Skin health and disease最新文献

A 61 year old male presented with clinical signs of Eosinophilic fasciitis (EF), a rare connective tissue disease. Early recognition of the diagnosis of EF is essential. Common examination findings are prayer sign and distal limb swelling, induration, venous guttering, and peau d'orange. CT PET scan can be helpful in supporting the diagnosis of EF.

Background: Resident memory T (T_RM) cells and immunosuppressive Foxp3-expressing regulatory T_RM (regT_RM) cells are present in healthy, non-inflamed and inflamed human skin. Both types of cells are found in both the epidermis and dermis with the dermis being much thicker than the epidermis. However, it is unclear if T_RM and regT_RM cells differ between reticular dermal layers in terms of number, function or characteristics.

Methods: This study examined numerical, phenotypic and functional differences in T_RM and regT_RM cells between the upper and lower reticular dermis in healthy, non-inflamed human skin using flow cytometry.

Results: The phenotype and cytokine expressions of both types of cells were similar between reticular dermal layers. However, the cell count of both T_RM and regT_RM cells was significantly higher in the upper reticular dermis than in the lower reticular dermis.

Conclusions: T_RM and regT_RM cells are phenotypically and functionally identical between reticular dermal layers. However, both types of cells are more abundant in the upper reticular dermis.

Mohs surgeons' fallibility is an important topic to explore. There are no studies on the role of cognitive biases in heuristic decision-making within Mohs micrographic surgery (MMS) as a contributing factor in mistakes or errors of clinical judgement. We reviewed established cognitive biases applied to heuristics during the pre-operative, intraoperative and reconstruction stages of MMS, and recommend conscious cognitive bias mitigating strategies for Mohs surgeons. Clinical errors/incidents may be reframed as opportunities to learn and develop, rather than evidence of competency or status. These experiences offer the opportunity to sharpen skills within metacognition and allow for more cognizant Mohs surgeons. We highly recommend all Mohs surgeons develop in-depth knowledge and maintain awareness of cognitive biases throughout clinical practice, to enhance clinical performance.

Pseudoxanthoma elasticum (PXE) is a genetic disorder characterized by ectopic calcification of tissues rich in elastic fibres (OMIM 264800). To date, PXE is considered a metabolic disease linked to an imbalance between pro- and anti-calcifying factors. The occurrence of sporadic erythematous flareups of PXE skin lesions is a complaint that we heard about on several occasions at the French PXE reference centre. However, this rare clinical aspect had never been extensively studied. We have had the opportunity to investigate a 13-year-old patient experiencing an erythematous flareup of his PXE lesions. We conducted this work to identify what type of inflammation was implicated in his lesions. An incisional skin biopsy on a recent erythematous inguinal PXE lesion was performed and sent for histological and transcriptomic analyses. The findings were compared to a non-erythematous PXE-affected skin biopsy obtained from another young PXE patient. Histological examination revealed perivascular T-cell infiltrates with Th1 polarity and elevated expression of cytotoxicity markers in RNAseq and RT-qPCR analyses. There was no increase in Th17 or Th2 markers. Our findings support the previous evidence of a possible inflammatory component in the development of PXE. Whether Th1-dependent inflammation contributes to the pathology as an active process or is an aggravating factor requires further investigations.

Minoxidil, originally developed as an antihypertensive medication, has evolved into a versatile therapeutic agent within dermatology, notably for its effectiveness in promoting hair growth. Despite its widespread use, understanding its precise mechanism of action remains a challenge. This paper addresses this gap by providing a comprehensive review of pharmacological properties, action mechanisms, clinical effectiveness and side effects associated with topical minoxidil. Furthermore, it highlights emerging trends and applications, including its role in treating androgenetic alopecia, its potential for alopecia areata management and its utilization in combination therapies. Additionally, this paper explores novel applications in scar treatment and wound healing. By synthesizing current knowledge and insights, this review adds clarity to the diverse applications of minoxidil, providing valuable guidance for clinicians and researchers aiming to optimize its therapeutic use in dermatology.

Background: Sedentary behaviour has a detrimental effect on health independent of the amount of physical activity undertaken. Despite the association of cardiometabolic and psychosocial comorbidities with psoriasis, how physical behaviour influences health outcomes in patients with psoriasis is poorly understood.

Objectives: We hypothesized that objective measurement of physical behaviour, using wearable digital technology, would have utility in understanding the clinical impact of an exercise intervention designed in partnership with patients with psoriasis.

Methods: Fourteen patients with psoriasis completed a 20-week study. During weeks 1-10, participants followed an incrementally progressive, exercise intervention, followed by independent activities during weeks 11-20. Accelerometers (GENEActiv Original) and pedometers recorded physical behaviour. Evaluation at week-0, -10, and -20 included assessment of psoriasis, cardiometabolic disease/risk, psychological health and functional capacity.

Results: Our intervention supported significantly increased physical activity, including moderate-vigorous physical activity (p = 0.04) and step count (p = 0.04). We also observed a significant association between physical activity and psoriasis area and severity index (PASI)-50 response (p = 0.01) and psychosocial functioning (p = 0.029) together with a significant negative correlation between step count and psoriasis severity (p = 0.012). We observed no change in total waking hour sedentary behaviour.

Conclusion: Objective measurement of physical behaviour, using wearable digital technologies, offers a mechanism to further understand the clinical impact of lifestyle behaviour interventions. Crucially, despite increased levels of physical activity, we observed no change in total waking hour sedentary time. Further investigation is required to establish how modification of physical behaviour could offer an adjuvant management strategy for patients with psoriasis.

Background: Retinoids, such as retinol, are widely investigated and utilized in skin care products as a treatment for photoaging but their use is limited by tolerability. Adapinoid (oleyl adapalenate, OA) is a novel third generation retinoid that is a pro-drug of adapalene, but there is little research on its effects on photoaging or its tolerability.

Objectives: The purpose of this study is to compare the effects and tolerability of OA 0.5% to retinol 0.5% cream regarding visible signs of facial photoaging including facial wrinkles, fine lines and pigmentation.

Methods: In this 12-week, double-blind, randomized clinical trial, 48 eligible participants were recruited and enroled from the Greater Sacramento region. The study consisted of a baseline and follow-up visits at weeks 4, 8 and 12. Participants were randomized to receive either topical OA 0.5% or retinol 0.5% for 12 weeks. The primary outcome was changes in the appearance of wrinkle severity at 12 weeks. Secondary outcome measures include changes in erythema, skin pigmentation, skin hydration and transepidermal water loss (TEWL).

Results: OA improved wrinkle severity by 9.45% (p < 0.0001) at week 12, whereas retinol improved wrinkle severity by 4.11% (p < 0.001) compared to baseline. When comparing the two treatment groups at week 12, the OA group improved significantly more than the retinol group (p = 0.001). OA decreased pigment intensity at week 12 by 3.88% (p < 0.0001), whereas retinol decreased pigment intensity by 3.15% (p < 0.03) compared to baseline. OA-based improvement in pigment intensity at week 12 was not significantly different from retinol (p = 0.62). OA reduced facial erythema by 13.39% (p < 0.05) at week 12, whereas the retinol group did not have a significant change. OA use led to a 14.92% decrease in TEWL by week 12 (p = 0.07), whereas the retinol group had no significant change. OA was better tolerated than retinol when assessed at all follow-up visits.

Conclusions: OA 0.5% is superior to retinol 0.5% in improving wrinkle severity and similar in improvement of pigment intensity. OA is better tolerated than retinol. Overall, the use of OA as a precursor to adapalene may be an effective method to improving the tolerability of retinoids while maintaining efficacy.

Trial registration: This study was registered on www.clinicaltrials.gov (NCT05778760).

Background: The bodily distribution of melanoma is frequently reported without consideration of the skin surface area, which could be misleading in melanoma risk regarding anatomical sites.

Objectives: To gain insights into the melanoma distribution on the body surface when the body surface area is considered.

Methods: Cutaneous melanoma data were extracted from a single dermatopathology laboratory, and the relative density from each body site was calculated by taking into consideration the skin surface area. Data from a previous publication were analyzed as a validation. Surveillance, Epidemiology and End Results Program data were also used for comparison.

Results: Relative tumour density (RTD) of melanoma in men and women exhibits a moderate head-to-toe linear gradient, with the upper body sites showing higher density than the lower body sites in general. In particular, the ear and face show the highest RTD while the least UVR (ultraviolet radiation)-exposed buttock, abdomen and groin have the lowest, followed by the thigh and lower legs. The trend is similar in both sexes, but more obvious for men.

Conclusions: It was well documented that the trunk and lower legs are the most frequently diagnosed sites for men and women, respectively. However, when the surface area is considered, the melanoma distribution exhibits a rough head-to-toe gradient, which perhaps reflects a combined effect of solar UVR and clothing coverage. UVR protection on the face and ear should be emphasized as these are the sites with the highest RTDs.