Clinical Skin Research Articles

Neuronal intranuclear inclusion disease with subclinical peripheral neuropathy: A case report

Rationale: Neuronal intranuclear inclusion disease (NIID) is a slowly progressing neurodegenerative disease with various manifestations and high heterogeneity. Clinical characteristics, imaging, skin biopsy, and genetic testing are necessary for its diagnosis. Electromyography may also be a useful tool for diagnosing NIID. In this study, we report a patient with motor and sensory nerve demyelination changes accompanied by axonal damage. Patient concerns: A 64-year-old woman was admitted to our department with gradually worsening forgetfulness for over a year. After 6 years of follow-up, the symptoms progressively deteriorated. Diagnoses: Cerebrospinal fluid analysis revealed increased protein levels. Brain magnetic resonance imaging showed characteristic “ribbon-like” high signals in the corticomedullary junction area on diffusion-weighted imaging. High-intensity signals in the white matter were also observed on T2 and fluid-attenuated inversion recovery imaging. Electromyography revealed multiple peripheral nerve damage and conduction changes, including motor and sensory nerve demyelination changes, accompanied by axonal damage. Skin biopsy revealed inclusion bodies with strong positive staining for P62 and ubiquitin antibodies in the nuclei of sweat gland cells, adipocytes, and fibroblasts. Genetic testing indicated that the number of GGC repeats in NOTCH2NLC alleles were 14 and 134, respectively. Consequently, the patient was diagnosed with NIID. Interventions: Currently, no effective treatment is available to delay the progression of the disease. Lessons: We report a case of NIID with subclinical peripheral neuropathy, although the patient did not experience sensory symptoms such as numbness in the extremities. Electromyography can be used to detect subclinical peripheral nerve damage.

Skin aging and dermatoporosis-the chronic skin fragility syndrome

Skin aging is divided into intrinsic and extrinsic aging, encompassing pigmentary, vascular, connective tissue, and fat tissue aspects that contribute to this complex process. Aging is genetically determined but is influenced by environmental factors such as ultraviolet radiation, air pollution, and smoking. Skin aging has not only cosmetic but also functional implications, as the loss of the extracellular matrix, especially hyaluronate, impairs the mechanical functions of the skin. Hyaluronate, which stabilizes skin structures, acts as acushion and reduces susceptibility to skin tears. Dermatoporosis, aterm coined by Saurat, describes the functional dimension of skin aging, manifesting in various stages from skin atrophy to severe complications like skin necrosis. It is increasingly observed in older patients, particularly from age70 onwards. Prevalence ranges from 22% in women to 38% in men, with higher rates in patients undergoing chronic steroid therapy and certain conditions. Diagnosis is made through clinical examination and skin thickness measurement via ultrasound. Prevention involves limiting exposure to harmful factors and using specific treatments such as hyaluronic acid and topical retinoids to improve skin health.

Primjena ibuprofena u pedijatrijskoj populaciji

Fever is a common clinical issue, causing concern for parents and being the most frequent reason for visits to pediatricians and pediatric emergency services. Pain accompanies children in various pathological conditions during their growth. Although the importance of pain perception and the use of analgesics is emphasized, pain in the pediatric population is still insufficiently recognized, unlike fever. Ibuprofen is one of the most commonly used medications in the pediatric population, indicated for reducing fever, as well as relieving pain and inflammation in various diseases. The pharmacological properties of ibuprofen indicate a good safety profile with effective results, contributing to its widespread use. The most commonly expected adverse reactions, considering the mechanism of action, such as gastrointestinal bleeding, are rare in children. In a healthy child, there are no adverse effects on the kidneys; however, in conditions of dehydration or kidney disease, fluid volume should be replenished before administering ibuprofen. Given its broad application during fever caused by infection, some conditions are associated with more severe clinical skin and respiratory infections. It is also linked to exacerbations of asthma and a higher risk of asthma if used during pregnancy and the early years of life.This potential association requires additional research to be methodologically confirmed. Therefore, in this paper, through a literature review, we present the effectiveness and safety of ibuprofen use in the pediatric population in various pathological condition.

Development of a Rapid Diagnostic Method for Sporotrichosis

Introduction: Sporotrichosis, a prevalent deep fungal infection in clinical settings, currently lacks rapid and accurate diagnostic methodologies. This study explores a novel rapid diagnosis method for sporotrichosis by combining FTA cards and nested PCR with fungal fluorescence staining. Methods: The study involved skin lesion tissues from 26 patients diagnosed with sporotrichosis (Experimental Group). The Positive Control Group consisted of fungal suspensions from clinical strains of Sporothrix, while the Negative Control Group included fungal solutions of other fungi, namely Trichophyton rubrum, Trichophyton mentagrophyte, and Candida albicans. DNA was extracted from the slurry of skin lesions in the Experimental Group and from fungal suspensions in the Control Group using FTA cards, followed by nested PCR amplification. Subsequently, nested PCR amplification was performed. Histopathological examinations, including HE and fluorescence staining, were conducted on paraffin sections prepared from skin lesion tissues in the Experimental Group. Results: Among the 26 clinical skin lesion tissues in the Experimental Group, 8 cases showed a specific positive band upon nested PCR amplification, resulting in a positive rate of 30.8%. In the Control Group, the fungal solution of the clinical strain of Sporothrix showed a specific positive band upon nested PCR amplification, while all other fungi Negative Control Group tested negative. Histopathological examination revealed granulomatous inflammatory changes in most samples after HE staining. Fluorescence staining detected spores in 17 cases, resulting in a detection rate of 65.4% (17/26). Conclusion: The combination of FTA cards with nested PCR method proved to be simple and rapid but demonstrated a relatively low positive rate. Fungal fluorescence staining significantly improved the sensitivity of detecting sporotrichosis in histopathological examinations, thereby improving the speed and efficiency of diagnosis.

Radiation dermatitis in the hairless mouse model mimics human radiation dermatitis

Over half of all people diagnosed with cancer receive radiation therapy. Moderate to severe radiation dermatitis occurs in most human radiation patients, causing pain, aesthetic distress, and a negative impact on tumor control. No effective prevention or treatment for radiation dermatitis exists. The lack of well-characterized, clinically relevant animal models of human radiation dermatitis contributes to the absence of strategies to mitigate radiation dermatitis. Here, we establish and characterize a hairless SKH-1 mouse model of human radiation dermatitis by correlating temporal stages of clinical and pathological skin injury. We demonstrate that a single ionizing radiation treatment of 30 Gy using 6 MeV electrons induces severe clinical grade 3 peak toxicity at 12 days, defined by marked erythema, desquamation and partial ulceration, with resolution occurring by 25 days. Histopathology reveals that radiation-induced skin injury features temporally unique inflammatory changes. Upregulation of epidermal and dermal TGF-ß1 and COX-2 protein expression occurs at peak dermatitis, with sustained epidermal TGF-ß1 expression beyond resolution. Specific histopathological variables that remain substantially high at peak toxicity and early clinical resolution, including epidermal thickening, hyperkeratosis and dermal fibroplasia/fibrosis, serve as specific measurable parameters for in vivo interventional preclinical studies that seek to mitigate radiation-induced skin injury.

Comparative analysis of the leprosy detection rate regarding its clinical spectrum through PCR using the 16S rRNA gene: a scientometrics and meta-analysis.

Leprosy is a chronic and disabling infectious disease caused by Mycobacterium leprae. It has a wide clinical spectrum and is operationally classified into paucibacillary (PB) and multibacillary (MB) cases. There is evidence that the 16S rRNA gene can be used in Polymerase Chain Reaction (PCR) for complementary detection with high sensitivity and specificity. However, there is no literature convention on its diagnostic correspondence regarding the particular operational classification of the disease. This study aimed to correlate, through a meta-analysis, the detection rate of leprosy between the PCR method with the 16S rRNA gene in the clinical forms PB and MB in relation to confirmed cases. This is a systematic review and meta-analysis study conducted according to the PRISMA 2020 guidelines, using the search descriptors with "AND": "Leprosy"; "Polymerase Chain Reaction"; "16S rRNA" in the PUBMED, SciELO, LILACS, and Science Direct databases. The search was limited to original observational articles in Portuguese, English, or Spanish, with no defined time frame. The methodological quality assessment of the selected articles was performed using the JBI checklists. A scientometric approach to the article using used the VOS Viewer and Scimago Graphica software. The meta-analysis was conducted using Comprehensive Meta-Analyses software, under Pearson's Correlation effect test and fixed effect model and subgroup analysis concerning the type of sample analyzed. The study was significant from the perspective of the paucibacillary group (Clinical biopsy: -0.45 [95% CI= -0.63 - -0.22], p < 0.001/ Slit smear skin: -0.52 [95% CI= -0.65 - -0.36], p < 0.001 / Overall: -0.50 [95% CI= -0.61 - -0.37], p < 0.001). The PCR diagnostic method for the16S rRNAgene ofM. lepraehas low viability and diagnostic sensitivity in both clinical biopsy samples and leprosy skin smears. This implies little validation of it as a PCR target gene for diagnosing the disease, highlighting limitations in the actual technique. https://www.crd.york.ac.uk/prospero/, identifier CRD42024588790.

Clinical vs. chronological skin age: exploring determinants and stratum corneum protein markers of differential skin ageing in 351 healthy women

Apparent skin age can be determined by several clinical measurements and may differ from chronological age, hence defining age acceleration/deceleration (Age A/D). Using data from 360 women with dermatological scoring of 21 clinical signs, we defined 3 well-separated co-occurring classes capturing the dryness, the elasticity and the oily nature of the skin. We related the risk of each clinical signs to the stratum corneum levels of 5 pre-selected proteins, we identified specific chronological age-adjusted signatures of each clinical sign. Using variable selection approaches, we identified 6 (of the 21) clinical signs which were jointly predictive of chronological age and used to define the clinical skin age, and subsequently age A/D. Applying univariate and multivariate approaches we found that stratum corneum levels of insulin degrading enzyme (IDE) was protective against (β = − 1.74, p = 3.3 × 10−6; selection proportion > 90%) accelerated skin ageing. In conclusion, our results support the fact that molecular markers found in the stratum corneum could predict skin ageing acceleration/deceleration.

Validation of the performance of a point of care molecular test for leprosy: From a simplified DNA extraction protocol to a portable qPCR.

The study aimed to optimize qPCR reactions using oligonucleotides from the first Brazilian molecular diagnostic kit for leprosy on a portable platform (Q3-Plus). In addition, we sought to develop a simplified protocol for DNA extraction that met point-of-care criteria. During optimization on the Q3-Plus, optical parameters, thresholds, and cutoffs for the 16S rRNA and RLEP targets of M. leprae were established using synthetic DNA, purified DNA from M. leprae, and pre-characterized clinical samples. For the simplified extraction protocol, different lysis solutions were evaluated using chaotropic agents, and purification was carried out by transferring the lysed material to FTA cards. The complete protocol (simplified extraction + qPCR on the portable platform) was then evaluated with pre-characterized clinical skin biopsy samples and compared with standard equipment (QuantStudio-5). LOD95% for the optimized reactions was 113.31 genome-equivalents/μL for 16S rRNA and 17.70 genome-equivalents/μL for RLEP. Among the lysis solutions, the best-performing was composed of urea (2 M), which provided good dissolution of the skin fragment and a lower Ct value, indicating higher concentrations of DNA. The complete technological solution showed a sensitivity of 52% in reactions. Our results highlight the need for additional optimization to deal with paucibacillary samples, but also demonstrate the feasibility of the portable platform for the qPCR detection of M. leprae DNA in low infrastructure settings.

B-056 Clinical and Analytical Performance Evaluation of Two Immunoassays for the Detection of Mite Specific Serum IgE for Allergy Diagnosis

Abstract Background IgE-mediated allergic diseases can be considered a modern epidemic, with exponential growth mainly in industrialized countries. Diagnosis is usually based on detailed medical history, physical examination, skin or challenge test and the determination of allergen-specific serum IgE - a laboratory test that has become a high-value tool in the allergy patient's journey over the last three decades. As the identification of specific immunoglobulin E (sIgE) for a given allergen is important to aid in the allergy diagnosis, several methods for detecting IgE in vitro are available worldwide and, in recent years, there have been several improvements in laboratory methodologies bringing greater advances in terms of clinical and analytical performance. The study aims to evaluate the clinical performance and correlation between two different sIgE assays (IMMULITE® 2000 3gAllergy™ and ImmunoCAP) and their concordance with Skin Prick Test (SPT) and clinical history. Methods This prospective study was conducted with approximately 130 consecutive patients who underwent evaluation of allergic diseases in different centers in Brazil. Clinical data, blood samples, and SPT results were collected. With the blood samples, the allergens D1, D2 and D201 were evaluated using both methods (IMMULITE® 2000 3gAllergy™ and ImmunoCAP) and the data were evaluated in a correlation study and clinical concordance analysis. Results Qualitatively evaluating the sIgE results between the two immunoassays, at the cutoff point considered clinically significant (≥ 0.35 KU/L), a total agreement of 95.2% (D1); 95.1% (D2), 91.7% (D201) and 96.8% (Derp2) was observed. Semi-quantitatively evaluating through reactive interpretation, an agreement of 89.5% (D1); 91.06% (D2); 87.60% (D201) and 93.33% (Derp2) was observed. Spearman's correlation between the analytical methods was 0.85 (D1), 0.93 (D2), 0.68 (D201) and 0.76 (Derp2). When compared with the SPT results, a total agreement of 78.7% and 80.1% was obtained for 3gAllergy and ImmunoCAP, respectively, with slightly higher positive agreement for both methods. Conclusions The two methods have good agreement with each other, with greater differences when evaluated quantitatively. However, when compared to clinical history and skin prick test results, both perform very similarly with a few differences that may be caused by the difference in the assay design.

Exploring the Gut Microbiota Landscape in Cow Milk Protein Allergy: Clinical Insights and Diagnostic Implications in Pediatric Patients

Cow milk protein allergy (CMPA) is a significant health concern characterized by adverse immune reactions to cow milk proteins. Biomarkers for the accurate diagnosis and prognosis of CMPA are lacking. This study analyzed the clinical features of CMPA, and 16S RNA sequencing was used to investigate potential biomarkers through fecal microbiota profiling. Children with CMPA exhibit a range of clinical symptoms, including gastrointestinal (83% of patients), skin (53% of patients), and respiratory manifestations (26% of patients), highlighting the complexity of this condition. Laboratory analysis revealed significant differences in red cell distribution width (RDW) and inflammatory markers between the CMPA and control groups, suggesting immune activation and inflammatory responses in CMPA. Microbial diversity analysis revealed higher specific diversity indices in the CMPA group compared with those in control group, with significant differences at the genus and species levels. Bacteroides were more abundant in the CMPA group, whereas Bifidobacterium, Ruminococcus, Faecalibacterium, and Parabacteroides were less abundant. The control group exhibited a balanced microbial profile, with a predominant presence of Bifidobacterium bifidum and Akkermansia muciniphila. The significant abundance of Bifidobacterium in the control group (23.19% vs 9.89% in CMPA) was associated with improved growth metrics such as height and weight, suggesting its potential as a probiotic to prevent CMPA and enhance gut health. Correlation analysis linked specific microbial taxa such as Coprococcus and Bifidobacterium to clinical parameters such as family allergy history, weight and height, providing insights into CMPA pathogenesis. Significant differences in bacterial abundance suggested diagnostic potential, with a panel of 6 bacteria achieving high predictive accuracy (area under curve (AUC) = 0.8708). This study emphasizes the complex relationship between the gut microbiota and CMPA, offering valuable insights into disease mechanisms and diagnostic strategies.

Proteomic Analysis Reveals Oxidative Phosphorylation and JAK-STAT Pathways Mediated Pathogenesis of Pemphigus Vulgaris.

Pemphigus vulgaris (PV) stands as a rare autoimmune bullous disease, while the precise underlying mechanism remains incompletely elucidated. High-throughput proteomic methodologies, such as LC-MS/MS, have facilitated the quantification and characterisation of proteomes from clinical skin samples, enhancing our comprehension of PV pathogenesis. The objective of this study is to elucidate the signalling mechanisms underlying PV through proteomic analysis. Proteins and cell suspension were extracted from skin biopsies obtained from both PV patients and healthy volunteers and subsequently analysed using LC-MS/MS and scRNA-seq. Cultured keratinocytes were treated with PV serum, followed by an assessment of protein expression levels using immunofluorescence and western blotting. A total of 880, 605, and 586 differentially expressed proteins (DEPs) were identified between the lesion vs. control, non-lesion vs. control, and lesion vs. non-lesion groups, respectively. The oxidative phosphorylation (OXPHOS) pathway showed activation in PV. Keratinocytes are the major cell population in the epidermis and highly expressed ATP5PF, ATP6V1G1, COX6B1, COX6A1, and NDUFA9. In the cellular model, there was a notable increase in the expression levels of OXPHOS-related proteins (V-ATP5A, III-UQCRC2, II-SDHB, I-NDUFB8), along with STAT1, p-STAT1, and p-JAK1. Furthermore, both the OXPHOS inhibitor metformin and the JAK1 inhibitor tofacitinib demonstrated therapeutic effects on PV serum-induced cell separation, attenuating cell detachment. Metformin notably reduced the expression of V-ATP5A, III-UQCRC2, II-SDHB, I-NDUFB8, p-STAT1, p-JAK1, whereas tofacitinib decreased the expression of p-STAT1 and p-JAK1, with minimal impact on the expression of V-ATP5A, III-UQCRC2, II-SDHB, and I-NDUFB8. Our results indicate a potential involvement of the OXPHOS and JAK-STAT1 pathways in the pathogenesis of PV.

Characterization of Endothelial Cell Subclusters in Localized Scleroderma Skin with Single-Cell RNA Sequencing Identifies NOTCH Signaling Pathway

Localized scleroderma (LS) is an autoimmune disease characterized by inflammation and fibrosis, leading to severe cutaneous manifestations such as skin hardening, tightness, discoloration, and other textural changes that may result in disability. While LS shares similar histopathologic features and immune-fibroblast interactions with systemic sclerosis (SSc), its molecular mechanisms remain understudied. Endothelial cells (EC) are known to play a crucial role in SSc but have not been investigated in LS. Single-cell RNA sequencing (scRNA-seq) now allows for detailed examination of this cell type in the primary organ of interest for scleroderma, the skin. In this study, we analyzed skin-isolated cells from 27 LS patients (pediatric and adult) and 17 healthy controls using scRNA-seq. Given the known role of EC damage as an initial event in SSc and the histologic and clinical skin similarities to LS, we focused primarily on endothelial cells. Our analysis identified eight endothelial subclusters within the dataset, encompassing both disease and healthy samples. Interaction analysis revealed that signaling from diseased endothelial cells was predicted to promote fibrosis through SELE interaction with FGFBP1 and other target genes. We also observed high levels of JAG in arterial endothelial cells and NOTCH in capillary endothelial cells, indicating the activation of a signaling pathway potentially responsible for epidermal abnormalities and contributing to LS pathogenesis. In summary, our scRNA-seq analysis identified potential disease-propagating endothelial cell clusters with upregulated pathways in LS skin, highlighting their importance in disease progression.

The expanding host range of lumpy skin disease virus in wild and domestic animals.

Clinical lumpy skin disease (LSD) predominantly affects cattle and, to lesser extent domestic water buffalos. Whilst earlier work focussed on the disease in Africa, the recent emergence of LSD virus (LSDV) as a major cause of disease in Asia has led to a widening range of susceptible hosts for the virus. This article lists the wild and domestic ungulates in which LSDV infection has been confirmed and considers the significance of the disease for these species in Asia.

In Vivo Histological Study Evaluating Non-Ablative Fractional 1940-nm Laser.

Non-ablative fractional lasers (NAFL) have increased in demand compared to ablative laser treatments as they provide lesser down time, fewer side-effects, and are safer to use. Non-ablative fractional treatment with lasers ranging from 1320 to 1927-nm have been shown to be safe and effective for skin resurfacing procedures. The objective of this study is to investigate healing of the 1940-nm NAFL-induced microthermal treatment zones (MTZs) in human skin from a histologic perspective. Three subjects received 1940-nm NAFL treatment to test areas on the abdomen at various timepoints during the study. The minimum 5 mJ/MTZ and maximum 20 mJ/MTZ energy settings were used at 20% coverage. Biopsies were taken coinciding with immediately posttreatment, 1, 3, 7 days, and 6 weeks posttreatment. Blinded analysis of hematoxylin and eosin stained slides was performed to measure the width and depth of the MTZs and evaluate the inflammatory and healing response of the skin over time (immediately to 6 weeks posttreatment). Safety was evaluated by assessing local skin responses and adverse events immediately after treatment and at all study visits. Histological analysis of tissue following NAFL 1940-nm treatments showed mild early inflammatory response (presence of lymphotic infiltrate) in some test areas and zones of necrosis and coagulation having widths and depths (immediately-3 days posttreatment) that scaled with the 1940-nm pulse energy. Signs of healing such as presence of dermal mucin, evidence of fibrosis, and absence of necrosis were observed long-term (7 days to 6 weeks posttreatment). Evidence of the MTZ persisted beyond the 6-week study and was predicted to last for 100 days. All local clinical skin responses healed within 6 weeks and were limited to mild, transient erythema and edema which resolved in less than 12-24 h following treatment. No serious adverse events occurred during the study. NAFL 1940-nm treatments are safe for inducing small fractional coagulation and necrosis zones in abdominal skin. NAFL 1940-nm laser creates fractional columns of injury with sufficient depth and coverage that suggest effective skin resurfacing, like other non-ablative fractional lasers.

Uncommon neoplasms mistakenly diagnosed as hidradenitis suppurativa: Report of three consecutive cases

Hidradenitis suppurativa (HS) poses diagnostic challenges due to its clinical overlap with various skin conditions and neoplasms, potentially leading to misdiagnoses. The absence of a definitive diagnostic test and infrequent use of histopathology contribute to diagnostic complexities, exacerbated by the recent increased focus on HS. Three cases initially diagnosed and treated as HS underwent clinical work-up and skin biopsies to resolve diagnostic complexities. Initially labeled as HS, the cases revealed a breast carcinoma on axillary ectopic tissue, a cutaneous gamma-delta T-cell lymphoma, and an infiltrating squamous cell carcinoma. Delayed recognition led to misguided therapies and adverse outcomes. This report stresses the need to explore alternative diagnoses for chronic skin nodules with or without ulcerations on the flexures. Timely skin biopsies are crucial for accurate diagnoses. Ongoing clinician education is essential to avoid misdiagnosis in challenging cases, in which histopathology aids in reaching a correct diagnosis.

Early Identification, Intervention, and Prevention of Hospital-Acquired Pressure Injuries Using a Nurse-Driven Pressure Injury Prevention Program.

The purpose of this quality improvement project was to reduce the hospital-acquired pressure injury (HAPI) rate to less than 1.177 per 1000 patient-days, increase staff competency and care in pressure injury prevention best practices through implementation of a nurse-driven pressure injury prevention program, to engage patients in pressure injury prevention through implementation of skin rounds, and improve staff adherence to documentation requirements for pressure injury interventions on an amputee/stroke unit. HAPIs can lead to negative patient outcomes including pain, infection, extended hospitalization, and morbidity. Using an evidence-based education strategy, the Agency for Healthcare Research and Quality pressure ulcer prevention clinical pathway and skin rounds were implemented. Focused education for nursing, staff competency, daily audits, HAPI rates, and documentation compliance were evaluated pre and post intervention. The HAPI rate reduced from 1.177 to 0.272 per 1000 patient-days. After completion, the unit maintained zero pressure injuries, daily patient care for pressure injuries improved, documentation compliance increased, and staffs' knowledge and skill set in early identification, intervention, and prevention of pressure injuries heightened. A nurse-driven pressure injury prevention program was successful in the reduction of the HAPI rate.

Basophil activation test is a complementary tool in the diagnosis of immediate reactions to platinum salts and taxanes.

Delabelling pathways offer confirmatory diagnosis and can prevent unnecessary second-line therapies or drug desensitization procedures after chemotherapeutic hypersensitivity reactions (CHT-HSRs). However, these pathways rely on risky invivo tests. Data on whether invitro tests could be helpful are scarce. We assessed the role of basophil activation test (BAT) in the diagnosis of HSRs to platin salts (PSs) and taxanes (TXs) in a well-defined population featuring varied endophenotypes and severities of HSRs. We conducted a 3-year-long multicentric, prospective study with 121 suspected-immediate CHT-HSR patients. The allergy workup included clinical history (initial reaction based on Type I, cytokine release syndrome, and mixed phenotype's symptoms and if unable to fit in any of these, as "indeterminate"), skin testing (ST), and drug provocation testing (DPT), provided risk assessment was favorable. Final diagnosis classified patients as "hypersensitive," "non-hypersensitive," or "inconclusive." We performed BAT using CD63 and CD203c as activation markers in patients and controls. Patients underwent DPT regardless of BAT results to prevent bias. ST positivity significantly correlated with skin involvement, Type I phenotype, cancer recurrence, and lifetime exposures before reactions. DPTs were negative in all indeterminate phenotype patients (p = .02) and those considered low-risk, whereas they were negative in 62% moderate-risk patients. 55% were confirmed as hypersensitive (mainly Type I reactions, p < .0001), 24% as non-hypersensitive (mainly TXs and indeterminate phenotypes), and 21% as inconclusive. BAT showed 79% sensitivity in Type I IgE-mediated reactions to PSs with a high correlation to ST. BAT is a promising tool for delabelling and endotyping CHT-HSRs, especially Type I reactions to PSs, possibly identifying patients at risk of positive DPT. ST seems useful in confirming CHT-HSRs, especially PS-induced reactions, and DPT remains the gold standard, being essential even in moderate-risk patients.

High-powered 675-nm laser: Safety and efficacy in clinical evaluation and in vitro evidence for different skin disorders.

Laser technology is a viable therapeutic option for treating a number of skin pathologic conditions, including pigmented lesions, vascular lesions and acne scars. In this work, through in vitro and clinical investigationswe test the efficacy, the safety and the speed of treatment of high-powered laser system emitting a 675-nm in the management of various skin condition. In vitro experiments were performed irradiating adult human dermal fibroblasts cells (HDFa) with 675-nm laser for 24, 48 and 72h with different fluences and Ki-67+ cells were counted. The confocal microscopy images of control and treated samples were acquired. Clinical skin rejuvenation/diseases treatments with 675nm laser device were performed with different laser parameters in 11 patients with pigmented lesions, 5 patients with acne scars and 23 patients for skin rejuvenation. Data were evaluated with the validated global score using 5-point scales (GAIS) and patient's satisfaction scale. The application of the high-power 675nm laser has proven effective in stimulating cell proliferation in in vitro experiments and it led to good results for all skin pathologies. GAIS showed values between 3 and 4 points for all treated pathologies, all scores between '75%-good improvements' and '100%-excellent improvements'. The treatment time was reduced by 50% compared to the old parameters setting, resulting in a faster and good patient's satisfying technique. No serious adverse effects were recorded. the preclinical and clinical data confirm the efficacy and safety of this high-powered 675nm laser for several skin condition.

Treatment of early oligoarticular psoriatic arthritis with apremilast: primary outcomes at week 16 from the FOREMOST randomised controlled trial

ObjectivesOligoarticular psoriatic arthritis (PsA) is frequent but rarely studied. The objective was to assess the efficacy of apremilast in early oligoarticular PsA.MethodsFOREMOST (NCT03747939) was a phase 4 multicentre, randomised, double-blind,...

Genetic testing and new variants in diagnosis of congenital ichthyoses.

The aim of this study was to evaluate how diagnostic practice in congenital ichthyoses has evolved during the years 2000-2020 and what kind of gene variants of congenital ichthyosis have been found. The study cohort of this register-based research consisted of a total of 88 patients, whose diagnostic testing was conducted, and ichthyosis diagnoses set at the Department of Dermatology and the Department of Clinical Genetics at Tampere University Hospital during the years 2000-2020. Diagnosis of ichthyosis was confirmed with genetic testing in 33 cases, and with conventional diagnostic methods, such as clinical findings, skin biopsy and family history of ichthyoses, in 55 cases. We observed four novel variants in patients with the clinical diagnoses of congenital ichthyoses. When genetic testing became available, it was offered primarily to patients with severe forms of ichthyosis. During the study period next-generation sequencing became the genetic testing method of choice providing new opportunities in diagnostics.