lesions, cutaneous thromboembolic "CT," and erythema multiforme-like lesions "EM-like") in confirmed COVID-19 instances. A total of 150 patients of both sexes were evaluated morphologically and were classified as early (44% of the total) or late based on the emergence of respiratory symptoms (one week before or two weeks after, respectively). The early and late diagnostic groups represented 44% and 56% of the total patients, respectively. Patients with no skin lesion and one skin lesion showed a significant correlation with disease timeline early and late stages (X2 = 22.38, P < 0.001; X2 = 4.432, P < 0.001, respectively). CT and EM-like were correlated with the disease severity, X2 = 50.51, P < 0.001; X2 = 19.186, P ≤ 0.001, respectively. In conclusion, our data suggested that the onset of dermatological lesions that developed during the COVID-19 pandemic may be a useful diagnostic and prognostic tool for COVID-19 severity. Therefore, a thorough examination of the skin may save time and bring physicians to an accurate diagnosis and, as a result, prompt treatment.