Skin health and disease最新文献

A 34-year-old male patient presented with a clinical picture of multilocular subcutaneous skin nodules in addition to marked lymphadenopathy and general physical deterioration. A comprehensive diagnostic workup including serology, skin biopsy and imaging studies led to the initial diagnosis of human immunodeficiency virus (HIV) infection in AIDS stage with rare multilocular subcutaneous bacillary angiomatosis (BA) caused by Bartonella henselae. BA describes a process of neovascularisation of the skin or of internal organs (particularly the liver and spleen) and was first described in HIV-positive patients by Stoler et al. in 1983. Both cutaneous and systemic symptoms are variable. There is no standardized treatment. The patient was started on antibiotic therapy with doxycycline, which was subsequently augmented with rifampicin. As the patient's general condition deteriorated and lymphocytopenia aggravated, he was transferred to an internal medicine ward for further treatment and subsequently commenced on antiretroviral therapy. This case corroborates numerous aspects of the cases described in the literature yet differs from them in that subcutaneous lesions are uncommon, particularly when infected with Bartonella henselae, illustrating the clinical spectrum of BA. Furthermore, it emphasises the significance of prompt and thorough diagnosis encompassing HIV serology in instances of skin lesions, accompanied by systemic signs and evidence of immunosuppression.

Radiation therapy is commonly used to treat various types of malignancies during or after radiation. Approximately 95% percent of patients develop common skin manifestations including dermatitis, atrophy and fibrosis. Rare manifestations, including non-melanoma skin cancers, morphea, cutaneous angiosarcoma and bullous pemphigoid, have been reported post-treatment. The development of lichen planus (LP) from radiation therapy is exceedingly rare, with only 14 previous cases reported. Of these, none were associated with malignant transformation. Malignant transformation from LP is uncommon, with reported cases mainly in oral manifestations of LP at rates of ∼1%-2%. Classic cutaneous manifestations of LP have not been associated with an increased risk of malignancy. We report a unique case of erosive cutaneous LP with malignant transformation in a previously radiated site. Our case highlights a novel cutaneous adverse event to radiation treatment and emphasises the importance of considering erosive LP on the differential when evaluating recalcitrant erosions in a previously radiated area and to monitor closely for transformation to squamous cell carcinoma.

Background: Treatment of keloids and hypertrophic scars is challenging. The current first-line treatment is a steroid which has high resistance and recurrence rate along with unacceptable adverse effects. Different studies involving the combination of TAC and 5-FU that have been done so far showed better treatment outcomes in terms of efficacy and safety.

Objective: The objective of this study was to compare the efficacy and safety of intralesional triamcinolone acetonide alone and its combination with 5-fluorouracil in patients with keloids and hypertrophic scars at 12 weeks follow-up.

Methods: In this randomized parallel group double-blinded clinical trial, we enroled 66 cases of keloids and hypertrophic scars randomly allocated into two treatment groups. Patients received an intralesional injection of triamcinolone acetonide (20 mg/mL) in Group A and an intralesional injection of a combination of triamcinolone acetonide (20 mg/mL) and 5-fluorouracil (25 mg/mL) in Group B for every 2 weeks until 10 weeks and the final evaluation was done at 12 weeks follow-up.

Results: There was a reduction in all the parameters at every follow-up visit in both groups. The ≥50% reduction in height, reduction in the VSS and POSAS scores, and good to excellent subjective improvement reported by both the patients and the observer were significantly greater in the combination group compared to TAC alone group. The response rate was faster and complications were lesser in the combination group as compared to TAC alone group.

Limitation: Single-centred, no long-term follow-up, and recurrence could not be assessed.

Conclusion: TAC alone and its combination with the 5-FU both were effective in keloids and hypertrophic scars. Yet, the TAC and 5-FU combination treatment was more efficacious with a faster response rate and safer than the TAC alone treatment.

The skin is the largest organ in the integumentary system, protecting against various external threats, including ultraviolet exposure, heat, infections, dehydration and mechanical injuries. Skin disorders can arise from various causes, including allergic reactions or breaches in the skin barrier, which allow microorganisms or chemicals to penetrate the sweat ducts. These conditions encompass a wide range of issues, including acne, xerosis (dry skin), fungal infections, atopic dermatitis (eczema) and psoriasis. Collectively, these ailments affect a significant portion of the global population, impacting approximately one-third of people worldwide. Additionally, oxidative stress induced by ageing and prolonged exposure to ultraviolet rays can manifest in visible alterations such as pigmentation, wrinkling and dehydration. Recent investigations have underscored the potential of natural antioxidant compounds in safeguarding skin health and combating ageing-related changes. Tocotrienols, a subgroup of vitamin E, have garnered significant attention owing to their antioxidant and anti-inflammatory properties. Significant amounts of tocotrienols can be found in rice bran, olive, oats and hazelnuts. Similarly, squalene, predominantly sourced from fish liver oils such as those from sharks, has been used as an emollient in cosmetic formulations. This article offers a comprehensive review of existing literature elucidating the dermatological benefits associated with tocotrienols and squalene, emphasising their roles as antioxidants, anti-inflammatories, skin barrier protection and facilitators of wound healing. Moreover, it sheds light on contemporary research findings suggesting these compounds' therapeutic promise in managing and ameliorating various skin conditions.

Background: Alopecia areata (AA) is an autoimmune disease causing chronic non-scarring hair loss. Different therapeutic regimens have been suggested for AA, which depend on patients' age, scalp involvement extent and duration. Topical immunotherapy with diphenylcyclopropenone (DPCP) is one of the treatment options for these patients.

Objectives: We aimed to investigate the response to DPCP in paediatric AA patients.

Methods: This retrospective study included 97 paediatric AA patients followed in the DPCP clinic from March 2016 to March 2021 at a referral dermatology hospital.

Results: In a cohort of 97 paediatric patients with AA under treatment with DPCP, with a mean age of 11.10 ± 0.9, 53.6% of the patients were male. Patchy alopecia was the most prevalent type (45.4%). After 6 months of DPCP treatment, 51.5% showed no response, while 3.1% achieved complete response. At the 12-month evaluation, among the 68 patients who continued treatment, complete response was observed in 8.8%. A significant positive correlation was found between alopecia type, specifically patchy, and treatment response (p = 0.031). Additionally, treatment duration emerged as a significant predictor of positive response at both six (OR 1.450, p = 0.026) and 12 months (OR 1.310, p = 0.043). A higher initial Severity of Alopecia Tool score was inversely correlated with treatment response (Spearman's rho -0.14, p = 0.002), indicating that initial disease severity may predict treatment efficacy.

Conclusions: One year after the onset of DPCP in paediatric AA patients, the complete response and any hair regrowth rates were 8.8% and 61.8%, respectively. The milder initial disease severity and longer duration of treatment resulted in a better response.

Epidermolysis bullosa pruriginosa (EBP) is a form of dystrophic EB associated with severe pruritus and has skewed Th2 inflammation. Our study suggests that JAK inhibitors may offer superior efficacy compared to dupilumab in treating EBP. Moreover, JAK inhibitors downregulate JAK-STAT signalling and Th1/2 cell differentiation in lesional skin while not in peripheral blood.

Wearable medical technology encompasses a range of electronic devices that act as biosensors. Atopic dermatitis (AD) is the commonest inflammatory skin disease and represents an important area of need in which to leverage the power of wearable biosensor technology, especially as the impact of COVID-19 increases the likelihood of virtual consultations becoming an integrated part of clinical practice. The aim of this review is to systematically define the published evidence for the utility of wearable biosensors in assessment and management of atopic dermatitis (AD). A systematic literature search was conducted for publications from 1995 onwards for 'sensor' OR 'sensing' OR 'biosensor' OR 'biomarker'. Results were combined ('AND') with a search for 'wearable' OR 'actigraphy' OR 'Internet of things' OR 'microneedle' OR 'patch' OR 'e-textile' OR 'smart textile' and atopic dermatitis (MESH terms). Fifty seven abstracts were identified from the database search of which 39 were selected for detailed review. Broadly, wearable sensing systems in atopic dermatitis were split into three categories: wearable biosensor modules (actigraphy and smartwatches), clothing and integrated fabrics placed onto the epidermis and intradermal or subcutaneous sensors. The best evidence for correlation with AD disease severity was with actigraphy measurements of itch. However, newer approaches including sensing skin barrier function, inflammation and small molecule analysis as well as employing artificial intelligence offer more potential for advanced disease monitoring. Skin diseases, specifically AD, stand to benefit greatly from wearable technology, because of the ease of direct contact to the skin, the high prevalence of the disease and the large unmet need for better disease control in this group. However, important emphasis must be placed on validating the correlation of data from such technology with patient-reported outcomes. Wearable biosensors offer a huge potential to deliver better diagnostics, monitoring and treatment outcomes for patients.

Acute generalised exanthematous pustulosis (AGEP) is a rare drug-induced pustular eruption characterised by the rapid onset of superficial pinhead pustules. We discuss the case of a 27-year-old man who presented with a generalised pustular eruption on the neck, trunk and limbs. He commenced upadacitinib for the treatment of atopic dermatitis (AD) 6 months before developing the rash, and the dose was increased from 15 to 30 mg daily, 3 months prior. His only other medication was oral terbinafine, for suspected tinea corporis, which was initiated 1 month before developing the pustular eruption. Laboratory investigations showed a mildly raised CRP 25 mg/L, neutrophilia 8.22 10 × 9/L, and a mildly raised ALT 46 U/L. A skin biopsy showed subcorneal pustules and a few scattered keratinocytes. Upadacitinib and terbinafine were suspended and the pustular eruption resolved. Updacitinib was reintroduced 3 weeks later as the rash was thought to be due to terbinafine and the rash recurred. He was diagnosed with AGEP secondary to upadacitinib. Upadacitinib is a selective JAK inhibitor that is increasingly used for the management of AD and clinicians should be aware that AGEP is a rare but severe adverse effect.

Eccrine angiomatous hamartoma (EAH) is a rare benign vascular lesion that is distinguished histologically by vascular and eccrine overgrowth. We report the case of a 46-year-old woman with EAH who was successfully treated with multimodal incobotulinum toxin A, pulsed dye laser and long-pulsed neodymium-doped yttrium aluminium garnet laser.

Background: Benign male genital pigmentation is a confusing field with poorly defined terminology. This entity is frequently encountered in our male genital lichen sclerosus (MGLSc) cohort and suggests an association with prior inflammation, however there is a limited literature on the topic.

Objectives: This paper describes the attributes of 21 patients with MGLSc and features of benign genital pigmentation, reviews the existing literature on benign male genital pigmentation and makes recommendations for better practice.

Methods: We prospectively identified 21 patients with MGLSc and clinical diagnoses of benign penile pigmentation who attended specialist male genital dermatoses clinics. Relevant findings were abstracted from clinical notes, outpatient letters, medical photographs, dermatoscopic images and histological reports.

Results: The clinical features of this cohort are discussed and the dermatoscopic images analysed. 15 of 21 patients were followed up for over 2 years and all of these had stable appearance of pigmentation. 87% reported pigmentation to have emerged after the onset of MGLSc symptoms, with latency ranging from one to over 25 years. The terms lentiginosis, melanosis, and post-inflammatory hyperpigmentation are discussed in context of the existing literature.

Conclusions: We propose that genital lentiginosis and melanosis are clinically indistinguishable macroscopically and are on a clinical and histopathological spectrum. Although there is a compelling narrative that genital melanosis is most often truly benign, there is also emerging evidence to suggest an increased risk of penile melanoma in patients with MGLSc. Furthermore, pigmented lesions in MGLSc can portray concerning morphological features even when benign. A low threshold for biopsy and follow-up is thus warranted.