Affected Skin Areas Research Articles

Effectiveness of cooling therapy (cryotherapy) on leg pain and self-efficacy in patients with chronic venous disease: A randomized controlled trial

BackgroundIndividuals with chronic venous disease (CVeD) frequently experience associated leg pain that may influence disease management self-efficacy. ObjectiveTo evaluate the influence of a cooling intervention on leg pain associated with more severe stages of CVeD and self-efficacy. This was a secondary aim of the trial. DesignRandomized, blinded, comparator-controlled, multisite trial. SettingThree wound clinics and an academic medical research center in the United States of America. Participants276 participants (54.3% female, 46.7% male) with stage 4 and 5 CVeD were randomly assigned by computer generated tables to the cooling intervention group (n = 138) or control group (n = 138). InterventionsParticipants received either a cooling (intervention) leg cuff or placebo cuff (control) to apply topically over the affected skin area. Both groups performed standard of care including wearing compression wraps and elevating legs for 30 min during the intervention. Study visits occurred at baseline, and months 1, 3, 6, and 9. MethodsVisit measures included: Numeric Rating Scale (NRS) for short term pain; VEINES-QOL/Sym questionnaire for long-term pain; and, the Self Efficacy for Managing Chronic Disease Scale (SEMCD-6) for self-efficacy. Data were collected from September 2010 to December 2015 and analyzed using pooled t-tests, Chi-square tests, and mixed effects models. Observed 9-month patient retention rates were 94/138 (68.1%) in the intervention group and 91/138 (65.9%) in the control group. The primary analysis was based on the intention-to-treat principle. ResultsBoth the cooling intervention and control group experienced statistically significant decreases in unadjusted and adjusted mean NRS pain scores of 1.2 (95% CI: (−1.82, −0.64); p < 0.0001) and 1.8 (95% CI: (−2.31, −1.24); p < 0.0001) respectively from baseline, however, no statistically significant differences in change scores were observed between groups. The unadjusted mean VEINES-QOL/Sym pain scores had statistically significant decreases of 0.9 ((95% CI: (−1.07, −0.62) p < 0.0001 cooling)) and 0.8 (95% CI: (−1.09, −0.55) p < 0.0001 – control) points. When adjusting the scores for demographic and clinical features, both cooling and control groups maintained statistically significant decreases (p < 0.001 for both). No statistically significant differences in change scores were observed between groups. The unadjusted and adjusted mean self-efficacy scores had no statistically significant improvements from baseline to month 9 within and between the cooling and control groups. ConclusionsPain was reduced in both groups while self-efficacy did not change. Findings suggest that strictly implemented standard of CVeD care in each study group, with or without cooling, improved pain while there were no effects on self-efficacy.

EXPERIENCE OF COMBINED APPLICATION OF METHYLPREDNISOLONE ACEPONATE AND MOLETOLO COSMETICS STEROIDSANDVIAGRAJY IN THE TREATMENT OF DERMATOSES

Skin diseases of non-infectious etiology, such as allergic contact dermatitis, atopic dermatitis, eczema and chronic actinic dermatitis have a significant impact on the quality of patient’s life, greatly reducing it. The most important place in the therapy of these diseases is found in topical glucocorticosteroids in combination with competent basic therapy.The aim of the study was to evaluate the clinical efficacy, safety profile, and tolerability of an external corticosteroid drug with a combination composition: methylprednisolone aceponate 0.1 % + urea 2 % (Komfoderm M2) in combination with dextpanthenol, allantoin and Shea butter (Dexpan plus cream) in dermatological practice in the treatment of eczematous process.Materials and methods. 48 patients, from 18 to 58 years old with mild to middle-severe eczematous process, were under observation, including 16 with allergic contact dermatitis, 14 patients with atopic dermatitis and 10 patients with eczema brushes, and 8 people with actinic dermatitis. Cream Komfoderm M2 was applied to the affected skin areas once a day in combination with cream Dexpan plus as standard therapy and emollient cosmetic. We investigated the parameters of the DLQI questionnaire “Dermatological Quality of Life Index” .Results As a result of the conducted observational study, data were obtained on the high effectiveness of therapy with the combined use of the drug Komfoderm M2 and Dexpan plus. An excellent evaluation of the efficacy of the scheme used was found in 37 (77 %) patients, a good one in 9 (18,8 %) and 2 (4.2 %) patients had a satisfactory result.Conclusions. This clinical study proves the high efficacy, safety and tolerability of the drugs — Cream with 0.1 % MPA and urea 2 % (Komfoderm M2) in combination with a cream containing dexpanthenol, allantonoin and Shea butter (Dexpan plus) in the treatment of eczematous process.

Erythromelalgia.

Erythromelalgia is a rare syndrome characterized by the intermittent or, less commonly, by the permanent occurrence of extremely painful hyperperfused skin areas mainly located in the distal extremities. Primary erythromelalgia is nowadays considered to be a genetically determined neuropathic disorder affecting SCN9A, SCN10A, and SCN11A coding for NaV1.7, NaV1.8, and NaV1.9 neuronal sodium channels. Secondary forms might be associated with myeloproliferative disorders, connective tissue disease, cancer, infections, and poisoning. Between the pain episodes, the affected skin areas are usually asymptomatic, but there are patients with typical features of acrocyanosis and/or Raynaud's phenomenon preceding or occurring in between the episodes of erythromelalgia. Diagnosis is made by ascertaining the typical clinical features. Thereafter, the differentiation between primary and secondary forms should be made. Genetic testing is recommended, especially in premature cases and in cases of family clustering in specialized genetic institutions after genetic counselling. Multimodal therapeutic intervention aims toward attenuation of pain and improvement of the patient's quality of life. For this purpose, a wide variety of nonpharmacological approaches and pharmacological substances for topical and systemic use have been proposed, which are usually applied individually in a step-by-step approach. Prognosis mainly depends on the underlying condition and the ability of the patients and their relatives to cope with the disease.

Novel topical agent containing superoxide dismutase 100000IU and 4% of plant extracts as a mono-therapy for atopic dermatitis.

Corticosteroids are the mainstay of treatment for the acute phase of atopic dermatitis (AD), whereas topical emollients are mainly used for maintenance of remission. A topical agent that combines emollient and anti-inflammatory properties would achieve control of all phases of AD, without the need for chronic corticosteroid use. To assess the efficacy of a novel topical agent containing superoxide dismutase (SOD) 100000IU and 4% of a combination of plant extracts (blackcurrant seed oil, sunflower oil concentrate, balloon vine extract). Twenty patients (age range from 8months to 72years old) with mild-to-moderate atopic dermatitis were assessed. The product was used as mono-therapy, applied to the affected skin areas twice daily. Patients were evaluated before and after a 30-day course using the SCORAD and the Visual Analog Scale for assessment of pruritus intensity. Primary endpoint was improvement of AD according to SCORAD and clinical assessment. Secondary endpoint was patient satisfaction and improvement of pruritus. Mean SCORAD on day 0 was 32.61(range=16.0-46.9) and decreased to 10.55 (range=0-17.0) on day 30, reflecting a reduction of 67.6%. On day 30, all patients described significant improvement in pruritus and quality of sleep. The application of the study product cream resulted in significant improvement of AD, as reflected by the objective SCORAD measurement, and the subjective assessment of pruritus and quality of life. This novel anti-inflammatory emollient product may emerge as a safe and effective therapeutic tool for all phases of AD without the adverse effects of chronic use of corticosteroids.

The impact of chronic vulvar dystrophy on sexual function at menopause

Chronic vulvar dystrophy is defined as growth of abnormal skin on the vulva, having two types according to the thickness of the skin – thin as lichen sclerosus, or thick like squamous hyperplasia. Lichen sclerosus appears as white, shiny patches of parchment-like tegument on the labia affecting mainly menopausal women. Symptoms are variable, from no obvious manifestations to intense itching and increasing vulvar pain. The affected skin area can easily bleed sometimes just by touch, often making sexual intercourse impossible. With squamous hyperplasia the vulvar skin becomes thick with white elevations, causing intense itching. Treatment includes topical corticosteroid and testosterone application, retinoids to reduce the connective tissue destruction and in advanced cases surgery. We examined a number of 25 menopausal patients, aged between 48 and 64 diagnosed with vulvar dystrophy in the interval 2014–2016. A percentage of 92% experienced difficulties in engaging sexual intercourse due to local pain, itching, dryness sensation, bleeding or labial fusion. From these, a number of 14 patients (56%) declared that vulvar symptoms determined them to cease any sexual activity because of intense complaints (40%) or physical impossibility caused by labial fusion (16%). All patients declared that the vulvar dystrophy had a negative impact on their sexual function and couple activity, affecting their quality of life between 7 and 10 on a visual analog scale. Topical corticosteroid and testosterone application was useful in most cases, relieving the symptoms after 3 months in 72% of the cases, while in the rest of the cases where the disease caused scarring or fusion of the labia surgical treatment was necessary. In conclusion, based on our study group we can affirm that chronic vulvar dystrophy can be a debilitating disease, affecting greatly menopausal women's quality of sexual life with long-term psychological implications.

Autologous platelet-rich plasma (PRP) in chronic penile lichen sclerosus: the impact on tissue repair and patient quality of life.

Lichen sclerosus (LS) is a chronic inflammatory skin condition that frequently involves the anogenital region. Ongoing research is focused on finding more effective treatments for tissue repair and reducing symptoms. The aim of this study is to evaluate the effectiveness of platelet-rich plasma (PRP) local injections in penile LS. Forty-five male patients affected by penile LS underwent injections of autologous PRP in the affected skin areas. Age at diagnosis and at first treatment, number of treatments, clinical conditions (phimosis, splitting, inflammation, synechiae, meatus stenosis), symptoms (pain, burning, itching), and functional impairment were considered. Treatment efficacy was also evaluated through the Investigator's Global Assessment (IGA) on a six-point Likert scale and the Dermatology Life Quality Index (DLQI). The patient age at LS diagnosis was 36.20±9.19years, while the mean age at the first PRP treatment was 42.96±11.32years (p<0.001). The number of treatments/patient ranged from 2 to 10. The follow-up was 17.60±5.63months. After PRP injections, it was observed in all patients a significant improvement in clinical conditions, with reduction/disappearance of symptoms. Topical steroid therapy, interrupted before PRP treatment, was not restarted by any patient. Only one patient underwent a later circumcision procedure. Both IGA scale and DLQI score showed a significant difference (p<0.001) before and after PRP treatment. PRP treatment in penile LS seems to be helpful to regenerate scarring, reduce symptoms, and improve patient quality of life. Further studies are necessary to evaluate long-term results.

The historical background of Jules and Augusta Dejerines’ work

The historical background of Jules and Augusta Dejerines’ work

Commentary on: "A genome-wide association study in Caucasian women suggests the involvement of HLA genes in the severity of facial solar lentigines" by Laville etal., 2016.

We have read with interest the study by Laville et al. that was published in the September 2016 issue of PCMR (Laville et al., 2016) and that represents the second genome-wide association study of facial solar lentigines. This study (SU.VI.MAX cohort) showed two novel genetic regions, both located on chromosome 6 [6p22 intergenic region (p=1.6×10-6) and 6p21 USP81P / HLA-C region (p=2.5×10-7)] but both not significantly associated with solar lentigines based on the genome-wide association study. Laville et al. reported, however, that one SNP in the 6p22 region was significantly associated with forehead lentigines in a recessive model (p=1.4×10-8). We were interested in the question of whether we could replicate these findings in our cohort of 2844 Dutch North-Europeans (mean age 67 years, 53% women). This is a subgroup of the Rotterdam Study (RS), for whom facial pigmented spots (mainly solar lentigines) were quantified as the percentage of affected skin area using digital facial photographs (Jacobs et al., 2015). This article is protected by copyright. All rights reserved.

Gold nanoparticle-filled biodegradable photopolymer scaffolds induced muscle remodeling: in vitro and in vivo findings

Therapeutic stem cell transplantation bears the promise of new directions in organ and tissue replacement, but a number of its difficulties and perils are also well known. Our goal was to develop a method of transplantation by which the transplanted cells remain confined to the transplantation site and induce favorable processes. With the help of mask-projection excimer laser stereolithography, 3D hybrid nanoscaffolds were fabricated from biodegradable, photocurable PPF:DEF resin with incorporated gold nanoparticles (Au NPs). The scaffolds were tested in vitro and in vivo in order to find out about their biocompatibility and fitness for our purposes.In vitro, macrophages and mouse autologous adipose stem cells (ASCs) were seeded over the hybrid scaffolds and non-hybrid (with Au NPs) scaffolds for 4days. The hybrid nanocomposite greater stem cell dispension and stem cell adhesion than PPF scaffolds without Au NPs, but such a difference was not seen in the case of macrophages.In vivo, stem cells, scaffoldings and scaffoldings covered in stem cells were transplanted under the back skin of mice. After 14days, blood samples were taken and the affected skin area was excised. Cytokine and chemokine profiling did not indicate elevated immunomediators in the sera of experimental animals. Interestingly, the autologous-stem-cell-seeded hybrid nanocomposite scaffold induced muscle tissue regeneration after experimental wound generation in vivo. We could not observe such stem cell-induced tissue regeneration when no scaffolding was used.We conclude that PPF:DEF resin nanoscaffolds with incorporated gold nanoparticles offer a safe and efficient alternative for the enhancement of local tissue remodeling. The results also support the idea that adipose derived stem cells are an optimal cell type for the purposes of regenerative musculoskeletal tissue engineering.

Proteomic Investigation of Dermal Fibroblasts Isolated from Affected and Unaffected Skin Samples from Patients with Limited Cutaneous Systemic Sclerosis: 2 Distinct Entities?

To identify using proteomic analysis the proteins of altered abundance in the affected and unaffected limited cutaneous systemic sclerosis (lcSSc) skin fibroblasts. Excision biopsies (3 mm) were obtained from the affected and unaffected skin of 5 patients with lcSSc. Dermal fibroblasts were isolated enzymatically. Two-dimensional gel electrophoresis was used to separate and define proteins in affected and unaffected fibroblast lysates. Proteins of altered abundance were identified by mass spectrometry. Differences among skin samples were confirmed also by immunohistochemistry (IHC) and by quantitative real-time PCR (qRT-PCR) for type I collagen (Col-1) and vimentin (VIM). Proteomic analysis revealed different expressions of proteins involved in cytoskeleton organization (27%), extracellular matrix remodeling (11%), response to oxidative stress (22%), energy metabolism (19%), protein metabolism (5%), cellular homeostasis (5%), signal transduction (3%), and protein transcription, synthesis, and turnover (8%). IHC analysis showed that SSc-affected epidermis is thickened and the dermis is strongly reactive to Col-1 and VIM (typical markers of activated myofibroblasts) compared to SSc-unaffected skin, whose stainings are comparable to those of control healthy skin. Overexpression of Col-1 and VIM mRNA levels in affected lcSSc fibroblasts compared to unaffected lcSSc ones was confirmed by qRT-PCR. Consistent with previous studies, these findings are important for 2 reasons: first, because they reveal the opposite behavior of dermal fibroblasts in the unaffected and affected skin areas of the same patient with lcSSc; second, because they demonstrate the histological/histochemical similarities between unaffected skin from patients with lcSSc and healthy control skin.

PASI (Psoriasis Area and Severity Index) in the evaluation of the clinical manifestations of psoriasis

Psoriasis is one of the most prevalent chronic inflammatory skin diseases. The severity of its clinical manifestations can vary greatly. Objective assessment of psoriasis severity is required to select an adequate therapy. One of the simplest and most consistent methods used to determine psoriasis severity is to calculate the PASI (Psoriasis Area and Severity Index). This index is based on the doctor’s determination of the sum of indices showing the intensity of the main symptoms of psoriasis: erythema, infiltration and peeling in view of the affected skin area. The PASI can also be used to assess the efficacy of treatment for psoriasis patients.

Characterisation and management of dermatologic adverse events to agents targeting the PD-1 receptor

BackgroundDermatologic adverse events (AEs) are some of the most frequently observed toxicities of immune-checkpoint inhibitor therapy, but they have received little attention. The drugs, pembrolizumab and nivolumab are recently approved inhibitors of the programmed death (PD)-1 receptor that have overlapping AE profiles however, the incidence, relative risk (RR), and clinico-morphological pattern of the associated dermatologic AEs are not known. MethodsWe conducted a systematic review of the literature, and performed a meta-analysis of dermatologic AEs observed with the use of pembrolizumab and nivolumab in cancer patients. An electronic search was conducted using the PubMed, and Web of Science, and on the American Society of Clinical Oncology and European Society for Medical Oncology meeting abstracts' libraries for potentially relevant oncology trials, that employed the drugs at Food and Drug Administration-approved doses and reported dermatologic AEs. The incidence, RR and 95% confidence intervals were calculated using either random- or fixed-effects models based on the heterogeneity of included studies. The clinical presentation, histology of affected skin areas, and management strategies (based on institutional experience), are also presented. ResultsRash, pruritus and vitiligo were found to be the most frequently reported dermatologic AEs. The calculated incidence of all-grade rash with pembrolizumab and nivolumab was 16.7% (RR = 2.6) and 14.3% (RR = 2.5), respectively. Other significant all-grade AEs included pruritus (pembrolizumab: incidence, 20.2% [RR = 49.9]; nivolumab: incidence, 13.2% [RR = 34.5]) and vitiligo (pembrolizumab: incidence, 8.3% [RR = 17.5]; nivolumab: 7.5% [RR = 14.6]). Interestingly, all the vitiligo events were reported in trials investigating melanoma. The RR for developing dermatologic AEs in general, was 2.95 with pembrolizumab, and 2.3 with nivolumab. ConclusionWe found that pembrolizumab and nivolumab are both associated with dermatologic AEs, primarily low-grade rash, pruritus, and vitiligo, which are reminiscent of those seen with ipilimumab. Knowledge of these findings is critical for optimal care, maintaining dose intensity, and health-related quality of life in cancer patients receiving PD-1 inhibitors.

An Applicator Delivery System for Fixed-Combination Calcipotriene Plus Betamethasone Dipropionate Topical Suspension (Gel): Innovating Psoriasis Vulgaris Treatment Through Patient Collaboration.

Treatment non-adherence is a complex problem encountered in all therapy areas, particularly in chronic diseases such as psoriasis vulgaris. To address adherence issues, focus is turning towards developing interventions tailored to individual patient needs. Topical therapies remain the mainstay of psoriasis treatment; however, these are associated with additional challenges where preparations may be perceived as messy, inconvenient and time-consuming. Once-daily fixed-combination calcipotriene 0.005% (Cal) and betamethasone dipropionate 0.064% (BD) topical suspension is a convenient and effective first-line topical psoriasis therapy. To improve the patient experience with this treatment, we undertook a program—in collaboration with patients and healthcare professionals—to develop a topical treatment delivery system that further caters to the unmet needs of psoriasis patients. The finalized Applicator comprises: an easy to operate pump-action lever providing consistently accurate dose delivery (0.05 g of Cal/BD topical suspension/pump); a single-tip nozzle allowing for targeted, precise application to body and scalp psoriasis plaques; two spreading surfaces designed to disperse treatment evenly across both large and small affected skin areas; and a protective cover. Patients listed the following as key Applicator attributes: ease of use, ‘less messy’ treatment, precise application, consistent accurate dosing, ‘no touch’ treatment, reduction of wasted treatment and extended length of reach for awkward areas. Although these attributes were well received by most patients and healthcare professionals, some patients did not perceive them all as improvements over their current treatment; this highlights the need to tailor treatment for each individual patient’s requirements. For patients who prefer using the Applicator, it has the potential to provide greater control over their daily psoriasis management by providing a simple, convenient treatment option, with minimal impact on their lives. The Applicator may represent a more acceptable treatment delivery system for some patients with psoriasis vulgaris and may, therefore, promote long-term treatment adherence. Funding: LEO PharmaElectronic supplementary materialThe online version of this article (doi:10.1007/s13555-015-0087-0) contains supplementary material, which is available to authorized users.

Induced pluripotent stem cells for the treatment of recessive dystrophic epidermolysis bullosa.

Epidermolysis bullosa (EB) is a group of genetically inherited skin disorders affecting nearly 1 to 3 of every 100,000 live births and almost 500,000 individuals worldwide (1). Autosomal recessive dystrophic EB (RDEB) is an aggressive EB subtype (approximately 25% of EB cases), caused by COL7A1 gene mutation encoding type VII collagen and resulting in binding defect of epidermis to dermal tissue, excessive skin and mucosal fragility, blistering and scarring. Lesions occur below the basement membrane zone in the upper part of the dermis. Until today no definite therapy is available and patients suffering from RDEB are managed conservatively avoiding skin damage and aiming in improve quality of life and reducing the risk of developing complications, such as infection and malnutrition, or undergo surgical or minimal invasive palliative procedures (2,3). Current research strategies include protein, gene and molecular therapies (4-6). In their article “Human COL7A1-corrected induced pluripotent stem cells for the treatment of recessive dystrophic epidermolysis bullosa” Sebastiano et al. propose an innovating cell therapy for RDEB treatment, by developing a state of the art protocol of genetically repaired induced pluripotent stem cells (iPSCs) as to generate sheets of normal skin tissue to treat affected skin areas (7). Moreover, as numerous stem cells are needed in order to cover the affected surface area, authors outline the necessity for creating personalized iPSCs banks as to provide a constant long-term iPSCs source.

Poly(3-hydroxybutyrate)-ethyl cellulose based bio-composites with novel characteristics for infection free wound healing application

A series of bio-composites including poly3-hydroxybutyrate [P(3HB)] grafted ethyl cellulose (EC) stated as P(3HB)-EC were successfully synthesised. Furthermore, natural phenols e.g., p-4-hydroxybenzoic acid (HBA) and ferulic acid (FA) were grafted onto the newly developed P(3HB)-EC-based bio-composites under laccase-assisted environment without the use of additional initiators or crosslinking agents. The phenol grafted bio-composites were critically evaluated for their antibacterial and biocompatibility features as well as their degradability in soil. In particular, the results of the antibacterial evaluation for the newly developed bio-composites indicated that 20HBA-g-P(3HB)-EC and 15FA-g-P(3HB)-EC bio-composites exerted strong bactericidal and bacteriostatic activity against Gram−E. coli NTCT 10418 as compared to the Gram+B. subtilis NCTC 3610. This study shows further that at various phenolic concentrations the newly synthesised bio-composites remained cytocompatible with human keratinocyte-like HaCaT skin cells, as 100% cell viability was recorded, in vitro. As for the degradation, an increase in the degradation rate was recorded during the soil burial analyses over a period of 42 days. These findings suggest that the reported bio-composites have great potential for use in wound healing; covering the affected skin area which may favour tissue repair over shorter periods.

A computer-based method for precise detection and calculation of affected skin areas.

The aim of this study was to describe and validate a method to obtain reproducible and comparable results concerning extension of a specific skin area, unaffected by individual differences in body surface area. A phantom simulating the human torso was equipped with three irregular areas representing the increasing extension of an affected skin area over time. A large sheet of flexible calques paper was placed at the phantom, and five clinicians copied the three irregular shapes two times, resulting in 60 copies. Subsequently, a digital photograph was taken of the calques papers with a clinical ruler placed at the margin. The images were postprocessed and measured in the program 'ImageJ' by two observers. An exact area measurement of the three irregular shapes was performed for comparison. We found an interobserver variation of 0·36% when comparing the measurements of all three areas. Comparing observer measurements with the exact areas size, we found an underestimate of 2·52%. We observed a tendency that the discrepancy in measurement increases when the measured area decreases. We find this method accurate, reproducible and easy to use. The presented method can be of help when documenting psoriasis and other dermatologic conditions as well as when exploring the effects of new types and variations of ultrasound-guided peripheral nerve blocks - especially in study volunteers.

P29. Transversal spinal cord lesion after electrical injury

Case A 37 year old electrician presented with pain and paresthesia after electrical injury. The patient reported that he was removing a heating system at work. Because of an incorrect electrical installation a short circuit was built up by the patient holding the heater in both hands. The 230 voltage flowed through both arms. Because of a defect fuse the electric flow was not interrupted. During and a short time after the accident the patient reported strong pain in both arms and between the scapulae. Initially the symptoms were regressive. With a delay of 1 week the pain restarted and paresthesia in both arms surfaced. The patient presented himself to an emergency department of a local clinic. He was admitted and within one more day a motoric syndrome with a tetraparesis and passive incontinence developed. The patient was sent to a local neurological clinic for further diagnostic investigation. MRI of the spinal cord showed a correlating lesion C 4/5–C5/6. Functional deficits resulted in a sensomotorical transverse section down from C6 with focus on both arms. Although specific diagnostic, including ultrasound and vasculitis screening, was negative the lesion was suspected to be a spinal ischemia. Following treatment was done at the Department of Neurological Rehabilitation. The patient’s history was reevaluated and the diagnosis was revealed as a symptomatic lesion after electrical injury. Clinical and electrophysiological investigations were performed at the Department of Neurology. Quantitative sensoric testing (QST) showed pathological results for temperature and pain reception. Additional, a reduction of the density of intraepidermal nerve fiber could be seen in biopsy of affected skin area. After a year of intensive neurorehabilitation most symptoms recovered, except mild paresthesia, erectile dysfunction and reduced fine motor skills. Conclusion Electrical injury is a rare cause of spinal cord lesion. While diagnostic and therapy is focused mostly on acute symptoms, also delayed complications have to be considered.

A Genome-Wide Association Study Identifies the Skin Color Genes IRF4, MC1R, ASIP, and BNC2 Influencing Facial Pigmented Spots

Facial pigmented spots are a common skin aging feature, but genetic predisposition has yet to be thoroughly investigated. We conducted a genome-wide association study for pigmented spots in 2,844 Dutch Europeans from the Rotterdam Study (mean age: 66.9±8.0 years; 47% male). Using semi-automated image analysis of high-resolution digital facial photographs, facial pigmented spots were quantified as the percentage of affected skin area (mean women: 2.0% ±0.9, men: 0.9% ±0.6). We identified genome-wide significant association with pigmented spots at three genetic loci: IRF4 (rs12203592, P=1.8 × 10(-27)), MC1R (compound heterozygosity score, P=2.3 × 10(-24)), and RALY/ASIP (rs6059655, P=1.9 × 10(-9)). In addition, after adjustment for the other three top-associated loci the BNC2 locus demonstrated significant association (rs62543565, P=2.3 × 10(-8)). The association signals observed at all four loci were successfully replicated (P<0.05) in an independent Dutch cohort (Leiden Longevity Study n=599). Although the four genes have previously been associated with skin color variation and skin cancer risk, all association signals remained highly significant (P<2 × 10(-8)) when conditioning the association analyses on skin color. We conclude that genetic variations in IRF4, MC1R, RALY/ASIP, and BNC2 contribute to the acquired amount of facial pigmented spots during aging, through pathways independent of the basal melanin production.

Postherpetic neuralgia

Postherpetic neuralgia is considered to be a neuropathic pain syndrome. Typically, patients experience pain in the dermatomes of skin lesions persisting for more than 3 months after skin restitution. About 10% of patients with herpes zoster develop postherpetic neuralgia. Its prevalence increases with age. Common clinical symptoms include continuous burning pain, sharp pain attacks, and allodynia. Additionally, sensory hyperactivation or loss in the affected skin area is present. Pathophysiology includes mechanisms of peripheral and central sensitization, based on damaged nerve fibers as the main mechanisms for pain generation and its maintenance. Clinical studies did show pain relief in postherpetic neuralgia after administration of antidepressants, antiepileptic drugs, opioids, and topical capsaicin and lidocaine. Nevertheless, about one third of patients do not respond to conventional treatment. Given the fact that postherpetic neuralgia is considered to be a chronic pain disease, a multidisciplinary treatment approach is necessary.

Effect of diaper cream and wet wipes on skin barrier properties in infants: a prospective randomized controlled trial.

The effect of different diaper care procedures on skin barrier function in infants has been minimally investigated and may be assessed using objective methods. In a single-center, prospective trial, 89 healthy 9-month-old infants (±8wks) were randomly assigned to three diaper care regimens: group I used water-moistened washcloths at diaper changes (n=30), group II additionally applied diaper cream twice daily (n=28), and group III used wet wipes and diaper cream twice daily (n=31). Transepidermal water loss (TEWL), skin hydration (SCH), skin pH, interleukin 1α (IL-1α) levels, and microbiologic colonization were measured in diapered skin (upper outer quadrant of the buttocks), nondiapered skin (upper leg), and if diaper dermatitis (DD) occurred, using the most affected skin area at day 1 and weeks 4 and 8. Skin condition was assessed utilizing a neonatal skin condition score and diaper rash grade. On diapered skin, SCH decreased in groups II and III, whereas TEWL values were reduced in group II only. Skin pH increased in groups II and III. In general, SCH, skin pH, and IL-1α levels were higher in healthy diapered skin than in nondiapered skin. The incidence and course of DD was comparable in all groups. Areas with DD had greater TEWL and skin pH than unaffected skin areas. Infants who received diaper cream had lower SCH and TEWL and higher pH levels in the diapered area than on nondiapered skin. No correlation with the occurrence of DD was found.