Daily Dermatological Practice Research Articles

A Triple Laser Combination Treatment for Facial Angiofibromata Management in Tuberous Sclerosis and Literature Review.

Angiofibromas are a common facial manifestation of tuberous sclerosis (TS). However, current treatments have proven ineffective due to high recurrence rates and noncompliance. To address this issue, we developed a new triple laser therapy protocol for more effective management of angiofibromas. We conducted tests to validate its efficacy. This is a prospective study of 10 patients with TS (4 women and 6 men, mean age 26.3 years [15-37 years]) with angiofibromata who received triple sequential laser therapy at our private dermatological clinic conducted from January 2000 to December 2022. We evaluated the outcome with the Facial Angiofibromata Severity Index (FASI) via clinical photography (0, 6 months, 1 year, and 2 years), and Dermatology Life Quality Index (DLQI). All patients had a successful recovery without any complications. Among these 10 patients, 4 experienced localized recurrences at their 6-month follow-up. These recurrences were treated with a second single carbon dioxide laser session. After 2 years of follow-up, we observed no recurring facial cutaneous manifestations. Furthermore, all patients experienced a decrease in their FASI score after treatment. According to the Visual Analogue Scale, patients reported 95% satisfaction, and DLQI indicated only a minor impact on their everyday lives. We believe that this protocol of three-step laser treatment is effective, safe, and compliable for patients with facial angiofibromata, providing a satisfactory outcome adaptable to the daily dermatological and plastic surgery practice.

Use of Dermoscopy among Greek Dermatologists in Everyday Clinical Practice: A National Questionnaire-Based Study.

Background: Dermatoscopy has been established as an important diagnostic tool for a wide range of skin diseases. This study aims to evaluate the use of dermatoscopy in clinical practice among Greek dermatologists. Methods: A nationwide questionnaire-based survey was conducted collecting data on the frequency of dermatoscopic examinations, the types of lesions examined, training and educational resources, as well as factors influencing the choice to incorporate dermatoscopy into daily clinical routines. Results: A total of 366 Greek dermatologists participated in the survey. Most of the respondents reported the daily use of dermatoscopy in their practice. Pigmented and non-pigmented lesions, inflammatory diseases, cutaneous infectious, hair disorders, and nail lesions were the most common indications for dermatoscopy. Factors influencing the utilization of dermatoscopy included increased diagnostic accuracy, enhanced patient care, better patient communication and general compliance, and improved satisfaction among dermatologists. Conclusions: This national questionnaire-based study demonstrates that dermatoscopy has become an integral part of daily dermatological practice in Greece. The findings highlight the significance of structured training and education to promote dermoscopy's effective and routine use. Incorporating dermatoscopy into clinical practice not only improves diagnostic precision but also enhances patient care, contributing to the overall quality of dermatological services in Greece.

Gabapentin and oral antidepressants for chronic pruritus: a prospective cohort study evaluating efficacy and side effects in daily dermatological practice

BackgroundChronic pruritus is frequently seen in daily dermatological practice and is associated with marked impact on quality of life. Research on the use of gabapentin and oral antidepressants in daily dermatological practice is scarce.ObjectiveTo evaluate the efficacy and safety of gabapentin and oral antidepressants in patients with chronic pruritus in daily clinical practice.MethodsA prospective observational single-center cohort study was conducted including adult patients with chronic pruritus and an indication for systemic treatment between June 2016 and May 2019.ResultsSystemic treatment with gabapentin and/or antidepressants was initiated in 31 patients with severe chronic pruritus (median average pruritus NRS score 7.0), in which most cases no underlying origin was identified (83.9%). In patients treated with gabapentin 900–1800 mg/day (N = 25), median average pruritus NRS decreased to 5.5 (IQR 3.0) after 4 weeks and remained stable up to 24 weeks of treatment. Efficacy of antidepressants was variable, with the highest response after initiation of amitriptyline, nortriptyline, and mirtazapine. Side effects were frequently observed in both gabapentin and antidepressant treatments; however, were mostly mild and temporary.LimitationsThis was a single-site observational study, with limited sample size.ConclusionTreatment with gabapentin and antidepressants should be considered in patients with chronic pruritus unresponsive to conventional treatment.

Gasdermin D (GSDMD) Is Upregulated in Psoriatic Skin-A New Potential Link in the Pathogenesis of Psoriasis.

Psoriasis is an important issue in daily dermatological practice. Not only is it an aesthetic defect but it is also a matter of decreased life quality and economic burden. However frequent, the pathogenesis of psoriasis remains uncertain despite numerous investigations. Gasdermins are a family of six proteins. Gasdermin D (GSDMD) is the best-studied from this group and is involved in the processes of inflammation, proliferation, and death of cells, especially pyroptosis. GSDMD has never been studied in psoriatic sera or urine before. Our study involved 60 patients with psoriasis and 30 volunteers without dermatoses as controls. Serum and urinary GSDMD concentrations were examined by ELISA. The tissue expression of GSDMD was assessed by immunohistochemistry. The serum-GSDMD concentration was insignificantly higher in the patients than controls. There were no differences in the urinary-GSDMD concentrations between the patients and controls. Strong tissue expression of GSDMD was significantly more prevalent in psoriatic plaque than in the non-lesional skin and healthy skin of the controls. There was no correlation between the serum-GSDMD concentrations and the psoriasis severity in PASI, age, or disease duration. Taking into consideration the documented role of gasdermins in cell proliferation and death, the increased expression of GSDMD in psoriatic skin may demonstrate the potential involvement of this protein in psoriasis pathogenesis. Neither serum, nor urinary GSDMD can be currently considered a psoriasis biomarker; however, future studies may change this perspective.

Hand eczema or psoriasis: update on the FB323 study occupational dermatology cohort

In daily dermatological practice, the distinction between eczema and psoriasis in dermatoses of the hands can be difficult. However, aclear diagnosis is necessary to initiate optimal therapy and management. In recent years, the so-called molecular classifier has been developed for optimized differentiation of eczema and psoriasis. An occupational dermatological cohort has been established at Heidelberg University Hospital since 2020. It is funded by the German Statutory Accident Insurance. The aim is to follow-up patients over 3years where this new diagnostic method is used and to compare the results with aretrospective occupational dermatological cohort. Recruitment ended in December 2022. The current analysis reports participants' occupational activity, insurance status, disease progression, and number of sick days. A total of 287patients were included; mean age was 50.4years and 63.5% (n = 181) were undergoing treatment at the expense of the liable statutory accident insurance at the start of the study. About 50% of the patients worked in health professions, metal industry, or construction. The average duration of occupational dermatosis was 6.5years. In 38.9% of the patients, the clinical diagnosis had been classified as unclear by the treating dermatologist. By using the molecular classifier, the diagnosis could be clarified in 98% of the cases (eczema vs. psoriasis). The first analyses demonstrate that the molecular classifier contributes to improving therapy by optimizing the diagnosis.

On Bir Yaşındaki Kızda Melanomu Taklit Eden Dermatofibrom

Dermatofibromas (DF) are common benign skin lesions that commonly affect female adults. They can be easily diagnosed in most cases. However, in some cases, their clinical and dermoscopical appearance can resemble other lesions, such as dysplastic nevi, melanomas, and other skin tumors. Here, we report a case of pigmented DF mimicking melanoma on the right arm of an 11-year-old girl. DFs are common lesions in daily dermatology practice, however in this case the young age of the patient, the atypical melanoma-like dermoscopic features, and the rapid growth of the lesion brought on the suspicion of malignant melanoma. The case was presented to emphasize that pigmented DFs must be considered in the differential diagnoses of pigmented lesions in children; which will prevent unnecessary surgical procedures.

Body Dysmorphic Disorder Questionnaire-Dermatology Version (BDD-DV): formation and validation of the Polish language version.

Body dysmorphic disorder (BDD) is a mental health condition defined by preoccupation with a non-existent or minimal flaw (defect) in appearance. This preoccupation causes significant social and occupational impairment, lot of distress and is not better accounted for by another mental disorder. The defect often regards the skin, face or body build. Data show that 8-14% of dermatological patients suffer from BDD, whereas in the cosmetic dermatology setting the incidence is reported as high as 8-37%. The Body Dysmorphic Disorder Questionnaire-Dermatology version (BDDQ-DV) is a screening tool that may help to diagnose patients with BDD in dermatology settings. The questionnaire is self-reported, therefore it can be used in daily dermatology practice. To create and validate the Polish language version of the BDDQ-DV. The Polish version of BDDQ-DV was created in accordance with international standards. To assess reliability of the questionnaire the Cronbach's α coefficient was used. The reproducibility (test-retest reliability) of the Polish language version of the questionnaire was evaluated using the interclass correlation coefficient (ICC) coefficient. The Polish version of BDDQ-DV was created. The Cronbach's α coefficient based on the first completion of the questionnaire was 0.92 indicating a correspondingly high internal consistency between the questions of the questionnaire. ICC was assessed at 0.998, which indicates excellent reliability. The Polish version of BDDQ-DV may help to identify patients with BDD among Polish-speaking individuals.

Aktuelles Management des Basalzellkarzinoms

We present the current standard in diagnosis and treatment of basal cell carcinoma. Useful procedures for clinical management should be derived from this. A systematic literature search was carried out in the PubMed online database. The collected information was analyzed and evaluated. An overall concept was created from the gained knowledge. Basal cell carcinoma is the most common tumor in humans and its incidence is expected to increase in the future. When managing the disease, a one-dimensional orientation towards the clinical or histological subtype is not sufficient because of the heterogeneity of the tumor. The primary implementation of risk stratification, which is decisive for the further diagnostic and therapeutic steps, is becoming increasingly important. The gold standard in treatment continues to be the surgical procedure, which should be carried out using micrographically controlled surgery if possible. In addition, there are other therapeutic methods such as radiotherapy or a number of topical therapy options (photodynamic therapy, cryotherapy, application of 5-fluorouracil or imiquimod), which can be used in certain cases. Hedgehog inhibitors are also effective drugs for advanced or metastatic basal cell carcinoma. Practitioners have gained several years of experience with regard to effectiveness and handling of adverse events. With the PD-1 inhibitor cemiplimab, another therapeutic option for inoperable or metastatic tumors has been available since June 2021. Basal cell carcinoma will continue to gain in relevance in daily dermatological practice in the coming years. A structured approach to the assessment of the existing risk category of the tumor and the subsequent determination of the optimal therapy regimen are of central importance. Advanced or metastatic tumors no longer represent a hopeless situation for the patient. With long-termhedgehog therapy, an adapted dosage scheme can avoid discontinuation of therapy due to side effects. The therapeutic potential of the PD-1 inhibitor cemiplimab can also be used with the side effect profile known from other types of skin cancer.

The daily use of dermoscopy in the Netherlands

Dermoscopy is a well-established tool for the diagnosis of skin diseases and skin cancer. Data on the use of dermoscopy by Dutch dermatologists is lacking. To identify factors influencing the use of dermoscopy in daily dermatology practice and compare the results with those from other European countries. As a part of a pan-European study, all registered dermatologists in the Netherlands were asked to complete an online survey regarding questions about training and attitude towards dermoscopy. Valid answers were collected from 213 respondents (out of 475 registered dermatologists), of whom 99% reported using dermoscopy. Of those, 41% reported dermoscopy training during residency. A high level of dermoscopy use for different types of skin diseases was reported by 28.9%. Users considered dermoscopy useful for pigmented lesions, especially for the early diagnosis of melanoma, but less advantageous for inflammatory diagnoses. Seventy-three percent reported that dermoscopy increased the number of melanomas detected compared to naked eye diagnosis, and two-thirds reported a decrease in unnecessary biopsies of benign lesions. Almost one third reported that on at least one occasion, a lesion that appeared benign on dermoscopy proved to be a melanoma after excision. This study reveals that nearly all Dutch dermatologists use dermoscopy, particularly for melanocytic lesions, but less so for inflammatory diagnoses. Most believe that they detected more melanomas as a result of using dermoscopy compared to the naked eye. A high level of dermoscopy use was significantly associated with seeing more skin cancer patients each month compared to infrequent use.

Tetracyclines-An Important Therapeutic Tool for Dermatologists.

Tetracyclines are a group of antibiotics whose first representative was discovered over 70 years ago. Since then, they have been of great interest in dermatology. In addition to their antibacterial activity, they are able to inhibit metalloproteinases and exhibit anti-inflammatory, anti-apoptotic and antioxidant effects. The side effects have been thoroughly studied over the years, the most characteristic and important ones in daily dermatological practice being: phototoxicity, hyperpigmentation, onycholysis, photoonycholysis, induced lupus erythematosus, and idiopathic intracranial hypertension. In this article, we summarize the use of tetracyclines in infectious diseases and inflammatory dermatoses, and further discuss the instances where the efficacy and safety of tetracyclines have been highlighted over the past few years.

How to decrease systemic corticosteroids in pemphigus patients under rituximab.

How to decrease systemic corticosteroids in pemphigus patients under rituximab.

Bacterial antimicrobial resistance and dermatological ramifications.

The spread of COVID-19 serves as a reminder of the might of microbes in the era of modern medicine. For years, another threat has preoccupied infectious disease experts and public health officials alike: rising antimicrobial resistance (AMR). Resistance is exceeding stewardship efforts as well as the rates of new drug development and approval in the market. A dry antimicrobial pipeline is threatening regression to a preantibiotic era. While the consequences of resistance may seem far removed from daily clinical practice, awareness of AMR is essential to dermatological care given that dermatologists prescribe more antibiotics per physician than other providers. Antibiotics in dermatology are often used for prolonged courses, with significant potential for microbiome alteration and antibiotic-related adverse effects. Through this review we hope to contribute to efforts of bringing the crisis of AMR to the forefront of daily dermatological practice.

Pruritus: A Sensory Symptom Generated in Cutaneous Immuno-Neuronal Crosstalk.

Pruritus or itch generated in the skin is one of the most widespread symptoms associated with various dermatological and systemic (immunological) conditions. Although many details about the molecular mechanisms of the development of both acute and chronic itch were uncovered in the last 2 decades, our understanding is still incomplete and the clinical management of pruritic conditions is one of the biggest challenges in daily dermatological practice. Recent research revealed molecular interactions between pruriceptive sensory neurons and surrounding cutaneous cell types including keratinocytes, as well as resident and transient cells of innate and adaptive immunity. Especially in inflammatory conditions, these cutaneous cells can produce various mediators, which can contribute to the excitation of pruriceptive sensory fibers resulting in itch sensation. There also exists significant communication in the opposite direction: sensory neurons can release mediators that maintain an inflamed, pruritic tissue-environment. In this review, we summarize the current knowledge about the sensory transduction of pruritus detailing the local intercellular interactions that generate itch. We especially emphasize the role of various pruritic mediators in the bidirectional crosstalk between cutaneous non-neuronal cells and sensory fibers. We also list various dermatoses and immunological conditions associated with itch, and discuss the potential immune-neuronal interactions promoting the development of pruritus in the particular diseases. These data may unveil putative new targets for antipruritic pharmacological interventions.

A retrospective analysis of the uses of BoNT-A in daily dermatological practice.

Botulinum toxin-A (BoNT-A) has been increasingly used in the cosmetic dermatology daily routine. The treatment areas of BoNT-A are glabellar lines, forehead wrinkles, periorbital lines (crow's feet), eyebrow lifting, perioral lines, platysmal bands, masseter hypertrophy, and hyperhidrosis. The aim of this study was to reveal the epidemiologic characteristics of the patients treated with BoNT-A and the frequencies of treatment areas. The patients were grouped into five categories: facial wrinkles, platysmal bands, masseter hypertrophy, axillary hyperhidrosis, and palmoplantar hyperhidrosis. Each patient received either onabotulinum toxin-A (diluted with 2cc saline) or abobotulinum toxin-A (diluted with 3cc saline) treatment. The patients' age, gender, and the total numbers of treatment received in each area were noted. SPSS version 21 was used for the statistical analysis. A total of 1614 patients were included: 165 (6.5%) male and 1509 (93.5%) female. There is no difference between genders in terms of treatment area (p=0.855). The number of treatment sessions is independent of the patients' gender (p=0.703). The mean age of the patients was 46.6years. There is a relationship between the patients' age and treatment area (sig 0.000). There is no relationship between the number of repetitive treatments and the patients' age (p=0.081). The number of repetitive treatments is dependent to the treatment area (p<0.001). Facial wrinkles, platysmal bands, and masseter hypertrophy are the most commonly treated areas. The treatment area is dependent on the age as platysmal bands are more commonly treated in older patients; however, no relationship between gender and treatment area was found. BoNT-A treatment for hyperhidrosis is not as commonly repeated as for that of cosmetic concerns.

Eponyms in Trichoscopy.

Trichoscopy is a non-invasive scalp and hair dermoscopy. In our daily dermatology practice, many eponyms are used. The present article highlights various eponyms in trichoscopy described in dermatology.

Difference in health‐related quality of life between anxiety and depressive symptoms in Japanese patients with plaque psoriasis: the ProLOGUE study

Anxiety symptoms and depressive symptoms are observed in approximately 20%-50% and 30% of patients with psoriasis, respectively.1,2 To date, however, evidence for the association of these symptoms with patients' direct perception of their disease (called patient-reported outcomes [PROs]) remains limited. We assessed the association of anxiety symptoms and depressive symptoms with the severity of psoriasis, psoriatic symptoms, health-related quality of life (HRQoL), and satisfaction levels in Japanese patients with psoriasis using baseline data of participants from a single-arm, open-label, multicenter, prospective cohort study-ProLOGUE (Japan Registry of Clinical Trials identifier: jRCTs031180037).3 Patients (aged ≥18 years) who had plaque psoriasis without peripheral arthritis symptoms and were eligible for self-administration of brodalumab were enrolled at 15 facilities across Japan (study period, October 2017-March 2020).3.

Overview of Ultrasound Imaging Applications in Dermatology [Formula: see text

Complete visualization of lesions is critical for the accurate diagnosis and management of dermatological diseases. Currently, the most readily available technologies used by dermatologists include dermoscopy and photography. Nevertheless, ultrasound has emerged as a useful non-invasive modality in dermatology, which can be added to the clinical examination supporting an early and more accurate diagnosis. Moreover, there are significant technological advances in recent years, such as the development of handheld devices and ultra-high frequency probes that have expanded the integration of ultrasound into daily dermatology practice. In this article, we reviewed the most common applications of ultrasound in the field of dermatology.

Lesion-directed screening to optimize skin cancer detection in dermatology practice: an observational study.

BackgroundEarly detection of skin cancer is still a major challenge in dermatology practice today. While surveillance programs are offered to high‐risk patients, systematic total‐body examination (TBE) in the general population is not cost‐effective. In the past, we demonstrated that a lesion‐directed screening (LDS) in the general population delivered similar detection rates to TBE and was less time‐consuming.ObjectivesTo study whether a lesion‐directed early‐access consultation can optimize skin cancer detection in dermatology practice.MethodsIn this observational study, we offered an early‐access consultation in patients contacting the dermatology department concerning 1 or 2 lesions of concern meeting predefined criteria.Results342 persons were seen at the dermatology department after triage by phone. Skin cancer detection rate was 13.2% (4.1% for melanoma). If advised/referred by a doctor skin cancer detection rate was 23.6% (9% for melanoma). With a history of skin cancer, detection rate was 24.3% (4.3% for melanoma). In patients with no referral and a negative history of skin cancer, detection rate was 7.7% (1.7% for melanoma), which is at least triple the rates reported by population‐based screening programs. In patients in whom the index lesion was benign, worry of having skin cancer had decreased significantly by the end of the consultation. Additional total‐body examination in these patients had low additional detection rate (0.5%) and a high number of unnecessary excisions (number needed to excise 13).ConclusionsAn early‐access dermatology consultation for LDS after triage by phone resulted in high overall skin cancer and melanoma detection rates. Our data indicate that performing TBE is especially useful if the index lesion is suspicious. In addition to surveillance programs in high‐risk patients, LDS may be a way to optimize skin cancer detection in the general population and use available time more efficiently in daily dermatology practice.

Hair Loss Severity and its Impact on Quality of Life in Patients Suffering from Androgenic Alopecia

Background: Androgenic alopecia (AGA) is a common form of nonscarring alopecia encountered in daily dermatology practice. Both apparent and imperceptible AGA has a significant impact on an individual's personality, where physical appearance plays an important role in the probable prospects for marriage as well as other social aspects. Hair loss, thus, can severely hamper them for both men and women with clinical severity of alopecia not necessarily correlating with the quality of life (QoL) of the patient. Objectives: The objective is to assess the QoL in patients with AGA attending a tertiary care hospital in western India and compare QoL with hair loss severity (HLS), rated by both dermatologist and patient. Materials and Methods: One hundred and four patients, clinically diagnosed with AGA, consenting for the study over a period of 1 year were included. Demographic data of the patients were recorded. QoL was assessed using skindex-16 questionnaire; HLS was assessed through self-administered questionnaires completed by patients and dermatologists. Data were analyzed using Wilcoxon signed-rank test, Kendall's tau correlation coefficients, and Chi-square test. Results: The mean global score of Skindex–16 was 45.75 ± 16.90, with highest scores from emotions (64.93 ± 23.26). A positive correlation was found between the patients' HLS rating (r = 0.33, P &lt; 0.0001) and the clinical HLS rating. However, patient rated the extent of their hair loss as more severe than the dermatologist. Patient-related HLS significantly correlated with the mean global score of Skindex–16 (P &lt; 0.0001) as well as with all the subdomain scores (P &lt; 0.0001), whereas dermatologist-rated HLS only significantly correlated with the global score of Skindex–16 (P = 0.04) but not with the subdomain scores. Limitations: As Skindex-16 is a self-reported questionnaire, there may be a recall bias. Another limitation of our study is the sample size; a study with a bigger sample size is required to vindicate our findings. Conclusion: The study demonstrates that AGA patients perceived their HLS as more severe than the dermatologist. Both patient-related HLS and dermatologist-rated HLS showed statistical correlation with the total global Skindex-16 score. Hence, dermatologists need to be more alert and should address the psychosocial and QOL issues, when treating patients with AGA.

Sistematización del programa de Teledermatología de la Universidad de Caldas – departamento de Caldas, 2002- 2010

Introducción: el uso de la teledermatología como herramienta diagnóstica está introduciéndose en la práctica diaria del dermatólogo. Múltiples factores explican el gran potencial que la teledermatología tiene en un país como el nuestro. Al momento, existen pocos estudios publicados acerca del tema y ninguno de ellos describe la aplicación y el impacto que generan los programas de teledermatología en nuestro medio. Materiales y métodos: estudio observacional-retrospectivo, realizado en el programa de Teledermatología de la Universidad de Caldas entre 2002 y 2012. Se describieron las características sociodemográficas, la frecuencia de enfermedades, la concordancia entre los diagnósticos emitidos por el médico general y el dermatólogo, la capacidad resolutiva, los motivos de derivación a la consulta presencial y los problemas para emitir un diagnóstico. Resultados: se analizaron 4333 teleconsultas y 4713 diagnósticos. Los grupos de enfermedades más frecuentes en la teleconsulta fueron las enfermedades inflamatorias (49%), seguidos por las neoplasias benignas (19%). La concordancia diagnóstica fue del 52,4%. La capacidad resolutiva fue del 68,5%. El motivo de derivación más frecuente fue la confirmación diagnóstica. El 2,2% de los casos presentó dificultades en la teleconsulta. El principal motivo fueron los problemas con las imágenes fotográficas. Conclusión: las características sociodemográficas y las enfermedades consultadas presentan una distribución similar a la de otros estudios. La capacidad resolutiva es alta y evita más de la mitad de las derivaciones a la consulta presencial. En pocos casos se tuvieron inconvenientes para realizar la teleconsulta. El grado de concordancia con el diagnóstico del médico general es adecuado.