Skin health and disease最新文献

This case report describes an interesting example of a syringocystadenoma papilliferum lesion presenting in a 72-year-old man. He presented with a 10-month history of a red nodule in his umbilicus with unexplained weight loss and reduced appetite. The patient had a background of chronic obstructive pulmonary disease, treated prostate cancer and pemphigus vulgaris that had previously been treated with azathioprine. The nodule would occasionally bleed with trauma, but there were otherwise no associated symptoms. Physical examination revealed a 12 × 12 mm firm red nodule within the umbilicus with some creamy exudate overlying it. Given the clinical presentation, differentials at the time included Sister Mary Joseph nodule, amelanotic melanoma and pyogenic granuloma. A shave biopsy was arranged to help diagnose the nodule and further investigations including computed tomography (CT) and colonoscopy were undertaken. CT and colonoscopy did not indicate any sinister pathology. Histopathological findings demonstrated mildly cystic invaginations arising from a papillomatous epidermis that were lined by rows of cuboidal-to-columnar epithelial cells, with oval nuclei and a pale eosinophilic cytoplasm with squamous metaplasia. The stroma contained a dense mononuclear infiltrate, which was comprised predominantly of plasma cells and lymphocytes. The histopathological findings were of syringocystadenoma papilliferum. This report discusses the clinical and histopathologicial presentation of syringocystadenoma papilliferum and the investigations and management to consider with this diagnosis. We also discuss the various differentials that should be considered for a red nodule in the umbilicus.

Androgenetic alopecia (AGA) is a hair disorder seen in both sexes. Its aetiology is multifactorial. Treating AGA has always been a challenge for dermatologists. Only a few drugs such as topical minoxidil and finasteride are U.S. Food and Drug Administration-approved for treating AGA. Thus, looking for new and more effective treatment options for AGA is imperative. This review was conducted to compare the efficacy of oral with topical minoxidil in treating AGA. Only clinical trials that compared oral with topical minoxidil in treating AGA were included in this review. PubMed, Cochrane, Scopus and ClinicalTrials.gov were searched. A total of 2063 studies were retrieved from the databases. Four studies met the inclusion criteria and were included in this systematic review. Outcomes such as hair density, terminal hair density, hair count, global photographic assessment and negative hair pull were studied in this review. The results showed that there was no significant difference between oral and topical minoxidil in terms of improving the hair density of patients with AGA (overall mean difference 0.95, 95% confidence interval -24.98 to 26.87). Two studies showed that the mean difference in terminal hair density was greater in patients treated with oral minoxidil, but there was no significant difference between the two treatments in terms of improving terminal hair density. The efficacy of oral minoxidil is comparable to that of topical minoxidil in terms of improving hair density and terminal hair density in patients with AGA. Oral minoxidil can be used as an adjunct or as a second-line treatment option for AGA.

Background: Atrophic scars, which affect many individuals and arise from various causes, currently lack a standardized treatment protocol. Recent studies suggest that combining microneedling with topical insulin (TI) may offer a promising new approach to improving the appearance of these scars.

Objectives: To evaluate the efficacy and safety of microneedling combined with TI for treating atrophic scars caused by acne, cutaneous leishmaniasis, striae alba and postoperative wounds. Additionally, we aimed to assess the impact of treatment on improving quality of life.

Methods: A total of 158 patients with various types of atrophic scars were divided into two groups: one received microneedling with TI and the other received microneedling with a placebo. Each participant underwent 12 monthly sessions, followed by a 1-year follow-up to assess long-term outcomes. Primary outcomes were measured via the Goodman and Baron qualitative grading system and acne scarring grading system, along with patient satisfaction and Dermatology Life Quality Index scores.

Results: A statistically significant improvement was observed in the TI group, as reported by patients and clinicians, especially regarding postacne and postleishmaniasis scars (P = 0.001). The improvement in quality of life was most pronounced in the postacne group (P = 0.002).

Conclusions: This study suggests that microneedling, when combined with TI, is a safe and effective standalone treatment for atrophic scars resulting from various causes. Additionally, this approach may enhance the quality of life for patients with this condition. However, further research with larger sample sizes is needed to validate these findings.

Background: Dermatological adverse effects may occur after COVID-19 infection or vaccine administration. Since the beginning of the pandemic, several case reports and systematic reviews have been published on vasculitis associated with both COVID-19 infection and vaccination. Fever, malaise, urticaria, and rash are common symptoms of COVID-19. These symptoms can also occur as adverse reactions to COVID-19 vaccines. However, the occurrence of serious autoimmune reactions due to COVID-19 infection or its vaccine is rare. Cutaneous small vessel vasculitis (CSVV) is an autoimmune disorder that manifests with palpable purpura and petechiae involving the extremities. It results from neutrophilic inflammation within and around dermal vessels and is usually self-limited.

Objective: We provide a thorough systematic review on CSVV occurring in the COVID-19 era.

Methods: We followed the PRISMA 2020 checklist for systematic review, searching PubMed, Google Scholar, Cochrane, and Embase. We included case reports, case series, correspondence articles, and letters to the editor written in English. Characteristics of each were then summarized and analyzed.

Results: 39 cases were included in our review - 27 due to the COVID-19 vaccine and 12 due to COVID-19 infection. Mean age of onset was similar, but mean time to onset was sooner in the vaccination group. Common treatments included systemic steroids, and almost all patients experienced complete recovery with the exception of a few patients in the COVID-19 infection cohort.

Conclusion: While most cases are self-limiting and resolve with no long-term sequalae, the occurrence of more severe reactions appears to be associated with COVID-19 infection rather than with vaccination.

Psoriasis is a prevalent skin disorder affecting approximately 2-3% of the population in the USA. Its complex and varied presentations necessitate a diverse range of available therapeutic options. While topical corticosteroid therapy is conventionally employed as first-line treatment, long-term usage increases the risk of adverse events, prompting the consideration of alternatives including steroid-sparing agents such as vitamin D. In this article, we review literature from topical and oral vitamin D trials for the treatment of psoriasis. Topically, vitamin D analogues have been well established as an effective long-term treatment, particularly when used in combination with other therapies. Moreover, combination therapy with immunomodulators such as apremilast and methotrexate has shown promise as well. Conversely, oral vitamin D supplementation trials have yielded more inconsistent results, with some supplementation clinical trials showing significant psoriasis resolution and others showing no significant changes in psoriasis outcome. Vitamin D deficiency status, seasonal variation and body mass index were factors that may have modulated the therapeutic effect of vitamin D supplementation. Further study combining vitamin D supplementation with pre-existing treatments may also augment the effect of monotherapy. Studies on the synergistic effects of combination therapies with oral vitamin D or the development of foam-based or microneedle drug delivery systems may be promising next steps.

Background: Head-and-neck skin cancers have a worse prognosis than those that develop elsewhere on the body. Self-screening this area for suspicious skin changes can be difficult. Hairdressers and barbers observe this area closely during hair appointments and could bring their customers' attention to suspicious skin changes earlier.

Objectives: To investigate a sample of UK hairdressers' and barbers' skin cancer education, customer screening practices and influences on screening, and to compare hairdressers' and barbers' screening practices.

Methods: Stratified random sampling was utilized to select hairdressers and barbers working in a UK city. Participants were invited to complete a survey.

Results: Thirty-seven participants completed the survey. Five per cent reported having had skin cancer awareness training and 24% were screening customers. Thirty-five per cent had advised a customer of a suspicious mole or skin lesion; of these participants, 39% had had customers diagnosed with skin cancer. 'Not having received training' was reported by 65% of participants as a deterrent to screening. Knowing someone who had experienced skin cancer was significantly associated with screening and advising customers of suspicious skin changes. Most participants (92%) indicated they would like, or maybe like, skin cancer awareness training.

Conclusions: In this UK city study, perceived knowledge of the signs and symptoms of skin cancer appeared to arise from knowing someone who had experienced skin cancer rather than formal training. Lack of skin cancer education was a deterrent to screening, but most participants would like training. Trained hairdressers and barbers could potentially provide regular head-and-neck skin screening for customers.

Background: Atopic dermatitis (AD) is a common chronic inflammatory skin condition. Currently, there is a lack of real-world evidence regarding the effectiveness of systemic therapies for moderate-to-severe AD. Abrocitinib is a novel Janus kinase 1 selective inhibitor licensed for AD in adults and adolescents requiring systemic treatment. The DREAM TO TREAT AD (D2T AD) study was set up to collect real-world data on abrocitinib and conventional systemic treatment use in moderate-to-severe AD. It aims to describe treatment patterns and effectiveness within a 3-year follow-up period in five registers: Ireland [Atopic Eczema Systemic Therapy Register (A-STAR) Ireland], Denmark (SCRATCH), Germany (TREATgermany), the Netherlands and Belgium (TREAT NL/BE), and the UK (A-STAR UK).

Methods: The study protocol and methodology were developed collaboratively by academics of the participating registers with the study funder. The study follow-up timepoints and outcomes are based on an international Delphi exercise previously run by the TREAT Registry Taskforce. All five registers collect data in several domains, including patients' characteristics and treatment outcomes in patients receiving systemic treatment. Assignment to treatment was decided by the treating clinician. Data collected by the registers will be transformed into harmonized datasets and then to analytical datasets (ADS) to address research questions. Study objectives include describing patient baseline characteristics, in addition to clinician- (Eczema Area and Severity Index) and patient-reported outcomes [Patient-Reported Eczema Measure (POEM), Children's/Dermatology Life Quality Index (C/DLQI), Peak Pruritus Numeric Rate Scale (PP-NRS)] at baseline and follow-up, as well as treatment patterns while on abrocitinib and conventional systemic treatments. The ADS will be analysed using the novel DataSHIELD solution that enables centralized statistical analysis on decentralized data (i.e. without data leaving the register of origin). The DataSHIELD solution includes central analytic hubs (CAHs) and local data nodes (LDNs). CAH can remotely interrogate LDNs via an internet connection using analytical commands. Each LDN produces local statistical results that are sent back to the CAH, which can then combine the results from all LNDs without seeing any patient-level data.

Discussion: D2T AD undertakes a novel federated data analysis approach across five registers in observational dermatology research and will provide crucial information on AD treatment outcomes for clinical decision-making, in addition to proving the feasibility of this type of scientific collaboration.

Protocol registration: EMA RWD Catalogue (EU PAS no.: 108468; study ID: 199009; https://catalogues.ema.europa.eu/node/3894/administrative-details).

Trisomy 18 is the second most common autosomal trisomy, associated with high mortality, with only 5-10% of affected individuals surviving beyond the first year of life. Consequently, comorbidities in long-term survivors are rarely reported. We describe the case of a 6-year-old East Asian girl with trisomy 18 who presented with calcinosis cutis. The patient initially developed a firm, non-tender subcutaneous nodule on the left wrist, which later spread to the forearm and upper arm. Physical examination and imaging revealed extensive subcutaneous nodules in other extremities. High-frequency ultrasonography showed hypoechogenic masses with posterior acoustic shadows, while skin biopsy revealed fat necrosis and calcium deposition. No significant abnormalities were detected in the levels of calcium, phosphorus, parathyroid hormone or vitamin D. Based on laboratory findings and the patient's medical history, metabolic, nutritional, inflammatory and iatrogenic causes of calcinosis cutis were unlikely. Consequently, the condition was classified as either dystrophic or idiopathic calcinosis cutis. The patient was managed as an outpatient without specific treatment. This report discusses the mechanisms of calcinosis cutis and the reasons for the limited research on its association with trisomy 18. To our knowledge, this is the first report describing calcinosis cutis as a concomitant condition in a paediatric patient with trisomy 18, and it is anticipated that increased awareness of this disease may lead to a rise in reported cases in the future.

Dyschromatosis universalis hereditaria (DUH) is a rare autosomal dominant pigmentary skin disorder characterized by hypo- and hyperpigmented macules over the body. Although DUH is associated with mutations in ABCB6 and SASH1, other factors also contribute to the pathogenesis of DUH, as the lesions typically appear on the exposed areas of the skin and do not develop in all individuals with SASH1 mutations. Most reported cases of SASH1 mutations are in Chinese or Japanese patients who do not require treatment. Herein, we report a rare case of an 11-year-old boy presenting with an 8-year history of widespread brown spots. The lesions, which began on his face and spread to the trunk, limbs and oral mucosa, developed without photosensitivity. Whole-exome sequencing helped identify a heterozygous SASH1 mutation (c.1529G > A; exon13, NM_015278.5). Initial treatment with intense pulsed light did not result in any improvement; however, subsequent picosecond laser treatment led to significant improvement. Hence, this case highlights the phenotypic variability of DUH associated with SASH1 mutations and the potential role played by additional genetic or environmental factors in disease expression. Furthermore, picosecond laser treatment may be effective against hyperpigmented lesions, although further studies are required to assess its long-term efficacy and safety.

Oncolytic viruses (OVs) can destroy cancer cells without harming healthy cells. This review explores the mechanisms by which OVs operate and the methods of delivering them. Melanoma is a common type of skin cancer with increasing prevalence in the UK; therefore, finding effective strategies to combat the disease is paramount. To understand the potential of OVs in treating melanoma, different types of viruses will be reviewed. Talimogene laherparepvec (T-VEC) is the only OV to be approved for treating melanoma; this review aims to understand the efficacy of T-VEC as a monotherapy and combined with other treatments. There is substantial evidence to support the use of OVs in treating melanoma by synthesizing the current perspectives of their use where they proved to be effective in clinical trials, as monotherapies and in combination with other treatments, as well as exciting innovative ventures using novel virus species. Gaps are also highlighted in the research, such as determining the influence that cancer gene mutational status has on how the tumour cells react to treatment, a concept that should also be considered in future research.