Dermatologic Therapy Research Articles

Sexual dysfunction with complex etiopathogenesis centered on vulvar cancer

Normal sexual activity is conditioned by the morphophysiology of the integrity of the genital organs and of the human brain, respectively by the absence of associated pathology. In the reported case, the 57-year-old female patient presented for a gynecological consultation, having very intense vulvar itching. Previously, the patient addressed the dermatology department, where she was diagnosed with ”vulvitis with significant edema and erythema” for which she underwent local treatment for 4 weeks. After dermatological therapy, the itching improved slightly, but persisted in association with the local stinging sensation. The vulvar itching became very intense, and the patient solicited a gynecological reexamination. It has to be noted that the patient believed, at that time, that the itching was due to psoriasis, a disease she had been suffering from since she was 10 years old.The emergency investigations establi- shed the existence of vulvar cancer, due to bilateral vulvar tumor. It should also be mentioned that the patient was undergoing therapy for the diagnosis of paranoid schizophrenia, for that of chronic peripheral venous insufficiency, respectively for manifest menopa- usal disorders. In this context, sexual intercourse has completely disappeared, due to complex sexual dysfuncti- on, so that the libido, the erection, the copulation and the orgasm no longer existed.

Needs and Gaps in Resident Trainee Education, Clinical Patient Care, and Clinical Research in Cosmetic Dermatology: Position Statement of the Association of Academic Cosmetic Dermatology.

Cosmetic dermatology is a key subspecialty of academic dermatology. As such, academic centers are expected to demonstrate excellence in the teaching of cosmetic dermatology skills to trainees, the clinical delivery of cosmetic dermatology services to patients, and the performance of clinical research that advances knowledge and uncovers new therapies in cosmetic dermatology. The Association of Academic Cosmetic Dermatology (AACD), a newly formed medical professional society, includes as its principal aims the support of all of these areas. AACD is comprised of group of board-certified dermatologists who teach cosmetic and laser dermatology at US dermatology residency programs. An expert panel constituted by the AACD recently convened a workshop to review gaps pertaining to academic cosmetic dermatology. This panel considered needs and potential corrective initiatives in three domains: resident education, patient experience, and clinical research. The work of the panel was used to develop a roadmap, which was adopted by consensus, and which will serve to guide the AACD moving forward.

241 Epidermal electronics for diagnostics and therapy in dermatology

Epidermal bioelectronics, consisting of thin, soft electronic systems that are interfaced with the human body, has started to transform traditional healthcare. Hundreds of early versions of sensors, actuators and transmitters integrated into patches or bandages are deployed in various medical conditions, and their number is ever-growing. Among many devices, epidermal biosensors are at the center of this effort and offer a huge potential to revolutionize conventional healthcare that involves a physical examination and biochemical analysis to assess overall health and detect abnormalities.

GNAQ mutations drive port wine birthmark-associated Sturge-Weber syndrome: A review of pathobiology, therapies, and current models.

Port-wine birthmarks (PWBs) are caused by somatic, mosaic mutations in the G protein guanine nucleotide binding protein alpha subunit q (GNAQ) and are characterized by the formation of dilated, dysfunctional blood vessels in the dermis, eyes, and/or brain. Cutaneous PWBs can be treated by current dermatologic therapy, like laser intervention, to lighten the lesions and diminish nodules that occur in the lesion. Involvement of the eyes and/or brain can result in serious complications and this variation is termed Sturge-Weber syndrome (SWS). Some of the biggest hurdles preventing development of new therapeutics are unanswered questions regarding disease biology and lack of models for drug screening. In this review, we discuss the current understanding of GNAQ signaling, the standard of care for patients, overlap with other GNAQ-associated or phenotypically similar diseases, as well as deficiencies in current in vivo and in vitro vascular malformation models.

Highlighting nuances of blue light phototherapy: Mechanisms and safety considerations.

The efficacy of blue light therapy in dermatology relies on numerous clinical studies. The safety remains a topic of controversy, where potentially deleterious effects were derived from in vitro rather than in vivo experiments. The objectives of this work were (1) to highlight the nuances behind "colors" of blue light, light propagation in tissue and the plurality of modes of action; and (2) to rigorously analyze studies on humans reporting both clinical and histological data from skin biopsies with focus on DNA damage, proliferation, apoptosis, oxidative stress, impact on collagen, elastin, immune cells, and pigmentation. We conclude that blue light therapy is safe for human skin. It induces intriguing skin pigmentation, in part mediated by photoreceptor Opsin-3, which might have a photoprotective effect against ultraviolet irradiation. Future research needs to unravel photochemical reactions and the most effective and safe parameters of blue light in dermatology.

Acanthosis Nigricans: Pointer of Endocrine Entities.

Acanthosis nigricans (AN) has been reported in relation to insulin resistance (IR). We aim to review AN through an endocrine and metabolic perspective focusing on IR in association with metabolic complications such as obesity, diabetes mellitus (DM), and metabolic syndrome (MS) with/without polycystic ovary syndrome (PCOS). We revised English papers on PubMed covering publications from the last 5 years. The current prevalence of AN varies from 4.5 to 74% (or even 100%, depending on the studied population), with equal distribution among females and males. Despite higher incidence with an age-dependent pattern, an alarming escalation of cases has been noted for obesity and MS in younger populations. Most frequent IR-associated sites are the neck, axilla, and knuckles, but unusual locations such as the face have also been reported. Quantitative scales such as Burke have been used to describe the severity of the dermatosis, particularly in correlation with IR elements. Dermoscopic examination are required, for instance, in cases with sulcus cutis, hyperpigmented spots, crista cutis, and papillary projections. A skin biopsy may be necessary, but it is not the rule. Both IR that clinically manifests with or without obesity/MS correlates with AN; most studies are cross-sectional, with only a few longitudinal. The approach varied from screening during school periodic checkups/protocols/programs to subgroups of individuals who were already known to be at high cardio-metabolic risk. AN was associated with type2DM, as well as type 1DM. Females with PCOS may already display metabolic complications in 60–80% of cases, with AN belonging to the associated skin spectrum. AN management depends on underlying conditions, and specific dermatological therapy is not generally required, unless the patient achieves metabolic control, has severe skin lesions, or desires cosmetic improvement. In IR cases, lifestyle interventions can help, including weight control up to bariatric surgery. In addition, metformin is a key player in the field of oral medication against DM type 2, a drug whose indication is extended to PCOS and even to AN itself, outside the specific panel of glucose anomalies. In terms of cosmetic intervention, limited data have been published on melatonin, urea cream, topical retinoids, vitamin D analogs, or alexandrite laser. In conclusion, awareness of IR and its associated clinical features is essential to provide prompt recognition of underlying conditions. AN represents a useful non-invasive surrogate marker of this spectrum in both children and adults. The pivotal role of this dermatosis could massively improve endocrine and metabolic assessments.

S2k guideline: Diagnosis and treatment of chronic pruritus.

Pruritus is a cross-disciplinary leading symptom of numerous diseases and represents an interdisciplinary diagnostic and therapeutic challenge. In contrast to acute pruritus, chronic pruritus (CP) is a symptom of various diseases that is usually difficult to treat. Scratching and the development of scratch-associated skin lesions can alter the original skin status. In the presence of an itch-scratch-cycle, even secondary diseases such as chronic prurigo can develop. Chronic pruritus leads to considerable subjective suffering of those affected, which can result in restrictions on the health-related quality of life such as sleep disturbances, anxiety, depressiveness, experience of stigmatization and/or social withdrawal up to clinically relevant psychic comorbidities. Medical care of patients should therefore include (a) interdisciplinary diagnosis and therapy of the triggering underlying disease, (b) therapy of the secondary symptoms of pruritus (dermatological therapy, sleep promotion, in the case of an accompanying or underlying psychological or psychosomatic disease an appropriate psychological-psychotherapeutic treatment) and (c) symptomatic antipruritic therapy. The aim of this interdisciplinary guideline is to define and standardize the therapeutic procedure as well as the interdisciplinary diagnosis of CP. This is the short version of the updated S2k-guideline for chronic pruritus. The long version can be found at www.awmf.org.

Release of Cervical Muscle Tension Improves Psychological Stress and Symptoms of Moderate-to-Severe Atopic Dermatitis: a Case Series with 20 Patients.

IntroductionAtopic dermatitis (AD) is a chronic relapsing inflammatory skin disease that is triggered by intense pruritus, impaired skin barrier function, and immune responses to allergenic substances. Break-through therapies for AD include molecular-targeted drugs and the effective management of severe symptoms of AD. However, patients with clinical improvements may continue scratching owing to the influence of psychological stress, which might lead to quick relapses of stressors and subsequent intensive scratching. New drugs may be ineffective because of such scratching behavior caused by stressors. Therefore, it may be useful to consider adjunctive treatment options that focus on external stressors as triggers of deterioration of AD. We hypothesized that improvement of psychological stress by relieving cervical muscle tension would reduce pruritus and atopic symptoms.MethodsOverall, 21 patients with moderate-to-severe AD were treated to relieve cervical muscular tension using Spineliner SA201, which assists in osteopathic manipulative treatment. We assessed the subjective and objective symptoms of AD, cervical muscle tension, which was evaluated using cervical range of motion (ROM), and psychological burden. Only moisturizers were applied topically during the study period, and no topical corticosteroid therapy was used.ResultsTwenty patients who completed the treatment demonstrated improvement in the symptoms of AD: changes on the visual analog scale (VAS) for pruritus were −44.2%, Eczema Area and Severity Index (EASI) was −67.9%, thymus and activation-regulated chemokine (TARC) was −56.2%, Hospital Anxiety and Depression Scale (HADS) was −27.2%, sleep disturbance was −49.7%, and Dermatology Life Quality Index (DLQI) was −46.7%. Additionally, the cervical muscle tension improved significantly: changes in cervical ROM were 14.7%.ConclusionsRelease of cervical muscle tension may improve psychological stress and have an effect on moderate-to-severe AD.

32479 Level of evidence of COVID-19 articles in dermatology literature

The drastic increase in the number of publications on COVID-19 poses a challenge for health care professionals to find a reliable source of information with a strong level of evidence. To address this issue, a comprehensive literature search was conducted in PubMed/MEDLINE, Embase, Cochrane Central, and Google Scholar on COVID-related articles published in dermatology journals from Jan 2020 to May 2021. Level of evidence of the published articles were then analyzed using modified Oxford Center for Evidence-based Medicine (OCEBM). Of the 1928 published articles on COVID-19 in dermatology journals, letter to the editor was the most common article type followed by original articles/research letters, and editorial/commentary. Of all the dermatology journals, Dermatologic Therapy (18.8%) and JAAD (13.8%) have published the highest number of articles on COVID-19. The majority of the articles had a weak level of evidence (level 5) on the OCEBM scale. The strongest level of evidence (level 1a-2b) was identified in only 2.8% of the COVID-19 related articles in dermatology journals. Furthermore, 69% of the articles with level of evidence 1a-2b were published in 2021 compared with 31% in 2020. With more time since the emergence of COVID-19, we expect to see publications with stronger evidence. Indeed, our analysis showed an increase in publication of studies with the strongest level of evidence in 2021 compared with 2020. Our study highlights the paucity of publications with strong evidence following the appearance of a novel virus, as well as the progression to stronger evidence as researchers gain additional time and experience.

SUPPLEMENT ARTICLE: Retinol: The Ideal Retinoid for Cosmetic Solutions.

Retinoids are a mainstay of dermatologic therapy. Although prescription retinoids are more potent than over the counter retinoids, when properly formulated cosmetic retinoids offer consumers an easily accessible, reasonably priced therapeutic option. Retinol has been shown to improve fine lines and wrinkles, hyperpigmentation, skin roughness, and the appearance of photoaged skin. The efficacy and tolerability of retinol makes it preferable to prescription retinoids as many patients are intolerant of these more potent forms. In this review, we will discuss the pharmacokinetics of retinol and the clinical studies confirming its efficacy, tolerability, and safety with long-term use. J Drugs Dermatol. 2022;21:7(Suppl):s4-10.

ANNOUCING NEW CHIEF-EDITOR THE JOURNAL DERMATOLOGIC THERAPY

Robert A. Schwartz, the Professor and Head of Dermatology at the Rutgers New Jersey Medical School, is the new Editor-in-Chief of Dermatologic Therapy, a peer-reviewed journal marking its 25th anniversary. He was recognized in Hanoi with Honorary Membership in the Vietnamese Society of Dermatology, and inducted as an Honorary Fellow of the Asian Academy of Dermatology and Venereology in 2017.

Scaffolds Loaded with Dialdehyde Chitosan and Collagen-Their Physico-Chemical Properties and Biological Assessment.

In this work, dialdehyde chitosan (DAC) and collagen (Coll) scaffolds have been prepared and their physico-chemical properties have been evaluated. Their structural properties were studied by Fourier Transform Infrared Spectroscopy with Attenuated Internal Reflection (FTIR–ATR) accompanied by evaluation of thermal stability, porosity, density, moisture content and microstructure by Scanning Electron Microscopy—SEM. Additionally, cutaneous assessment using human epidermal keratinocytes (NHEK), dermal fibroblasts (NHDF) and melanoma cells (A375 and G-361) was performed. Based on thermal studies, two regions in DTG curves could be distinguished in each type of scaffold, what can be assigned to the elimination of water and the polymeric structure degradation of the materials components. The type of scaffold had no major effect on the porosity of the materials, but the water content of the materials decreased with increasing dialdehyde chitosan content in subjected matrices. Briefly, a drop in proliferation was noticed for scaffolds containing 20DAC/80Coll compared to matrices with collagen alone. Furthermore, increased content of DAC (50DAC/50Coll) either significantly induced the proliferation rate or maintains its ratio compared to the control matrix. This delivery is a promising technique for additional explorations targeting therapies in regenerative dermatology. The using of dialdehyde chitosan as one of the main scaffolds components is the novelty in terms of bioengineering.

Australian experience and practical approach to the 308-nm excimer light therapy in dermatology.

The monochromatic excimer light therapy (308-nm excimer laser and lamp) is used to treat focal dermatoses with inflammation or hypopigmentation. In Australia, despite excimer light therapy being a proven effective treatment for many cutaneous conditions, barriers such as access and affordability provide considerable limitations to patients. This study aims to retrospectively evaluate the different applications of excimer light therapy in treating dermatologic conditions within the Australian setting and provide practical information for its use.

Flexible polymeric patch based nanotherapeutics against non-cancer therapy.

Flexible polymeric patches find widespread applications in biomedicine because of their biological and tunable features including excellent patient compliance, superior biocompatibility and biodegradation, as well as high loading capability and permeability of drug. Such polymeric patches are classified into microneedles (MNs), hydrogel, microcapsule, microsphere and fiber depending on the formed morphology. The combination of nanomaterials with polymeric patches allows for improved advantages of increased curative efficacy and lowered systemic toxicity, promoting on-demand and regulated drug administration, thus providing the great potential to their clinic translation. In this review, the category of flexible polymeric patches that are utilized to integrate with nanomaterials is briefly presented and their advantages in bioapplications are further discussed. The applications of nanomaterials embedded polymeric patches in non-cancerous diseases were also systematically reviewed, including diabetes therapy, wound healing, dermatological disease therapy, bone regeneration, cardiac repair, hair repair, obesity therapy and some immune disease therapy. Alternatively, the limitations, latest challenges and future perspectives of such biomedical therapeutic devices are addressed.

Research update of adipose tissue-based therapies in regenerative dermatology.

Mesenchymal stromal/stem cells (MSCs) have a spontaneous propensity to support tissue homeostasis and regeneration. Among the several sources of MSCs, adipose-derived tissue stem cells (ADSCs) have received major interest due to the higher mesenchymal stem cells concentration, ease, and safety of access. However, since a significant part of the natural capacity of ADSCs to repair damaged tissue is ascribable to their secretory activity that combines mitogenic factors, cytokines, chemokines, lipids, and extracellular matrix components, several studies focused on cell-free strategies. Furthermore, adipose cell-free derivatives are becoming more attractive especially for non-volumizing purposes, such as most dermatological conditions. However, when keratinocytes, fibroblasts, melanocytes, adipocytes, and hair follicle cells might not be locally sourced, graft of materials containing concentrated ADSCs is preferred. The usage of extracellular elements of adipose tissue aims to promote a self-autonomous regenerative microenvironment in the receiving area restoring physiological homeostasis. Hence, ADSCs or their paracrine activity are currently being studied in several dermatological settings including wound healing, skin fibrosis, burn, and aging.The present work analyzing both preclinical and clinical experiences gives an overview of the efficacy of adipose tissue-derivatives like autologous fat, the stromal vascular fraction (SVF), purified ADSCs, secretome and extracellular matrix graft in the field of regenerative medicine for the skin.

Treatment Analysis of Patients Followed up With Postherpetic Neuralgia in Nothern Cyprus.

Background:Postherpetic neuralgia (PHN) is a frequent complication of herpes zoster (HZ). Treatment of this chronic pain syndrome and results are often not clear. Tricyclic antidepressants, gabapentinoids and potent opioids are first-line treatments and are highly effective, but their use is limited due to adverse effects that may occur in elderly patients with significant medical comorbidities or interaction due to multiple drug use. There are no head-to-head comparisons of non medical treatments. Dry needling appears comparable to conventional physical therapy for treating PHN.Objective:Our aim is to determine the incidence of PHN in our population and to compare the treatments in patients with postherpetic neuralgia.Methods:A search for HZ and PHN was conducted in a general practice research database, comprising 2 general practices (dermatologist and physiatrist) and representing 5600 people. We analyzed a retrospective 37 case with PNH of 170 herpes zoster patient admmited to the dermatology and physical therapy and rehabilitation outpatient clinic between October 2018 and October 2020. Dry needling and physical therapy methods applied in addition to medical treatment in PHN treatment were compared.Results:In patients with postherpetic neuralgia, both dry needling therapy group and physical therapy group LANSS scores decreased significantly in the first week and in the third week compared to baseline. Dry needling therapy group has also similar results in VAS scores in the first and third week. But in physical therapy group, the VAS score did not show a significant decrease in the first week compared to the baseline, but it decreased significantly in the third week.Conclusion:PHN is a complex, difficult to treat and severe neuropathic pain that affects patients’ daily function and quality of life. Various agents and methods are available to relieve the symptoms of PHN. This study shows as both physical therapy and dry needling therapy are effective treatment for postherpetic nevralgia..

Use of Cyclosporine Therapy in Dermatology During COVID-19 Pandemic

Use of Cyclosporine Therapy in Dermatology During COVID-19 Pandemic

Impact of IPL treatments on parameters of acne skin.

In the treatment of acne, skin parameters such as sebum secretion, hydration, and the content of hemoglobin and melanin are very important. The values of these parameters at the appropriate level show the maintenance of good functionality of the epidermal barrier and the impact of a given treatment procedure on the condition and physiology of the epidermis. The aim of the study was to evaluate the effectiveness of anti-acne therapy with IPL by volunteers, as well as to quantify parameters such as sebum secretion, hydration level, and the content of melanin and hemoglobin in the skin. The study involved 27 volunteers with moderate acne. A series of 4 treatments was performed with intense pulse light at weekly intervals. The secretion of sebum, skin hydration, and the content of melanin and hemoglobin was measured. A decrease in sebum secretion in the forehead area after light treatments was observed, the level of hydration remained the same in all areas examined, as did the levels of melanin and hemoglobin. The volunteers were asked about the satisfaction with the effects of the treatment: 100% answered that they were satisfied with the effects of the treatment to a degree of 7.8±1.5. During anti-acne therapy, therapists usually focus only on reducing acne lesions, forgetting that proper care has a large impact on the success of dermatological therapies. It is very important to know the influence of treatment procedures on the parameters of the skin in order to choose the right care for the best treatment effect.

Phototherapy for Generalized Pruritus of Unknown Origin: Single-Center Experience.

Phototherapy is a well-established therapy in dermatology. However, there is limited evidence regarding phototherapy for the treatment of generalized pruritus of unknown origin (GPUO). The objective of this study was to assess the efficacy and safety of narrowband ultraviolet B (NB-UVB) phototherapy in patients with GPUO. Researchers conducted a retrospective review of the treatment outcomes of patients with GPUO who were treated with NB-UVB between 2004 and 2019 at their facility. Investigators included 67 patients diagnosed with GPUO treated with NB-UVB. Complete remission was achieved in more than 70% of the patients. No serious adverse events were documented. For patients with GPUO, NB-UVB may be a safe and effective treatment option.

Kortikosteroidna topikalna terapijska paleta - mesto fluocinolon-acetonid gela

Since the early days of use, in the mid of twentieth century, topical corticosteroids became the basis of contemporary dermatological therapy, because of their antiinflammatory efficiency, comfort of application free from unpleasant characteristics of previous generations of dermatotherapeutics, tar or antralin. With numerous evidences about potencies of specific corticosteroid molecules for adverse effects, optimal and efficient use of topical corticosteroid is the empiric art of dermatology, based on precise diagnosis, knowledge about the pathophysiology of dermatosis and characteristics of topical medication, and good communication with patients to promote optimal use of therapy. There are numerous strategies for optimization of skin atrophy risk and suboptimal therapeutic efficacy, caused by too restrictive topical drug use. Preferences of patients with chronic dermatoses are an important factor for good adherence with therapy, generally favoring formulations that are easier for application, less occlusive and less time-consuming. In most medical systems Fluocinolon gel is topical steroid formulation continuously present from the early days of use. It is adequate for use both for glabrous and hair-bearing skin and for oral mucosa also. A long history of use, the knowledge about effiancy and adverse effects make fluocinolone gel the important part of topical corticosteroid palette, parallel with new modern formulations.