Hasil untuk "Dermatology"

Ming-xing Gong, Shan-shan Li, He Huang et al.

BackgroundIsotretinoin is a vitamin A derivative widely used for moderate-to-severe acne, and is known to cause multiple systemic and ocular adverse events. Refractive errors, such as myopia and astigmatism, are commonly considered reversible after discontinuation of isotretinoin treatment. However, the visual changes and subsequent prognosis after re-exposure to isotretinoin are rarely reported.Case PresentationA 21-year-old male initiated oral isotretinoin at 10 mg twice daily for acne vulgaris. Twelve days later, the patient developed acute visual deterioration. The eye examination revealed mild myopic astigmatism in the right eye and mild myopia in the left eye. The patient’s visual acuity returned to normal at approximately 20 days after isotretinoin cessation. Then, the patient later self-restarted isotretinoin (10 mg, twice daily) for 10 days, which again resulted in decreased visual acuity. Although the patient discontinued isotretinoin, the visual acuity did not recover to baseline over a 14-month follow-up period. The Naranjo Adverse Drug Reaction Probability Scale was eight points, indicating a “probable” causal relationship between isotretinoin and refractive error.ConclusionMyopia and astigmatism might happen concurrently after isotretinoin administration. In addition, recurrent and persistent refractive errors might occur upon restarting isotretinoin in patients with prior history of isotretinoin-related ocular complications. Clinicians should consult patients to take extra precautions on isotretinoin medication when they have a history of ocular disease or ocular complications with isotretinoin administration.

Lu Xing, Tao Wu, Hongyan Xu et al.

Sumit Sehgal, Harshit Bansal

Mohamed Nasr, Moustafa AH El-Nawasany, Haytham E Ali et al.

Background: Diabetic foot ulcers (DFUs) are a serious complication of diabetes that can lead to significant morbidity. Autologous platelet-rich plasma (PRP), rich in growth factors and cytokines, has emerged as a promising treatment to enhance ulcer healing. This study aimed to compare the clinical and histological efficacy of injected PRP versus topically applied PRP and traditional wound care in the management of DFUs. Methods: Sixty patients with DFUs were randomly assigned to three equal groups (n = 20 each). Group A received locally injected autologous PRP; Group B received topically applied autologous PRP; and Group C received standard wound care. All patients were followed twice weekly for 12 weeks or until complete healing. Skin biopsies were obtained at baseline and after 12 weeks (or upon completion for unhealed ulcers) for histopathological evaluation. Results: By the end of the 12-week follow-up, 87.5 % of patients treated with PRP (35 out of 40 in Groups A and B) achieved complete ulcer healing, compared to a significantly lower healing rate in the traditional care group (Group C). Histological findings supported the clinical outcomes. No significant difference was found between injected and topically applied PRP in terms of clinical effectiveness. Conclusion: PRP treatment, whether injected or topically applied, significantly enhances the healing of DFUs compared to traditional wound care. Both methods of PRP application demonstrated comparable clinical efficacy.

Omar Suljagić, Emir Tupković, Kenana Ljuca et al.

Aim Any aesthetic procedure in the head and/or in the face might have an impact on psychological status of the treated participants. Aim of this study was to investigate whether Botulinum toxin treatment for aesthetic purpose in the face influences on the level of happiness, depression and anxiety. Methods This prospective cohort observational study included 30 participants, who were treated by botulinum toxin (Botox) due to aesthetic corrections. The treatment included laugh lines, frown lines and horizontal forehead lines. Preprocedural, three and six months after the treatment the participants were assessed by The Oxford Happiness Questionnaire (OHQ), The Beck Depression Inventory (BDI) and The Beck Anxiety Inventory (BAI) to determine the level of happiness, anxiety and depression was used. Results Three months after the treatment by Botox the level of happiness was significantly increased (5.26±0.43 vs 4.3±0.34; p<0.0001). The levels of depression (7.6±6.0 vs 14.2±8.3; p<0.0001) and anxiety (8.8±6.3 vs 16.4±8.8; p<0.0001) were significantly decreased compared with preprocedural level. Significant increased level of happiness and decreased levels of depression and anxiety remained six months after the treatment, but attenuated. A dose of applied botulinum toxin was negatively correlated with the level of depression (r = -0.394; p=0.0421) and anxiety (r = -0.387; p=0.0302). Conclusion Botulinum toxin treatment for aesthetic purpose in the face positively influences psychological status of the treated individual in the short-therm.

Zahra Valizadeh, Farideh Jafari-Raddani, Safoura Shakoei et al.

Abstract Introduction Para-Kala-Azar Dermal Leishmaniasis (para-KDL) is a rare manifestation of leishmaniasis that occurs concurrently with active Visceral Leishmaniasis (VL). It is characterized by a combination of cutaneous and systemic symptoms, posing diagnostic and therapeutic challenges. This condition is even more complex in immunocompromised patients, such as those with HIV. Case presentation We report a case of a 52-year-old male from south of Iran, who presented with prolonged fever, severe weight loss, pancytopenia, and massive splenomegaly. The patient was diagnosed with HIV and had been receiving antiretroviral therapy (ART). He underwent a splenectomy 1 month later and developed progressive generalized lymphadenopathy and hepatomegaly 5 months after that. Histopathological analysis of lymph node biopsies confirmed leishmaniosis, and the patient was started on Meglumine antimoniate. Shortly after, he developed widespread maculopapular skin lesions. Subsequent diagnostic evaluations, including skin biopsy, confirmed the presence of Leishman bodies. The patient was successfully treated with liposomal amphotericin B, leading to significant clinical improvement. Conclusion The co-existence of active VL and PKDL can make diagnosis difficult, potentially leading to misdiagnosis and treatment, particularly in immunocompromised patients. The simultaneous occurrence of VL and PKDL-like skin lesions requires heightened clinical suspicion, especially in endemic regions. Delayed or misdiagnosed cases may lead to significant morbidity. Further research is needed to understand the pathophysiology, immune response, and optimal treatment strategies for para-KDL in HIV-infected individuals.

Berliana Hamidah, Cennikon Pakpahan, Laksmi Wulandari et al.

Excessive inflammatory response is a hallmark of severe COVID-19. This study investigated the associations between interferon-stimulated genes (ISGs) expression, genetic variation in the interferon α/β receptor 2 (IFNAR2) gene, and COVID-19 mortality.We investigated 67 patients with moderate-to-severe COVID-19. Of them, 22 patients (32.8 %) died because of COVID-19. We examined the expression of ISGs in total RNA of peripheral whole blood. We observed a significant increase in the expression of all ISGs examined in non-surviving patients, indicating a heightened interferon type I signaling activation in non-survived patients. Subsequently, we analyzed whether the increase in ISGs expression was correlated with polymorphism within the IFNAR2 gene. Intriguingly, no significant association was observed between IFNAR2 gene polymorphism and COVID-19 mortality. Similarly, no association was noted between the IFNAR2 and ISGs expression levels.Overall, our data showed that higher ISGs expression, which presumably indicates heightened interferon type I activation, is associated with COVID-19 mortality.

Yu L. Teh, Adawiyah Jamil

Background: Vitiligo is characterized by depigmentation due to melanocyte destruction. Itch is an under-recognized symptom; its pathophysiology is unclear. Aims: To compare epidermal biophysical characteristics of the vitiligous skin and normal skin and to determine the association with thyroid auto-immunity and itch. Methods: A cross-sectional study involving vitiligo patients was conducted. Hydration, pH, and trans-epidermal water loss (TEWL) at the vitiligous skin and normal adjacent skin were measured. The Vitiligo Disease Activity Score (VIDA) and Vitiligo Area Scoring Index (VASI) were assessed. Itch severity and thyroid auto-antibodies were determined. Results: Thirty-nine (62.9%) females and 23 (37.1%) males participated. Twenty-six (41.9%) had stable vitiligo, and 36 (58.1%) had active disease with a median VASI was 0.8 (2.2). Hydration was lower [93 (83) to 125.5 (111) vs 104 (73) to 156 (100), P < 0.01] and TEWL [7.13 (6.18) to 8.86 (6.93) vs 5.54 (5.90) to 6.88 (6.37), P < 0.01] was higher at the vitiligous skin compared to the normal skin. A non-significant higher pH trend was observed in the vitiligous skin. Thyroid antibody was detected in 19.7% patients. There were no significant differences in biophysical characteristics between patients with and without thyroid antibodies, with hydration of 88 (159) to 129.5 (120) vs 91.5 (81) to 116 (101) and TEWL of 7.08 (2.03) to 9.97 (6.38) vs 7.65 (7.54) to 8.22 (6.52). Itch was reported by 14 (22.6%). Patients with itch had lower hydration and higher TEWL but were not significantly different from patients without itch. Conclusions: The vitiligous skin has reduced hydration and increased TEWL, suggesting a defective epidermal barrier. Thyroid antibody positivity was not associated with biophysical characteristics or itch. Itch was not associated with hydration, pH, and TEWL. An impaired epidermal barrier and itch need to be addressed in vitiligo management.

Taraneh Yazdanparast, Mansour Shamsipour, Azin Ayatollahi et al.

Background: Rapid diagnosis of melanoma is necessary for a good prognosis. Using teledermatology and artificial intelligence for this issue is developing, but its diagnostic accuracy is less measured in a clinical setting. Objective: The purpose of this study was to assess the diagnostic accuracy of the teledermoscopy method using the FotoFinder device as well as the Moleanalyzer Pro artificial intelligence (AI) Assistant and to compare them with the face-to-face clinical examination for the diagnosis of melanoma confirmed with histopathology. Methods: Thirty melanocytic moles of 29 patients were included in the study. Each mole was assessed face-to-face, using FotoFinder teledermoscopy and Moleanalyzer Pro software methods. The results obtained from each method were compared with the results of the gold standard (pathology). The sensitivity and specificity of the three methods were calculated for malignant and borderline versus benign lesions. Inter-method reliability between a gold standard and other methods was evaluated using per cent agreement and Cohen’s kappa coefficient. Results: Five moles had a histopathological diagnosis of melanoma, and six and 19 moles were diagnosed as borderline and benign, respectively. Sensitivities and specificities were, respectively, as follows: face-to-face (90.9%, 57.9%), FotoFinder teledermoscopy (63.6%, 78.9%), FotoFinder® Moleanalyzer Pro (36.4%, 42.1%). Agreement with biopsy-obtained diagnosis categories of benign, borderline and malignant for face-to-face was 63.33%, FotoFinder teledermoscopy 73.33%, and FotoFinder® Moleanalyzer Pro 40%. Conclusions: Teledermoscopy had the highest agreement with reference diagnosis as well as the highest specificities that caused a reduction of biopsy referrals. The FotoFinder® Moleanalyzer Pro had the lowest agreement. Therefore, it cannot replace dermatologist decision making.

Lixiang Sun, Xiaowei Zhang, Shuai Wu et al.

Summary: Dermal adipocyte lineage cells are highly plastic and can undergo reversible differentiation and dedifferentiation in response to various stimuli. Using single-cell RNA sequencing of developing or wounded mouse skin, we classify dermal fibroblasts (dFBs) into distinct non-adipogenic and adipogenic cell states. Cell differentiation trajectory analyses identify IL-1-NF-κB and WNT-β-catenin as top signaling pathways that positively and negatively associate with adipogenesis, respectively. Upon wounding, activation of adipocyte progenitors and wound-induced adipogenesis are mediated in part by neutrophils through the IL-1R-NF-κB-CREB signaling axis. In contrast, WNT activation, by WNT ligand and/or ablation of Gsk3, inhibits the adipogenic potential of dFBs but promotes lipolysis and dedifferentiation of mature adipocytes, contributing to myofibroblast formation. Finally, sustained WNT activation and inhibition of adipogenesis is seen in human keloids. These data reveal molecular mechanisms underlying the plasticity of dermal adipocyte lineage cells, defining potential therapeutic targets for defective wound healing and scar formation.

Raid M. Al-Ani, Thamir A Kubaisi

Abstract Background Trichoepithelioma is a rare benign tumor. It could be an inherited or acquired condition. Trichoepithelioma has mostly involved the face with bilateral multiple lesions. Involvement of the auricle by this tumor is extremely rare encountered in clinical practice. Case presentation A 36-year-old female presented to the Dermatology Clinic with painless right auricular papules 4 years ago. Examination revealed multiple non-tender, firm, rounded, dome-shaped, flesh-colored, pink, and shiny papules. There was mild bleeding from the lesions after trivial trauma. There was no family history of similar problem. No abnormality was found on other examinations. An excisional biopsy of one lesion was performed under local anesthesia. The histopathological evaluation confirmed the diagnosis of trichoepithelioma. The lesions under local anesthesia were excised with primary closure of the wound. No recurrence was seen during 2 years of follow-up. Conclusion Only five cases of trichoepitheliomas that affected the auricle were reported in the PubMed database. Four of them are affecting both auricles as well as other parts of the body, particularly the face. The fifth case was with a unilateral single giant auricular lesion. Our case was with non-familial multiple unilateral auricular trichoepitheliomas. The tumors responded well on surgical excision and primary closure.

Bhakinai Temnithikul, Suthat Rungrunanghiranya, Piyakan Limtanyakul et al.

Abstract Purpura fulminans (PF) is an uncommon syndrome of acute purplish skin eruption characterized by coagulation of the microvasculature, which leads to purplish lesions and skin necrosis. There are three subtypes; idiopathic PF, neonatal PF and, the most common subtype, acute infectious PF (AIPF). Acute infectious PF is related to the thrombotic subtype of disseminated intravascular coagulation (DIC) and usually is superimposed on sepsis. This can rapidly lead to multi‐organ failure from thrombotic occlusion of small and medium‐sized blood vessels. We report a case of Klebsiella‐induced AIPF in a 78‐year‐old Thai woman and also review other published cases.

Jasmine Rana, MD, Nolan J. Maloney, MD, Kerri E. Rieger, MD, PhD et al.

, Sebastian Schölch, Benedikt Brors et al.

Objective Measuring the success of molecularly guided therapies is a major challenge in precision oncology trials. A commonly used endpoint is an intra-patient progression-free survival (PFS) ratio, defined as the PFS interval associated with molecularly guided therapy (PFS2) divided by the PFS interval associated with the last prior systemic therapy (PFS1), above 1.3 or, in some studies, above 1.33 or 1.5.Methods To investigate if the concept of PFS ratios is in agreement with actual response evaluations by physicians, we conducted a survey among members of the MASTER (Molecularly Aided Stratification for Tumor Eradication Research) Programme of the German Cancer Consortium who were asked to classify the success of molecularly guided therapies in 194 patients enrolled in the MOSCATO 01 trial based on PFS1 and PFS2 times.Results A comparison of classification profiles revealed three distinct clusters of PFS benefit assessments. Only 29% of assessments were consistent with a PFS ratio threshold of 1.3, whereas the remaining 71% of participants applied a different classification scheme that did not rely on the relation between PFS times alone, but also took into account absolute PFS1 intervals. Based on these community-driven insights, we developed a modified PFS ratio that incorporates the influence of absolute PFS1 intervals on the judgement of clinical benefit by physicians. Application of the modified PFS ratio to outcome data from two recent precision oncology trials, MOSCATO 01 and WINTHER, revealed significantly improved concordance with physician-perceived clinical benefit and identified comparable proportions of patients who benefited from molecularly guided therapies.Conclusions The modified PFS ratio may represent a meaningful clinical endpoint that could aid in the design and interpretation of future precision oncology trials.

Libo Yu-Taeger, Viktoria Gaiser, Larissa Lotzer et al.

A three-base-pair deletion in the human TOR1A gene is causative for the most common form of primary dystonia: the early-onset dystonia type 1 (DYT1 dystonia). The pathophysiological consequences of this mutation are still unknown. To study the pathology of the mutant torsinA (TOR1A) protein, we have generated a transgenic rat line that overexpresses the human mutant protein under the control of the human TOR1A promoter. This new animal model was phenotyped with several approaches, including behavioral tests and neuropathological analyses. Motor phenotype, cellular and ultrastructural key features of torsinA pathology were found in this new transgenic rat line, supporting that it can be used as a model system for investigating the disease’s development. Analyses of mutant TOR1A protein expression in various brain regions also showed a dynamic expression pattern and a reversible nuclear envelope pathology. These findings suggest the differential vulnerabilities of distinct neuronal subpopulations. Furthermore, the reversibility of the nuclear envelope pathology might be a therapeutic target to treat the disease.

Benson KF, Newman RA, Jensen GS

Kathleen F Benson,1 Robert A Newman,2,3 Gitte S Jensen1 1NIS Labs, Klamath Falls, OR, 2Department of Experimental Therapeutics, University of Texas MD Anderson Cancer Center, Houston, 3Nerium Biotechnology Inc, San Antonio, TX, USA Objective: To evaluate a blend of two natural ingredients on immune parameters relevant for their current topical use and potential support of microcirculation in skin tissue. Materials and methods: A blend (BL) of Aloe vera-based Nerium oleander extract (NAE-8i, oleandrin-free) and hydrolyzed water-soluble egg membrane (WSEM) was applied to human whole-blood cultures for 24 hours, with each separate ingredient serving as a control. Immune-cell subsets were analyzed for expression levels of the activation markers CD69 and CD25. Culture supernatants were analyzed for cytokines, chemokines, and immunoregulating peptides. Results: BL increased CD69 expression on lymphocytes, monocytes, and CD3&ndash;CD56+ natural killer cells, and CD25 expression on natural killer cells. The number of CD69+CD25+ lymphocytes increased in cultures treated with BL and the separate ingredients. BL triggered production of multiple cytokines and chemokines, where CC chemokines MIP1&alpha; and MIP3&alpha;, as well as cytokines involved in wound healing &ndash; Gro&alpha;, Gro&beta;, ENA78, and fractalkine &ndash; reached levels manyfold above treatment with either NAE-8i or WSEM alone. Conclusion: Data on BL showed that WSEM strongly enhanced NAE-8i&rsquo;s effects on immunoactivation in vitro. This has potential relevance for support of immunity in skin tissue, including antibacterial and antiviral defense mechanisms, wrinkle reduction, and wound care. Keywords: chemokines, cytokines, leukocyte activation

Hiram Larangeira de Almeida Jr, Rodrigo Nunes Siqueira, Renan da Silva Meireles et al.

Abstract Pitted keratolysis is a skin disorder that affects the stratum corneum of the plantar surface and is caused by Gram-positive bacteria. A 30-year-old male presented with small punched-out lesions on the plantar surface. A superficial shaving was carried out for scanning electron microscopy. Hypokeratosis was noted on the plantar skin and in the acrosyringium, where the normal elimination of corneocytes was not seen. At higher magnification (x 3,500) bacteria were easily found on the surface and the described transversal bacterial septation was observed.

Myfanwy Morgan, Rose McCreedy, J. Simpson et al.

Naoko Inomata

Angioedema is the end result of deep dermal, subcutaneous and/or mucosal swelling, and is potentially a life- threatening condition in cases where the pharynx or larynx is involved. Drug-induced angioedema has been reported to occur in response to a wide range of drugs and vaccines. Drug-induced angioedema, like other cutaneous drug reactions, has been reported to be most frequently elicited by beta-lactam antibiotics and nonsteroidal anti-inflammatory drugs, although reliable data from epidemiologic studies are scarce. Recent reports suggested an increasing role of angiotensin-converting enzyme inhibitors (ACEIs) in the causation of life- threatening angioedema. ACEI-related angioedema is never accompanied by urticaria and occurs via a kinin- dependent mechanism. ACEI-related angioedema not only can start years after beginning the treatment, but it can then recur irregularly while under that treatment. Furthermore, allergy tests are unreliable for the diagnosis of ACEI-related angioedema, and so the relationship between angioedema and ACEIs is often missed and consequently quite underestimated. Accordingly, better understanding of the kinin-dependent mechanism, which is particular to angioedema, is necessary for the appropriate management of drug-induced angioedema.

G. Norman, D. Rosenthal, L. Brooks et al.