Pilosebaceous Unit Research Articles

TRPV3 promotes sebocyte inflammation via transcriptional modulating TLR2 in acne

Acne is a common chronic inflammatory disease of the pilosebaceous unit. Transient receptor potential vanilloid 3 (TRPV3) is an ion channel that is involved in inflammatory dermatosis development. However, the involvement of TRPV3 in acne-related inflammation remains unclear. Here, we used acne-like mice and human sebocytes to examine the role of TRPV3 in the development of acne. We found that TRPV3 expression increased in the skin lesions of Propionibacterium acnes (P. acnes)-injected acne-like mice and the facial sebaceous glands (SGs) of acne patients. TRPV3 promoted inflammatory cytokines and chemokines secretion in human sebocytes and led to neutrophil infiltration surrounding the SGs in acne lesions, further exacerbating sebaceous inflammation and participating in acne development. Mechanistically, TRPV3 enhanced TLR2 level by promoting transcriptional factor phosphorylated-FOS-like antigen-1 (p-FOSL1) expression and its binding to the TLR2 promoter, leading to TLR2 upregulation and downstream NF-κB signaling activation. Genetic or pharmacological inhibition of TRPV3 both alleviated acne-like skin inflammation in mice via the TLR2-NF-κB axis. Thus, our study revealed the critical role of TRPV3 in sebaceous inflammation and indicated its potential as an acne therapeutic target.

Topical application of vitamin D cream in particiants with inflammatory acne due to vitamin D deficiency

Acne vulgaris (AV) represents a chronic inflammatory condition affecting pilosebaceous units, characterized by a multifactorial etiology. AV can manifest as both inflammatory and non-inflammatory skin lesions. Non-inflammatory acne is termed a comedone, which can be either closed (whiteheads) or open (blackheads). Inflammatory acne encompasses papules, pustules, nodules, and pseudocysts. The most common regions for acne occurrence are the facial region (90%), thoracic area (14%), and dorsal region (60%). In the study involving transdermal application of vitamin D cream (applied twice daily; morning and evening) in subjects with inflammatory acne due to vitamin D deficiency, 33 participants took part, comprising 8 males and 25 females. The age group most affected was 18-25 years (adolescent age), followed by a lesser impact in the 26-30 age group, and the lowest incidence observed in the late 36-45 age group. Among males, facial and thoracic regions were most affected by inflammatory acne (37.5%), while among females, the facial region showed a higher percentage of 54%, and the thoracic area was at 40%, with a minimal impact on the dorsal region (M=25%; F=8%). Reductions in inflammatory acne ranged from 100% to 10%, with substantial improvements noted in the male population, achieving 100% and 80% reduction (100% reduction: facial region 25%, thoracic area 12.5%, 80% reduction: dorsal region 25%). Similarly, the female group, with a larger sample size (25 participants), demonstrated significant reductions (100% reduction: facial region 36%, thoracic area 24%, 80% reduction: dorsal area 4%). Overall, improvements were evident in all participants, with none falling below a 30% reduction, indicating remarkable outcomes after one month of vitamin D cream use. Numerous factors contribute to the onset of inflammatory acne, with this study specifically highlighting vitamin D deficiency in the blood. Other indications include the occurrence of polycystic ovaries and reduced thyroid function in women, heightened stress, and prostate issues in men. Reduced or deficient vitamin D levels may be associated with further immune system suppression, activating the aforementioned factors. This research marks a significant stride in uncovering the manifold health benefits of vitamin D. Keywords: acne, vitamin D, participants

Biosensing circulating MicroRNAs in autoinflammatory skin diseases: Focus on Hidradenitis suppurativa.

MicroRNAs (miRNAs) play a crucial role in the early diagnosis of autoinflammatory diseases, with Hidradenitis Suppurativa (HS) being a notable example. HS, an autoinflammatory skin disease affecting the pilosebaceous unit, profoundly impacts patients' quality of life. Its hidden nature, with insidious initial symptoms and patient reluctance to seek medical consultation, often leads to a diagnostic delay of up to 7 years. Recognizing the urgency for early diagnostic tools, recent research identified significant differences in circulating miRNA expression, including miR-24-1-5p, miR-146a-5p, miR26a-5p, miR-206, miR338-3p, and miR-338-5p, between HS patients and healthy controls. These miRNAs serve as potential biomarkers for earlier disease detection. Traditional molecular biology techniques, like reverse transcription quantitative-polymerase chain reaction (RT-qPCR), are employed for their detection using specific primers and probes. Alternatively, short peptides offer a versatile and effective means for capturing miRNAs, providing specificity, ease of synthesis, stability, and multiplexing potential. In this context, we present a computational simulation pipeline designed for crafting peptide sequences that can capture circulating miRNAs in the blood of patients with autoinflammatory skin diseases, including HS. This innovative approach aims to expedite early diagnosis and enhance therapeutic follow-up, addressing the critical need for timely intervention in HS and similar conditions.

LAMA PENGGUNAAN MASKER TIDAK MEMENGARUHI TIMBULNYA JERAWAT PADA PEREMPUAN USIA 15-60 TAHUN

Acne is an inflammatory dermatosis of the pilosebaceous follicular unit. Many factors influence the onset of acne, including facial skin hygiene and skin moisture. The use of masks can have an impact on increasing facial skin moisture and pressure on the skin. This study aims to determine relationship between length use of masks and appearance of acne and factor influencing in women age 15-60 years old. A cross sectional design was conducted on respondents with inclusion criteria of women aged as mentioned previously. Data was collected using a google form questionnaire. The relationship between variables were analyzed statistically with Spearman test with p <0,05 and Chi Square test with p <0,05 significantly different. Total of 225 respondents participated in this study. Respondents used masks for 3 hours and more are 190 (84.5%) respondents. Respondents reported the occurrence of acne after using the mask are 143 (63.5%). Statistical analysis did not find a significant relationship between the duration of using a mask and the onset of acne (p=0.391). Factors that showed a significant relationship with the onset of acne were age, menstrual cycle, education level, facial care, and washing face more often. The duration of using a mask is not related to the appearance of acne in women of reproductive age. Factors influencing with the appearance of acne are age, menstrual cycle, education level, facial care, and washing face more often.

Treatment of Nevus Sebaceous with Short-term Photodynamic therapy combined with simple Surgery

SignificanceNevus sebaceous is a benign cutaneous hamartoma involving the epidermis, pilosebaceous units, and other adnexal structures. To avoid or minimize the scar, photodynamic therapy (PDT) is recommended as a non-surgical treatment. ApproachIn this report, we present a successful case of recurrent nevus sebaceous treated with a combination therapy of PDT and surgical excision. The patient was followed-up for a period of 6 months to evaluate the effectiveness of the treatment. ResultsThe patient underwent three sessions of PDT at three-week intervals, followed by surgical resection. Following the procedure, there was no recurrence of the lesion after 6 months, and the achieved a favorable cosmetic outcome. ConclusionsIn cases where the nevus sebaceous affects larger areas, employing a short-term PDT regimen in conjunction with surgical intervention proves to be an effective strategy, reducing the extent of surgical excision and yielding superior cosmetic results for our patients.

Prevalence and biological characteristics of acne in adult women employees of a university

Background: Increasingly observed in adulthood, adult female acne is considered a common chronic inflammatory disease of the pilosebaceous unit, presenting polymorphic lesions, risk of sequelae and negative impact on quality of life. This is a disease that may persist from adolescence (persistent acne) or manifest de novo in adulthood (late onset acne). Its etiology is multifactorial, and most of patients don’t have any abnormality in plasma androgen levels. Objectives: To investigate the prevalence and biological characteristics of acne in adult women, over 25 years, employees of a university in Sao Paulo, Brazil. Material and Methods: Project approved by Institutional Review Board. All participants signed online Consent Form and Authorization for Photography. This was a cross-sectional online study by using a questionnaire which was uploaded at the intranet of the university. It was sent and visualized by 2560 women employees, but just 241 filled the 59 questions. The data are presented in a descriptive way, in number and percentage. Results: We’ve received 9.4% of responses (241/2560); acne was reported by 94.2% (227/241) and 87.2% (198/227) were still suffering from acne. The real prevalence of acne in that population may be estimated in 7.7% (198/2560); 96% of patients reported inflammatory lesions; 58% on face; 68.7% persistent and 8.5% late onset acne. Regarding the severity, 48.5% were mild, 44.9% moderate and 6.6% severe. Familial history of acne was present in 79% of the patients with persistent acne and 81% late onset acne. Polycystic ovary syndrome was observed in 35% of women with persistent acne, 15% have already been treated or were under treatment; on the contrary 21% presented late onset acne and 64% were treated. Psychological impact was reported by 39% of women with persistent acne and 46% used antidepressants. On the other hand, 8% of women with late onset declared psychological disturbances and 30% were in use of antidepressants. Stress was reported by 51% of women with late onset acne. Additionally, 54% and 68% of women with persistent and late onset acne, respectively, reported sleep disturbances. Our study showed that 60% and 55% of women with persistent and late onset, respectively, consumed a diet featuring a high glycemic load, preferably including sweets. Results about the use of skin care during the treatment (persistent X late onset acne) were quite similar: regular use of sunscreen (50% X 58%); moisturizers (30% X 43%) and cleanser for oily skin (42% X 47%). In addition, 32% X 26% were submitted to chemical peeling; 55% X 41% used oral antibiotic, 28% X 26% combined oral contraceptive, 11% X 19% oral spironolactone, and 22% X 13% oral isotretinoin. Conclusions: The prevalence of acne among adult women employees at a university from Sao Paulo, Brazil is high, and the biological characteristic of the disease corroborates many previous studies. It is important to highlight the predominance of persistent acne, mild to moderate, inflammatory lesions, frequent report of ovary polycystic syndrome with low level of medical care and sleep disturbances. The excessive use of oral antibiotics instead of hormonal treatment point out the need of medical education for the management of this disease that causes important negative impact in women’s quality of life.

Serum Interleukin-6 Levels are Positively Correlated with the Severity of Acne Vulgaris

Acne vulgaris is a chronic inflammatory disease that affects the pilosebaceous unit. This disease occurs on the skin of the face, body, back, and other areas of the body, and can leave scars on the skin which can be temporary or permanent. Recent data shows that the inflammatory process is the initial process in the pathogenesis of acne, several pro-inflammatory cytokines, one of which is interleukin 6 (IL-6), which plays a role in acne vulgaris. Analytical observational study with a cross-sectional approach. The research was carried out from February - November 2023 at the Skin and Venereology Polyclinic, RSUP Prof. Dr. I.G.N.G. Ngoerah Denpasar and the Clinical Pathology Laboratory of Prof IGNG Ngoerah Hospital. The sample consisted of 47 samples of patients with acne and 20 samples without acne aged 8 - 45 years who were selected through consecutive sampling according to inclusion and exclusion criteria. A sample of 3 milliliters of venous blood is taken which will then be checked for IL-6 with an ELISA kit. Data analysis with SPSS version 24 and p value <0.05 is significant. The mean IL-6 serum levels in the acne group was 110.2 ± 88.3 pg/ml while in the non-acne group it was 26.7 ± 23.7 pg/ml. There was a significant difference in the category of IL-6 levels in the acne and non-acne groups (95% CI 55.1 - 155.3, p<0.001). The correlation analysis of IL-6 levels with the severity of acne was strongly positive (r=0.951, p<0.001).

Comparing the Efficacy of Topical 4% Benzoyl Peroxide Versus Topical 0.1% Adapalene for Treatment of Acne Vulgaris in Skin of Color Population: A South Asian Perspective.

Introduction Acne vulgaris is one of the most common skin problems encountered in the dermatology department. It is a chronic, inflammatory disease of the pilosebaceous unit, clinically presenting with comedones, papules, pustules, nodules, and cysts. With its particularly high prevalence in the younger population, it has significant adverse sequelae on patient's quality of life. At present, due to an enhanced understanding of the pathogenesis of acne, various therapeutic modalities are available. The current management strategies generally follow a systematic treatment escalation based on disease severity and treatment response. However meticulous choice of appropriate anti-acne medicine for the acne type is the key to the management plan. Starting with mild to moderate types of acne as per the Leeds photometric grading scale, the most useful topical agents include topical retinoids, benzoyl peroxide, and topical antibiotics while systemic therapies such as oral antibiotics or isotretinoin are generally reserved for moderate to severe acne treatment. The skin of color (SOC) population is a relatively neglected group concerning the optimum and safe management strategies in different dermatological conditions and acne is no different, where there remains a need for comparing the available topical modalities for appropriate drug selection in the treatment of mild to moderate acne in SOC population. Objective The objective of this study was tocompare the efficacy of topical 4% benzoyl peroxide versus topical 0.1% adapalenein the treatment of acne vulgaris in the SOC population. Methods The participants were divided into two groups, groups A and B. A total of 64 patients of both genders, with acne vulgaris (duration > three months) were included in the study. In group A, 32 patients were administered topical 0.1% adapalene whereas, in group B, 32 patients were given topical 4% benzoyl peroxide. Both medicines were applied at night daily. Patients were called for follow-up after 12 weeks. In both groups, the final efficacy evaluation was done using the Global Acne Grading System (GAGS) scoreafter 12 weeks of treatment period. Results In group A, the age ranged from 15 to 40 years with a mean age of 25.781±3.93 years while the duration of complaint was 5.843±1.27 months. GAGS score was 25.281±2.65 and mean BMI was 23.092±3.51 kg/m2. In group B, the mean age was 25.187± 4.06 years, the duration of complaint was 7.375±2.25 months, the GAGS score was 23.906± 2.60 while the mean BMI was 21.485±3.88 kg/m2. Efficacy in group A was noted in 25 (78.1%) patients as compared to 24 (75%) patients in group B (p =0.768). Conclusion The present study showed that the safety and efficacy of 0.1% adapalenethe traditional drug 4% benzoyl peroxide in the SOC population was comparable.

A Novel Systems-Wide Approach in Addressing Acne with a Multi-Targeting Nutraceutical.

Acne vulgaris (AV) is one of the top concerns dermatologists encounter from women. Until now, therapies addressing AV have largely centered around, and have been successful at, targeting the pathophysiological mechanisms that occur at the pilosebaceous unit: sebum hypersecretion, follicular keratinization, over-proliferation of Cutibacterium acnes, and a localized immune response. In addition to these, there is good evidence to suggest that other systemic drivers of a generalized inflammatory response may contribute to the development or exacerbation of acne and that addressing these underlying factors may open more opportunities for developing effective treatments. These include psycho-emotional stress, diet and metabolism, hormonal fluctuations, skin and gut microbiome, oxidative stress, and immune response. While there is accumulating evidence that vitamins, minerals, and botanicals may mitigate some of the pro-inflammatory effects from the activation of these underlying systems, their use and recommendations are limited by a lack of quality efficacy and safety evidence. Here, we present the current evidence for the use of individual supplements in addressing the 6 systemic underlying drivers of AV. We also present a clinical study on the safety and efficacy of a nutraceutical combining many of these ingredients in the management of AV in men and women.  J Drugs Dermatol. 2024;23(3):160-167     doi:10.36849/JDD.8138.

Alterations in epidermal stem cells within the pilosebaceous unit in atrophic acne scars.

Atrophic acne scarring is a common sequela of inflammatory acne, causing significant problems for affected patients. Although prolonged inflammation and subsequent aberrant tissue regeneration are considered the underlying pathogenesis, the role of epidermal stem cells, which are crucial to the regeneration of pilosebaceous units, remains unknown. To examine the changes occurring in epidermal stem cells in atrophic acne scars. Changes in collagen, elastic fibre and human leukocyte antigen (HLA)-DR expression were analysed in normal skin and inflammatory acne lesions at days 1, 3 and 7 after development. The expression of epidermal stem cell markers and proliferation markers was compared between normal skin and mature atrophic acne scar tissue. In acne lesions, inflammation had invaded into pilosebaceous units over time. Their normal structure had been destructed and replaced with a reduced amount of collagen and elastic fibre. Expression of stem cell markers including CD34, p63, leucine-rich repeat-containing G protein-coupled receptor (LGR)6 and LGR5, which are expressed in the interfollicular epidermis, isthmus and bulge of hair follicles, significantly decreased in atrophic acne scar tissue compared to normal skin. Epidermal proliferation was significantly reduced in scar tissue. These findings suggest that as inflammatory acne lesions progress, inflammation gradually infiltrates the pilosebaceous unit and affects the resident stem cells. This disruption impedes the normal regeneration of the interfollicular epidermis and adnexal structures, resulting in atrophic acne scars.

Predicting Human Dermal Drug Concentrations Using PBPK Modeling and Simulation: Clobetasol Propionate Case Study

Quantitative in silico tools may be leveraged to mechanistically predict the dermato-pharmacokinetics of compounds delivered from topical and transdermal formulations by integrating systems of rate equations that describe permeation through the formulation and layers of skin and pilo-sebaceous unit, and exchange with systemic circulation via local blood flow. Delivery of clobetasol-17 propionate (CP) from DermovateTM cream was simulated using the Transdermal Compartmental Absorption & Transit (TCATTM) Model in GastroPlus®. The cream was treated as an oil-in-water emulsion, with model input parameters estimated from publicly available information and quantitative structure-permeation relationships. From the ranges of values available for model input parameters, a set of parameters was selected by comparing model outputs to CP dermis concentration-time profiles measured by dermal open-flow microperfusion (Bodenlenz et al. Pharm Res. 33(9):2229–38, 2016). Predictions of unbound dermis CP concentrations were reasonably accurate with respect to time and skin depth. Parameter sensitivity analyses revealed considerable dependence of dermis CP concentration profiles on drug solubility in the emulsion, relatively less dependence on dispersed phase volume fraction and CP effective diffusivity in the continuous phase of the emulsion, and negligible dependence on dispersed phase droplet size. Effects of evaporative water loss from the cream and corticosteroid-induced vasoconstriction were also assessed. This work illustrates the applicability of computational modeling to predict sensitivity of dermato-pharmacokinetics to changes in thermodynamic and transport properties of a compound in a topical formulation, particularly in relation to rate-limiting steps in skin permeation. Where these properties can be related to formulation composition and processing, such a computational approach may support the design of topically applied formulations.

Differences in hidradenitis suppurativa patterns of cutaneous involvement between sexes: Insights from a cross-sectional study

Hidradenitis suppurativa is a chronic, inflammatory condition of the pilosebaceous unit in which patients manifest multiple, painful cutaneous nodules, abscesses and tunnels. These lesions are described to affect the intertriginous zones, however, the condition exhibits significant phenotypic variability. Such variability is influenced by the patients lifestyle, genetic predisposition and sex. In this cross-sectional study, we investigate sex differences in patterns of hidradenitis suppurativa skin involvement, specifically at site of first involvement and most bothersome cutaneous site of involvement.

A microRNA focus on acne.

Acne (syn. acne vulgaris) is a common inflammatory skin disorder associated with puberty and adolescence. The disease is characterized by comedoneous lesions, papules, pustules, and nodules that are mostly found on the face. These lesions are caused by intricate interactions between the pilosebaceous unit and the Cutibacterium acnes (C. acnes) bacteria. Unhealthy acne and its aftereffects, like pigment changes and scarring, have a detrimental impact on one's quality of life. Recent years have seen a sharp increase in the approval of nucleic acid therapies (NATs), such as antisense oligonucleotides and short-interfering RNA medications, for rare diseases for which there are few or no effective treatments. These developments suggest that NATs may be useful in acne treatment plans down the road, as do clinical trials for microRNA (miRNA) modulation in skin contexts. We highlight promising miRNA targets for anti-acne therapy in this review. We outline the pathophysiology of acne in brief and emphasize the functions of C. acnes. Next, we concentrate on the distinct impacts of biofilm and planktonic C. acnes on a Toll-like receptor 2 axis that spans miR-146a-5p, which was recently discovered. Before discussing the potential contributions of miR-21-5p, miR-233-3p, and miR-150-5p to inflammatory axes in acne, we evaluate miR-146a-5p in sebocytes. Finally, we address patient involvement in miRNA-related acne research and translational perspectives.

Grading system of acnes vulgaris

Background: Acne vulgaris is an inflammatory disease of the pilosebaceous unit, consisting of comedones, papules, pustules, nodules, and cysts. With the complexity of polymorphic nature, acne vulgaris is inherently difficult to assess and the measurement and grading of this condition is a recognized challenge for clinicians. This article presents a comprehensive preview of acne severity assessment according to timelines to give an overview of methods used to measure acne severity. Methods: A systematic search of the literature was performed to identify publications describing acne classification methods. Many combinations of search terms were used with the help of search engines consisting of Pubmed, Google Scholar, Uptodate, and Medscape. Results: 31 documents were retrieved, of which seven articles were removed because the full-text copy could not be found. After reviewing the content of 24 documents, 12 were excluded as they did not focus on acne outcome instruments, did not present a novel approach, did not focus on assessment of physical symptoms, or were not reported in the English language. Finally, 12 methods were included in the review. Conclusion: Acne vulgaris is a common disease, the diversity of classification is useful and allows clinicians to choose a variety of assessment and investigation methods. Key words: acne vulgaris - assessment - classification - evaluation - severity - scale.

Association of different cell types and inflammation in early acne vulgaris.

Acne vulgaris, one of the most common skin diseases, is a chronic cutaneous inflammation of the upper pilosebaceous unit (PSU) with complex pathogenesis. Inflammation plays a central role in the pathogenesis of acne vulgaris. During the inflammatory process, the innate and adaptive immune systems are coordinately activated to induce immune responses. Understanding the infiltration and cytokine secretion of differential cells in acne lesions, especially in the early stages of inflammation, will provide an insight into the pathogenesis of acne. The purpose of this review is to synthesize the association of different cell types with inflammation in early acne vulgaris and provide a comprehensive understanding of skin inflammation and immune responses.

A clinical study of Kumkumadi Tailam Nasya in Yuvan Pidaka w.s.r. to Acne Vulgaris

Yuvan Pidaka is a common skin disease which generally occurs during adolescence. Acharya Sushruta described Yauvan Pidika, under the heading of Kshudrarogas.[1] It occur due to vitiation of Kapha-Vata Dosha and Rakta Dhatu,[2] producing Shalmalika-Kantaka Sadrusha Pidakas over face. Swabhava[3] (natural status) has also been considered as one of the causative factors. Though the Tarunya-Avastha (adolescent period) is the age for Shukra Pradurbhava (manifestation of Shukra Dhatu) and Sharangadhara has mentioned Vaktre Snigdhata (unctuousness on face) and Pidika (boil) formation on face as Mala (waste product) of Shukra Dhatu.[4] It is correlated with Acne vulgaris[5] a chronic inflammatory disease of Pilosebaceous Unit. Imbalanced hormonal levels also play a key role in Acne vulgaris. According to Acharyas nasal cavity is a door to provide medicinal drugs to the brain, so Nasya drugs act on brain through cavernous sinus. Observing the Sthana-Samshraya and Vyaktasthana of the disease as mentioned by Acharya Sushruta,[6] an erudite physician always treat patients with wounds in places above clavicular region, showing pain and vitiation by Kapha and Vata, selecting Nasya line of treatment. Kumkumadi Tailam has properties which alleviate vitiated Vata-Kapha and acts as Rakta Prasadhak, hence Kanti Vardhak. According to Acharya Sarangadhar,[7] Uttarkhanda 8th chapter in Marsha Nasya Taila is Srestha as Sira is Adhisthan of Kapha, and also stated that Marsha Nasya Taila can be applied in Kapha or Kapha-Vata related Vikaras with Oushad Dravyas.

Pigmented Squamous Cell Carcinoma of Skin: A Rare Entity

Squamous cell carcinoma, the second most common form of skin cancer, is caused by the cumulative exposure of skin to UV light. It originates from epidermal keratinocytes or adnexal structures (such as eccrine glands or pilosebaceous units). Squamous cell carcinoma (SCC) has several histologic variants, such as clear cell SCC, signet ring SCC, basaloid SCC, desmoplastic SCC, verrucous and pigmented SCC, among others. Although dendritic melanin containing melanocytes can be seen in a variety of epithelial neoplasms, but only 0.01% to 7% of all squamous cell carcinomas (SCC) are pigmented. Most of which have occurred in the oral and ocular mucosa, with relatively few cases to originate in the skin. The main clinical differential diagnosis for pigmented squamous cell carcinoma are pigmented basal cell carcinoma and melanoma. Herein we report a case of 62 year old male who presented with a blue-black growth over the left inguinal region. Routine lab investigations showed no change and no lymphadenopathy was observed. Biopsy of the growth was received and histopathological evaluation revealed pigmented squamous cell carcinoma. Microscopic examination revealed squamous cell carcinoma with numerous dendritic melanophages showing pigmented melanin. Pigmented SCC can be confused with benign and malignant melanocytic neoplasms, pigmented basal cell carcinoma, actinic keratosis, seborrheic keratosis and pigmented bowen’s disease. In conclusion, this case demonstrates that although pigmented squamous cell carcinomas are relatively rare, they should be included in differential diagnosis of pigmented cutaneous lesions and must be distinguished from other tumors with similar histological findings.

Deroofing: A safe, effective and well-tolerated procedure in patients with hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a recurrent, debilitating, chronic disorder of the pilosebaceous unit. Although advances in HS treatment have been made, more than 45% of patients remain dissatisfied with systemic treatment, and more than one-third are dissatisfied with surgical procedures. A prospective, observational study on the deroofing procedures in HS with special attention paid to patient satisfaction and complications. HS lesions were assessed clinically and by the use of ultrasound. Patients reported outcomes, including pain, itch and satisfaction, were measured at 24 h post-surgery by a numeric rating scale (NRS) ranging from 0 to 10. Additionally, the timeline of objective wound closure reported by patients in (weeks), in addition to the need for any analgesics use, were both evaluated. The mean closure time of the post-deroofing wound was assessed as 4.4 ± 1.9 weeks. A statistically longer time was necessary for complete closure in males than in females (4.9 ± 2.2 weeks and 3.9 ± 1.6 weeks, respectively; p = 0.046). The closure time correlated positively yet weakly with the HS tunnel's width (r = 0.27, p = 0.016) and length (r = 0.228, p = 0.044). Patients assessed mean pain at 24 h post-op as mild with 0.7 ± 1.2 points according to NRS, with no differences between sexes. Similarly, itch in the first 24 h was assessed as mild with 1.8 ± 1.1 points, without differences between sexes. No pain, itch or adverse events were reported after 1 week following deroofing. Moreover, no cases of wound infection were reported. An overall patient satisfaction was assessed as 9.9 ± 0.4 points (range 9-10 points). Deroofing is an easy, effective and safe dermatosurgical procedure that does not require surgical experience or operating theatre. It is associated with no complications and very low post-op pain and should be part of holistic HS management.

Prevalence of Acne and its Association with Stress in Female Medical Students

Background: Acne vulgaris is described as a chronic skin disease involving blockage and inflammation of pilosebaceous units. The objective of this study was to determine the prevalence of acne and its association with stress in female students. Methods: This is a cross-sectional study carried out at Rawalpindi Medical University. The study included female medical students of all five years of MBBS excluding lactating and pregnant females and the ones who were diagnosed with skin disorders other than acne. The sample size was 271. A questionnaire consisting of PSS (Perceived Stress Scale) and GAGS (Global Acne Grading System) was used. Data was analyzed by using SPSS and basic statistics and Spearman correlation were applied. Results: In this study, it was found that out of a total of 271 students, 138(50.9%) students didn’t have acne, and 133(49%) did have Acne. Out of a total of 271 students, 19 (7%) students had low stress, 204 students (75.3%) had moderate stress, and 48 students (17.7%) had high perceived stress. Out of 133 who were found to have acne, 87(32.1%) of the participants had mild acne, 36(13.3%) had moderate acne, 9(3.3%) had severe acne, and 1(0.4%) had very severe acne. An increase in stress severity was moderately correlated (r=0.393) with an increase in acne severity which was not statistically significant (p>0.05). Conclusions: Almost half of the study population was found to have Acne. A positive correlation has been found between stress and acne indicating stress as one of the causative factors of acne.

The effect of phototherapy on Demodex density: acase-control study.

Human Demodex mites, Demodex folliculorum and Demodex brevis, are microorganisms that reside in the pilosebaceous units, usually without causing symptoms. Phototherapy has been linked to demodicosis in previous studies. We aimed to determine whether there was an increase in the frequency of demodicosis and Demodex density after 20 phototherapy sessions. A case-control study was conducted with 32 participants who received narrowband ultraviolet B or ultraviolet A-1 therapy for various dermatological indications. Standardized skin surface biopsies were performed before and after phototherapy to assess Demodex density. The presence of Demodex-related skin conditions was assessed before phototherapy. A statistical analysis was performed to compare the Demodex densities and prevalence of demodicosis between the baseline and 20th session of phototherapy. No significant change was observed in Demodex density after 20 sessions of phototherapy. The average Demodex density before treatment was 2.75 ± 4.48 (/cm2 ), and after treatment, it was 2.85 ± 4.81 (/cm2 ), indicating no significant difference (P = 0.879). The percentage of patients with demodicosis in at least one region of the face was 28.1% (9/32) before treatment, and after treatment, it was 31.3% (10/32), with no significant difference (P = 1.00). Our findings contradict previous studies that suggested an increased Demodex density and demodicosis prevalence after phototherapy. The data from previous studies are open to debate due to their selected samples, designs, and interpretations regarding the phototherapy-immunosuppression-Demodex relationship. Larger-scale longitudinal studies conducted on a homogeneous sample are warranted to better understand the relationship between phototherapy and demodicosis.