Sebaceous Research Articles

Cutaneous Toxicities of MEK Inhibitor Use in Children: A Comparison of Binimetinib and Selumetinib

ABSTRACTBackgroundBinimetinib and selumetinib are two mitogen‐activated protein kinase kinase (MEK) inhibitors used to treat low‐grade gliomas and plexiform neurofibromas. Cutaneous toxicities are commonly associated with MEK inhibitors; however, limited studies have examined cutaneous effects in a pediatric population or whether toxicities vary between MEK inhibitors.MethodsWe conducted an IRB‐approved, single‐center, retrospective review of pediatric neuro‐oncology patients on binimetinib or selumetinib who presented to NYU from April 2016 through July 2022.ResultsForty‐six children met inclusion criteria (23 females, 23 males) with a mean age of 11.7 years. Thirty‐three were treated with binimetinib and 13 with selumetinib. Dermatologic adverse events were encountered in 97.8% of the cohort, and the most common were acneiform eruption (63.0%), paronychia (58.7%), and xerosis (54.3%). Children 12 years and older were more likely to have acneiform eruption (p < 0.001) and seborrheic dermatitis (p < 0.001), while children under 12 were more likely to have xerosis (p = 0.037). The incidence of cutaneous adverse events was significantly different between MEK inhibitors for folliculitis and hair pigment dilution (39.4% binimetinib, 0% selumetinib, p = 0.009). Significantly, more patients required MEK inhibitor dose reduction/hold on binimetinib (87.9%) than selumetinib (46.2%) (p = 0.006). Severity of cutaneous disease was not associated with tumor response.ConclusionsOur study confirms dermatologic adverse events are common in children on MEK inhibitors. Age appears to be associated with increased likelihood of certain cutaneous reactions. Overall, the selumetinib patients in our cohort presented with less severe adverse events and decreased risk of MEK inhibitor dose reduction/hold. Our results will aid clinicians in providing appropriate counseling, treatments, and improved preventive care.

Successful Treatment of Pityrosporum Folliculitis with Isotretinoin

Pityrosporum Folliculitis (PF) is a condition characterized by pruritic 1-2 mm monomorphic follicular papules and pustules on the upper back, chest and shoulders. PF is caused by overgrowth of Malassezia furfur, a commensal yeast found in the infundibulum of sebaceous glands and may be exacerbated by immunosuppression, occlusion and sweating. We present a case of PF with inadequate response to both topical and systemic antifungal therapy, which completely cleared on isotretinoin.

Bilateral Dermoid Ovarian Cysts in a Young Woman - A Case Report and Literature Review.

Ovarian tumors are a common type of neoplasm in women, with mature cystic teratomas being the most frequent variant. These tumors occur bilaterally in approximately 10% of cases. However, bilateral and multiple occurrences are rarely reported. A 22-year-old nulliparous woman presented with amenorrhea and sudden, generalized, dull lower abdominal pain. Diagnostic imaging, including ultrasound and computed tomography (CT) scans, revealed large solid-cystic lesions in both ovaries, with internal hyperechoic foci consistent with fat and calcification, along with thin internal septations. A laparoscopic cystectomy was successfully performed, preserving ovarian function. Histopathological examination confirmed the presence of stratified keratinized squamous epithelium, sebaceous glands, hair follicles, mature adipose tissue, blood vessels, and lymphatic vessels within the resected cysts, with no evidence of malignancy. This unique case provides valuable insights into the understanding and management of bilateral dermoid cysts, highlighting the importance of preserving ovarian function in young women.

Exome Profiling Suggests Combined Effect of Myeloperoxidase, Toll-Like Receptors, and Metallopeptidase in Hidradenitis Suppurativa

Background: Hidradenitis suppurativa, also called acne inversa, is a chronic skin inflammatory condition involving hair follicles, sebaceous glands, and apocrine glands. Symptoms can be variable in intensity, ranging from mild to severe. The exact causes of hidradenitis suppurativa are not fully understood, but the etiology is presumed to be multifactorial, encompassing genetics and environmental factors. Methods: Two families presented with hidradenitis suppurativa with an autosomal dominant pattern. We performed whole-exome sequencing in two unrelated patients from the two families. Results: We identified two and three variants in the two families, respectively. Variants involved the TLR2 and MPO genes in the first family and the MMP2, GJB2, and TLR4 genes, some of which have already been previously reported as possible candidates for hidradenitis suppurativa. Conclusion: It is very likely that variants in a single gene only rarely cause the condition and that most cases, especially familial hidradenitis suppurativa cases, may more probably take the form of polygenic disorders.

Efficacy of Topical Rosemary Extract Lotion Versus Topical 2% Ketoconazole Lotion in the Treatment of Seborrheic Dermatitis: A Double Blind Randomized Controlled Clinical Trial

Introduction: Seborrheic dermatitis manifests as greasy, itchy lesions, commonly affecting sebum-rich areas like the scalp and face. Its prevalence is 11.6% in the general population, with various internal and environmental factors contributing to its development. Objectives: This study aimed to compare the efficacy of rosemary extract lotion in the treatment of seborrheic dermatitis in comparison with topical 2% ketoconazole lotion. Methods: This double-blind, randomized clinical trial included 42 patients with scalp seborrheic dermatitis, divided into rosemary and ketoconazole lotion groups. Both lotions were applied twice daily for 2 months. The severity of scalp dandruff was assessed using the Adherent Scalp Flaking Score. Itchiness of the scalp and quality of life were assessed using itchy quant and the Dermatology Life Quality Index (DLQI), respectively. Stata software was applied for statistical analysis. Results: The reduction in the Adherent Scalp Flaking Score score was statistically significant the ketoconazole group compared to the patients in the rosemary group (P value = 0.011). However, the reduction in itching score was statistically significant more in the rosemary group at the end of the first and second months in comparison to the ketoconazole group (P value < 0.001). The statistical analysis demonstrated no significant difference in the reduction of DLQI scores between the rosemary and ketoconazole groups at the end of 1 and 2 months after starting the treatment in both crud and adjustment with base-line score analysis. Conclusion: Both rosemary and ketoconazole lotions were effective in treating scalp seborrheic dermatitis and decreasing the patient's DLQI score.

Prevalence and Clinical Significance of Skin Manifestations in Parkinson Disease Patients

Background: Parkinson's disease (PD) is primarily characterized by motor symptoms, but non-motor symptoms, including skin manifestations, are increasingly recognized. These remain underexplored despite their potential impact on quality of life. Objectives: This study aimed to evaluate the prevalence and clinical features of skin findings in PD patients, with a focus on identifying potential pathogenetic links between dermatological conditions and PD. Methods: A total of 215 PD patients were included. Comprehensive dermatological examinations were performed, and demographic and clinical data were collected. Statistical analysis was conducted using SPSS 23.0, with significance set at P < 0.05. Results: Skin conditions were found in 92.1% of PD patients. Xerosis, seborrheic dermatitis, and hyperhidrosis were the most common findings. Pre-PD xerosis was associated with an earlier stage of PD (P = 0.001). Use of PD medications, such as levodopa/carbidopa/entacapone, was linked to a lower incidence of seborrheic dermatitis (P = 0.040). A significant correlation was also noted between rosacea and cherry angioma (P = 0.01). Conclusion: Dermatological conditions are prevalent in PD and may precede its motor symptoms. Skin assessments could aid early diagnosis and management of PD, highlighting the need for further research on their pathogenetic mechanisms.

Patient and Healthcare Provider Perspectives on Disease Burden of Seborrheic Dermatitis in the United States: Results from a National Survey.

Seborrheic dermatitis (SD) is a common, chronic inflammatory skin disease, but the physical and emotional burden of patients with SD experience has not been well characterized. The Harris Poll conducted online surveys of US patients and healthcare providers (HCPs) from December 2021 to January 2022. Almost half of patients reported that SD negatively impacts their emotional and physical well-being "a lot/a great deal"; HCPs underestimate the level of impact on patients. Most patients with SD reported a significant mental health impact, including anxiety, depression, anxiety about interacting with other people, and isolation. Two-thirds of patients said they did not know anyone else who had been diagnosed with SD, and even after diagnosis, less than half of patients still said they did not know anyone else with SD. Nearly all patients and HCPs agreed that it was challenging to hide SD symptoms, and most patients felt embarrassed when people commented on their SD symptoms. Most patients agreed that they would be further along in their career if they did not have SD, and SD symptoms made them less confident at work and less likely to want to interact with people at work. Almost half of patients reported ever missing work as a result of SD symptoms. These insights emphasize the physical and emotional patient burden associated with SD, impacting all aspects of patients' lives. Graphical abstract available for this article.

SSA-ZP on Scalp Seborrheic Dermatitis: Regulating Sebum Levels and Scalp Barrier.

The occurrence of scalp seborrheic dermatitis (SD) is closely related to the production of sebum and scalp barrier function. Supramolecular salicylic acid has the keratolytic and anti-inflammatory properties, and zinc pyrithione is an antifungal drug delivered as a microparticle to skin epithelia. This study aimed to assess the efficacy and safety of 2% supramolecular salicylic acid (SSA) combined with 0.8% zinc pyrithione conditioner (SSA-ZP) in treating scalp SD focusing on key outcome measures including sebum levels and scalp barrier function. Five patients with mild to moderate scalp SD were included in the 2-week self-controlled prospective study, receiving daily SSA-ZP treatment. Evaluation on days 0, 7, and 14 included dermoscopy, the adherent scalp flaking scale (ASFS), sebum level, transepidermal water loss (TEWL), pH, and stratum corneum hydration. We also performed the fungal count across specific scalp regions, such as the left and right sides of the forehead, the top of the head, and the occiput. Five patients with mild to moderate scalp SD participated in this study. After 2 weeks of SSA-ZP treatment, significant reductions in ASFS scores, sebum levels, and fungal count were observed, alongside improvements in TEWL and pH values across multiple scalp regions. Moreover, there was no difference in the hydration of stratum corneum. SSA-ZP demonstrated efficacy in treating scalp SD without adverse effects, suggesting its potential as a first-line treatment option. Further research with larger sample sizes and longer follow-up periods is warranted to validate these findings.

Evaluation of Geh gene expression in Staphylococcus aureus isolated from acne patients

Acne vulgaris is a chronic skin disease that affects the hair follicle and sebaceous glands. Staphylococcus aureus colonizes human skin and causes infections ranging from local skin infections to systemic infections that may threaten human life due to its ability to produce many virulence factors and antibiotic resistance. The objective of this study is to measure the genetic expression of Geh gene responsible for producing the lipase enzyme from S. aureus isolated from acne patients. This study was conducted by collecting 130 swabs from acne patients at Tikrit Teaching Hospital. Using routine bacterial isolation and identification methods, 50 samples (38.4%) of the total samples were identified as S. aureus through its ability to grow in mannitol salt agar medium, the fermentation of mannitol sugar, and the change of the medium color to yellow. The Geh gene expression of ten S. aureus isolates from acne patients was examined using RT-PCR. The results showed that Geh gene was expressed in all isolates, with an expression ranging from 1.5 to 7.2, and that the mean folding of the Geh gene for ten samples was 4.2. This indicates the presence of high gene expression of the Geh gene in S. aureus isolates. Therefore, it is concluded that Lipase enzyme plays an important role in the pathogenesis of S. aureus in acne patients.

Programmable Artificial Skins Accomplish Antiscar Healing with Multiple Appendage Regeneration.

Functional appendage regeneration is essential for skin rehabilitation, but it has always failed by current existing healing approaches, owing to their inefficacy in preventing disfiguring scars. In this study, a novel regeneration-directing artificial skin (RDAS) system is presented, which is based on the rational design of multi-layered hydrogels that closely mimic natural skin matrices. By leveraging the programmability and architectural rigidity of DNA components, without the need for exogenous cell transplantation, such RDAS effectively minimizes tissue fibrosis by accurately guiding the regenerative process in wound fibroblasts, enabling rapid scarless wound repair, restoration of dermal function, and successful in situ regeneration of multiple appendages, such as hair follicles (HFs), sebaceous glands (SGs), and sweat glands (SwGs). Therefore, the RDAS offers a cell-free antiscarring therapeutic strategy for regenerative wound healing, resulting in improved outcomes. This innovative approach holds great potential for future clinical applications and burn rehabilitation.

Identifying diagnostic biomarkers for Erythemato-Squamous diseases using explainable machine learning

Erythemato-squamous diseases (ESD) are a heterogeneous group encompassing six clinically and histopathologically overlapping subtypes, representing a substantial diagnostic challenge within dermatology. The existing body of research reveals a notable void in detailed examinations that deconvolute the distinct features endemic to each ESD variant. To bridge this knowledge gap, our study applied Explainable Artificial Intelligence (XAI) techniques to systematically elucidate the intricate diagnostic biomarker profiles unique to each ESD category. Methodological rigor was fortified through the employment of stratified cross-validation, bolstering the robustness and generalizability of our diagnostic model. The CatBoost classifier emerged as a preeminent algorithm within our analytical framework, manifesting exemplary classification prowess with an accuracy of 99.07%, precision of 99.12%, recall of 98.89%, and an F1 score of 98.97%. Central to our inquiry was the deployment of Shapley Additive exPlanations (SHAP) values, which afforded granular insight into the contributory weight of individual diagnostic biomarkers for each ESD subtype. Our findings delineated pivotal diagnostic biomarkers including saw-tooth appearance of retes (STAR), melanin incontinence (MI), vacuolisation and damage of basal layer (VDBL), polygonal papules (PP), and band-like infiltrate (BLI) as instrumental in the identification of seborrheic dermatitis, while Psoriasis was characterized by fibrosis of the papillary dermis (FPD), thinning of the suprapapillary epidermis (TSE), elongation of the rete ridges (ERR), clubbing of the rete ridges (CRR), and notable psoriatic spongiosis. This integrative approach, leveraging the analytical acumen of Random Forest coupled with the interpretability afforded by SHAP, signifies a significant advancement in the nuanced diagnostic landscape of ESD.

Surgical Management of Moderate Rhinophyma with Nasal Nodules: An Electrosurgery Approach

Introduction: Rhinophyma, a severe manifestation of rosacea, is characterized by hypertrophy of sebaceous glands and fibrosis of the nose, often leading to significant aesthetic and functional impairments. Surgical treatment is the preferred approach for advanced cases to restore nasal appearance and function. Case Report: We present the case of a 60-year-old man with moderate rhinophyma and nodules on the nostrils. Surgical management under local anesthesia involved the use of thermal loops for excision of the lesions and bipolar electrosurgery for hemostasis. The patient was also treated for rosacea with topical agents, including metronidazole and azelaic acid, and oral doxycycline for inflammatory lesions. Directed healing followed the surgery, along with LED phototherapy and ablative erbium laser sessions to optimize results. Discussion: The use of thermal loops and electrosurgery allowed for precise excision and control of bleeding. Postoperative care, including daily greasy vaseline dressings, facilitated rapid healing. Mild infection at the excision sites was treated with topical and prophylactic antibiotics. Six sessions of LED therapy combining four types of light (infrared, red, yellow, and blue) improved healing and reduced inflammation. Ablative erbium laser was proposed to further enhance the aesthetic outcome. Conclusion: A combined surgical approach and careful postoperative management yielded satisfactory results in the treatment of rhinophyma.

New insights from the integration of dapsone, flutamide, tea tree oil, and rose oil as a topical combined microemulsion for the management of Acne Vulgaris: Design, development, and in vitro/in vivo characterization

Acne vulgaris (AV) is a multifactorial sebaceous glands disorder resulting from androgen receptor activation associated with follicular colonization by bacteria. Oral administration of the androgenic antagonist flutamide (FLU) and the antibacterial dapsone (DAP) may cause several side effects. Hence, this study aimed to design a topical microemulsion (ME) combining these drugs to manage AV. Drugs solubility was examined in different oils, surfactants and cosurfactants. Pre-formulation and compatibility studies were performed. The selected MEs were characterized to determine one ME to be investigated regarding stability, and skin irritation as well as antibacterial, anti-inflammatory, and anti-acne activities. Based on the in vitro characterization of the selected MEs, o/w ME (F1) based on 15 % w/w oils (tea tree oil (TTO)/rose oil (RO)) and 40%w/w of tween 20 as surfactant together with transcutol p as co-surfactant was chosen as the optimized ME. The results revealed that F1 showed acceptable pH, viscosity, conductivity, and droplet size (172.6 ± 9.7 nm). The in vitro release and ex vivo permeation of DAP and FLU were efficiently enhanced by their combination in F1. Moreover, F1 exhibited considerable antimicrobial activity against Staphylococcus aureus (S. aureus). Topical application of F1 resulted in low expression levels of interleukin 1β associated with a reduction in the number of androgenic receptors (AR). In conclusion, F1 could be suggested as a combination topical therapy to control AV via its anti-inflammatory, anti-acne, and antimicrobial activities.

Targeted Drug Delivery in Periorbital Non-Melanocytic Skin Malignancies.

Targeted drug delivery has emerged as a transformative approach in the treatment of periorbital skin malignancies, offering the potential for enhanced efficacy and reduced side effects compared to traditional therapies. This review provides a comprehensive overview of targeted therapies in the context of periorbital malignancies, including basal cell carcinoma, squamous cell carcinoma, sebaceous gland carcinoma, and Merkel cell carcinoma. It explores the mechanisms of action for various targeted therapies, such as monoclonal antibodies, small molecule inhibitors, and immunotherapies, and their applications in treating these malignancies. Additionally, this review addresses the management of ocular and periocular side effects associated with these therapies, emphasizing the importance of a multidisciplinary approach to minimize impact and ensure patient adherence. By integrating current findings and discussing emerging trends, this review aims to highlight the advancements in targeted drug delivery and its potential to improve treatment outcomes and quality of life for patients with periorbital skin malignancies.

Autophagy-Mediated Cellular Remodeling during Terminal Differentiation of Keratinocytes in the Epidermis and Skin Appendages.

The epidermis of the skin and skin appendages, such as nails, hair and sebaceous glands, depend on a balance of cell proliferation and terminal differentiation in order to fulfill their functions at the interface of the body and the environment. The differentiation of epithelial cells of the skin, commonly referred to as keratinocytes, involves major remodeling processes that generate metabolically inactive cell remnants serving as building blocks of the epidermal stratum corneum, nail plates and hair shafts. Only sebaceous gland differentiation results in cell disintegration and holocrine secretion. A series of studies performed in the past decade have revealed that the lysosome-dependent intracellular degradation mechanism of autophagy is active during keratinocyte differentiation, and the blockade of autophagy significantly alters the properties of the differentiation products. Here, we present a model for the autophagy-mediated degradation of organelles and cytosolic proteins as an important contributor to cellular remodeling in keratinocyte differentiation. The roles of autophagy are discussed in comparison to alternative intracellular degradation mechanisms and in the context of programmed cell death as an integral end point of epithelial differentiation.

Elevated anti‐Müllerian hormone in a stallion (Equus f. caballus) with terratoma and high inguinal testicle

AbstractThis report describes a stallion presenting a unilateral high inguinal undescended testicle and a unilateral scrotal testicle teratoma. Blood tests showed increased levels of anti‐Müllerian hormone. Following castration, histological examination revealed that the teratoma contained testicular tissue, hair, hair bulbs, sebaceous glands, cartilage and endochondral bone. To our knowledge, this is the first study to report elevated anti‐Müllerian hormone levels in a stallion with both a teratoma and a high‐inguinal testicle.

8242 A Case of Ayme Gripp Syndrome

Abstract Disclosure: P. Jaisinghani: Consulting Fee; Self; Novo Nordisk. J. Pappas: None. We present a 35 year old female with cataracts, generalized seizures and oligodontia, referred to us for hair loss and elevated TSH. For over 10 years, patient had a diffuse hair loss which progressed to a focal patch of hair loss in the setting of prior use of keppra and seborrheic dermatitis. Patient has regular menses, and no symptoms of hyper/hypothyroidism or family history of thyroid disease. Patient established care with dermatology and scalp biopsy noted early androgenetic alopecia. Physical exam was notable for short stature, height 4'11, 98 lbs, BMI 19.8 kg/m², progeric appearance, facial hyperpigmented spot, hair thinning, palpable thyroid R>L. Laboratory evaluation included TSH 6.150 (0.450 - 4.500 uIU/mL), DHEAS 263 (84.8 - 378.0 ug/dL), total testosterone 15 (10 - 55 ng/dL), FSH 6.6 (Follicular phase 3.5 - 12.5 mIU/mL), LH 7.6 (Follicular phase 2.4 - 12.5 mIU/mL), estradiol 83 (Follicular phase 12.5 - 166.0 pg/mL). Thyroid US demonstrated smaller than average size left lobe measuring 2.93 cm x 0.84 cm x 1.36cm vs right lobe measured 4.34 cm x 0.90 cm x 1.62. Labs noted TSH 5.690 (0.450 - 4.500 uIU/mL), establishing subclinical hypothyroidism and negative thyroid antibodies. Clinical genetics evaluation included trio exome sequencing which revealed a de novo pathogenic variant p.(Ser54Leu) (TCG>TTG): c.161 C>T in exon 1 of the MAF gene (NM_005360.4) which establishes the diagnosis of a Ayme- Gripp syndrome (AGS). AGS is characterized by a triad of cataract, sensorineural hearing loss, and characteristic facial features in combination with neurodevelopmental abnormalities. 21 affected individuals from 19 families have been reported with AGS. Clinical features in our case characteristic of AGS included short stature, brachycephaly, midface hypoplasia, long philtrum and premature hair loss. Hypothyroidism was identified in childhood in 3/15 identified individuals who responded to thyroid hormone replacement therapy. For this patient, we will monitor thyroid function tests every 3-6 months and monitor for symptoms of hypothyroidism. Patient has been referred to cardiology and nephrology, and will continue to follow with genetics and dermatology. Our case further establishes the association of hypothyroidism with AGS. Our case demonstrates the value of expanding the differential of endocrinopathies to rare genetic conditions which are currently identifiable by clinically available genomic tests. Presentation: 6/1/2024

Current trends in hair care in men

Hair care is essential for men for a variety of reasons, spanning from esthetics to overall health. A clean scalp reduces the risk of hair concerns in men such as seborrheic dermatitis and bacterial infections. Engaging in regular hair care routines can be a form of self-care, contributing to a sense of well-being and personal satisfaction. Proper hair care can also help reduce the risk of damage and hair loss. Avoiding harsh treatments and using appropriate products can preserve hair health and prevent excessive shedding. A diet rich in vitamins and minerals supports healthy hair growth. This review discusses hair cosmetics and its importance in men.

Transcription factor KROX20 marks epithelial stem cells for hair follicle formation.

Epidermal stem cells control homeostasis and regeneration of skin and hair. In the hair follicle (HF) bulge of mammals, populations of slow-cycling stem cells regenerate the HF during cyclical rounds of anagen (growth), telogen (quiescence), and catagen (regression). Multipotent epidermal cells are also present in the HF above the bulge area, contributing to the formation and maintenance of sebaceous gland and upper and middle portions of the HF. Here, we report that the transcription factor Krox20 is enriched in an epidermal stem cell population located in the upper/ middle HF. Expression analyses and lineage tracing using inducible Krox20-CreERT showed that Krox20-lineage cells migrate out of this HF region and contribute to the formation of bulge in the HF, serving as ancestors of bulge stem cells. In vivo depletion of these cells arrests HF morphogenesis. This study identifies a novel marker for an epidermal stem cell population that is indispensable for hair homeostasis.

Development of Bacillus stratosphericus Lysate Concentrate to Control Sebum Secretion through In vitro Studies and Clinical Trial

The sebum on human skin is generated for various causes. The composition of the formed sebum increases the proliferation of Cutibacterium acnes (C. acnes) residing on the skin. As C. acnes proliferates, it produces skin irritants that stimulate the sebaceous glands, increasing sebum production. Skin troubles such as acne may occur. The lysate concentrates of Bacillus stratosphericus (B. stratosphericus), first discovered in the stratosphere, confirmed a 66.35% inhibition of Nitric Oxide (NO) production at 0.50 mg/ml concentration in vitro. Additionally, the growth inhibition efficacy of B. stratosphericus lysate concentrate (BSLC) against C. acnes was confirmed, showing a 95.1% inhibition of growth proliferation at a consistency of 0.50 mg/ml. Based on the in vitro results, the efficacy of BSLC in degrading and reducing sebum was confirmed by reacting it with artificial sebum to various concentrations. The results showed a concentration-dependent decrease in artificial sebum ccording to the efficacy results confirmed in vitro, a clinical trial was conducted to evaluate the daily sebum reduction efficacy of a serum formulation containing 50 mg/ml of BSLC. After a 4-week application, the test group containing BSLC determined a significant 28.68% reduction in sebum levels, demonstrating the practical implications of the research. In conclusion, BSLC is considered to have sufficient industrial value as a valuable ingredient for the cosmetics industry aimed at sebum improvement.