Dermatologic Perspective Research Articles

English

Vitamin D is a fat-soluble steroid hormone that is crucial for human health. Since long the role of epidermal keratinocytes in the UVB-induced photochemical conversion of 7- dehydrocholesterol to vitamin D3 is known, and also for the enzymatically controlled hydroxylation of the photolysis product. This whole process results in the formation of the biologically active final product 1, 25-(OH)2 D3 (Calcitriol). Moreover recently various research articles have shown benefits of calcitriol and various other vitamin D analogues having a therapeutic role in various dermatologic conditions like psoriasis, atopic dermatitis, acne, vitiligo owing to its anti-inflammatory, anti- proliferative action. The present review shows a summary of role of vitamin D in dermatologic perspective.

DC-T cell virological synapses and the skin: novel perspectives in dermatology.

Virological synapses (VS) increase cell-to-cell viral transmission and facilitate propagation of human immunodeficiency virus type 1 (HIV-1) and human T-cell leukaemia virus type 1 (HTLV-1). VS formation also plays a more general role in viral replication and dissemination. VS have been observed in vitro and ex vivo between uninfected T cells and T cells infected with HIV-1 or HTLV-1. In addition, dendritic cells (DC) infected with HIV-1 also play an important role in viral transmission to uninfected CD4+ T cells via VS formation. Recent studies revealed that several DC subsets are also infected with HTLV-1. These findings may help explain the rapid dissemination of both viruses within secondary lymphoid tissues in vivo. VS also explain, at least in part, why HIV-1 can propagate in the mucosal sites during sexual transmission. Furthermore, in the case of HTLV-1, VS can potentially explain some of the features of HTLV-1-associated dermatitis as infected T cells in the skin contribute to the pathogenesis of this condition.

Skin diseases in tea collectors

The tea collection is a difficult and laborious task, but few studies have analyzed risks by work activities or the work environment. To investigate the effects of work activities and work environment on tea collectors by looking from dermatological perspective, detailed dermatological examination was performed on tea collectors and clinical backgrounds of the participants were questioned and all findings were noted. The participants clinically suspected for skin, hair and nail infections have been referred to our hospital microbiology laboratory for sampling. The most common diseases in the participants were allergic contact dermatitis, irritant contact dermatitis and acute paronychia. These three diseases accounted for 59.1% of the total diseases in tea collectors. Clinical background story was unremarkable in the vast majority of participants. The current study draws attention to this business area and health problems of tea collectors. The authors think that, use of protective equipment such as masks and gloves during working and receiving of safety training related to their job will decrease work-related health problems of tea collectors.

RETRACTED: Bullous pemphigoid: Associations and management guidelines: Facts and controversies

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Editor following the discovery that the text overlaps significantly with sections of several articles that are cited in the reference section, including the following: Culton DA, Diaz LA. Treatment of subepidermal immunobullous diseases. Clin Dermatol 2012;30:95–102. Meurer M. Immunosuppressive therapy for autoimmune bullous diseases. Clin Dermatol 2012;30:78–83. Ljubojevic S, Lipozencic J. Autoimmune bullous diseases associations. Clin Dermatol 2012;30:17–33. Sehgal VN, Verma. Leflunomide: dermatologic perspective. J Dermatolog Treat 2013;24:89–95. Gürcan HM, Ahmed AR. Analysis of current data on the use of methotrexate in the treatment of pemphigus and pemphigoid. Br J Dermatol 2009;16:723–31. Chen YJ, Wu CY, Lin MW, et al. Comorbidity profiles among patients with bullous pemphigoid: a nationwide population-based study. Br J Dermatol 2011;165:593–9

Morgellons: a novel dermatological perspective as the multisystem infective disease borreliosis

Morgellons disease (MD) is a term that has been used in the last decade to describe filaments that can be found in human epidermis. It is the subject of considerable debate within the medical profession and is often labeled as delusions of parasitosis or dermatitis artefacta. This view is challenged by recent published scientific data put forward between 2011-2013 identifying the filaments found in MD as keratin and collagen based and furthermore associated with spirochetal infection. The novel model of the dermopathy put forward by those authors is further described and, in particular, presented as a dermal manifestation of the multi-system disease complex borreliosis otherwise called Lyme disease. A differential diagnosis is drawn from a dermatological perspective. The requirements for a diagnosis of delusional disorder from a psychiatric perspective are clarified and the psychological or psychiatric co-morbidity that can be found with MD cases is presented. A concurrent case incidence is also included. Management of the multisytem disease complex is discussed both in general and from a dermatological perspective. Finally replacement of the term ‘Morgellons’ by ‘borrelial dermatitis’ is proposed within the profession.

Vaccines from a Dermatology Perspective: HPV Vaccines

Vaccines from a Dermatology Perspective: HPV Vaccines

Behcet′s disease in India: A dermatological perspective

Behcet's disease (BD) is a chronic, recurrent, multi-system inflammatory disorder involving mucocutaneous (MC), ocular, intestinal, articular, vascular, urogenital and neurologic systems. BD occurs with a high prevalence in the Mediterranean population. There is scarcity of clinical data on BD from India with only three case series in the last two decades. To study demographic profile, clinical manifestations and treatment outcome of patients with BD presenting to the dermatologic clinic in a tertiary hospital in north India. Prospective analysis of all patients diagnosed to have BD between 1997 to 2011. Twenty nine patients were diagnosed to have BD. The disease had a female preponderance (M:F = 1:3.8) with a mean age of disease onset of 27.4 (range 16-61) years. The prevalence of various MC and systemic manifestations are as follows: oral aphthae (100%), genital aphthae (93.1%), erythema nodosum (62%), papulopustular and acneiform lesions (31%), articular involvement (68.9%), ocular involvement (31%) and gastrointestinal (GI) involvement (3.4%) . Pathergy test positivity was observed in 31%. The treatment comprised of colchicine (16/29 patients), dapsone (7/29), dapsone with pentoxiphylline (3/29), systemic steroid (2/29), systemic steroid with methotrexate (1/29). Colchicine was effective and well tolerated in all patients. The disease occurs in a much milder form in India and is primarily mucocutaneous and arthritic. A high index of suspicion in patients with MC lesions may result in early diagnosis, management and prevention of complications of BD. We suggest colchicine as an effective and safe therapeutic option for MC and joint involvement.

Oral lesions associated with injected hydroxyapatite cosmetic filler - reply

Objective The purpose of the study was to present the clinical and microscopic features of oral foreign body granulomas associated with the injectable dermal filler Radiesse, and to increase awareness of this potential complication as the use of dermal fillers by the aging Baby Boom generation increases. Study Design Demographic and clinical data of 8 patients with foreign body granulomas containing the characteristic microscopic appearance of hydroxyapatite microspheres were studied. Analysis of the microspheres of 1 case was carried out by energy dispersive x-ray microanalysis to confirm the calcium and phosphorus content. Results The clinical and microscopic appearance of Radiesse-induced foreign body granulomas is illustrated and discussed. Conclusions Foreign body granulomas containing hydroxyapatite microspheres in patients receiving treatment with the cosmetic filler Radiesse have a characteristic microscopic appearance. Oral Radiesse-induced nodules occur more often in older women, most commonly in the lips and the mandibular labial vestibule.

Guidelines for the management of androgenetic alopecia (2010)

Guidelines for the management of androgenetic alopecia (2010) Ryoji TSUBOI, Satoshi ITAMI, Shigeki INUI, Rie UEKI, Kensei KATSUOKA, Sotaro KURATA, Takeshi KONO, Norimitsu SAITO, Motomu MANABE, Masashi YAMAZAKI, GUIDELINES PLANNING COMMITTEE FOR THE MANAGEMENT OF ANDROGENETIC ALOPECIA Department of Dermatology, Tokyo Medical University, Tokyo, Department of Regenerative Dermatology, Osaka University Graduate School of Medicine, Osaka, Department of Dermatology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Department of Dermatology, School of Medicine, Kitasato University, Sagamihara, Kurata Clinic, Beppu, Department of Dermatology, Nippon Medical School, Tokyo, and Department of Dermatology, Akita University Graduate School of Medicine, Akita, Japan

Psoriatic arthritis: from a dermatological perspective

Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy associated with psoriasis, and included among the seronegative spondyloarthropathies. The presence of cutaneous psoriasis is very important for correct and early diagnosis of PsA, because the cutaneous lesions precede the appearance of joint manifestations. Thus, dermatologists are in a position to detect the condition at its inception. PsA is clinically subdivided into asymmetric oligoarticular arthritis, symmetric polyarthritis, distal interphalanges predominant, arthritis mutilans, and spondylitis types. PsA has several unique characteristics, such as enthesopathy, dactylitis and abnormal bone remodeling. Genetic, environmental, and immunological factors are important in its development. The triggering role of physical stress is seen in the "deep Koebner" phenomenon, which causes inflammation in the synovial membrane and in enthesis, resulting in peripheral arthritis. Cellular infiltrates such as activated T-cells and macrophages are thought to play important roles in the induction of inflammatory and destructive processes in joint tissues, as well as psoriatic skin. New ideas regarding the involvement of the IL-23/Th17 axis have emerged, and the dramatic effects of targeting therapies have highlighted the physiological role of key cytokines in psoriasis. Current views on the pathogenesis of PsA are reviewed from a dermatological perspective.

Clinical parameters in male genital lichen sclerosus: a case series of 329 patients

The dermatological aspects of male genital lichen sclerosus (MGLSc) have not received much prominence in the literature. Sexual morbidity appears under-appreciated, the role of histology is unclear, the relative places of topical medical treatment and circumcision are not established, the prognosis for sexual function, urinary function and penis cancer is uncertain and the pathogenesis has not been specifically studied although autoimmunity (as in women) and HPV infection have been mooted. To illuminate the above by analysing the clinical parameters of a large series of patients with MGLSc. A total of 329 patients with a clinical diagnosis of MGLSc were identified retrospectively from a dermatology-centred multidisciplinary setting. Their clinical and histopathological features and outcomes have been abstracted from the records and analysed by simple descriptive statistics. The collation and analysis of clinical data derived from the largest series of men with MGLSc ever studied from a dermatological perspective has been achieved. These data allow the conclusions below to be drawn. MGLSc is unequivocally a disease of the uncircumcised male; the adult peak is late in the fourth decade; dyspareunia is a common presenting complaint; non-specific histology requires careful interpretation; most men are either cured by topical treatment with ultrapotent steroid (50-60%) or by circumcision (>75%); effective and definitive management appears to abrogate the risk of developing penile squamous cell carcinoma; urinary contact is implicated in the pathogenesis of MGLSc; HPV infection and autoimmunity seem unimportant.

Dermonutrition and akin care: the Essensis®case

The skin is an outward sign of inner health and well being. Providing protection is certainly one of the most important function of the skin functions. As a protective barrier, the skin must prevent water loss and protect against pathogen and foreign substances entering the body. One of the primary layers that provide this protection is the stratum corneum (SC). Lifestyle changes such as ageing, and environmental factors, in particular cold weather, can impair the functioning of this barrier through alterations to the composition of the lipids which make up the SC. Under such circumstances, transepidermal water loss levels may be elevated and the natural moisture barrier may be more susceptible to irritation or to the development of dry skin. It is now well established that good skin condition is dependent upon nutrients in the diet. Interestingly some nutritional factors could help to improve skin barrier such as fatty components (fatty acids, vitamin E) that helps to improve the natural moisture barrier of the skin and or keratinocyte cellular differentiation which in vitro improve SC barrier function. Essensis is a fermented dairy product specifically formulated with borage oil, green tea extract and vitamin E to improve skin barrier function as part of a healthy diet. Essensis addresses the healthy population – globally and from a dermatological perspective.

The pathobiology of psoriatic synovium

Psoriatic arthritis pathogenesis is incompletely understood and the pathophysiologic role of the synovium is only beginning to be elucidated. Currently, approaches similar to those applied to rheumatoid arthritis are being applied to psoriatic arthritis synovia. Synovitis is being re-examined along with efforts to better characterize the clinical phenotype and improve patient stratification. The dermatological perspective brings an alternative view of autoimmunity and the role of innate immunity. A pathogenetic basis for the differing roles of skin and synovium is suggested by a landmark animal study that demonstrated a psoriasis-like skin disease coupled with a T cell and B cell dependent arthritis. The histopathology of the synovio-entheseal complex has been described. Systematic methods for evaluating synovitis have been developed and cross-sectional evaluations of psoriatic arthritis synovia in the context of other arthritides have been performed. Fresh looks at psoriatic arthritis synovia suggest similarity to rheumatoid arthritis synovia. Research into the pathophysiology of psoriatic arthritis is at an early, yet promising stage. Instruments are being developed to characterize and stratify psoriatic arthritis. The role of synovia remains unclear, but we now have a better understanding of the pathology of innate and adaptive immunity and are reminded that psoriatic arthritis is a systemic disease.

Autoinflammatory syndromes with a dermatological perspective

The term autoinflammatory syndromes describes a distinct group of systemic inflammatory diseases apparently different from infectious, autoimmune, allergic and immunodeficient ones. Originally, it was almost synonymous with clinically defined hereditary periodic fever syndromes, including familial Mediterranean fever, hyper immunoglobulin D syndrome with periodic fever and tumor necrosis factor receptor-associated periodic syndrome. Similar but distinct periodic fever syndromes accompanied by urticarial rash, familial cold autoinflammatory syndrome, Muckle-Wells syndrome and chronic infantile neurological cutaneous articular syndrome, have all been reportedly associated with CIAS1 mutations and are collectively called cryopyrin-associated periodic syndromes. Consequently, the concept of autoinflammatory syndromes has been spread to contain other systemic inflammatory diseases: rare hereditary diseases with or without periodic fevers, such as pyogenic sterile arthritis, pyoderma gangrenosum and acne syndrome, Blau syndrome and chronic recurrent multifocal osteomyelitis, and the more common collagen disease-like diseases, such as Behcet's disease, Crohn's disease, sarcoidosis and psoriatic arthritis. These diseases are all caused by or associated with mutations of genes regulating innate immunity and have common clinical features accompanied with activation of neutrophils and/or monocytes/macrophages. In this review, major autoinflammatory syndromes are summarized and the pathophysiology of related skin disorders is discussed in association with dysregulated innate immune signaling.

Anal intraepithelial neoplasia and anal cancer in dermatological practice

Anal intraepithelial neoplasia is considered to be a precursor lesion of invasive anal cancer. It is now increasingly recognized in high-risk groups, such as men who have sex with men and HIV-infected patients. Human papillomaviruses are considered to be an important aetiological agent in both anal intraepithelial neoplasia and anal cancer. Dermatologists are likely to encounter these conditions among the differential diagnoses to be considered in high-risk patients presenting with perianal and anal lesions. Anal cancer rates are also increasing among the HIV-infected and HIV-non-infected population. The successful treatment of anal intraepithelial neoplasia may reduce the risk of subsequent development of anal cancer. However, current therapies for anal intraepithelial neoplasia may be associated with treatment-related morbidity and are not well validated. It is currently not proven that they reduce the likelihood of the development of anal cancer. Nevertheless, screening for anal intraepithelial neoplasia is being advocated for high-risk groups and may become standard dermatological care for these patients. In view of recent developments in the understanding of this condition, this article reviews the current understanding of anal intraepithelial neoplasia and its treatment from a dermatological perspective.

Kutaner Lupus erythematodes

Cutaneous lupus erythematosus (CLE) is a heterogenous disorder with a wide range of skin manifestations. Therefore, it has been difficult to develop a unifying concept for classifying CLE from the dermatologic perspective in the past. In 2004, the classification system was updated and includes now acute CLE (ACLE), subacute CLE (SCLE), chronic CLE (CCLE), and intermittent CLE (ICLE). Additional rarely described variants are not listed as separate entities but are included in the classical forms. Diagnosis of the different subtypes of CLE is made by considering genetic, clinical, histopathologic, and immunoserologic findings, with a systematic analysis of individual criteria. In the past years, the etiology and pathogenesis of CLE has been subject of intensive research and it has been shown by several groups that exogenous factors, such as ultraviolet light and drugs, can induce CLE. The first part of this review will enable the reader to identify the various clinical manifestations of CLE and to employ characteristic criteria to assess differential diagnostic considerations.

Biological warfare from a dermatologic perspective.

Biological warfare agents have been used in this century by both organized armed forces and terrorist organizations. Beset with many problems that limit their tactical value on the battlefield, such "weapons of mass destruction" have tremendous terror appeal. Unusual presentations or clustering of diseases associated with biowarfare might alert the clinician that an attack has occurred. The clinical presentations, current recommended treatments, and preventive measures of agents such as anthrax, smallpox, plague, and the viral hemorrhagic fevers are discussed, as well as some of the issues that have been raised as authorities are considering how and when to resume smallpox vaccinations. References focus on current Internet web sites, which will provide up-to-date information and advice for allergists with immunization questions or who feel they might have encountered a patient with one of these diseases.

Human immunodeficiency virus infection. Dermatologic perspective

High prevalence and atypical cutaneous symptoms, signals and evolution are main characteristics of HIV-associated dermatosis, where infections and neoplasms are quite common. Mostly difficult, diagnosis of skin involvement is important to corroborate the clinical suspicion of HIV infection. In the present work, after a short review on epidemiology, pathogeny and clinical aspects of the HIV infection, main AIDS-related dermatosis are described. The usual clinical patterns and their modifications are reviewed.

When Is a Skin Rash More than Just a Rash? Sexually Transmitted Diseases: A Dermatological Perspective

When Is a Skin Rash More than Just a Rash? Sexually Transmitted Diseases: A Dermatological Perspective

Abnormal cervical cytology in pregnancy: a laboratory and clinical dermatologic perspective.

The dermatologic examination of the pregnant woman with abnormal cervical cytology can be a challenge to the clinician. This article explores both the laboratory and clinical examinations and the special issues of each that are affected by pregnancy. The technique of obtaining an adequate Pap test as well as guidelines on managing the abnormal Pap result will be addressed. Normal and abnormal colposcopic findings are described with reasons why they may be more difficult to differentiate in pregnancy. As long as no invasive cancer is found, the pregnancy may proceed with continued surveillance. Postpartum regression rates of intraepithelial neoplasia are high.