Hasil untuk "Dermatology"

Nina Mehta, BS, Anne Friedland, MD, Jayson Miedema, MD

Bhavana Doshi, Siri B Vaidya

Blastomycosis, caused by Blastomyces dermatitidis, typically manifests in the lungs but can disseminate, notably affecting the skin. A 46-year-old male postrenal transplant presented with enlarging, asymptomatic skin lesions on the gluteal region. Biopsy confirmed blastomycosis with findings of pseudo-carcinomatous hyperplasia, multinucleated giant cells, and characteristic spores. Despite no pulmonary symptoms, high-resolution computed tomography revealed a lung nodule. Treatment commenced with itraconazole, carefully managed alongside immunosuppressive therapy. Geographic considerations complicate the diagnosis outside endemic areas such as the US Midwest and South-Central regions. Histopathological examination and staining techniques play crucial roles in confirming the diagnosis due to overlapping clinical presentations with other infections and malignancies. Treatment guidelines recommend azole therapy based on expert opinion and case studies, lacking direct comparative trials. This case underscores the importance of maintaining clinical suspicion for rare diseases, particularly in transplant recipients and highlights the global challenge of diagnosing region-specific infections in the diverse healthcare settings.

Mishek Thapa, BS, Brianna Green, BS, Michael Kasperkiewicz, MD

Georgi Tchernev, Konstantin Georgiev Tchernev Jr, Simona Kordeva

A 54-year-old male presented with a painful nodular, tumor-like lesion, in the right occipital region, present for approximately two years, clinically suspected of atheroma. Surgical excision of the lesion was recommended.

Runqun Liu, Xiaoqing Xiang, Yanliang Li et al.

Verrucous carcinoma, a well-differentiated variant of squamous cell carcinoma with low-grade malignancy, is often associated with localized human papillomavirus (HPV) infection and excessive penile foreskin. We report a 45-year-old male who presented with a verrucous plaque on the glans penis for over four months, along with itching. Examination revealed a verrucous, erosive lesion with a cauliflower-like surface, firm texture, and irregular shape, accompanied by pain, bleeding, and a foul odor. Syphilis and HIV tests were negative, and a biopsy confirmed verrucous carcinoma.The patient underwent initial circumcision at a local hospital, but persistent lesions raised concerns about further surgery impairing sexual function and anatomical integrity. To preserve both anatomical and functional integrity, the patient opted for Hematoporphyrin Derivative-Photodynamic Therapy (HpD-PDT). Post-treatment, the lesions regressed, and after four years of follow-up, there was no scarring or recurrence. The clinical outcome was favorable with complete lesion regression.We propose that PDT is a viable treatment option for penile verrucous carcinoma, offering advantages over traditional methods in terms of function preservation and cosmetic outcomes.

JI Liyue, QIU Xiaonan, WANG Xijuan et al.

[Objective] To evaluate the clinical efficacy and safety of intralesional injection of heparin sodium versus carbon dioxide (CO2) laser ablation in the treatment of xanthelasma palpebrarum. [Methods] A total of 38 patients with Grade Ⅰ-Ⅲ xanthelasma and normal blood lipid levels were retrospectively enrolled, and divided into two groups based on the treatment modality: the heparin sodium group (n=20) treated with intralesional injection of heparin sodium and the CO2 laser group (n=18) treated with CO2 laser ablation. The primary and secondary outcomes were compared between the two groups, including the therapeutic effect at 1 week post-treatment, the recurrence rate at 3 months, the incidence of adverse events during treatment and follow-up, and patient satisfaction. [Results] There was no significant difference in the overall therapeutic effect between the two groups (P=0.107). All patients in the CO2 laser group achieved excellent response (100%), while 80.00% of patients in the heparin sodium group achieved excellent response, and 20.00% achieved good response. Regarding patient satisfaction, the satisfaction rate was higher in the heparin sodium group than in the CO2 laser group (100% vs. 83.33%, P=0.023). For adverse events, the incidence of scar formation (72.22%) and hypopigmentation (33.33%) in the CO2 laser group was significantly higher than that in the heparin sodium group (both P<0.01). In contrast, the incidence of hyperpigmentation in the heparin sodium group was higher than that in the CO2 laser group (60.00% vs. 5.56%, P<0.001), and most cases of hyperpigmentation spontaneously resolved or improved within 6 months. No statistically significant difference was observed in the recurrence rates between the two groups (P=0.663). [Conclusions] Intralesional injection of heparin sodium for xanthelasma offers comprehensive advantages, including “definite efficacy, no risk of scarring, and high treatment satisfaction,” making it a potentially viable alternative for treating xanthelasma.

Charlie Garnett-Benson, Sarah Warren, Anne Monette et al.

Therapies targeting the programmed cell death protein-1/programmed death-ligand 1 (PD-L1) (abbreviated as PD-(L)1) axis are a significant advancement in the treatment of many tumor types. However, many patients receiving these agents fail to respond or have an initial response followed by cancer progression. For these patients, while subsequent immunotherapies that either target a different axis of immune biology or non-immune combination therapies are reasonable treatment options, the lack of predictive biomarkers to follow-on agents is impeding progress in the field. This review summarizes the current knowledge of mechanisms driving resistance to PD-(L)1 therapies, the state of biomarker development along this axis, and inherent challenges in future biomarker development for these immunotherapies. Innovation in the development and application of novel biomarkers and patient selection strategies for PD-(L)1 agents is required to accelerate the delivery of effective treatments to the patients most likely to respond.

Manjula Nayak, S Smitha Prabhu, Virendra S Ligade

Maryam Nilghaz, Masoumeh Mahdavi-Ourtakand, Fatemeh Noorbakhsh

Background and Objectives: Psoriasis is a chronic and inflammatory skin disease, which is has no definitive cure. Several microbial agents have been identified that have a role in the exacerbation of psoriasis, one of which is Staphylococcus aureus. Increased Methicillin-resistance Staphylococcus aureus (MRSA) strains is a major problem worldwide. This study aims to evaluate the antibacterial effect of Cinnamomum zeylanicum essential oil on MRSA strains isolated from skin lesions in patients with psoriasis. Methods: In this study, participants were 140 patients with psoriasis referred to the dermatology and rheumatology clinic of Shariati Hospital in Tehran, Iran. Diagnostic tests including gram staining, catalase test, tube coagulase test, mannitol fermentation test, and deoxyribonuclease test were performed. To identify the phenotype of MRSA strains, methicillin susceptibility testing was performed using cefoxitin by disk diffusion method. The antimicrobial activity of Cinnamomum zeylanicum essential oil was investigated by broth microdilution method and its minimum inhibitory concentration against MRSA strains was calculated. Results: Of 140 patients, 43.57% had infection with Staphylococcus aureus and 14.28% had MRSA infection. There was no significant relationship between gender, age and sampling area in patients with MRSA infection. The results showed that Cinnamomum zeylanicum essential oil had antimicrobial effects on MRSA strains. Conclusion: The Cinnamomum zeylanicum essential oil can be a suitable alternative to antibiotics for the control and treatment of skin infections caused by Staphylococcus aureus.

Amanda M. Smith, Angela M. Verdoni, Haley J. Abel et al.

Summary: Mutations in the gene encoding DNA methyltransferase 3A (DNMT3A) are the most common cause of clonal hematopoiesis and are among the most common initiating events of acute myeloid leukemia (AML). Studies in germline and somatic Dnmt3a knockout mice have identified focal, canonical hypomethylation phenotypes in hematopoietic cells; however, the kinetics of methylation loss following acquired DNMT3A inactivation in hematopoietic cells is essentially unknown. Therefore, we evaluated a somatic, inducible model of hematopoietic Dnmt3a loss, and show that inactivation of Dnmt3a in murine hematopoietic cells results in a relatively slow loss of methylation at canonical sites throughout the genome; in contrast, remethylation of Dnmt3a deficient genomes in hematopoietic cells occurs much more quickly. This data suggests that slow methylation loss may contribute, at least in part, to the long latent period that characterizes clonal expansion and leukemia development in individuals with acquired DNMT3A mutations in hematopoietic stem cells.

Brian J Hall, Bin Yang, Cheng Wang et al.

Objectives The COVID-19 pandemic has overwhelmed health systems globally. With the increase of global migration, quantifying the health needs and key correlates of these outcomes is a global health priority. This study assessed migration characteristics, COVID-19 attitudes and the postmigration social environment as key correlates of depression, quality of life and alcohol misuse among international migrants in China.Design A nationwide cross-sectional online survey was conducted from 17 February and 1 March 2020.Setting Links to the online survey were disseminated by migrant-focused community-based organisations through WeChat.Participants English speaking international migrants who met the inclusion criteria. Inclusion criteria were being born in a country outside of China, aged 18 years or over, cumulatively living in China for 1 month or more and staying in China between December 2019 and February 2020.Outcome measures Depression, quality of life and alcohol misuse.Results Regression models indicated that planning or considering leaving China due to COVID-19, lacking the confidence to protect themselves and not being confident that the epidemic would end soon was associated with greater depression, lower quality of life and greater levels of alcohol misuse. Worry about contracting COVID-19 and feeling helpless to prevent infection were associated with greater depression and lower quality of life. General perceived social support, and trust in Chinese people, institutions and systems were protective factors for depression and associated with higher reported quality of life.Conclusions This study identifies key correlates that, if adequately addressed through public health outreach, may safeguard migrant well-being during a public health emergency. Trust in people and systems within the postmigration environment is an important consideration for future public health planning efforts.

Ediléia Bagatin, Caroline Sousa Costa, Marco Alexandre Dias da Rocha et al.

Abstract Background: Isotretinoin is a synthetic retinoid, derived from vitamin A, with multiple mechanisms of action and highly effective in the treatment of acne, despite common adverse events, manageable and dose-dependent. Dose-independent teratogenicity is the most serious. Therefore, off-label prescriptions require strict criteria. Objective: To communicate the experience and recommendation of Brazilian dermatologists on oral use of the drug in dermatology. Methods: Eight experts from five universities were appointed by the Brazilian Society of Dermatology to develop a consensus on indications for this drug. Through the adapted DELPHI methodology, relevant elements were listed and an extensive analysis of the literature was carried out. The consensus was defined with the approval of at least 70% of the experts. Results: With 100% approval from the authors, there was no doubt about the efficacy of oral isotretinoin in the treatment of acne, including as an adjunct in the correction of scars. Common and manageable common adverse events are mucocutaneous in nature. Others, such as growth retardation, abnormal healing, depression, and inflammatory bowel disease have been thoroughly investigated, and there is no evidence of a causal association; they are rare, individual, and should not contraindicate the use of the drug. Regarding unapproved indications, it may represent an option in cases of refractory rosacea, severe seborrheic dermatitis, stabilization of field cancerization with advanced photoaging and, although incipient, frontal fibrosing alopecia. For keratinization disorders, acitretin performs better. In the opinion of the authors, indications for purely esthetic purposes or oil control are not recommended, particularly for women of childbearing age. Conclusions: Approved and non-approved indications, efficacy and adverse effects of oral isotretinoin in dermatology were presented and critically evaluated.

Margaret Coates, Min Jin Lee, Diana Norton et al.

The skin and intestine are active organs of the immune system that are constantly exposed to the outside environment. They support diverse microbiota, both commensal and pathogenic, which encompass bacteria, viruses, fungi, and parasites. The skin and intestine must maintain homeostasis with the diversity of commensal organisms present on epithelial surfaces. Here we review the current literature pertaining to epithelial barrier formation, microbial composition, and the complex regulatory mechanisms governing the interaction between the innate immune system and microbiota in the skin and intestine. We also compare and contrast the skin and intestine—two different organ systems responsible creating a protective barrier against the external environment, each of which has unique mechanisms for interaction with commensal populations and host repair.

Fumi Miyagawa, Anna Nakajima, Yasuhiro Akai et al.

We report the case of a 45-year-old female with generalized morphea (GM), who exhibited positivity for the anti-centromere antibody (Ab). She frequently developed multiple sclerotic skin lesions, whose histological findings were compatible with morphea. She demonstrated favorable responses to topical and oral steroids. Cases of GM associated with systemic sclerosis (SSc)-specific Abs (anti-Scl-70 Ab, anti-centromere Ab, and anti-RNA polymerase III Ab) have rarely been reported. The previously reported GM cases involving anti-SSc-specific Abs exhibited some skin manifestations of SSc, such as nailfold capillary changes. However, our case did not show any signs of SSc or limited cutaneous SSc. More cases are needed to clarify whether GM with SSc-specific Abs leads to SSc.

Swati Dahiya, Kondajji Ramchandra Vijayalakshmi, Mubeen Khan

Hereditary sensory and autonomic neuropathies (HSANs) are a group of disorders characterized by insensitivity to noxious stimuli and autonomic dysfunction, associated with pathological abnormalities of the peripheral nerves. Five types of HSAN have been reported in literature, out of which Type V known as congenital insensitivity to pain (CIP) is a rare autosomal recessive condition. Self-mutilation is an invariable feature of this disorder, involving the teeth and orofacial structures. This case report describes a case of a 6-year-old girl with CIP brought by her parents for prostheses to replace her self-extracted primary teeth.

Aya Morimoto, Jun Asai, Yusuke Wakabayashi et al.

Dickson Shey Nsagha, Elijah Afolabi Bamgboye, Jules Clement Nguedia Assob et al.

BACKGROUND: Leprosy is caused by Mycobacterium leprae and manifests as damage to the skin and peripheral nerves. The disease is dreaded because it causes deformities, blindness and disfigurement. Worldwide, 2 million people are estimated to be disabled by leprosy. Multidrug therapy is highly effective in curing leprosy, but treating the nerve damage is much more difficult. The World Health Assembly targeted to eliminate leprosy as a public health problem from the world by 2000. The objective of the review was to assess the successes of the leprosy elimination strategy, elimination hurdles and the way forward for leprosy eradication. METHODS: A structured search was used to identify publications on the elimination strategy. The keywords used were leprosy, elimination and 2000. To identify potential publications, we included papers on leprosy elimination monitoring, special action projects for the elimination of leprosy, modified leprosy elimination campaigns, and the Global Alliance to eliminate leprosy from the following principal data bases: Cochrane data base of systematic reviews, PubMed, Medline, EMBASE, and the Leprosy data base. We also scanned reference lists for important citations. Key leprosy journals including WHO publications were also reviewed. RESULTS: The search identified 63 journal publications on leprosy-related terms that included a form of elimination of which 19 comprehensively tackled the keywords including a book on leprosy elimination. In 1991, the 44th World Health Assembly called for the elimination of leprosy as a public health problem in the world by 2000. Elimination was defined as less than one case of leprosy per 10000 population. Elimination has been made possible by a confluence of several orders of opportunities: the scientific (the natural history of leprosy at the present state of knowledge), technological (multi-drug therapy and the blister pack); political (commitment of governments) and financial (support from NGOs for example the Nippon Foundation that supplies free multi-drug therapy) opportunities. Elimination created the unrealistic expectation that the leprosy problem could be solved by 2000. First, the elimination goal was not feasible in several areas which had high incidence of leprosy. Even if elimination was to be attained, significant numbers of new cases of leprosy would continue to occur and many people with physical imperfections, severe psychological, economic and social problems caused by leprosy would need continuous assistance. Extra-human reservoirs of Mycobacterium leprae, the relationship between leprosy and poverty, prevention of disabilities, lack of a reliable laboratory test to detect subclinical infection and a vaccine are also challenging issues. CONCLUSION: The evidence base available to inform on leprosy elimination is highly positive with the availability of multi-drug therapy blister packs. There are concerns that leprosy was not the right disease to be targeted for elimination as there are no reliable diagnostic tests to detect subclinical infection including the lack of a vaccine, extra-human reservoirs (monkeys and armadillos), increase in the burden of child cases, no good epidemiological indicator as prevalence instead of incidence is used to measure elimination. Multi-drug therapy treats leprosy very well but there is no proof that it concurrently interrupts transmission. The high social stigma, prevention of disabilities, and the relationship between leprosy and poverty are still major concerns.

Daniel O Morris, R. Kennis

M. B. Sulzberger, R. Baer

H. Williams