Susanne Melchers, Susanne Melchers, Susanne Melchers
et al.
Primary cutaneous T cell lymphomas (CTCL) are a heterogeneous group of rare lymphoproliferative disorders originating in the skin. Extracorporeal photopheresis (ECP) is an established, effective and excellently tolerable CTCL therapy, that can also be applied for the treatment of graft vs. host disease (GvHD). However, the underlying molecular mechanisms of ECP have not yet been fully clarified and seem to be dependent on the underlying disease. In this study, peripheral blood samples collected from six CTCL and three GvHD patients were analyzed pre- and post-ECP within one treatment of ECP for short-term alterations in the cytokine and chemokine milieu in the plasma and the composition of the peripheral blood mononuclear cell (PBMC) subsets. In CTCL, the plasma profiling revealed a lower expression of IL-15, IL-17, ICOS and higher expression of IL-13 post-ECP compared to the pre-ECP samples. Additionally, ECP led to an increased expression of the cell death inducers Fas and TRAIL. Flow cytometry revealed a significant increase in the CD14+ monocytes post-ECP in the CTCL patients, and a tendency of higher CD3+CD4- cytotoxic T cells in GvHD patient. Therefore, one cycle of ECP can induce detectable alterations in the peripheral blood of both CTCL and GvHD patients. This study contributes to the elucidation of the molecular mechanisms of ECP therapy and the detection of potential biomarkers for therapeutic response to ECP.
Ching-Liang Hsieh, Sheng-Jie Yu, Kuo-Lung Lai
et al.
Biologics are widely used to treat moderate-to-severe psoriasis. However, we have unmet needs for predicting individual patient responses to biologics before starting psoriasis treatment. We investigate a reliable platform and biomarkers for predicting individual patient responses to biologics. In a cohort study between 2018 and 2023 from a referral center in Taiwan, twenty psoriasis patients with or without psoriatic arthritis who had ever experienced two or more biologics were enrolled. Peripheral blood mononuclear cells obtained from these patients were treated with <i>Streptococcus pyogenes</i> and different biologics. The PASI reduction rate was strongly correlated with the reduction rate in the IL-13 level (<i>p</i> = 0.001) and the ratios of IFN-γ to IL-13 (<i>p</i> < 0.001), IFN-γ to IL-4 (<i>p</i> = 0.019), and IL-17A to IL-13 (<i>p</i> = 0.001). The PASI reduction difference was strongly correlated with the difference in the IFN-γ level (<i>p</i> = 0.002), the difference in the ratios of IFN-γ to IL-4 (<i>p</i> = 0.041), the difference in the ratios of IFN-γ to IL-13 (<i>p</i> = 0.006), the difference in the ratios of IL-17A to IL-4 (<i>p</i> = 0.011), and the difference in the ratios of IL-17A to IL-13 (<i>p</i> = 0.029). The biomarkers IFN-γ, IL-13, IFN-γ/IL4, IFN-γ/IL13, IL-17A/IL-4, and IL-17A/IL-13 are representative of the effectiveness of psoriasis treatment.
Sanusi Umar,1– 3 Raveena Khanna,3,4 Alejandro Gonzalez,5 Kavish Chouhan,6 Juan Carlos Maldonado,7 Osman Tayfun Oguzoglu,8 Aron Nusbaum9 1Department of Medicine, Dermatology Division, University of California, Los Angeles, CA, USA; 2Division of Dermatology, Harbor-UCLA Medical Center, Torrance, CA, USA; 3Dr. U Hair and Skin Clinic, Manhattan Beach, CA, USA; 4Department of Dermatology, Howard University College of Medicine, Washington, DC, USA; 5Mxcapilar Clinic, Chulavista, Sonora, Mexico; 6Department of Dermatology, DermaClinix, New Delhi, India; 7Hair Evolution Robotics, Medellin, Colombia; 8Dr. T Hair Transplant, Istanbul, Turkey; 9Hair Transplant Institute, Miami, Coral Gables, FL, USACorrespondence: Sanusi Umar, Dr. U Hair and Skin Clinic, 2121 N Sepulveda Blvd, Suite 200, Manhattan Beach, CA, 90266, USA, Tel +1-310-480-0490, Fax +1-310-318-1590, Email drumar@dru.comBackground: Current no-shave long hair-follicular unit excision (LH-FUE) techniques employ recesses (slots, notches, or grooves) in punch tips to reduce the long-hair shaft break rate (SBR) and graft transection rate (GTR). However, these methods demand advanced skills and extended procedure time.Objective: We aimed to evaluate a skin-responsive FUE technique without the use of recess-tipped punches, accommodating diverse hair and skin types in LH-FUE procedures.Methods and Materials: We retrospectively analyzed patients who underwent this technique using a UGraft Zeus device at five multinational clinics (Mexico, Colombia, India, United States, and Türkiye) from August 9, 2021, to April 11, 2023. Donor zones were pre-operatively graded for expected difficulty using the Sanusi FUE Scoring (SFS) Scale, ranging from class I (low difficulty) to V (high difficulty).Results: Among 152 patients (mean age, 46 years; 146 straight-wavy, 6 curly-coiled hair), most (n=107) were class I donors. The GTR ranged 2.2%– 4.3%, and was highest in class IV donors and those with thick-firm scalps. The SBR was 12.2%, and the average graft excision rate (GER; speed) was 440 grafts/h. Only 19G and 18G punches were used. All patients were satisfied with the procedure, with 57.4% reporting that they were “very happy”. Surgeon willingness to perform no-shave LH-FUE significantly increased from 1.25 to 4.20 (on a scale of 1– 5) after adopting this device. SFS class, skin thickness, and firmness, more than hair curliness, influenced the GTR, SBR, torque, and punch movement duration.Conclusion: Our findings reveal consistent success in conducting no-shave LH-FUE using this skin-responsive device across diverse patients. Notably, success was achieved without recess-tipped punches, resulting in low GTR and SBR, along with a high GER and increased patient satisfaction. These outcomes suggest enhanced procedure speed and ease of use, contributing to a greater willingness among surgeons to adopt this technique.Plain Language Summary: Despite the increasing popularity of no-shave long-hair follicular unit excision (FUE) as a hair transplant technique for its advantages in preserving the donor area and immediately assessing results after implanting long hairs, its adoption by surgeons has been slow due to its demanding nature. It is time-consuming and skill-intensive because it requires specialized punches with recesses (slots, notches, or grooves) on their tips that must align to accommodate and protect the long hair shafts from breakage during each extraction.Our study reports a novel skin-responsive FUE device for performing nonshaven long-hair FUE called the UGraft Zeus, whose recess-free punch (The intelligent Punch) features a minimal-assist-navigation capability to simplify the procedure and enhances performance parameters, including speed, graft transection rate, hair shaft break rate, and its easy adoption rate by surgeons, including novices. Additionally, patient satisfaction is high.Additionally, skin characteristics, specifically thickness and firmness, play a more critical role than the degree of hair curliness. Thicker and firmer skin requires increased torque and a longer punch movement duration during surgery. Furthermore, the skin-responsive FUE device was successful in performing no-shave long hair FUE in patients with Afro-textured hair, a population typically considered to be a hair transplant challenge.Keywords: follicular unit extraction, nonshaven FUE, unshaven FUE, long-hair FUE, hair transplantation, hair restoration surgery
Abstract Macrophage activation syndrome (MAS) is a rare but life‐threatening disorder that is associated with multiple organ involvement. Here, we described cutaneous granuloma annulare in MAS. This novel histological finding is a reminder to explore the underlying mechanisms of skin involvement in MAS, which may reveal its pathogenesis.
Abstract Introduction This study aims to describe the demographic, clinical, laboratory, and ultrasonic characteristics of patients with psoriatic arthritis (PsA) in the Psoriatic Arthritis cohort of West China Hospital. Methods In this cross-sectional study, we included patients diagnosed with PsA according to the Classification Criteria for Psoriatic Arthritis, collected their demographic information, medical histories, and treatments, evaluated all domains (skin and nail lesions, tenderness, swelling, enthesitis, dactylitis, and axial arthritis) related to PsA, and then performed descriptive statistical analyses of all data. Results A total of 275 patients with PsA were included in this study. The ratio of male to female patients was 2.16:1. Skin lesions preceded arthritis in 86.5% of these patients with PsA with a mean interval of 10.1 years. The metacarpophalangeal (MCP) joints, proximal interphalangeal (PIP) joints of fingers, and sacroiliac joints are the most commonly involved sites of tenderness, swelling, and the spine, respectively. Among all comorbidities, fatty liver has the highest incidence with 33.1%. Finally, we noted that the mean disease duration of PsA was 4.2 years, suggesting a delay in the diagnosis of PsA. Conclusion Our study proposes that the prevalent population of PsA are male patients with psoriasis over 40 years of age who have a long disease course. For patients with PsA, MCP, PIP joints of fingers, and sacroiliac joints are the most frequently affected anatomical sites. With respect to comorbidities, the association between PsA and fatty liver and the underlying molecular mechanisms are worthy of further exploration.
Blue rubber bleb nevus syndrome (BRBNS) usually has a sporadic onset. It is characterized as blue to purple, soft, rubbery, compressible nodules over any region in the skin or mucous membrane. It may be complicated by acute hemorrhage, iron deficiency anemia, bowel infarction, skeletal bowing, pathologic fracture, etc., Here, we present the case of a 9-year-old boy who presented with a complaint of multiple reddish to bluish nontender nodules over the tongue, chest, neck, abdomen, back, B/L upper limb, scrotum, and B/L lower limb including sole. Dermoscopic examination demonstrated red–purple globules with verrucous surface with lacunae separated by a white linear structure corresponding to fibrous demarcations. With the help of dermoscopic and clinical examination, the patient was diagnosed as having BRBNS.
COVID-19 has become a pandemic since its discovery in December 2019. Respiratory symptoms are the most prominent ones, but as we learn more we start to find reports of symptoms from other organ systems, like integumentary. The dermatological manifestation of COVID-19 is polymorphic and a proposal has been presented to categorize it into six distinct groups, namely (i) urticarial rash, (ii) confluent erythematous / maculopapular / morbilliform rash, (iii) papulovesicular exanthem, (iv) chilblain-like acral pattern, (v) livedo reticularis / racemosa-like pattern, and (vi) purpuric “vasculitic” pattern. Each group has their own set of characteristics, which includes: onset and duration of symptoms, accompanying symptoms, and treatment choices. Our study aims to look deeper at the aforementioned characteristics and discuss their practical implications in daily practice. We believe that the knowledge of the efflorescences might be useful as a basis for doing COVID-19 screening but more studies are needed to further understand it.
Britney N. Wilson, MBS, Mary Sun, BSE, BA, Alyssa Gwen Ashbaugh, BA
et al.
Background: Previous reports have revealed inadequate resident education and textbook representation of dermatological conditions in patients with skin of color (SoC). This suggests that the literature and continuing medical education are important alternative dermatology educational resources to aid in diagnosing and treating patients of color. Objective: This study develops criteria to assess and examine the prevalence of SoC-related publications among top dermatology journals. Methods: We developed the first-ever prespecified criteria that allow for the assessment of diversity in the dermatologic literature. The archives of 52 dermatology journals from January 2018 to October 2020, selected based on Scopus ranking, were analyzed for journal characteristics and content regarding skin and hair of color, diversity and inclusion, and socioeconomic/health care disparities that affect underrepresented populations with SoC. Results: Our study reveals that the average percentage of overall publications relevant to SoC is quite low. The percent of SoC articles ranged from 2.04% to 16.8% with a mean of 16.3%. The top-performing dermatology journals in SoC were, not surprisingly, from countries with populations with SoC; however, the Journal of Cosmetic and Laser Therapy, Australasian Journal of Dermatology, and Journal of the American Academy of Dermatol Case Reports were among the top 10. Research and higher-impact journals were among the lowest in SoC rankings, including the Journal of Investigative Dermatology, Experimental Dermatology, and Journal of the American Academy of Dermatology, and had <5% of articles on SoC. Conclusion: We believe that the criteria we established could be used by journal editors to include at least 16.8% of SoC-relevant articles in each issue. Increasing SoC content in the dermatological literature, and particularly in high-impact journals, will serve as an invaluable educational resource and aid in promoting excellence in the care of patients with SoC.
Snehal Balvant Lunge, Vijayalakshmi M Dhorigol, Anisha P Bindagi
Porokeratosis (PK) is a rare group of heterogeneous disorders of keratinization representing diverse phenotypic expressions of the same genetic defect, which is mainly inherited in an autosomal dominant manner. This report describes the case of a 40-year-old female with PK over the gluteal region. The rarity of this disorder, unusual site of presentation, and involvement of unilateral side of gluteal region, which is unusual in this form of PK, and the occurrence in a female patient motivated to report this case.
Context: Hair disorders are a common complaint in dermatology clinics and can be caused by a number of conditions. Children have etiologies different from adults.
Aims: There is a paucity of studies in evaluating pediatric hair disorders. The ultimate aim was to provide a guide for evaluating hair disorders commonly occurring in childhood in our environment.
Materials and Methods: A prospective observational study was conducted from August 2014 to August 2015. Children suffering from various hair disorders were included in the study.
Results: We report a clinico-epidemiological study of 503 children suffering from various scalp/hair disorders. The most common causes were folliculitis, furunculosis, pediculosis, alopecia areata, and tinea capitis.
Conclusions: As has been observed in this study, hair problem may be due to various infections, and this is a very important problem to think of, especially in developing countries.
Background: Condylomata acuminata is human papilloma virus (HPV) infection, and one of the most common sexually transmitted disease, characterized with papul or papillomatous nodul in genital, perineum and anal, this disease can be asymptomatic as well. Some study proved sexually transmitted infection increase the incidence of Human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS), and vice versa. Purpose: To evaluate the profile of condylomata acuminata in HIV/AIDS patients. Methods: Retrospective study of the incident of condylomata acuminata in HIV/AIDS patients using medical record within 4 years period from 2011 to 2014. Results: HIV/AIDS patients in outpatient clinic intermediate care infection disease unit RSUD Dr.Soetomo Surabaya in period 2011-2014 is 4057 patients, 63 (1.15%) of it with condylomata acuminata. HIV/AIDS patients with condylomata acuminata at the age group 25-44 (69.8%), the most sexual partner is heterosexual (58.7%), CD4+ count group mostly shown < 200/mm3 (46.0%), most of the patients got antiretroviral therapy (ART) as 66.7%, the most therapy for condylomata acuminata is trichloracetic acid (TCA) with fucidic acid (98.4%), most of the patient through 1-3 times therapy (50.8%), and the result is mostly not yet healed (76.2%). Conclusion: Most of condylomata acuminata patient in outpatient clinic intermediate care infection disease unit (UPIPI) got ART, TCA, and fucidic acid, and not complete resolution.
Omar Bari,1 Philip R Cohen2 1School of Medicine, University of California San Diego, La Jolla, CA, USA; 2Department of Dermatology, University of California San Diego, La Jolla, CA, USA Abstract: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant condition with a prevalence of ~1 in 5,000 individuals. The pathophysiology of this condition centers on the lack of capillary beds between arterioles and venules, leading to direct contact between these vessels. This results in telangiectases on characteristic locations such as the face, fingers, mouth, and nasal mucosa. Visceral arteriovenous malformations (AVMs) are also observed in many patients, and these are most commonly seen in the brain, gastrointestinal tract, and lungs. Liver AVMs are present in many patients with HHT, though these individuals are usually asymptomatic; however, liver AVMs may lead to serious complications, such as high output cardiac failure. Diagnosis of HHT hinges upon fulfilling three out of four criteria: family history of the condition, mucocutaneous telangiectases, spontaneous and recurrent episodes of epistaxis, and visceral AVMs. Management is guided by international consensus guidelines and targets patients’ specific AVMs. Prognosis is good, though severe complications including hemorrhage and paradoxical emboli are possible. Novel therapeutics are being explored in clinical trials; bevacizumab and pazopanib inhibit angiogenesis, while thalidomide bolsters blood vessel maturation. Pregnancy in patients with HHT is considered high risk. While the majority of pregnancies proceed normally, severe complications have been reported in some women with HHT; these include heart failure, intracranial hemorrhage, pulmonary hemorrhage, and stroke. Such complications occur most often in the second and third trimesters when maternal changes such as peripheral vasodilation and increased cardiac output are at their maximum. Awareness of the diagnosis of HHT has been associated with improved outcomes in pregnancy. Management guidelines for pregnant patients with HHT are reviewed. Keywords: arteriovenous, hereditary, hemorrhagic, malformations, pregnancy, telangiectasia
Jessica Chuang, Christian Barnes, Brian J. F. Wong
Abstract
Facial plastic surgery is a multidisciplinary specialty largely driven by otolaryngology but includes oral maxillary surgery, dermatology, ophthalmology, and plastic surgery. It encompasses both reconstructive and cosmetic components. The scope of practice for facial plastic surgeons in the United States may include rhinoplasty, browlifts, blepharoplasty, facelifts, microvascular reconstruction of the head and neck, craniomaxillofacial trauma reconstruction, and correction of defects in the face after skin cancer resection. Facial plastic surgery also encompasses the use of injectable fillers, neural modulators (e.g., BOTOX Cosmetic, Allergan Pharmaceuticals, Westport, Ireland), lasers, and other devices aimed at rejuvenating skin. Facial plastic surgery is a constantly evolving field with continuing innovative advances in surgical techniques and cosmetic adjunctive technologies. This article aims to give an overview of the various procedures that encompass the field of facial plastic surgery and to highlight the recent advances and trends in procedures and surgical techniques.
Cutaneous squamous cell carcinoma of the ear represents a high-risk tumor location with an increased risk of metastasis and local tissue invasion. However, it is uncommon for these cancers to invade through nearby cartilage. Cartilage invasion is facilitated by matrix metalloproteases, specifically collagenase 3. We present the unusual case of a 76-year-old man with an auricular squamous cell carcinoma that exhibited full-thickness perforation of the scapha cartilage. Permanent sections through the eroded cartilage confirmed tumor invasion extending to the posterior ear skin.
Victoria Küttner, Claudia Mack, Kristoffer TG Rigbolt
et al.
Abstract The mammalian cellular microenvironment is shaped by soluble factors and structural components, the extracellular matrix, providing physical support, regulating adhesion and signalling. A global, quantitative mass spectrometry strategy, combined with bioinformatics data processing, was developed to assess proteome differences in the microenvironment of primary human fibroblasts. We studied secreted proteins of fibroblasts from normal and pathologically altered skin and their post‐translational modifications. The influence of collagen VII, an important structural component, which is lost in genetic skin fragility, was used as model. Loss of collagen VII had a global impact on the cellular microenvironment and was associated with proteome alterations highly relevant for disease pathogenesis including decrease in basement membrane components, increase in dermal matrix proteins, TGF‐β and metalloproteases, but not higher protease activity. The definition of the proteome of fibroblast microenvironment and its plasticity in health and disease identified novel disease mechanisms and potential targets of intervention.