Skinmed最新文献

The cult of saints in Western Europe developed during the late period of antiquity and the early Middle Ages. Their importance to European society was undeniable; holy medicine was the only hope for people, because there were no doctors. The number of saints had increased over the years, and people sought medical help from them through prayer and other religious practices. Some of the saints became "specialized" in treating various wounds and dermatologic diseases. During our research, we tried to determine whether the cult of saints led to the develop-ment of hospitals that treated skin diseases, as discovered in the Hospital Brother of Saint Anthony. A large number of saints who were patrons of wounds and skin diseases were collected in three studies. In the first report, we presented a great number of saints who were patrons to treat animal bites. The second report presented patron saints of wounds, ulcers, burns, and frostbites; and the third report decsribed saints who treated contagious diseases (such as ergotism, leprosy, and scabies). The phenomenon of holy medicine is part of the history of dermatology and is important due to "specializations," which refer to an understanding of skin diseases and the methods of treating various wounds and dermatologic diseases.

Pseudoxanthoma elasticum (PXE) is an inherited disorder characterized by degradation and fragmentation of elastic fibers and calcium depos- its in the dermis. It clinically manifests as yellow papules or plaques in a cobblestone distribution or "plucked-chicken skin" appearance on the lateral neck and/or flexural areas. In addition, it can also affect the eyes, cardiovascular, and gastrointestinal systems. It is considered as the prototype of ectopic heritable mineralization disorders, usually diagnosed in the second decade of life. The majority of patients are sporadic but recessive, but pseudodominant autosomal forms have been described as well. Mutations affecting the ATP-binding cassette subfamily C member 6 (ABCC6) gene or gamma-glutamyl carboxylase (GGCX) gene lead to PXE. Accumulating evidence in the literature has found that numerous disorders may demonstrate cutaneous PXE-like clinical and/or histologic features without any other systemic evidence of PXE or any genetic documentation of inherited mutations. In this review, we aimed to highlight all the disorders that were reported to exhibit PXE-like clinical and/or microscopic changes and to discuss possible underlying mechanisms leading to such an overlap.

The optimal frequency and timing of laboratory monitoring during isotretinoin treatment remains controversial. We aimed to investigate the frequency, timing, and severity of abnormal results during isotretinoin for acne. We conducted a retrospective cohort study comprising 444 acne patients prescribed isotretinoin at Boston Medical Center from 2004 to 2017; these patients had at least one available baseline laboratory result. We categorized patients into two groups: group A (normal values at baseline and during the first 2 months of isotretinoin therapy) and group B (abnormal values at baseline or during the first 2 months of isotretinoin therapy) and assessed the laboratory values after 2 months. The frequency of abnormal results for triglycerides, cholesterol, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) after 2 months for patients in group A was 21.1%, 13.6%, 8.8%, and 6.0%, respectively, with very rare grade 2 (moderate) or higher abnormalities. In contrast, the frequency of abnormal results for patients in group B for triglycerides, cholesterol, AST, and ALT was higher at 67.9%, 88.0%, 40.0%, and 25.0%, respectively (P < 0.05, except for ALT). No patient developed higher than grade 1 (mild) complete blood count (CBC) abnormality. This study proposed that healthy patients with normal results at baseline and during the first 2 months of isotretinoin therapy might not need routine monitoring after month 2 of medication. Routine monitoring of CBC is not necessary.

An 87-year-old man was referred to our department for evaluation of his dystrophic left fingernails that developed progressively for the past 2 years. His past medical history included hemodialysis for 10 years for chronic renal failure. Examination of his nails revealed xanthonychia, onycholysis, Beau's lines, and marked hyperkeratosis of the nail plate involving all of his left fingernails. However, his right fingernails were not affected (Figure 1). He also had edema of the left hand associated with puffy fingers but without trophic disorders (Figure 2). Mycologic exam-ination with direct microscopy and culture of his affected nails were negative. Antinuclear antibodies (ANAs), Scl-70 (anti-topoisomerase) antibodies, anti-centromere antibodies, and anti-RNA polymerase III antibodies were all negative. Capillaroscopy showed no abnormalities. An X-ray of his left hand showed no bony abnormalities. For the past 5 years, the patient had suffered from paresthesia and numbness on the left hand in the area of the median nerve. Paresthesia, pain, burning, and tingling involved mainly the thumb, plus the index and middle fingers, but not the little finger. Carpal tunnel syndrome (CTS) was suspected. Neurologic examination and electromyography (EMG) confirmed the diagnosis of CTS of the left hand explaining his unilateral onychodystrophy. The patient was then referred to a hand surgeon for his CTS.

A 40-year-old African-American man was referred to our dermatology clinic for management of his long-standing thyroid dermopathy. The patient was diagnosed with hyperthyroidism at the age of 20, and was treated with radioactive iodine I-131 but subsequently lost to follow-up. He had not consulted physicians again until the age of 30. Then he presented with severe thyroid eye disease, significant weight gain, hypothy-roidism, and painful leg swelling. Levothyroxine was initiated, which stabilized his thyroid levels but had no effect on his exophthalmos and leg swelling.

Veganism is a practice that promotes abstinence from all animal-derived products or foods. While veganism commonly refers to adopting a vegan diet, the term "veganism" also encompasses broader lifestyle practices. As veganism grows in popularity, patients often turn to their der-matologists for guidance regarding the identification of vegan ingredients in personal care and hair care products.¹ Additionally, several over-the-counter (OTC) and prescription medications recommended in the management of dermatologic conditions are often questioned about their applicability to veganism. We discuss the relevance of vegan diets to dermatologic clinical practice, address common questions relevant to patients, and offer guidance on how to identify vegan products.

Spevigo^® (spesolimab-sbzo) injection was recently approved for the treatment of generalized pustular psoriasis (GPP) in adults aged 18- 75 years. Spesolimab, a monoclonal antibody, binds to the interleukin-36 (IL-36) receptor and prevents its activation by IL-36 cytokines, leading to reduced inflammation, skin lesions, and flares. In a randomized placebo-controlled, phase 2 study (Effisayil-1, NCT03782792), 53 patients were randomized to spesolimab (n = 35) and placebo (n = 18) to evaluate the effect of a one-time 900-mg dose of spesolimab versus placebo against GPP flares. The primary endpoint was Generalized Pustular Psoriasis Physician Global Assessment (GPPGA) pustulation subscore of 0 (no visible pustules) and the key secondary endpoint was the GPPGA total score of 0 or 1 (clear or almost clear skin) at the end of week 1. The primary endpoint was achieved by 54% (19/35) of patients in the spesolimab group and 6% (1/18) of patients in the placebo group. The key secondary endpoint was achieved by 43% (15/35) of patients in the spesolimab group and 11% (2/18) of patients in the placebo group. In the first week, adverse events (mild to severe) were reported in 66% (22/35) of patients in the spesolimab group and 56% (10/18) in the placebo group.