Normal Skin Color Research Articles

7640 The first description of an MC4R variant in a patient with Kallmann syndrome and obesity

Abstract Disclosure: A.A. Aslam: None. S. Lim: None. R. Willemsen: None. K. Koysombat: None. M. Young: None. W.S. Dhillo: None. A. Abbara: None. S. Howard: None. E.F. Gevers: None. Introduction: Pathogenic MC4R gene variants result in hyperphagia and early onset obesity but puberty is not usually affected. We describe an MC4R variant in a patient with Kallmann syndrome and obesity. A 16 year old male with repaired Tetralogy of Fallot, anosmia, autism and anxiety, was referred with obesity and delayed puberty. His birth weight was 3360 g (-0.26 SDS). Height was -1.31 SDS, BMI 30.7 kg/m2. He had high arched palate, normal skin and hair colour, mild hypertelorism and upward slanting palpebral fissures. Pubertal staging was A2P1G1 5ml testes bilaterally. Results: LHRH test showed borderline low peaks (LH 5.0 U/L, FSH 2.6 U/L) and inhibin B 108 pg/mL (25-325 pg/mL). MRI brain showed hypoplastic olfactory bulbs, absent olfactory sulci and normal pituitary anatomy. CGH microarray, karyotype and the UK hypogonadism gene panel were normal. He underwent whole genome sequencing in the Genetic Factors Affecting the Timing of Puberty Study; no abnormalities in 52 known genes associated with GnRH deficiency were found but a previously described heterozygous variant was detected, MC4R c.542G>A, p.Gly181Asp, classified pathogenic and absent in control databases. Management: He was commenced on Testosterone but showed progression of testicular size to 10 mL and testosterone was stopped but required restarting. Repeat investigations off treatment, aged 22 years (height 178 cm, BMI 42 kg/m2, testes 15 mL): inhibin B 66 pg/mL, testosterone 2 nmol/L, baseline LH 2.4 U/L, stimulated peak 24.9 U/L, baseline FSH 1.2 U/L, stimulated peak 4.2 U/L. Cortisol and IGF1 were in the normal range. He also developed autoimmune hypothyroidism with raised TPO antibodies (TSH 24.7 mU/L, FT4 5.6 pmol/L). Discussion: Previous in vitro work has shown complete loss of function of MC4R p.Gly181Asp due to reduced cell surface expression and reduced binding to a-MSH. Heterozygous p.Gly181Asp variants have been described in several children/adults with obesity; but hypogonadism in heterozygous carriers has not. Homozygous MC4R p.Gly181Asp was found in a male with obesity and partial HH thought to be due to abnormal GnRH production but with normal olfactory bulbs. We are the first to describe a heterozygous MC4R p.Gly181Asp variant in a patient with partial hypogonadism and anosmia with hypoplastic bulbs in addition to obesity. Interaction between POMC-MC-leptin circuits and Kisspeptin-GnRH circuits is recognised although not completely understood. Previous work has shown that a subset of kisspeptin neurons express MC4R and that KNDy neurones receive synaptic input from POMC neurons. In addition, inhibition of MC4R/MC3R results in delayed onset of puberty in rats. Our results support a role for MC4R in GnRH secretion and potentially olfactory /GnRH neuronal migration. Assessment of spontaneous gonadotrophin production and response of gonadotrophin production to kisspeptin stimulation is currently in progress. Presentation: 6/1/2024

Smashed skin grafting in stable vitiligo: Efficacy and safety

Background: Vitiligo is a common skin disorder that entails cosmetic disfigurement due to depigmentation and carries a social stigma. Smash grafting is an easy-to-master surgical treatment modality for stable vitiligo that has failed to respond to other treatments. The technique involves procuring a thin skin graft from a donor site, smashing it into the thinnest possible pieces, and grafting the smash onto the dermabraded vitiligo site. Objective: To analyze the efficacy and safety of smash grafting in patients with stable vitiligo. Materials and Methods: Thirty patients underwent smash grafting in stable recalcitrant vitiligo lesions. The patients were randomly placed in groups A and B. Group A received PUVASOL therapy postprocedure, while group B received only sunlight exposure after smash grafting. The patients were followed up every month for 3 months to assess repigmentation of the grafted site compared to the patient’s normal skin color. Results: Repigmentation was noticed at the grafted site starting as early as 3 weeks postprocedure in all the patients, and an increase in pigmentation intensity was observed until the end of the study follow-up. At the end of the 3-month follow-up, 76.66% of the patients had regained 50% or more pigmentation of the involved lesion. Conclusion: Smash grafting provided excellent repigmentation in >75% of patients without any significant complications. It is a simple and effective surgical technique that is underutilized. Furthermore, this procedure is less resource-intensive and easier to master than other surgical techniques for vitiligo.

Impact of herbal treatments for Vitiligo disease

Vitiligo is a common skin disorder resulting from the breakdown of functional epidermal melanocytes. The global prevalence of vitiligo ranges from 0.5% to 2%, with higher rates reported in certain populations. Melanocytes, responsible for skin color, are destroyed in vitiligo condition leading to the appearance of smooth, white patches on the skin. The progression of vitiligo is influenced by various factors, including genetics, autoimmunity, psychosis, melanocyte self-destruction, trace element deficiency, oxidative stress, and other biochemical and environmental variables. Recent research has identified herbal plant extractions as potential agents for re-pigmentation and regeneration of normal skin color. Specific components of these herbal plants, such as furocoumarin, thymoquinone, flavonoids, curcuminoids, and glycyrrhizin, play crucial roles in promoting re-pigmentation. Combination therapies involving these herbal compounds have shown promise in increasing tyrosinase activity and reducing oxidative stress, which are two important aspects of vitiligo treatment. The review aims to comprehensively evaluate the efficacy of herbal plant therapies for melanocyte re-pigmentation in vitiligo patients. By analyzing the effectiveness of various herbal extracts and their active components, this study seeks to advance the understanding and potential application of herbal treatments for vitiligo. The findings from this review may contribute to the current knowledge on therapeutic options available for vitiligo patients.

Management of Shwitra (Vitiligo) Through Ayurveda

A condition of acquired macular depigmentation called vitiligo is linked to melanocyte degeneration, caused by the autoimmune destruction of melanocytes cells. This vitiligo can be correlated to Shwitra in Ayurveda because of the disease's resemblance in appearance. In the Ayurveda classics especially Charaka Samhita, Shwitra has been mentioned under the heading of Kushta Roga Chikitsa. Methodology: The present case report is of 11 years old female child, came with complaints of whitish discolored patches on the almost all over body, effectively treated with Shamana and Shodhana Chikitsa. Result: Patient showed encouraging result after Shodhana Chikitsa, where subjective criteria evaluated using scoring method and objective criteria evaluated using VASI scoring method. Discussion: Patient was treated with Shamana Aushadis and Shodhana, where white discolored patches turned to pinkish, and after that the patches turned into normal skin color. Subject was observed with 95% improvement in subjective criteria & VASI scoring improved from 19.85 to 3.2. Conclusion: The present case study validated the efficacy of Ayurveda medicine in treating Shwitra.

Facial appearance associates with longitudinal multi-organ failure: an ICU cohort study

BackgroundFacial appearance, whether consciously or subconsciously assessed, may affect clinical assessment and treatment strategies in the Intensive Care Unit (ICU). Nevertheless, the association between objective clinical measurement of facial appearance and multi-organ failure is currently unknown. The objective of this study was to examine whether facial appearance at admission is associated with longitudinal evaluation of multi-organ failure.MethodsThis was a sub-study of the Simple Intensive Care Studies-II, a prospective observational cohort study. All adult patients acutely admitted to the ICU between March 26, 2019, and July 10, 2019, were included. Facial appearance was assessed within three hours of ICU admission using predefined pictograms. The SOFA score was serially measured each day for the first seven days after ICU admission. The association between the extent of eye-opening and facial skin colour with longitudinal Sequential Organ Failure Assessment (SOFA) scores was investigated using generalized estimation equations.ResultsSOFA scores were measured in 228 patients. Facial appearance scored by the extent of eye-opening was associated with a higher SOFA score at admission and follow-up (unadjusted 0.7 points per step (95%CI 0.5 to 0.9)). There was no association between facial skin colour and a worse SOFA score over time. However, patients with half-open or closed eyes along with flushed skin had a lower SOFA score than patients with a pale or normal facial skin colour (P-interaction < 0.1).ConclusionsThe scoring of patients’ facial cues, primarily the extent of eye-opening and facial colour, provided valuable insights into the disease state and progression of the disease of critically ill patients. The utilization of advanced monitoring techniques that incorporate facial appearance holds promise for enhancing future intensive care support.

Genital Condyloma in a 2-Year-Old Child Secondary to Circumcision: A Case Report

Accumulated condylomas are exophytic tumors with a warty and hyperkeratosic surface due to the Human papillomavirus (HPV). Its prevalence in children is difficult to estimate due to limitations in epidemiological data. Its recurrent character is found in 30% of patients. Its management is very complex in children because of skin fragility. Circumcision is an operation consisting of the removal of part of the foreskin. This practice is done either with a simple knife or a pair of non-aseptic scissors which can be a source of contamination including HPV (Condyloma). Traditional circumcision does not seem to be reported in the literature as a mode of contamination. We report a case of genital condyloma in a child 2 years after circumcision. This is a 2-year-old male with no medical history but with a surgical history of circumcision that was brought by his parents in dermatological consultation for papular lesions accumulated on the penis. At the interrogation, we found the notion of recent circumcision performed by a tradithérapeute. The physical examination finds a good general condition. Dermatological examination reveals on the glans of multiple papules, exophitic, with warty and hyperkeratotic surface, of normal skin color. Furthermore, the physical examination of both parents was normal. The diagnosis of accumulated condyloma secondary to probable circumcision was retained before the clinical appearance of the lesions. Two electrocoagulation sessions spaced one month apart under local anesthesia were the treatment with a favorable evolution.

Management of Medoja Granthi (pedunculated lipoma) by Apamarga Ksharasutra ligation and Ayurveda medications: A case report

Abstract INTRODUCTION: A pedunculated lipoma is a benign fat tissue tumor conventionally treated by surgical excision. This condition can be correlated with Medoja Granthi. Ksharasutra ligation is an effective minimal invasive parasurgical procedure suggested for its management in Ayurveda. MATERIALS AND METHODS: In this case report, a 65-year-old female patient came with complaints of swelling at the lateral aspect of the right upper arm, which was of normal skin color, mobile, nontender without any dilated veins, or elevated local temperature since 5 years and was diagnosed as Medoja Granthi. She was treated with Apamarga Ksharasutra ligation locally along with Triphala Guggulu (250 mg), two tablets twice a day orally with lukewarm water for 10 days, and Yastimadhu Ghrita local application at the base for 12 days. RESULTS AND CONCLUSIONS: In this case study, the pedicle of the lipoma de-sloughed completely on the 10th day of Ksharasutra ligation. Thus, Apamarga Ksharasutra therapy showed promising outcomes in pedunculated lipoma treatment without any adverse effects. Randomized clinical trials on an appropriate sample size can help establish the clinical efficacy of the treatment procedure adopted in the current case study in the management of Medoja Granthi.

An open labelled clinical study to evaluate the effect of Manjistha Lepa on Savarnikarana of Vrana Vastu w.s.r. to scar

Vranavastu is the scar formed on the skin after the Vrana is healed. It remains for the rest of life even after the healing of Vrana is completed.[1] This Vranavastu forms discoloration of skin, to treat this discoloration of skin various procedures are explained in Vaikrutapaha Chikitsa[2] of Vrana, which helps to restore the normal skin color after healing. Cosmetology[3] was given utmost importance even in the Vedic period. It emphasizes not only on physical beauty but also on psyche beauty for the purpose of attaining an admirable personality. Reference of Manjishta[4] used in skin disorders is mentioned in Charaka Samhitha under Varnya Gana. This study is carried out in a single group of 30 diagnosed cases of Vrana vasthu. This study is based on clinical evaluation of effect of Manjishta Lepa in Vrana Vasthu. Obtained observations and results have been analyzed in terms of Ayurveda and Contemporary science.

The puzzling etiologies of transient black discoloration in Nile Tilapia (Oreochromis niloticus) intensively cultured under RAS system

The aim of this study is to identify the hidden etiologies of the black chromo-shifting transient phenomenon affecting Nile tilapia, Oreochromis niloticus, farmed in RAS-controlled ponds together with the assessment of the immunological reaction against the chronic irritating effects of the invasive agent. A total of 100 Nile Tilapia were collected from a private farm at Kafrelsheikh Province, located on the northern side of the Egyptian Nile Delta. The clinical history of the affected fish farm showed an unknown chromo-shifting phenomenon where tilapias were exhibiting severe black skin coloration, which gradually disappeared after removal from the tank’s water. A comprehensive gross examination of the collected fish; including parasitological examination of skin and gill scraps, was performed. Blood biochemical testing was performed on the infested blackish O. niloticus and control non-infested fish. The current study showed that the monogenean parasite, Gyrodactylus cichlidarum, was the abundant parasite detected in the infested fish leading to abnormal black discoloration of skin and disruption of the immune system represented by significant increase of cortisol levels, lysozyme activity and different liver enzymes compared to the control. Treatment trials have been applied with moderate degrees of success, where the monogenean count was sharply decreased, and the normal skin color was remarkably restored, at the end of day 14 post-treatment. A triple treatment plan was initiated through 7 days’ application of 0.7 g/m3 copper sulfates pentahydrate preceded by 1.5 ml/m3 hydrogen peroxide 40% solution for the same period. One day after the end of the initial treatment, a maintenance dosage of 0.095 ml/m3 of glutaraldehyde (15%)/quaternary ammonium compounds (QACs) mixture was administered for 3 days. As a supportive/immune-stimulant regimen, a weekly dosage of vitamin C (0.45 g g/m3) and Saccharomyces cerevisiae (0.45 g/m3) was added into the tank’s water to improve the general fish health.

Ayurvedic Management of Shwitra : The Case Study

Kushtha is one among the Ashtamahagad explained in Ayurveda as there is structural changes in appearance of skin[i]. In Ayurveda Vitiligo is known as "Shwitra”. It is one of the varieties of Kushta in Ayurvedic classics, caused due to vitiation of Tridosha and Dhatus like Rasa, Rakta, Mamsa and Medas. Unbalanced diet (Virrudhahara) is also an important cause. It signifies production of toxic metabolites as an important cause for the development of the disease. Vitiligo is a specific type of a acquired leukoderma and this is idiopathic, patterned, circumscribed hypomelanosis of the skin and hair in which other cause of leukoderma have been excluded. The disease is important principally because of the social stigma associated with vitiligo. Diet restriction and psychological counselling was also a necessary part of the treatment. Leech saliva is reported to have many therapeutic contents like hirudin, bdellins, Hyaluronidase, etc.; among them, eglins and bdellins have anti-inflammatory and antifungal property which gives relief in symptoms. The Shamanaushadhis are also had a crucial part in easing the symptoms by reducing the size of lesion, and restoring normal skin colour.&#x0D; &#x0D; Daga, H. , Toshikhane,H. , Thakur K. , Raole V.,(2020) “Ayurvedic Management of Vicharchika – Single Case Study, International Journal Of Pharmaceutical Research, Vol 12 | Issue 4. org/10.31838/ijpr/2021.13.02.075.&#x0D;

A V-Y shaped flap with digital artery nerve at metacarpophalangeal joint was used to repair the defect of middle and distal phalanx

To explore a surgical method for the reconstruction of volar soft tissue defect and sensory and vascular repair in middle and far phalangeal digits. From January 2016 to January 2020, a total of 14 patients , 9 males and 5 females, ages ranging from 22 to 69 years old, and with volar soft tissue defects in the middle and distal digits 2 to 4, underwent surgical reconstruction using the V-Y shaped flap with digital artery and nerve at the metacarpophalangeal joint. The defect area was (2.0~2.5) cm×(1.5 ~2.0) cm. The procedure involved the harvest of a V-Y shaped flap with the digital artery and nerve from the metacarpophalangeal joint. Flap design, dissection of blood vessels and nerves, and anastomosis with the digital artery and nerve were performed according to a standardized protocol., Functional exercise of affected finger was initiated 3 weeks postoperatively. Subsequent assessments were conducted to evaluate finger pulp sensation, shape and other relevant parameters. According to the upper extremity functional evaluation standard set up by Hand Surgery Branch of Chinese Medical Association, the surgical outcomes were evaluated. All 14 cases demonstrated successful tissue transplantation, , with immediate recovery of sensation observed in 10 cases with distal finger pulp defects. Four patients with middle phalangeal defects experienced gradual sensory recovery within 2 to 3 months postoperatively. Thirteen patients were followed up for a mean duration of (8.8 ± 4.49) months, during which satisfactory outcomes were observed. The average two-point resolution of the finger pulp was 4-6mm, and sensory function evaluation yielded a score of S3 or above. Patients exhibited realistic finger shape, normal skin color and temperature, good wear resistance, and cold resistance. Furthermore, finger joint function was essentially normal. The V-Y shaped flap with digital artery and nerve at the metacarpophalangeal joint offers a suitable solution for repairing the defect of the middle or distal phalangeal finger. This technique is characterized by its simplicity, low risk, and favorable outcomes, including restored finger shape, blood supply and sensation. Moreover, high patient satisfaction was achieved.

Giant and Profuse Xanthogranuloma in a 14-Month-Old Infant at the Dermatology Hospital of Bamako

Juvenile xanthogranuloma (JXG) is a proliferative disease included in the group of non-Langerhansian histiocytoses (NLH) that mainly affects infants and children, and is congenital in 40-70% of cases. This condition is usually a single or few lesions but the profuse form is very rare. We report a case of giant, profuse xanthogranuloma in a 14-month-old infant. A 5-month-old infant was brought to the dermatology department with a rash that had been flaring for more than a month. The infant had no previous history of the disease and the lesions were asymptomatic. Clinical examination revealed firm nodulopapular lesions of normal skin colour, varying in size from 5 mm to 1 cm, scattered over the body. The lesions were most prominent on the neck and trunk. Biopsy of one nodule was concluded to be a juvenile xanthogranuloma. We reassured the parents about the disease and abstained from treatment. After 9 months of evolution, the child was readmitted to dermatology for aggravation of the rash. On examination, turgid nodules of 1-2cm in diameter were observed, profuse on the body. Elsewhere the clinical and biological examination was unremarkable. We report a case of giant diffuse xanthogranuloma in a 14-month-old infant, evident by histological examination. Our observation is peculiar because of its mode of extension and the giant nature of the lesions. It remains to be seen whether the evolution of this disease passes through this turgid stage. Further work is needed to support the pathogenesis of the lesions.

Multiple Nonfamilial Trichoepitheliomas: A Rare Case with Review of the Literature

Trichoepitheliomas are benign tumors of follicular origin and often appear in childhood or early adolescence. They present as small, firm papulonodular lesions of normal skin color or translucent. The lesions gradually increase in size and then stabilize. They sit electively on the face, mainly in the nasolabial folds, on the forehead, chin, and cheeks, and sometimes on the scalp and neck. Trichoepitheliomas can be divided into three subgroups: multiple familial Trichoepitheliomas, solitary non-hereditary Trichoepitheliomas, and desmoplastic Trichoepitheliomas. Nonfamilial multiple trichoepitheliomas are rarely described. We report a case of a 12-year-old child whose clinical history and clinicopathologic correlation allowed us to retain the diagnosis of multiple non-familial trichoepitheliomas.

0860 Comparative description of sleep, thyroid-stimulating hormone and calcium metabolism in 5 vitiligo patients under phototherapy

Abstract Introduction Vitiligo is an autoimmune skin disease represented by melanocytes destruction. Clinically, it evolves with spots that are lighter than normal skin color. Periodical evaluation of patients is recommended, including thyroid function. Phototherapy is its gold standard treatment, consisting in specific range of ultraviolet B (UVB) light sections. Sleep may play an immunological role, and should be investigated in vitiligo. The study aimed to compare results of thyroid-stimulating hormone (TSH), parathyroid hormone (PTH), serum calcium and vitamin D 1.25(OH)2D and 25(OH)D; and Pittsburgh Sleep Quality Index (PSQI) scores of vitiligo patients before and after phototherapy period. Methods Five individuals with vitiligo were evaluated at a University Dermatology Service, following ethical guidelines. Blood collection and PSQI application were performed before and after phototherapy. Laboratory elements were those related to calcium metabolism (PTH, calcium and vitamin D) and TSH. Results The sample included 4 female individuals with 21, 46, 65 and 70 years old; and a 57 years old male. Three of them had large skin involvement and 2 had localized vitiligo. After 6 months under phototherapy, patients returned for reassessment. All showed skin lesions improvement. Quantitative increase in TSH, PTH, 1.25(OH)2D and 25(OH)D was observed; serum calcium varied among the sample. Regarding PSQI before phototherapy, all 5 scores were &amp;gt;5 (1 score&amp;gt;10). The PSQI was reapplied only in 3 of the 5 volunteers after phototherapy; 2 scores reduced, and 1 score increased. This results, although from few individuals, alert to the possible role of UVB phototherapy on TSH and calcium metabolism substrates. Vitamin D increase may be associated to improvement of subjective sleep of 2 individuals. It was described that vitamin D in sufficient concentration could be related to better sleep quality. Phototherapy, by acting on clinical improvement of vitiligo, may influence subjective sleep, as reported in PSQI; and it could influence on melatonin and circadian rhythm. Conclusion The interaction between vitiligo/autoimmunity, phototherapy, vitamin D and sleep is complex and may have interrelated pathways. A better understanding of this pathophysiology through larger studies is worthy for benefiting clinical management of vitiligo and associated sleep disorders. Support (if any) AFIP, CAPES and CNPq.

Nadolol Treatment of Infantile Hemangiomas

Source: Pope E, Lara-Corrales I, Sibbald C, et al. Noninferiority and safety of nadolol vs propranolol in infants with infantile hemangioma: a randomized clinical trial. JAMA Pediatr. 2022;176(1):34-41; doi:10.1001/jamapediatrics.2021.4565Investigators from multiple institutions conducted a blinded randomized trial to compare the effectiveness and safety of nadolol and propranolol for treatment of children with infantile hemangioma (IH). Study participants were enrolled at 2 academic pediatric dermatology clinics in Canada and included infants with a corrected gestational age of 1-6 months who had a facial IH >1.5 cm or IH ≥3 cm on other parts of the body with the potential to cause functional impairment or cosmetic disfigurement. At enrollment, study patients were randomized to receive oral nadolol or propranolol. Infants in both groups were begun on 0.5 mg/kg/day, with the dose increased to a maximum of 2.0 mg/kg/d. Participants were enrolled for up to 52 weeks. At study visits, investigators, blinded to treatment group, assessed change from baseline in IH bulk and color using 100 mm visual analogue scales (VAS) that had previously been validated, with VAS scores ranging from -100, indicating increase in bulk or persistent dis-coloration, to +100, indicating complete resolution or normal skin color. The primary outcome was change in VAS scores for bulk and color at 24 weeks. A priori, it was determined that nadolol was non-inferior to propranolol if the difference in bulk and color VAS scores between groups was >-10 units. T-tests were used to compare scores between groups. Cox regression was used to compare rates of achieving 75% and 100% shrinkage of IH among children in the 2 treatment groups. Parents reported adverse events in their children, and decreases in blood pressure and blood glucose levels were assessed at study visits.Data were analyzed on 71 patients, including 35 receiving nadolol and 36 randomized to propranolol. The mean age at enrollment was 3.2 months for those in the nadolol group and 3.1 months for infants receiving propranolol; 74% and 86%, respectively, of participants in the nadolol and propranolol groups were female. At 24 weeks, differences in VAS scores for bulk and color between children in the 2 treatment groups were 8.8 units (95% CI, 2.7, 14.9) and 17.1 units (95% CI, 7.2, 30), both in favor of nadolol and meeting the non-inferiority criteria. Time to 100% involution was significantly shorter in infants receiving nadolol than in those receiving propranolol (hazard ratio [HR], 2.1; 95% CI, 1.2, 3.7); there was not a statistically significance between groups in time to 75% involution (HR, 1.6; 95% CI, 0.9, 2.6). Adverse events were similar in the 2 groups, with no serious adverse events related to study participation reported.The authors conclude that nadolol was non-inferior to propranolol for treatment of children with IH.Dr Dubik has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.IH is the most common vascular tumor of infancy, affecting 4.5% of neonates.1 Typically absent or barely evident at birth, IH arise during the first few weeks of life.2 Risk factors include: females, Caucasians, prematurity with low birth weight, and twins.2 80% of IH develop on the head and neck region.3 Although most regress spontaneously by age 4 years without complication, approximately 10% to 15% can cause significant functional or cosmetic sequelae and warrant treatment.4Historically, treatment of IH relied on corticosteroids or surgery.5 However, regression of IH with propranolol was serendipitously discovered in 2008, quickly became first-line therapy, and is the only FDA-approved treatment for complicated IH.5,6Propranolol, a lipophilic nonselective beta-adrenergic receptor antagonist, has a well-established safety profile. However, propranolol crosses the blood-brain barrier and can cause CNS effects, such as disturbances of sleep.6 Like propranolol, nadolol is a non-selective beta-blocker, but nadolol is less lipophilic and less likely to cause CNS side effects.Use of nadolol was first reported in a small retrospective study in 2013.7 Similar to the results of a recent study of atenolol for IH, the results of the current investigation indicate that the effectiveness of nadolol is at least non-inferior to propranolol. (See AAP Grand Rounds. 2021;46[1]:6.)8The COVID-19 pandemic slowed down recruitment, and this study was concluded early, just shy of the 78 patients needed to adequately power it. However, the authors argue that further recruitment likely would not have affected the results.For the treatment of IH, nadolol appears to be at least as effective as propranolol.Although the theoretical pharmacokinetic superiority of nadolol (vs propranolol) was not borne out in the current study in terms of a reduction in adverse events, we await the results of a larger (post COVID-19?) trial. Regardless of drug choice, therapy is best restricted to the minority of infants with IH-associated impaired vision, respiration, and hearing, and those with ulcerated or disfiguring lesions and platelet consumption.4

Clinical Appearance of Vitiligo and Piebaldism: A Review Article

Introduction: Vitiligo is idiopathic hypomelanosis characterized by the presence of white macules that can expand. Can affect all parts of the body that contain melanocyte cells, for example, hair and eyes. The cause is unknown, various trigger factors are often reported, for example emotional crisis and physical trauma. Pathogenesis of vitiligo still unclear, there is an association between vitilligo and Hashimoto’s thyroditis, pernicious anemia, and hypoparathyroid melanocytes found in the serum of 80% of vitiligo patients. Moreover, there is disease that similar to vitiligo, called piebaldism. Patches of skin that do not contain pigment that is found at birth and persists for life.The disease is inherited autosomally, due to differentiation and possibly the melanoblast membrane. Discussion: Inheritance of vitiligo can involve genes related to the biosynthesis of melanin, the response to oxidative stress and autoimmune regulation. The macula is white with a diameter of several millimeters to several centimeters, round or oval with defined boundaries, with no other epidermal changes. Hypomelanotic macules are sometimes seen in addition to apigmented macules. In vitiligo macules can be found macules with normal pigmentation or hyperpigmentation called perifollicular repigmentation. Occasionally there is a raised edge of the lesion, erythema and itching, which is called inflammatory. Piebaldism is In the form of skin patches that do not contain pigment on the forehead, median or paramedian, accompanied by white hair. White patches are sometimes also found on the upper chest, abdoment and legs. Normal skin color or hypermelanosis there are areas that are hypomelanosis. Ultrastructural investigation showed no visible melanocytes and melanosomes in hypomelanotic areas. On the other hand, hypemelanotic islets are found with melanocytes that produce melanosomes normally, but if abnormal spheric milanosomes and granules are found, abnormal spherical and ganular melanosomes are also found. Conclusion: It is distinguished from vitiligo which usually does not appear at birth, the shape and distribution are also different. On piebaldism. In piebaldism accompanied by white forlock and the presence of islets with normal pigments in hypomelanotic areas. Differentiated from the nevus with depigmentosus, in the nevus the number of melanocit is normal. If piebaldism is accompanied by abnormalities in the distance of the two pupils or is accompanied by deafness, then the possibility of Waardenburg syndrome should be considered.

Extensive unilateral osteosclerosis in the mandible of a child

An orthodontic examination of an eight-year-old female patient revealed osteosclerosis with displaced tooth germs in the left mandible as an incidental finding. The patient has no known underlying diseases. Extraorally, there is normal skin colour without asymmetry with intact sensitivity and motor function. Intraorally, there is an age-appropriate mixed dentition with a discreetly distended mandible on the left.

Hypothermia and Cold Injury in Children.

Hypothermia and Cold Injury in Children.

Natural History of Pressure Injury Among Ethnically/Racially Diverse Nursing Home Residents: The Pressure Ulcer Detection Study.

The current observational study provides descriptive data on 270 pressure injuries (PrIs) among 142 racially/ethnically diverse nursing home (NH) residents over 16 weeks. Weekly assessments were conducted with the Bates-Jensen Wound Assessment Tool. NH data were obtained from public government websites. NH, resident, and PrI characteristics across race/ethnicity groups were compared using analysis of variance and chi-square. Participants were 62% female and 89% functionally dependent. More Black and Asian individuals had peripheral vascular disease. More Black individuals had persistent trunk and Stage 4 PrIs. Black and Hispanic individuals had normal skin color surrounding PrIs. More Asian individuals had PrIs surrounded by purple/red discolored skin. More Black individuals' heel PrIs were unstageable, necrotic, and showed no granulation. Black and Hispanic individuals exhibited more deep tissue injury. No NH or prevention differences existed. Health disparities found validate administrative data results. Differences in PrI characteristics should be further examined among diverse NH residents. [Journal of Gerontological Nursing, 47(3), 37-46.].

Skin of Color – An enigma: A systematic review

The color of human skin varies according to race, ethnicity, and geographic location, which leads to differing appearances of the same cutaneous condition. The nonwhite population is projected to increase worldwide in the coming decades owing to globalization and changing demographics. Thus, this review aims to focus on the varying nature of cutaneous conditions in this population, which differ from traditional descriptions in textbooks. A thorough search of PubMed, MEDLINE, Cochrane, and Google Scholar databases was done for relevant articles focusing on appearances of various dermatoses in skin of color. Erythematous diseases such as psoriasis, pityriasis rosea, and atopic dermatitis presented with inconspicuous/less conspicuous erythema in individuals with colored skin. Postinflammatory pigmentary changes were frequent in individuals with Fitzpatrick Grading III to VI and in the darker phenotypes, the hyperpigmentation may be difficult to distinguish from normal skin color. Acne hyperpigmented macules are encountered as primary lesions in colored skin, causing a considerable amount of apprehension in affected individuals. Hypopigmented disorders such as arsenicosis, macular postkala-azar dermal leishmaniasis, and dhoti or saree-induced depigmentation were particularly observed in this population. A focused review addressing the visual aspects, especially the color of skin diseases in individuals with Fitzpatrick Grading III to VI is the need of the hour to sensitize dermatologists regarding the specific dermatoses and reaction patterns occurring in this population.