Dermatologic Therapy Research Articles

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.

Zašto topikalni kortikosteroid plus antibiotik?

Numerous dermatoses can be treated (at least in certain phases of the disease) exclusively with local therapy. Although there is a large number of dermatological diseases, therapeutic options for local therapy are not numerous. However, adequate and timely application of available topical preparations and their combination, enables a large number of different dermatoses to be treated with a relatively small number of topical preparations. The framework of local dermatological therapy and the most commonly prescribed preparations are corticosteroids. Topical corticosteroids are used to treat inflammatory dermatoses, while they are not recommended for use in acne vulgaris, fungal and bacterial skin infections. Designing preparations that contain a topical corticosteroid and antimycotic, corticosteroid and antibiotic, and sometimes all three substances, enables the use of corticosteroids in the above-mentioned infectious skin diseases. Topically applied antibiotics play a significant role in the treatment of mild forms of acne vulgares, while in localized bacterial skin infections, their importance is such that they often make general antibiotic therapy-unnecessary. Topical corticosteroids are most often combined with oxytetracycline, bacitracin and aminoglycosides - gentamicin and neomycin. The combination of betamethasone and gentamicin in a topical preparation is often used in everyday medical practice. It is recommended for many skin diseases in which betamethasone acts anti-inflammatory, immunosuppressive, vasoconstrictive, reducing erythema, edema and skin inflammation, while gentamicin acts on gram-positive and negative bacteria that are sensitive to it and are present on the surface of affected lesions due to superinfection. Since betamethasone is a potent corticosteroid with a good effect on a large number of dermatoses and gentamicin has antibiotic and anti-inflammatory properties and effect, the combined preparation of betamethasone - gentamicin is an excellent and rational solution in local therapy of many dermatoses.

UNDER MY SKIN: A REVIEW ON DELUSION OF PARASITOSIS

Delusion of parasitosis is a fixed and firm belief of being infested by parasite, usually perceiving those parasites are crawling and burrowing beneath skin with onset at 20-30 age groups and other at 50 years and older. Women show a greater prevalence of developing this condition. Diagnosis can only be confirmed if the most essential criteria are met. Patient should be experiencing two conditions: idea of being infested by pathogen and abnormal sensation in skin that can only be explained because of the first situation. Management is focused on Dermatological therapy to include treatment for the visible damage on skin like intensified skin care, Psychopharmacology and Social psychiatric services.

Dapsone, More than an Effective Neuro and Cytoprotective Drug.

BackgroundDapsone (4,4'-diamino-diphenyl sulfone) is a synthetic derivative of sulfones, with the antimicrobial activity described since 1937. It is also a drug traditionally used in dermatological therapies due to its anti-inflammatory effect. In recent years its antioxidant, anti-excitotoxic, and antiapoptotic effects have been described in different ischemic damage models, traumatic damage, and models of neurodegenerative diseases, such as Parkinson's (PD) and Alzheimer's diseases (AD). Finally, dapsone has proven to be a safe and effective drug as a protector against heart, renal and pulmonary cells damage; that is why it is now employed in clinical trials with patients as a neuroprotective therapy by regulating the main mechanisms of damage that lead to cell death.ObjectiveThe objective of this study is to provide a descriptive review of the evidence demonstrating the safety and therapeutic benefit of dapsone treatment, evaluated in animal studies and various human clinical trialsMethodsWe conducted a review of PubMed databases looking for scientific research in animals and humans, oriented to demonstrate the effect of dapsone on regulating and reducing the main mechanisms of damage that lead to cell death.ConclusionThe evidence presented in this review shows that dapsone is a safe and effective neuro and cytoprotective treatment that should be considered for translational therapy.

Treatment of Cutaneous Photoaging of Glabella with Autologous Platelet Concentrate

Introduction: Platelet rich plasma (PRP) is an autologous blood product obtained after centrifugation of the blood. Contains high concentrations of platelets and growth factors. It is currently a very popular therapy in dermatology; however, few studies objectively evaluate its efficacy. Objective: To evaluate the efficacy and safety of intradermal microinjection of autologous platelet concentrate (APC) in the treatment of glabella rejuvenation. Method: An observational, analytical and longitudinal study was carried out in 60 patients from the Hospital Clínico Quirúrgico: “Hermanos Ameijeiras”, in the period between March 1, 2017 and March 31, 2020. The treatment was applied monthly. for 1 year. The final evaluation was carried out 3 months after the end of the treatment. Results: 60 women with an average age of 45 ± 4.3 years were treated. After treatment, there were significant changes in the Glogau Photo Damage Scale (P = 0.012), in the Photo numeric Scale for evaluating the severity of glabella wrinkles (P = 0.031) and in the Global Aesthetic Improvement Scale (P = 0.012). The adverse events found were pain, inflammation and ecchymosis. The degree of satisfaction reported by the patients was good (25.0%) and very good (75.0%) (P = 0.027). Conclusions: The autologous platelet concentrate proved to be effective and safe in reducing the signs of skin aging in glabella, associated with a high degree of patient satisfaction.

Sleep loss and the skin: Possible effects of this stressful state on cutaneous regeneration during nocturnal dermatological treatment and related pathways.

Cutaneous homeostasis can be modulated by sleep. Although there is little evidence about the efficacy of medications topically applied in the morning compared to those administered in the evening, they are commonly prescribed to be used overnight. Poor sleep may affect the tegument, but its repercussion on dermatological therapy is not clear. This communication aims to carry out an overview on the relationship between sleep and the skin, particularly in respect of the effectiveness of topical substances during the night versus the day; and the possible impact of sleep dysregulation on these treatments. Features related to this external organ, involving hydration, blood flow, and the permeability of the superficial barrier have physiological variations in sleep period. Our hypothesis is that sleep loss could alter drug absorption in the dermis and impair the success of the treatment. This can depend on the integrity of the mechanical skin barrier, and the enzymatic process after drug penetration, which may be influenced by the circadian rhythm. We raise the role of sleep disturbance in relation to skin aging and the cutaneous microbiota. The organ integrity and local immunology can be guided by sleep distress, which can modify the control of dermatological diseases. Future comparative analyses are warranted to explore the possible changes of the integumentary system influenced by circadian rhythm, and interference in response to topical dermal treatments. We emphasize the importance of sufficient sleep to improve the clinical management of several dermatosis and cosmetic complaints that need percutaneous therapeutics.

Venous Leg Ulcers: Advanced Therapies and New Technologies.

The prevalence of venous leg ulcers (VLUs) differs between 1.5% and 3% in the general population. The challenge in treating VLUs is common recurrence. Moreover, VLUs can be resistant to healing, despite appropriate treatment. In these cases, advanced wound therapies should be considered. The number of new technologies, applied in VLUs treatment, has increased in the last years. These therapies include biophysical interventions such as ultrasound therapy, electrical stimulations, electromagnetic therapy, or phototherapy. Furthermore, stem cell therapies, biologic skin equivalents, platelet-rich plasma therapy, oxygen therapies, anti-TNF therapy, or negative pressure wound therapy are advanced venous ulcer therapeutic methods that may support the standard of care. Medical devices, such as a muscle pump activator, or intermittent pneumatic compression device, may be especially useful for specific subgroups of patients suffering from VLUs. Some of the above-mentioned technologies require broader evidence of clinical efficacy and are still considered experimental therapies in dermatology.

Dermatology on the global stage: The role of dermatologists in international health advocacy and COVID-19 research.

BackgroundOver the last decade, there has been a surge in interest and funding for global health dermatology. Skin conditions are now recognized as the fourth leading cause of nonfatal disease burden worldwide in disability-adjusted life years. Dermatologists are uniquely positioned within global health because skin conditions are often the presenting sign of severe illnesses, such as neglected tropical diseases and COVID-19.MethodsWe review four major areas of work by dermatologists within global health: i) characterization of global burden of skin disease, ii) advocacy for dermatologic therapies on the World Health Organization's Model List of Essential Medicines, iii) advancements in global programming for skin-related tropical diseases, and iv) the role of dermatologists during the COVID-19 pandemic. For each area of work, the significance and impact on the health of women and girls is briefly highlighted.ResultsDermatologists have led the efforts to quantify and evaluate the global burden of skin disease, the burden of which is disproportionately shared by women. The dermatology community has also championed global efforts to eliminate skin-related neglected tropical diseases, such as scabies. Through national and international policy advocacy, dermatologists have pushed for more dermatologic therapies in the World Health Organization's Model List of Essential Medicines, helping to secure better care for patients with skin disease throughout the world. Since 2020, the dermatology community has worked collaboratively in the fight against COVID-19, establishing a worldwide registry for cutaneous manifestations of SARS-CoV-2 and pursuing research that has allowed colleagues in the house of medicine to better understand this landmark disease.ConclusionThrough the study and promotion of global health, dermatologists have an important role in the house of medicine.

Hypofractionated radiotherapy for nonmelanoma skin cancer during the COVID-19 pandemic: experience in 31 cases.

As a result of the coronavirus disease 2019 (COVID-19) pandemic, radiation therapies have been modulated to reduce the risk of infection during outpatient activities and hypofractionated regimens or radiotherapy delay for nonmelanoma skin cancer (NMSC) were suggested. Hypofractionated radiotherapy not only may confer no disadvantage in regard to outcome when compared to a more protracted schedule but might also reduce the risk of infection. We report the experience of a dermatologic radiation therapy department concerning a group of patients with a diagnosis of NMSC selected for a radiation treatment plan aimed to minimize the number of their accesses to our department.

New diagnostic and imaging technologies in dermatology.

Diagnosis of dermatological disorders is primarily based on clinical examination in combination with histopathology. However, clinical findings alone may not be sufficient for accurate diagnosis and cutaneous biopsies are being associated with morbidity. The objective of this article is to review the newer technologies along with their applications, limitation and future prospectus. Comprehensive literature search was performed using electronic online databases "PubMed" and "Google Scholar". Articles published in English language were considered for the review. In order to improve and/or widen the armamentarium in dermatologic disease diagnosis and therapy, newer emerging technologies are being made available which aid in diagnosis and management. New emerging technologies include confocal microscopy, digital photographic imaging, optical coherence tomography, high frequency ultrasonography, and artificial intelligence. There have been advancements in the dermoscopes. Significant progress is seen in the diagnostic methods and imaging technologies in dermatology, each having its advantages and limitations. Artificial intelligence/machine-based learning software may have a great scope to influence the dermatological practice.

141 Short chain dehydrogenase/reductase family 16C member 5 (SDR16C5) is a keratinocyte differentiation-dependent regulator of cutaneous retinoid metabolism

The metabolism of retinoids influences the homeostasis of the skin and represents an important target of therapies in dermatology. Short chain dehydrogenase/reductase family 16C member 5 (SDR16C5) is a member of the SDR enzyme family that converts retinol into retinaldehyde and retinaldehyde into retinoic acid. The aim of this study was to determine the expression pattern of SDR16C5 in human skin and skin appendages. Human primary epidermal keratinocytes were induced to differentiate in vitro. SDR16C5 mRNA and protein levels were determined by quantitative RT-PCR and western blot analysis. The expression pattern of SDR16C5 in human skin was investigated by immunohistochemistry. Gene expression analysis in human organs showed predominant expression of SDR16C5 in the skin. SDR16C5 mRNA and protein strongly increased in abundance during terminal differentiation of keratinocytes in monolayer culture and in organotypic skin models. In human skin, SDR16C5 was detected in the granular layer of the epidermis. In addition, SDR16C5 was expressed in sebaceous glands. The results of this study suggest that SDR16C5 is a keratinocyte differentiation-dependent regulator of cutaneous retinoid metabolism.

139 Local dermatitis upon tapestripping and vaseline treatment of healthy human skin is attenuated by coal tar: insights into AHR-targeting therapies for inflammatory skin diseases

Coal tar therapy, an old dermatological therapy, exerts its therapeutic effect through activation of the aryl hydrocarbon receptor (AHR) and AHR-targeting molecules show therapeutic efficacy in phase 2/3 trials for chronic inflammatory skin diseases. The anti-inflammatory mechanisms of AHR activation in the skin are partially understood, but mostly studied in animal models. Here we aimed to investigate the therapeutic effects of AHR activation by coal tar application on epidermal responses after skin barrier disruption and inflammatory cues in human skin. Healthy volunteers (n=9) were treated with pix lithanthracis (5% in vaseline lanette) or vehicle (vaseline lanette) after complete removal of the stratum corneum by tape stripping. Non-invasive biophysical measurements (TEWL, hydration, erythema), stratum corneum tapes (NMF and protein profiling) and biopies were taken during 4 days of treatment. Application of vaseline on tapestripped skin led to an acute inflammatory response characterized by increased keratinocyte proliferation and subsequent acanthosis, a dense dermal CD45+ and MPO+ immune cell infiltrate indicative of (neutrophilic) granulocytes and increased levels of human beta defensin-2 (hBD2). Most strikingly, coal tar treated sites clearly showed less immune cell infiltrate, less pronounced acanthosis and hBD2 levels in the stratum corneum were significantly lower than upon vaseline treatment. No differential effects were found between vaseline and coal tar treatment for the other parameters we investigated. This in vivo human acute dermatitis model indicates that activation of AHR signaling reduces the influx of inflammatory cells potentially resulting in less epidermal activation. The lack in positive effects on skin barrier parameters by coal tar may be due to the relative short study period. Further investigations on the inflammatory signaling molecules driving the acute inflammation can provide new insights in the coal tar and AHR-mediated therapeutic effects.

Journal club Update on systemic therapies in paediatric dermatology.

Journal club Update on systemic therapies in paediatric dermatology.

Platelet-rich Plasma and Its Application in Clinical Trial

Platelet-rich Plasma and Its Application in Clinical Trial

Retrospective Analysis of 170 Patients Followed up with Herpes Zoster and Postherpetic Neuralgia in Nothern Cyprus

Herpes zoster is viral infection that occurs with reactivation of the varicella-zoster virus (VZV). It is usually a painful but self-limited dermatomal rash with cutaneous distribution. Although it's usually a painful, self-limiting rash, it can be much more serious; In addition, acute cases often lead to postherpetic neuralgia (PHN) and seriously impair quality of life. It is important to recognize those at risk of developing postherpetic neuralgia, early treatment and prevent complications.
 Objectives :Our aim is to determine the clinical features of our herpes zoster diseases and to review 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 physatrist) and representing 5600 people. We analyzed a retrospective 170 case series of pediatirc and adults addmited to the dermatology and physical therapy and rehabilitation outpatient clinic between October 2018 and October 2020. 
 Results: A total of 170 new cases had been diagnosed with HZ in the dermatology and physical therapy and rehabilitation clinics over 2 years . Female to male ratio was 2:1 and the age ranged from 5 years to 88 years. The thoracic dermatomes were the most commonly involved. The risk of developing PHN 1 month after the start of the zoster rash was 21 %. Independent risk indicators for the occurrence of PHN were age [55–74] years.
 Conclusion : The risk of developing PHN increases with age and with commorbitity. Preventive strategies such as vaccination should focus on patients with herpes zoster aged >55 years.

Peeling with 25% trichloroacetic acid in the treatment of facial skin photoaging

Introduction: The chemical peel consists of the application of chemical exfoliants that eliminate the layers of the skin so that it can regenerate with an improved texture and pigmentation. It is currently a valuable therapy in dermatology, however, few studies objectively evaluate its efficacy. Objective: To evaluate the efficacy and safety of peeling with 25% trichloroacetic acid in the treatment of facial skin rejuvenation. Method: An observational, analytical and longitudinal study was carried out in 250 patients from two hospitals (Surgical Clinic: “Hermanos Ameijeiras” and General Teaching: “Enrique Cabrera”), in the period between January 2010 and January 2020. Treatment It was applied monthly for 6 months. The final evaluation was carried out 3 months after the end of the treatment. Results: 238 women and 12 men were treated with an average age of 30.5 (± 8.4) years. After treatment, there were significant changes in the Glogau Photo Damage Scale (P=0.012), in the Lemperle Wrinkle Assessment Scale (P=0.016) and in the Global Aesthetic Improvement Scale (P=0.021). The adverse events found were burning, inflammation and scaling. The degree of satisfaction reported by the patients was good (4.4%) and very good (95.6%) (P=0.011). Conclusion: The 25% trichloroacetic acid peel proved to be effective and safe to reduce the signs of facial skin aging, associated with a high degree of patient satisfaction.

Efficacy and Safety of Autologous Platelets Concentrate in the Treatment of Crow's Feet Photo Aging

Introduction: Platelet rich plasma (PRP) is an autologous serum that contains high concentrations of platelets and growth factors. It is currently a versatile therapy in dermatology; however, few studies objectively evaluate its efficacy. Objective: To evaluate the efficacy and safety of intradermal microinjection of autologous platelet concentrate (APC) in the treatment of crow's feet rejuvenation. Method: An observational, analytical and longitudinal study was carried out in 60 patients from the Hospital Clínico Quirúrgico: “Hermanos Ameijeiras”, in the period between March 1, 2017 and March 31, 2020. The treatment was applied monthly. for 1 year. The final evaluation was carried out 3 months after the end of the treatment. Results: 60 women with an average age of 45 ± 4.3 years were treated. After treatment, there were significant changes in the Glogau Photo Damage Scale (P = 0.0022), in the Photonumeric Scale to assess the severity of crow's feet (P = 0.0111) and in the Global Aesthetic Improvement Scale. (P = 0.0033). The adverse events found were pain, inflammation and ecchymosis. The degree of satisfaction reported by the patients was good (16.6%) and very good (83.3%) (P = 0.0021). Conclusions: The autologous platelet concentrate proved to be effective and safe in reducing the signs of cutaneous aging of crow's feet, associated with a high degree of patient satisfaction.

Retraction statement: Role of resolvin D1 in psoriasis before and after narrowband ultraviolet B phototherapy: A case-control study.

Retraction: Elmasry, MF, Hassan, E, Rashed, LA, Abdel Halim, DM. Role of resolvin D1 in psoriasis before and after narrowband ultraviolet B phototherapy: A case-control study. Dermatologic Therapy. 2021; 34:e14879 (https://doi.org/10.1111/dth.14879). The above article, published online on 14 February 2021 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal's Editor-in-Chief, Dr Robert Schwartz, and Wiley Periodicals, LLC. The retraction has been agreed due to errors within the methodology section. The authors previously indicated that resolvin D1 was measured using a PCR technique, when it was actually an ELISA test that was used. As a result, significant changes to the methodology section and corresponding updates to tables and figures are needed. Due to the number of changes needed, the journal is unable to determine the veracity of the authors' previously reported results and conclusions and so has taken the decision to retract the article.