Acta Dermatovenerologica Alpina Pannonica et Adriatica最新文献

Introduction: Dermatomyositis is an inflammatory disease that affects the skin and skeletal muscles, with variants including clinically amyopathic dermatomyositis and malignancy-associated dermatomyositis.

Methods: This research analyzes the characteristics of dermatomyositis in women. A retrospective cross-sectional study evaluated clinical presentation, muscle involvement, immunological markers, association with malignancy, complications, and mortality in females during a 15-year follow-up at a tertiary dermatology center.

Results: Thirty women (mean age 63.6 ± 11.6 years) were analyzed. The most common skin manifestations were the V-sign (73.3%), followed by a heliotrope rash and Gottron's papules (70.0% each). Periungual erythema appeared in 50.0%, and the shawl sign in 46.7%. Receiver operating characteristic curve analysis linked the V-sign with age ≥ 62.5 years (area under the curve = 0.75) and periungual erythema with age ≤ 68.5 (area under the curve = 0.76). Muscle weakness was present in 63.3% of cases. Myositis-associated autoantibodies and myositis-specific autoantibodies were positive in 53.3%. Seven patients (23.3%) had malignancy-associated dermatomyositis, including ovarian, breast, endometrial, lung, gastric, and nasopharyngeal cancers.

Conclusions: The V-sign, a heliotrope rash, and Gottron's papules were the most common skin findings. Muscle involvement affected nearly two-thirds of patients. Malignancy was detected in almost a quarter of patients, emphasizing the need for thorough evaluation and early diagnosis, especially in cancer-associated cases.

Introduction: Pityriasis lichenoides (PL) predominantly affects children and young adults. Its etiology is unclear, and the condition ranges from a harmless inflammatory disease to possible progression or pre-manifestation of cutaneous T-cell lymphoma.

Methods: A long-term cohort included 242 patients with PL of all age groups diagnosed and treated at our department from 2009 to 2019. Follow-up lasted until 2024. We analyzed the disease duration, demographic and clinical features, and outcomes in our patients.

Results: The cohort of PL patients studied included 107 adults and 135 children. A total of 221/242 (91%) patients were followed for 5 to 15 years (the median follow-up period was 9.9 years). No statistically significant difference (p > 0.05) in disease duration or lesion distribution was found between different PL forms in children or adults. The results show a male-to-female ratio of 1.7:1 for pediatric patients and 0.6:1 for adults, with a higher incidence of male patients among children (p < 0.01). During the follow-up period, no progression to cutaneous T-cell lymphoma was established.

Conclusions: PL encompasses a spectrum of papulosquamous disorders with male predominance among children and female predominance in adults. In addition, the study results underscore the benign course of PL.

The conventional dependence on mammalian models in dermatological research is increasingly subject to ethical and sustainability-focused scrutiny, prompting a transition toward new approach methodologies (NAMs). Within this paradigm, zebrafish (Danio rerio) have surfaced as a persuasive alternative due to their genetic and physiological congruence with human skin, optical clarity during early developmental stages, accelerated life cycle, prolific reproductive capacity, and economically viable maintenance. This review describes recent research using zebrafish models in dermatology, including skin pigmentation disorders, barrier function, wound healing and regeneration, pharmacological discovery, genetic and inflammatory skin conditions, and melanoma. By examining the research, ethical, and logistical merits of zebrafish NAMs, this review emphasizes their contribution to fostering more humane and efficient research frameworks. Such integration also aligns with various United Nations Sustainable Development Goals (SDGs) 3, 9, 12, 13, 14, and 17, particularly regarding the accessible biomedical innovation in low- and middle-income countries (LMICs). The review also recognizes ongoing challenges, such as regulatory fragmentation and inconsistent validation of dermatological endpoints, which impede widespread translational acceptance. It concludes by presenting strategic recommendations for international collaboration, targeted financial support, cross-sector partnerships, and regulatory harmonization to realize the potential of zebrafish-based NAMs in dermatological research.

Melasma is a chronic and refractory hyperpigmentation disorder that predominantly affects women and individuals with darker skin tones. Treatment remains challenging due to issues related to efficacy, side effects, and high recurrence rates. Cysteamine is a depigmenting agent that has demonstrated promising outcomes in melasma management with minimal adverse effects. This study evaluates the effectiveness of cysteamine as a treatment for melasma. A systematic review was conducted using databases from PubMed, Google Scholar, and ScienceDirect, including articles published over the past 10 years (2013-2023). Eight studies met the inclusion criteria for this review. Cysteamine showed good therapeutic efficacy, reflected in reductions in the melasma area and severity index (MASI) ranging from 1.5 to 10.07, with a mean decrease of 5.73. No severe adverse effects were reported, and only mild reactions such as erythema, itching, irritation, dry skin, tingling, and burning sensations were noted. Overall, cysteamine is demonstrated to be an effective and safe therapy for melasma, offering satisfactory clinical improvement with minimal side effects.

Introduction: Acrocyanosis is the most common form of angiodystonic vascular acrosyndrome, characterized by functional microcirculatory alterations without structural vessel damage. It is traditionally classified as either primary or secondary, the latter often associated with underlying conditions.

Methods: Some observations suggest a frequent association between acrocyanosis and connective tissue diseases (CTDs). To investigate this, we conducted a study on 53 patients diagnosed with acrocyanosis: 45 females and eight males, 15 to 82 years old, with a mean age of 35 years. Secondary acrocyanosis was identified in 24 patients (45.3%).

Results: Advanced age (≥ 40 years) was a significant risk factor for secondary acrocyanosis (relative risk = 2.5, 95% confidence interval: 1.4-4.5, p = 0.002). No significant differences were observed between sexes. CTDs were the most common conditions associated with acrocyanosis (32% of the study population and 71% of the secondary forms).

Conclusions: Although generally considered benign, acrocyanosis may indicate an underlying systemic disease. Clinical examination remains essential for the diagnosis of acrocyanosis. Our findings reveal a high prevalence of secondary acrocyanosis associated with CTDs. Patients with strong clinical suspicion should be referred to specialized centers for capillaroscopy and antinuclear antibody testing.

Trachyonychia is a disease of the nail matrix that can present as either opaque or shiny trachyonychia. Although it is often idiopathic, it can be associated with conditions such as alopecia areata (AA), psoriasis, and lichen planus. Isolated nail psoriasis (NP) can mimic trachyonychia, making diagnosis challenging. Dermoscopy, a non-invasive imaging technique, has proven useful in identifying NP features. This report presents two cases: one with isolated psoriatic trachyonychia and another with AA-associated trachyonychia. In both cases, jagged erythema and teardrop-shaped spots on the lunula were observed, with the latter being described for the first time in trachyonychia literature. These findings suggest a potential link between inflammation and nail matrix pathology, warranting further investigation.

Introduction: Alopecia areata (AA) is an autoimmune condition characterized by non-scarring hair loss. The Janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathway is believed to play a central role in the autoimmune inflammatory processes underlying AA. Baricitinib, an oral JAK inhibitor, has been approved by the Food and Drug Administration (FDA) for the treatment of severe AA. This study evaluates the efficacy and safety of baricitinib in the management of AA.

Methods: A retrospective cohort study was conducted on patients with AA receiving baricitinib 4 mg daily and that had completed a 1-year follow-up. Disease severity was assessed at baseline and the end of follow-up using the Severity of Alopecia Tool (SALT) score. Adverse events were systematically recorded.

Results: Among 87 patients included in the analysis, the mean age was 29.84 years, and the mean baseline SALT score was 77.07%. After a mean of 52 weeks, 37.20% of patients achieved a SALT score ≤ 20. A significant reduction in SALT scores was observed at the end of follow-up (p < 0.001). In addition, 72.40% of patients experienced mild or no adverse events, and no serious adverse events were reported.

Conclusions: In this 52-week real-world cohort, baricitinib demonstrated both effectiveness and good tolerability in the treatment of severe AA. These findings contribute to the understanding of long-term outcomes with baricitinib therapy.

CO2 laser resurfacing is a widely used cosmetic procedure for facial rejuvenation, addressing wrinkles, scars, and other skin imperfections. Although complications are rare, post-laser skin lesions have been reported, particularly in patients with a history of non-melanoma skin cancer (NMSC). This report presents a rare case of a 41-year-old female that developed a solitary keratoacanthoma (KA) 3 weeks after CO2 laser resurfacing. A detailed medical history was taken, and an excisional biopsy was performed. Histopathological examination confirmed KA, a rare but documented complication of fractional laser resurfacing. The lesion was excised without recurrence, and healing was uneventful. This case is unique because the patient had no prior NMSC history, making KA an unusual occurrence. Previous studies typically associate KA with known risk factors such as NMSC or immunosuppression. This report highlights the importance of post-laser surveillance, even in patients without recognized risk factors. It contributes to the understanding of potential complications of CO2 laser resurfacing, emphasizing the need for clinical awareness.

Introduction: Alopecia and iron deficiency are significant public health issues in northern Sudan, and no research about this topic has been conducted. The aim is to examine the prevalence of iron deficiency and alopecia and associated factors among adolescents in northern Sudan.

Methods: A cross-sectional study was conducted through a questionnaire and clinical examination.

Results: A total of 312 adolescents participated: 147 males (47.1%) and 165 females (52.9%). Among them, 21.2% of adolescents exhibited alopecia. Females experienced higher rates of alopecia, with 93.9% affected compared to 6.1% of males. Serum ferritin was significantly lower in adolescents with alopecia compared to those without it (6.05 [2.58‒12.63] vs. 9.40 [4.88‒23.40] μg/l, p = 0.002). Multivariate analysis indicated that iron deficiency (adjusted odds ratio [AOR] = 1.97, 95% confidence interval [CI] = 1.04-3.71) was associated with alopecia. However, age, body mass index, and parental education level showed no association. Among the adolescents with alopecia, 27.3% had patchy alopecia, 37.9% had diffuse alopecia, and 34.8% had traction alopecia.

Conclusion: There is a significant prevalence of adolescent alopecia, predominantly among females. Iron deficiency was a key factor associated with alopecia, underscoring the importance of nutritional monitoring in this population.

Introduction: Severe anaphylaxis in patients with clonal mast cell disorders highlights the need for proper use of adrenaline autoinjectors. This study assessed knowledge retention and adherence to autoinjector use in c-KIT p.D816V-positive individuals with hymenoptera venom allergy undergoing venom immunotherapy (VIT) and prescribed two autoinjectors.

Methods: Seventy-one VIT patients received personalized autoinjector education, with knowledge assessed at 3, 4 to 12, 12 to 24, and > 24 months. Fifteen patients 5 years post-VIT underwent video-based retraining and were assessed 1 month later.

Results: Knowledge retention was 82.3% at 3 months, dropping to 40.0% at 12 to 24 months (p = 0.0160) and 22.2% after 24 months (p = 0.0005), indicating a clear decline over time. Common errors included ignoring the safety cap (16.7%), insufficient injection force, finger injection risk, and upper arm activation (totaling 19.0%). In addition, 19.8% failed to hold the autoinjector in the muscle for 3 seconds, 26.9% did not know to lie supine during anaphylaxis, and 14.3% did not seek emergency help. In the video-retrained group, 80.0% lacked proficiency 1 month later, 73.3% were unaware of the second dose, and 66.7% did not carry their devices.

Conclusions: Ongoing tailored education is essential to ensure effective autoinjector use, especially in c-KIT p.D816V-positive venom-allergic patients. Video instruction alone may be insufficient.