Desquamation Research Articles

Chikungunya virus infection in the skin: histopathology and cutaneous immunological response

Alphavirus chikungunya virus (CHIKV) is an arbovirus, belonging to the Togaviridae family. The disease caused by CHIKV generally evolves with spontaneous resolution in a few weeks; however, progression to a chronic disease may occur. The most common symptoms are fever, myalgia, and arthralgia; however, skin manifestations may occur in 40 to 80% of infected individuals. Morbilliform and maculopapular erythematous eruptions, vesiculobullous lesions, generalized erythema, maculopapular eruption and skin peeling, hypermelanosis, painful oral lesions, and urticarial lesions have been reported. Usually, these manifestations disappear, but they can become sequelae. Since the skin is the first line of defense against CHIKV infection, in this study, we aimed to investigate the immunohistopathological aspects of the skin of infected individuals during the acute phase of the disease by performing histopathological and ultrastructural analysis, detection and quantification of the viral genome, detection of viral antigen and immune cells, and cytokines/chemokines’ characterization. The main histopathological findings were perivascular and inflammatory infiltrates, blood capillary ectasia, and interstitial edema. The immunohistochemistry revealed CHIKV antigen in the epidermis, endothelial cells, fibroblasts, and macrophages in the reticular and papillary dermis; inflammatory cells infiltrate; arrector pili muscle; sweat and sebaceous glands; and hair follicle. Moreover, inflammatory infiltrates were composed of lymphocytes (CD4+ and CD8+) and macrophages (CD68+) in the dermis and perivascular infiltrate. TNF-α, IL-6, RANTES, and VEGFR2 were expressed in the epidermis, blood vessels, sweat glands, and migrating cells. Loss of contact among adjacent keratinocytes, epidermis presenting necrotic cells, and fibroblasts with dilated cisternae in the endoplasmic reticulum and mitochondria with few cristae was observed by transmission electron microscopy. Studies involving skin immunopathogenesis during CHIKV infection are still scarce; therefore, the findings presented here can contribute to a better understanding of the disease immunopathogenesis.

SYNDROME OF BURNED SKIN IMPROVEMENTS IN TREATMENT AND DIAGNOSIS

Background: Staphylococcus aureus produces epidermolytic toxins that disrupt epidermal cell connections, resulting in staphylococcal scalded skin syndrome (SSSS). Blisters, erythematous cellulitis, and superficial skin peeling characterize this condition. Objective: To provide an overview of the clinical foundation, etiopathogenesis, complications, current treatment options, and potential future advancements in managing SSSS. Methods: This review synthesizes available data on the pathogenesis, clinical manifestations, differential diagnoses, and therapeutic interventions for SSSS. Results: It is classified as a toxin-mediated infection, primarily affecting adults and pediatric patients. Key therapeutic interventions include: Wound care to protect damaged skin. Antibiotic therapy with antistaphylococcal medications. Supportive care with analgesia. Differential diagnoses such as toxic epidermal necrolysis, adverse drug reactions, and Stevens-Johnson syndrome require multidisciplinary evaluation by dermatologists, infectious disease specialists, and surgeons. Conclusion: Effective management of SSSS involves a multidisciplinary approach to reduce mortality. Future developments may enhance understanding and treatment outcomes for this toxin-mediated disease.

Analisis Produktivitas dan Efektivitas Pada Pembuatan Alat Pengupas Kulit Kelapa Muda

This study aims to design and analyze a young coconut skin peeling tool to improve efficiency and safety in the coconut-cutting process, which is currently done manually. The manual process, which takes an average of 3 minutes per coconut, is potentiallyinefficient and risky. With the development of this tool, it is expected to speed up the peeling process, increase productivity, and support the growth of Pak Agung's business in Sidoarjo Regency. The methods used in this study include productivity analysis and effectiveness analysis of the tool. The productivity analysis was conducted by calculating the time required to peel a certain number of coconuts before and after the use of the tool, while the effectiveness analysis evaluates how much the tool can reduce processing time and increase the number of coconuts that can be processed in a unit of time. The analysis results show that after using the tool,the time needed to peel 30 coconuts was reduced from 95 minutes to only 16 minutes, and the processing time per coconut dropped from 3 minutes to 32 seconds. This achievement shows a significant improvement, reflecting better operationalefficiency. This study emphasizes the importance of innovation in tools and technology to support the sustainability of micro and small businesses, as well as to contribute positively to the performance of the coconut processing industry. Keywords: Cost Analysis, Effectiveness, Productivity, Product Design

EGFR Mutation in Neonatal Nephrocutaneous Syndrome: Unveiling a Genetic Challenge

AbstractEpidermal growth factor receptor (EGFR) is a transmembrane glycoprotein that exhibits tyrosine kinase signaling activity, playing a pivotal role in various cellular processes. Overexpression or overactivity of EGFR is significantly associated with inflammatory and malignant diseases, particularly lung cancer. Conversely, germline loss-of-function mutations in EGFR have been distinctly linked to a rare condition known as neonatal nephrocutaneous syndrome. We report a case of a preterm female neonate, born to consanguineous parents and from a pregnancy that was complicated by polyhydramnios. From birth, she displayed distinctive clinical features, including fragile skin and widespread erythema, sparse scalp hair, bilateral ankyloblepharon, thick eyebrows, and arachnodactyly. Subsequently, she developed progeroid features marked by skin desquamation, along with failure to thrive, diarrhea, and severe electrolyte and acid–base imbalances. Additional complications comprised anemia, generalized mucocutaneous candidiasis, external otitis, and recurrent septic episodes. Genetic analysis confirmed a homozygous EGFR mutation c.1283G > A p.(Gly428Asp). The infant's neurological status remained stable, albeit requiring pain management through oral morphine and gabapentin. Palliative care became imperative, given the dismal prognosis. The identified mutation is exceedingly rare, with only 24 reported cases known thus far. Each of these instances resulted in a complex multisystemic condition marked by a wide range of challenging symptoms and signs. This clinical journey highlights the intricate interplay among genetic mutations and complex medical conditions, and underscores the critical significance of multidisciplinary care.

Effect of topical treatment with urea in ichthyosis, atopic dermatitis, psoriasis, and other skin conditions—a systematic review

Introduction: The urea composition has a profound effect on skin disorders, specifically xerosis, desquamation, and scaling, which are some of the main concerns of the current health industry. The application of urea is relatable and more bioactive than alternate treatments. The objective of this systematic review was to evaluate the effectiveness of topically applied urea in the treatment of ichthyosis, psoriasis, and other dermatologic conditions. Data and sources: Research articles were retrieved through electronic databases, including Google Scholar, PubMed, EMBASE, Elsevier, and Sage, selected based on the provision of online free literature from its inception till November 2023. The significant findings were skin dryness, transepidermal water loss (TEWL), and eczema. Study selection: A total of 1826 studies have been found, of which 31 were selected based on inclusion criteria. The primary reason for the exclusion of the studies was the application of urea as a control. All in vivo studies disclosed the effectiveness of urea treatment separately or in addition to another compound on skin conditions. The selected studies have reported findings related to the improvement in xerosis, erythema, scaling, and reduction in TEWL. Conclusion: According to the in-depth review of the research articles, the application of urea has a tremendous effect on different skin diseases. Still, its role as monotherapy is overlooked due to the presence of more susceptible alternate products that need to be addressed. However, in the future, the evaluation of the effects of treatment containing urea with antibiotics on skin diseases would be more beneficial for practical knowledge.

Acyclovir Induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis - A Rare Case Report

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis are serious, life-threatening conditions often triggered by drug reactions, characterized by widespread skin detachment and mucosal involvement. This case report describes a 29-year-old woman who developed Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis after receiving prophylactic acyclovir for suspected herpes. The patient initially presented with oral ulcers that rapidly progressed to widespread blisters, ulcers, and severe skin peeling. A thorough diagnostic evaluation, including skin biopsy and the Naranjo algorithm, identified acyclovir as the causative agent. The patient was managed in intensive care with intravenous methylprednisolone 500mg per day for 3 consecutive days as pulse therapy, antibiotics, and other supportive treatments. This case underscores the importance of early recognition, prompt discontinuation of the offending drug, and a multidisciplinary treatment approach. It also highlights the critical need for heightened awareness among healthcare professionals regarding the potential for severe adverse reactions with commonly used medications like acyclovir, to improve patient safety and outcomes.

Severe Cutaneous Toxicity in A 67-Year-Old Patient with Metastatic Urothelial Carcinoma Undergoing Therapy with Enfortumab Vedotin and Pembrolizumab.

Enfortumab vedotin (EV) combined with pembrolizumab (EV+P) is a promising first-line therapy for metastatic urothelial carcinoma. While it has shown significant efficacy, severe cutaneous adverse events such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been reported. We present this case as another example of severe skin off-target toxicity associated with this treatment, emphasising the importance of recognising this potential complication. A 67-year-old male with metastatic urothelial carcinoma, chronic kidney failure and liver cirrhosis presented with fever, respiratory symptoms and a pruritic rash after two doses of EV+P. The rash rapidly worsened, leading to extensive skin desquamation affecting 20-30% of his body surface area. Skin biopsies confirmed SJS with early-stage TEN (SJS/TEN overlap). The patient was treated with high-dose intravenous steroids, empirical antibiotics for neutropenia and intensive topical care. Significant re-epithelialisation occurred by day 13, and the patient was discharged on day 15 with cessation of EV+P therapy. This case demonstrates the potential for severe cutaneous toxicity in patients receiving EV+P, especially those with complex comorbidities. Early recognition and prompt, aggressive management with systemic corticosteroids are essential for improving outcomes. The case highlights the need for vigilance in monitoring for such adverse events and reporting them to improve patient safety. High clinical suspicion recognition of early signs of dermolysis is essential in managing severe cutaneous toxicity associated with enfortumab vedotin.A multidisciplinary approach the management of Stevens-Johnson syndrome/toxic epidermal necrolysis should involve a multidisciplinary team, especially in patients with complex comorbidities.Pharmacovigilance continuous monitoring and prompt reporting of adverse events to health authorities are vital for improving patient safety and therapeutic outcomes.

Multi-scale modeling of hydrogel-based concrete formed under the ambient environment and the extremely harsh environment of Mars

Hydrogel-based concretes (HBCs) are an emerging class of load-bearing composite materials consisting of inert particles joined together by micro-hydrogel joints. As HBCs can harden via sol-gel process and H2O phase changes under a freezing temperature and vacuum, they are suitable for future exterritorial constructions. Previous studies have demonstrated that the internal microstructure of the hydrogel joints in HBC varies significantly with curing temperature and air pressure, leading to variations in their mechanical properties. In this study, we present a new multi-scale model that quantitatively predicts the mechanical properties of HBC formed under different curing environments including Martian atmosphere. On the micro-scale, four representative joint microstructures are studied, including tubular, foamy, honeycomb, and tube-cased-foam joints. We experimentally studied and analytically derived the constitutive relationship between the joint force and displacement. Particularly, we determined the process of hydrogel skin peeling from the particle's surface of tubular joints based on force and energy equilibrium. On the macro-scale, we simplified the constitutive joint relationships in a linear parallel bond model (LPM) and employed them to quantify interparticle relationships in a discrete element method (DEM)-based HBC model. The Weibull distribution is used to consider the variation of tensile and shear strengths of the hydrogel joints in the DEM. The modeling results are not only validated with the experimentally acquired compressive stress-strain curves of HBC, but also accurately predict the combined influence of mix design and curing conditions on the mechanical properties.

Human acute poisoning incidents associated with neonicotinoid pesticides in the U.S. Incident Data System (IDS) database from 2018–2022 – frequency and severity show public health risks, regulatory failures

BackgroundNeonicotinoid pesticides (‘neonics’) – imidacloprid, thiamethoxam, clothianidin, acetamiprid, dinotefuran—are the most widely used class of insecticides in the world. They have a neurotoxic mechanism of action, similar to nicotine. They are detected in food, waterways, tap water, and breast milk.MethodsWe make use of the non-occupational human pesticide poisoning reports in the U.S. Environmental Protection Agency (EPA) online Incident Data System (IDS). The data set contains individual incidents, and incidents aggregated and submitted in bulk to EPA. IDS reports are predominantly self-reported information of varying and often low level of detail and are not routinely validated or verified by EPA.ResultsWe reviewed 842 non-occupational human poisoning incidents associated with neonics in the IDS from 2018 through 2022. There are four human fatality reports, two associated with clothianidin and two with acetamiprid. Major illnesses such as seizures were reported in several cases, including with dinotefuran cockroach bait product, and an imidacloprid lawn product. Moderate poisonings make up 88% of the total poisonings (740 of 842), with most of those associated with imidacloprid (547 incidents) or dinotefuran (102 incidents). Common reported symptoms classified as moderate often included two or more of the following: headaches; dizziness; lethargy; eye or throat irritation; skin itching and rash; chemical burns and skin peeling; face swelling; muscle weakness or tremors; vomiting; diarrhea; pain and tightness in chest; open sores; and general pain. These incidents stem mainly from residential uses, such as lawn and garden insect repellents, home pest treatments for bed bugs or roaches, and products used to treat pets for fleas and ticks.ConclusionGiven the evidence of neurotoxicity, EPA should use its legal authority to cancel unsafe products and unnecessary uses – including from seed treatments, and residential pet and lawncare products – to prevent further human suffering.

Deflazacort-induced Steven-Johnson syndrome: a case report and literature review

Objective: To summarize the clinical features and outcomes of deflazacort-induced Steven Johnson syndrome (SJS)-toxic epidermal necrolysis (TEN) to raise awareness among patients with Duchenne muscular dystrophy (DMD), neurologists as well as other deflazacort users. Methods: The clinical data of a boy with DMD who had SJS induced by deflazacort treated at the Department of Rheumatology & Clinical Immunology of Tianjin Children's Hospital in July 2024 was analyzed retrospectively. Taking "deflazacort" "Steven-Johnson syndrome" "toxic epidermal necrolysis" in Chinese or English as the keywords, literature was searched at CNKI, Wanfang, China Biomedical Literature Database and PubMed up to July 2024. The clinical characteristics, treatment and outcomes of deflazacort-induced SJS-TEN were summarized. Results: A 12-year-old boy was admitted with a 3-day history of rash. He was diagnosed with DMD at the age of 3 and had been treated with prednisolone since the age of 8. Forty-four days before admission, the patient started deflazacort to replace prednisolone. Three days before admission, progressively worsening erythematous maculopapular rashes, blisters and skin peeling (8% body surface area), oral mucosal erosion, and exudative conjunctivitis occurred, thus deflazacort was discontinued. Complete remission of SJS was achieved after treatment with intravenous immunoglobulin (IVIG, total 1.4 g/kg), 2 doses of etanercept (0.9 mg/kg, once), subcutaneous injection and intravenous methylprednisolone (0.7 mg/(kg·d)). Based on the literature, there were 5 reports in English while none in Chinese, altogether 7 cases were reported. All the patients were male, aged 3-45 years. Duration of deflazacort exposure was 2-8 weeks. Dermatology diagnosis of our case was SJS, and 5 cases were TEN. One patient was diagnosed with exudative erythema multiforme, and subsequent deflazacort oral challenge test was positive. Treatment included methylprednisolone or dexamethasone in 5 cases, IVIG in 6 cases, etanercept in 3 cases and cyclosporine in 1 case. All patients recovered completely. Conclusion: The synthetic corticosteroid deflazacort can cause rare but severe adverse reactions such as SJS-TEN, which needs close monitoring and prompt recognition and management.

Comparison of Self-Esteem in Patients Before and after Chemical Skin Peeling: An Interventional Study

Objective: To evaluate the self-esteem of patients undergoing chemical peeling for therapeutic reasons. Study Design: Pre-post Observational study. Place and Duration of Study: Department of Dermatology Combined Military Hospital, Multan Pakistan, from Mar to Aug 2021. Methodology: Forty-four patients were included in the study. After detailed history and clinical examination, self-esteem of all selected patients meeting the inclusion criteria was determined using RSES (Rosenberg Self-Esteem Score) score. Four sessions of chemical peeling were done using 30% salicylic acid with interval of 2 weeks between each session. (At week 0, 2, 4 and 6) All patients were advised the use of similar sun blocks during the treatment period. Post-peel RSES was re-assessed at 6 weeks. Results: The pre-peel RSES score (17.95±2.29) improved significantly after the sessions of chemical peeling. The post-peel RSES score was (19.47±1.95). p-value<0.001 Conclusion: Our study showed chemical peeling with 30% salicylic acid caused a significant enhancement of patients’ self- esteem, as significant difference in Rosenberg Self-Esteem Scores was seen before and after chemoexfoliation.

Comprehensive analysis of Hibisci mutabilis Folium extract's mechanisms in alleviating UV-induced skin photoaging through enhanced network pharmacology and experimental validation.

Skin photoaging induced by ultraviolet A (UVA) and ultraviolet B (UVB) radiation manifests as skin roughness, desquamation, pigmentation, and wrinkle formation. Current treatments, such as sunscreen, hormones, and antioxidants, have limitations and side effects. Traditional Chinese Medicine Hibisci Mutabilis Folium (HMF), or Mu-Fu-Rong-Ye in Chinese name, refers to the dried leaves of the plant Hibiscus mutabilis L., which belongs to the Malvaceae family. It has been used traditionally to treat acute mastitis, parotitis, neurodermatitis, burns. The reported activities of HMF include anti-inflammatory and anti-oxidant effects. However, the therapeutic potential of HMF in preventing and treating UV-induced skin photoaging remains unexplored. This study aimed to investigate the protective effects of HMF extract (EHMF) against UV-induced skin photoaging and the underlying mechanisms of action, by using network pharmacology and experimental verification. Network pharmacology was employed to identify the effective chemical components of EHMF. Potential targets were identified via PPI network analysis. Representative compounds were characterized using UPLC-MS/MS. In vitro validation involved assessing HaCaT cell viability, observing live/dead cell staining through fluorescence microscopy, and measuring inflammatory factors using ELISA. For in vivo validation, a UV-induced skin photoaging mice model was treated transdermally with EHMF or Methotrexate daily for 7 days. Dermatitis severity, skin morphology, and collagen fiber pathology were evaluated. Inflammatory cytokine and protein expression in dorsal skin lesions was confirmed using Elisa Kits, Western blot and immunohistochemistry. A total of 22 active ingredients of EHMF were identified. GO enrichment and KEGG pathway analyses revealed a focus on inflammatory signaling pathways. In vitro experiments showed that EHMF significantly reduced UV-induced inflammatory factors in HaCaT cells and improved cell survival rates. In vivo, EHMF alleviated back skin lesions in UV-exposed mice, reducing epidermal and dermal thickening and pathological inflammatory cell infiltration. It also decreased abnormal MMP-9 expression and collagen fiber proliferation, along with levels of inflammatory factors like TNF-α, IL-6, IL-17, and EGFR. Western blot and immunohistochemistry results indicated that the over-activation of the AKT-STAT3 signaling pathway was inhibited. EHMF effectively reduced UV-induced skin damage, inflammation, and wrinkles, providing strong support for its clinical application as a dermatological agent.

A case of peeling skin syndrome type 1 with novel CDSN gene variation successfully treated with upadacitinib.

Peeling skin syndrome type 1 (PSS1) is an autosomal recessive genodermatosis caused by the CDSN gene loss-of-function mutation and characterized by widespread superficial skin peeling and erythroderma with unbearable pruritus. Because of its ultra-rarity and unclear mechanism, this rare disease has no established treatment regimen. Herein, we reported a Chinese woman who presented with congenital generalized pruritic erythroderma and exfoliation, notable for significantly elevated IgE levels. The whole exome sequencing identified an unpublished homozygous variant (c.295C>T, p.Gln99*) in the CDSN gene, confirming the diagnosis of PSS1. Immunohistochemistry analysis of the affected skin confirmed the lack of corneodesmosin expression, revealed the overexpression of T helper 2 (Th2)-related cytokines harboring interleukin (IL) 4 and IL-13. After Janus kinase 1 (JAK1) inhibitor upadacitinib administration, both the patient's skin rashes and itching symptoms were significantly alleviated. Our work expanded the PSS1-related CDSN gene mutation spectrums, substantiated the hypothesis regarding the overexpression of Th2-related cytokines, and uncovered the important role of JAK1 underlying PSS1. JAK1 signaling may dominate the pathogenesis in PSS1 and represent a potential therapeutic target.

Image-guided Hypofractionated Radiotherapy as an Alternative to Radical Prostatectomy in Localized Prostate Cancer in Elderly Patients with Low Life Expectancy.

Radical prostatectomy is appropriate for any patient whose cancer appears clinically localised to prostate. However because of potential perioperative morbidity, radical prostatectomy is generally reserved for patients whose life expectancy is more than ten years. Moderate hypofractionation for localized prostate cancer is safe and effective. There is a growing body of evidence in support of extreme hypofractionation for localized prostate cancer. Hypofractionation for prostate cancer was originally carried out in the pursuit of efficiency and convenience, but has now attracted greatly renewed interest based upon a hypothesis that prostate cancers have a higher sensitivity to fraction size, reflected in a low α/β ratio, then do late responding organs at risk such as the rectum or bladder. From January 2017 to December 2020 we treated 112 patients of localised Prostate Cancer with Image Guided Radiotherapy (IGRT). They were in range of 75-85 years. They were of stage T1-T3, N0 or N1. There were significant comborbidities. ECOG performance status was 0-1. They were given 3 months of Androgen Deprivation Therapy (ADT) before starting IGRT. Patients were immobilised with casts and subject to CT simulation. CBCT was taken daily. Dose was 70 Gy @ 250 cGy per fraction at a frequency of 5 fractions per week. Complete blood counts were done weekly for assessment of haematological toxicity. Androgen Deprivation Therapy was continued post IGRT. All the patients were able to complete the treatment. Evaluation was done at one month, three month and six months post treatment. 104 out of 112 patients achieved complete response. Other 8 had near complete response. There were no acute grade 3-4 toxicities. Grade 1-2 toxicities like skin desquamation, diarrhoea, burning micturition were managed conservatively. Late toxicity was rectal bleeding seen after one year of completion of treatment and was managed with steroid enemas. 23 patients required argon plasma laser therapy. Image guided radiotherapy is well tolerated, easy to implement and an effective alternative to radical prostatectomy in elderly patients with comorbidities and low life expectancy.

Toxic epidermal necrolysis associated with phenytoin in a 6-year-old child: a case report

Toxic epidermal necrolysis (TEN) is a severe mucocutaneous syndrome often triggered by adverse drug reactions, characterized by extensive skin detachment. We present a rare case of a 6-year-old boy developing TEN associated with phenytoin use for post-bacterial meningitis seizures. The patient initially presented with fever, epigastric pain, oral ulcers, and skin rashes, later progressing to extensive skin peeling. Phenytoin was promptly discontinued. The SCORTEN score indicated a mortality rate of 35.3%. Informed consent was taken by parents. The patient received supportive care, including IV fluids, antibiotics, and topical treatments. The patient exhibited a positive response to early initiation of systemic steroids (Dexamethasone) and cyclosporine, leading to a successful recovery within 15 days. This case underscores the importance of recognizing and managing drug induced TEN promptly, especially in pediatric populations, and highlights potential immunopathologic pathways and genetic predispositions to the condition.

Coincidence of acral peeling skin syndrome and Nagashima-type palmoplantar keratosis in a Japanese pedigree with acral skin peeling.

Acral peeling skin syndrome (APSS; MIM 609796) is a rare genodermatosis characterized by painless focal cutaneous exfoliation of the dorsal hands and feet, typically displaying autosomal recessive inheritance. While cases associated with a founder mutation in TGM5 are relatively common in European Caucasian populations, no APSS cases have been reported from Japan or other East Asian countries. In contrast, Nagashima-type palmoplantar keratosis (NPPK; MIM 615598), caused by variants in SERPINB7, is relatively common in East Asia due to founder mutations. We describe a 27-year-old Japanese woman with spontaneous focal cutaneous exfoliation of the dorsal hand following prolonged glove use, indicative of APSS. Histopathological examination revealed a cleft between the stratum corneum and stratum granulosum and within the horny layer of the epidermis, supporting this diagnosis. However, her mother and maternal uncle exhibited similar symptoms, and there was no reported consanguinity in the patient's parents or grandparents, prompting suspicion of an autosomal dominant genodermatosis. Whole-genome sequencing (WGS) revealed compound heterozygous variants in TGM5 (c.1037G>A and c.684 + 1G>A) as suspected causative variants in the patient, leading to an APSS diagnosis, the first reported in East Asia. On the other hand, her mother and maternal uncle were diagnosed with NPPK due to compound heterozygous pathogenic variants in SERPINB7 (c.796C>T and c.455-1G>A). This case highlights the complexity of diagnosing skin disorders when multiple genodermatoses with similar phenotypes exist within a pedigree. Comprehensive genetic analyses, such as whole-exome sequencing and WGS, are invaluable for identifying causative variants in such complex cases.

Safety and Tolerance Evaluation of a Suncare Product in Ethnically Diverse Children With Atopic Dermatitis-Prone Skin

Atopic Dermatitis (AD) is a common chronic inflammatory skin condition, with high prevalence in children. Sun protection is important for children with eczema and AD-prone skin, yet many sunscreens can cause skin irritation due to their formulations. In this study, we evaluated the safety and tolerance of an SPF 50 sunscreen in ethnically diverse children with a history of AD over 4 weeks of product use. A total of 45 children from diverse racial/ethnic backgrounds, aged 3 to 12 years old with skin phototypes I-VI, plus a history of eczema and perceived sensitive skin completed the study. All participants applied sunscreen daily on the face and body, at least 15 minutes prior to sun exposure and as needed. After 4 weeks, evaluations were performed by a dermatologist and by participants for tolerability. Product performance questionnaires were also completed by parents/guardians of pediatric participants. After 4 weeks of sunscreen application, tolerability assessments of skin dryness, peeling, erythema, and edema were all absent in children participants. Parent/guardian evaluations of sunscreen tolerability for their child also revealed no perceived skin issues. These results were consistent with no adverse event being observed throughout the study. Parents/guardians reported that sunscreen application on children was smooth and even, with the absence of a white cast appearance on children with skin of color. We conclude from this study that this SPF 50 sunscreen is safe to use in ethnically diverse children with a history of AD and sensitive skin. J Drugs Dermatol. 2024;23(8):669-673.  doi:10.36849/JDD.8282.

A CASE OF EHLER DANLOS SYNDROME REVEALED BY POLYARTHRALGIA: CASE REPORT AND LITERATURE REVIEW

Ehlers-Danlos Syndrome (EDS), a disorder affecting connective tissue, can be incapacitating in certain instances. This disorder is marked by varying levels of skin hyperextensibility, joint hypermobility, and vascular fragility. These symptoms of EDS stem from abnormal collagen, particularly involving types I, III, and V collagen. Complications include musculoskeletal pain, dislocations, atrophic scars, easy bleeding, vessel or viscera rupture, obstetric complications, and severe scoliosis. Accurate identification of EDS patients is crucial to initiate proper treatment. Herein we report a 5-year-old male with polyarthralgia, skin desquamation, hyperhidrosis, recurrent oral aphthosis, and diffuse abdominal pain. Physical exam showed joint hypermobility (Beighton score 6/9), skin hyperelasticity, and blue sclera, leading to a diagnosis of Ehlers-Danlos syndrome. He is undergoing analgesic treatment and functional rehabilitation.

Recombinant scFv-Fc Anti-kallikrein 7 Antibody-Loaded Thermosensitive Hydrogels Against Skin Desquamation Disorders.

Human tissue kallikrein-related peptidase 7 (KLK7) is a serine protease implicated in the physiology of skin desquamation, and its uncontrolled activity can lead to chronic diseases such as psoriasis, atopic dermatitis, and Netherton syndrome. For this reason, kallikrein 7 has been identified as a potential therapeutic target. This work aimed to evaluate Pluronic (PL) hydrogels as topical carriers of four specific scFv-Fc antibodies to inhibit KLK7. The hydrogels comprised PL F127 (30% w/v) alone and a binary F127/P123 (28-2% w/v) system. Each formulation was loaded with 1 μg/mL of each antibody and characterized by physicochemical and pharmaceutical techniques, considering antibody-micelle interactions and hydrogel behavior as smart delivery systems. Results showed that the antibodies were successfully loaded into the PL-based systems, and the sol-gel transition temperature was shifted to high values after the P123 addition. The antibodies released from the gels preserved their rheological properties (G' > G'', 35- to 41-fold) and inhibitory activity against KLK7, even after 24 h. This work presented potential agents targeting KLK7 that may provide strategies for treating skin abnormalities.

Ayurvedic Management of Palmo-Plantar Psoriasis(~Ek kushta) : A Case Report

Psoriasis is a chronic variant of Psoriasis that characterstically affects the skin of the palms and soles and produces significant functional disability. It features hyperkeratotic, pustular skin lesions. Palmoplantar Pustulosis is a possibly related to dermatosis characterized by small sterile pustules that may be a type of Palmoplantar Psoriasis. As such they are associated with substantial impairment in quality of life. The exact cause of Palmoplantar Psoriasis is unkown. However, it is caused by a combination of genetic and enviornmental factors. In the present case study, female of age 40yrs visit in Ayurveda OPD had complaint of severe itching, redness and pain in skin lesions, transient white, brown, or red macule, localized at bilateral sole region and palm region since 2yrs. She had associated complaint of loss of appetite, headache, dizziness, disturbed sleep and irregular bowel evacuation since 2yrs. She took allopathic treatment but does’nt get any improvement so she decided to switch on Ayurveda management for better cure and preventive care. On the basis of clinical presentation patient was diagnosed with Vicharchika, type of Kushtha Roga so the line of management is based on Kushtha Chikitsa. After 2months of drug intervention Panchtikt Ghrita 10ml, OD in morning, in combination with Mahakalyanak Ghrita in dose of 5ml HS(at bed time) and Cap.Stresscom 2tab at night, patient get significant relief in symptoms ie. dryness and peeling of skin, pain and bleeding with severe itching. Size of lesions is reduced. This is effective in reducing the progression of disease and improve quality of life of patient.