Management Of Dermatological Diseases Research Articles

The growing importance of high-efficiency ultrasound in diagnosis and management of dermatological diseases

Introduction: High-frequency ultrasonography (HF-USG) uses frequency above 20 MHz, which allows to visualize skin layers and measure their thickness. As it is simple, non-invasive and reliable technique, it has become a relevant tool in the field of dermatology along with other methods like for example dermoscopy. It can be used not only for the evaluation, diagnosis and management of various skin diseases, but also for analysis of the healthy skin structure
 Aim of the study: The aim of this review is to present information on the use of high-efficiency USG and its application in dermatology.
 Materials and methods: The literature available in the PubMed and Google Scholar data bases was reviewed, using the following keywords: "dermatologic ultrasound", "skin ultrasound, "HFUS dermatology".
 Conclusions: HFUS has given many opportunities in dermatology. Although ultrasound is not a new thing and it has been used in the field of dermatology for more than four decades, its significance has evolved with improvements in technology. We already have some pathognomonic sonographic features for skin lesions, but this amount will definitely increase due to the growing popularity of HFUS devices in clinical practice.

Therapeutic Potential of Minor Cannabinoids in Dermatological Diseases-A Synthetic Review.

Dermatological diseases pose a significant burden on the quality of life of individuals and can be challenging to treat effectively. In this aspect, cannabinoids are gaining increasing importance due to their therapeutic potential in various disease entities including skin diseases. In this synthetic review, we comprehensively analyzed the existing literature in the field of potential dermatological applications of a lesser-known subgroup of cannabinoids, the so-called minor cannabinoids, such as cannabidivarin (CBDV), cannabidiforol (CBDP), cannabichromene (CBC), tetrahydrocannabivarin (THCV), cannabigerolic acid (CBGA), cannabigerol (CBG), cannabielsoin (CBE), cannabimovone (CBM) or cannabinol (CBN), while drawing attention to their unique pharmacological properties. We systematically searched the available databases for relevant studies and analyzed the data to provide an overview of current thematic knowledge. We looked through the full-text, bibliographic and factographic databases, especially Scopus, Web of Science, PubMed, Polish Scientific Journals Database, and selected the most relevant papers. Our review highlights that minor cannabinoids exhibit diverse pharmacological activities, including anti-inflammatory, analgesic, antimicrobial, and anti-itch properties. Several studies have reported their efficacy in mitigating symptoms associated with dermatological diseases such as psoriasis, eczema, acne, and pruritus. Furthermore, minor cannabinoids have shown potential in regulating sebum production, a crucial factor in acne pathogenesis. The findings of this review suggest that minor cannabinoids hold therapeutic promise in the management of dermatological diseases. Further preclinical and clinical investigations are warranted to elucidate their mechanisms of action, determine optimal dosage regimens, and assess long-term safety profiles. Incorporating minor cannabinoids into dermatological therapies could potentially offer novel treatment options of patients and improve their overall well-being.

Role of teledermatology in the management of dermatological diseases among marine workers: A cross-sectional study comparing general practitioners and dermatological diagnoses.

BackgroundDiagnosis and treatment of skin disease in sea workers is an unmet need. The purpose of this study is to highlight how remote management of dermatological conditions appears inadequate in this scenario.ObjectiveThis study aimed to identify the best epidemiology for seafarers' diseases and analyze the adequacy of medical assistance in the diagnosis of dermatological maritime diseases.Material and methodsA total of 420 cases of requests for dermatological diseases received by the Telemedical Maritime Assistance Service of the International Medical Radio Center (C.I.R.M.). in a referral year were included in this cross-sectional study. All pictures of cutaneous lesions had been submitted to both C.I.R.M. doctors and an expert dermatologist who provided their diagnosis.ResultsThe most frequent diagnosis in both groups was infectious or inflammatory skin diseases. The main differences are represented by the amount of “unclassified dermatitis” or descriptive diagnosis, such as “cutaneous eruption” which were the most frequent diagnosis of C.I.R.M. doctors (p < 0.05 and p > 0.0001). In these cases, Cohen's K was <0.5 consistent with low concordance between dermatologic diagnosis and C.I.R.M. diagnosis.Conclusion and relevanceOur study emphasizes the magnitude of dermatological diseases in the maritime sector, although often underestimated, and highlights the difficulty in their diagnosis for doctors on call that need more training on specific dermatological issues.

Women's Health: Most Common Physiologic and Pathologic Cutaneous Manifestations During Pregnancy.

Pregnant women are susceptible to various physiological and pathological skin and body habitus changes during pregnancy due to the alterations that occur in a multi-organ-system fashion. Pregnancy can be the onset of different dermatological diseases and can exacerbate pre-existing cutaneous conditions. Moreover, management of dermatologic diseases during pregnancy might be challenging as it requires special attention to both mother and fetus. We aim to assess the most common cutaneous changes and conditions that occur during pregnancy by reviewing the previous studies conducted on this subject.The medical literature was explored through PubMed and Google scholar databases starting from 2015 to 2021. The included searching terms were a combination of "Cutaneous changes and pregnancy," Dermal conditions and pregnancy," Pregnancy-associated dermal conditions," and "Dermatological changes and pregnant women." The inclusion criteria included original articles conducted on pregnant women and full text- articles.A total of 134 articles were obtained, 11 articles were eligible for the inclusion criteria. The 11 studies included a total number of 14,813 pregnant women and covered four countries. The most common cutaneous conditions experienced by pregnant women were primarily physiological skin changes, pregnancy-specific dermatopathologies, and exacerbations of other common skin diseases.All in all, this systematic review concluded that pregnant women are more vulnerable to various dermatological conditions during pregnancy. These changes were more commonly physiological such as hyperpigmentations. However, pathological pregnancy-specific skin conditions and exacerbations of pre-existing dermatoses like atopic eruptions were also reported.

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

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

Management of pemphigus vulgaris and bullous pemphigoid in times of COVID-19 pandemic

Background: The pandemic the world is facing today started in the city of Wuhan, central China, in December 2019, and presented as unexplained lower respiratory infections. On February 11, 2020, the World Health Organization announced that the disease caused by the severe acute respiratory syndrome coronavirus 2 virus be called “corona virus disease 2019 (COVID-19).” Since the beginning of the pandemic there has been quite some debate regarding starting or continuing the treatment of diseases requiring immunosuppression. The major issues arise with management of dermatological diseases, such as vesiculobullous disorders, moderate-to-severe psoriasis, acute severe drug reactions, and connective tissue diseases which would require high level of immune-suppression or immune-modulation as treatment. In this article, we discuss the management strategies adopted for the management of pemphigus vulgaris (PV) and bullous pemphigoid (BP) as the prototypical examples. We will discuss the algorithm we evolved in our department for managing such cases during COVID-19 pandemic to give optimum benefit for our patients along with decreasing their risk for increased vulnerability for severe COVID-19 infection. The same principle can be used for other diseases requiring immunosuppressive or immunomodulatory therapies. Objectives: The management of the patients suffering from BP and PV that came to our department during the national lockdown during COVID-19 pandemic. Materials and Methods: It was a prospective study of 30 consecutive patients that came to our outpatient department either previously diagnosed or as fresh cases of PV or BP. Results: Treating patients with BP or PV during the pandemic has been a challenge. Analyzing the risk versus benefit and making a custom-based treatment helped us minimize the risk for severe COVID-19 infection as well as the side effects due to the primary drugs that are used in BP/PV. We were successful in keeping the primary disease in control. None of our patients was infected with symptomatic COVID-19 infection. Conclusion: With rapidly changing scenario of the pandemic it is very difficult to assess the optimal management of complex diseases such as PV and BP. With contradictory data available whether suppressing the immunity will result in a milder form of COVID 19 with less complications or render the patient at higher risk of complicated COVID-19 is unknown. Thus we, as dermato-physicians, need to keep ourselves and our patients updated, educated, and choose the best possible option where in the risk for severe COVID-19 infection minimized while keeping their primary disease in control.

Controversies in off-label prescriptions in dermatology: the perspective of the patient, the physician, and the pharmaceutical companies.

The term "off-label drug use" involves the prescription of medications for unapproved indications or in unapproved dosage, dosage form, or route of administration. Off-label medications are common in the management of dermatologic diseases. In the recent years, new indications for botulinum toxin, biologics, spironolactone, topical calcineurin, and topical vitamin D analogues emerged, and these drugs are being used off-label to treat a variety of conditions. The high cost and long time required for the approval discourage pharmaceutical companies from developing studies and pursuing the approval by regulatory agencies. Patients and physicians may have a different perspective regarding the off-label use of medications. The ethical discussion is based on the different opinions concerning the need for informed consent by the patient and how this could be applicable in the clinical practice.

Research Techniques Made Simple: An Introduction to Use and Analysis of Big Data in Dermatology

Big data is a term used for any collection of datasets whose size and complexity exceeds the capabilities of traditional data processing applications. Big data repositories, including those for molecular, clinical, and epidemiology data, offer unprecedented research opportunities to help guide scientific advancement. Advantages of big data can include ease and low cost of collection, ability to approach prospectively and retrospectively, utility for hypothesis generation in addition to hypothesis testing, and the promise of precision medicine. Limitations include cost and difficulty of storing and processing data; need for advanced techniques for formatting and analysis; and concerns about accuracy, reliability, and security. We discuss sources of big data and tools for its analysis to help inform the treatment and management of dermatologic diseases.

Inflammatory Vulvar Dermatoses.

Inflammatory vulvar dermatoses affect many women, but are likely underdiagnosed due to embarrassment and reluctance to visit a health care provider. Although itch and pain are common presenting symptoms, the physical examination can help distinguish between different disease entities. Because many women's health providers have minimal training in the categorization and management of dermatologic disease, definitive diagnosis and management can be difficult. Herein, strategies for diagnosing vulvar lichen sclerosus, lichen planus, contact dermatitis, lichen simplex chronicus, and psoriasis are discussed along with basic management of these diseases, which commonly involves decreasing inflammation through behavioral change, gentle skin care, topical corticosteroids, and systemic therapies.

Therapeutic dose monitoring of mycophenolate mofetil in dermatologic diseases

Mycophenolate mofetil (MMF) is used for prevention of allograft rejection in transplantation medicine. In dermatology it is used as a corticosteroid-sparing agent. The pharmacokinetics of MMF are known to vary by individual. Therapeutic dose monitoring of mycophenolic acid (MPA), the active metabolite of MMF, is used as a guide in transplantation medicine, but limited data exist on the benefit of measuring MPA levels in the management of dermatologic disease. We sought to describe the use of MPA level monitoring in the management of dermatologic disease. We retrospectively searched for cases of patients who were treated with MMF for a dermatologic condition at our tertiary care center, and who had at least 1 trough level measurement of MPA from January 1, 2003, through November 30, 2009. Our search identified 24 patients treated with MMF for autoimmune bullous diseases, connective tissue diseases, erythema multiforme, atopic dermatitis, or pyoderma gangrenosum who had at least 1 MPA trough level measured. The range of MPA levels in patients who responded to therapy was 1.2 to 8 μg/mL at a dose range of 1 to 3.5 g/d of MMF. Four cases were analyzed in detail to highlight the use of therapeutic dose monitoring in the management of dermatologic disease. This was a retrospective study. We recommend monitoring MPA levels only in patients not responding to the standard 2-g/d dosage of MMF. MPA levels can help the dermatologist to increase the dose in patients who have poor absorption or to detect therapeutic noncompliance.

Trends in the use of topical over the counter products in the management of dermatologic disease in the United States

Trends in the use of topical over the counter products in the management of dermatologic disease in the United States

Trends in the use of topical over the counter products in the management of dermatologic disease in the United States

Over the counter (OTC) products play an important role in treating and preventing disease in the U.S. Topical OTCs are widely used but use in dermatology is not well defined. To characterize topical OTC use in the U.S. The National Ambulatory Medical Care Survey was queried for physician visits in which topical OTCs were recorded. Physician specialty, patient demographics, and diagnoses were examined and linear regressions were performed to determine trends over time. From 1989 to 2008, there were an estimated 320 million visits documenting topical OTC recommendations; the majority of which were visits to a dermatologist (33.5%). Dermatologists most commonly recommended hydrocortisone (16.9%), benzoyl peroxide (13.3%), and sunscreen (7.4%). Dermatologists were more likely than other providers to use moisturizers in the treatment of dermatologic disease. Overall, topical OTC recommendations by all physicians has decreased over time (p < 0.0001). However, dermatologists' recommendations for moisturizers and sunscreens has increased significantly. Topical OTC products have an important role in the prevention and treatment of dermatologic disease. Topical OTC recommendations are decreasing over time whereas their use as complementary components (sunscreen/moisturizers) appears to be increasing. Increased awareness of the utility of these agents may help to improve patient outcomes.

ANTIMALARIALS

Antimalarial medications have become the parenteral drugs of choice for treating the cutaneous manifestations of lupus erythematosus. The immune-modulating activity of these agents makes them useful in a variety of other dermatoses. With prudent dosage and monitoring, these agents can be used safely and effectively in the treatment and management of dermatologic disease.