Skin Phototype Research Articles

Histological and histopathological structural changes in the skin of the Basal Cells Carcinoma patients

Background: Basal Cell Carcinoma (BCC) is the most common type of skin carcinoma and is considered an epidemic disease due to its increasing frequency in many countries. The most important problem of BCC is local invasion It grows in a “silent” way into immediately adjacent tissue. It rarely metastasizes. The early tumors are commonly small, translucent or pearly, raised and rounded areas located on a few dilated, superficial vessels. There are six subtypes of BCC that include nodular, pigmented, superficial, morphea form, cystic. The most important risk factor for basal cell carcinoma is exposure to UV-radiation. Outdoor workers with a long history of work-related UV-exposure are at increased risk of developing BCC. Other risk factors include family history of skin carcinoma, light skin phototypes, advanced age. Objective: The current study investigated pathological and histological changes in tissue sections to identify the factors contributing to the infection frequency. Patients and Methods: Thirty-three BCC patients' samples have been collected from the main care center at al-Baquba Teaching Hospital of Diyala Province, Iraq. All patient groups were clinically diagnosed as BCC by dermatologists. Results: The study showed macroscopic and microscopic histological changes. An ulcerated macroscopic appearance of the lesion was shown. The tumor lesions are located on the face. It was noted that the percentage of patients was higher in men than women and higher in light skin than dark skin. The study also showed that the age group 66-74 years had a higher infection percentage, while the lower percentage was of the age group > 83 years. Conclusion: These findings pave the way for future research endeavors aimed at prevention, early detection, and targeted treatment strategies for this prevalent skin carcinoma.

Latin American consensus on the treatment of melasma.

Melasma is a chronic, relapsing hyperpigmentation disorder that primarily affects photoexposed areas, occurring most frequently in adult women with darker skin phototypes. The primary factors contributing to its development include sun exposure, sex hormones (e.g., pregnancy), and genetic predisposition. Melasma is highly prevalent in Latin America, where many countries lie in intertropical zones and exhibit significant ethnic diversity because of centuries of intermixing among Native Americans, Europeans, and Sub-Saharan Africans. Nine Latin American experts formulated a DELPHI-based consensus to develop a valuable approach for treating melasma in this diverse population. After establishing an accurate diagnosis, assessing the impact on quality of life, and determining disease severity, the consensus recommends mitigating known triggers and promoting rigorous photoprotection. Active therapy should be tailored based on individual characteristics (e.g., pregnancy status, previous treatments, skin sensitivity). Treatment options include topical depigmenting agents, systemic therapies, and procedural interventions such as laser therapy, microneedling, and chemical peels. Periodic reassessment of the treatment is essential, with strategies adjusted if targeted outcomes are not achieved. Once clinical remission is attained, patients should continue using topical depigmenting agents and maintain strict photoprotection measures to prevent recurrence.

AI in Psoriatic Disease: Scoping Review.

Artificial intelligence (AI) has many applications in numerous medical fields, including dermatology. Although the majority of AI studies in dermatology focus on skin cancer, there is growing interest in the applicability of AI models in inflammatory diseases, such as psoriasis. Psoriatic disease is a chronic, inflammatory, immune-mediated systemic condition with multiple comorbidities and a significant impact on patients' quality of life. Advanced treatments, including biologics and small molecules, have transformed the management of psoriatic disease. Nevertheless, there are still considerable unmet needs. Globally, delays in the diagnosis of the disease and its severity are common due to poor access to health care systems. Moreover, despite the abundance of treatments, we are unable to predict which is the right medication for the right patient, especially in resource-limited settings. AI could be an additional tool to address those needs. In this way, we can improve rates of diagnosis, accurately assess severity, and predict outcomes of treatment. This study aims to provide an up-to-date literature review on the use of AI in psoriatic disease, including diagnostics and clinical management as well as addressing the limitations in applicability. We searched the databases MEDLINE, PubMed, and Embase using the keywords "AI AND psoriasis OR psoriatic arthritis OR psoriatic disease," "machine learning AND psoriasis OR psoriatic arthritis OR psoriatic disease," and "prognostic model AND psoriasis OR psoriatic arthritis OR psoriatic disease" until June 1, 2023. Reference lists of relevant papers were also cross-examined for other papers not detected in the initial search. Our literature search yielded 38 relevant papers. AI has been identified as a key component in digital health technologies. Within this field, there is the potential to apply specific techniques such as machine learning and deep learning to address several aspects of managing psoriatic disease. This includes diagnosis, particularly useful for remote teledermatology via photographs taken by patients as well as monitoring and estimating severity. Similarly, AI can be used to synthesize the vast data sets already in place through patient registries which can help identify appropriate biologic treatments for future cohorts and those individuals most likely to develop complications. There are multiple advantageous uses for AI and digital health technologies in psoriatic disease. With wider implementation of AI, we need to be mindful of potential limitations, such as validation and standardization or generalizability of results in specific populations, such as patients with darker skin phototypes.

A New Approach with Combined Microneedle and Sublative Fractional Radiofrequency for Photoaging Management: A Clinical, Histometric, and Immunohistochemical Study.

Fractional radiofrequency (FRF) has been reported to be effective in improving wrinkles. A combination of microneedle and sublative fractional radiofrequency (SFRF) may have the potential synergy to improve photoaged skin. To evaluate the efficacy and safety of combined microneedle and SFRF in photoaging management. This prospective study included 12 subjects with moderate photoaging (skin phototype III-IV). The subjects received three consecutive combined microneedle and sublative FRF at 1-month intervals. Punch biopsies were obtained before and after three months of treatment. Routine H&E, Masson-trichrome, Orcein staining, histometric measurements, as well as Collagen type I and Elastin immunohistochemical staining were performed. Significant improvement was noticed regarding skin tightening and texture (p < 0.05), rhytides, and volunteers' satisfaction (p < 0.001). Collagen fibers appeared better organized, with a significant increase in collagen type I (p = 0.001). Meanwhile, normal-appearing elastic fibers were restored, and a significant reduction in abnormal elastin was achieved (p = 0.0005). Combined microneedle and sublative FRF may provide a new therapeutic approach for photoaged skin. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Dosimetry model for photobiomodulation based on anthropometric and hemodynamic variables in patients with orofacial pain post-Covid-19: Study protocol for randomized clinical trial.

Orofacial pain and tension headache are symptoms that affect a large portion of the population, compromising productivity, social ability, and functional development. The treatment for reducing painful sensation should be chosen carefully, as pharmacological treatment may bring side effects and overload the organism of patients in pain. Low-level laser therapy has been used with local and systemic [vascular] applications for pain control. However, there is still uncertainty in the literature about the ideal dosimetric parameters for photobiomodulation treatment according to patient characteristics. The objective of this project is to validate a dosimetry model based on the relationship between the effects of photobiomodulation with anthropometric and hemodynamic variables, both in local application and systemic application in patients with symptoms of orofacial pain and tension headache. For this purpose, 180 participants with orofacial pain post-covid eligible participants will be randomly assigned to Group 1-Local Photobiomodulation, Group 2-Vascular Photobiomodulation, Group 3-Placebo Local Photobiomodulation, or Group 4-Placebo Vascular Photobiomodulation [Therapy EC-DMC device, São Carlos, Brazil,- 660 nm, 100mW] using stratified block randomization. Before the application, sociodemographic information such as age, skin phototype [classified by the Fitzpatrick scale], weight, height, body mass index [BMI], oxygen saturation [SaO2], blood pressure [BP], heart rate [HR], and thickness of skin, fat, and facial muscles will be collected. During the application, we will collect local temperature, SaO2, BP, and HR. Before and after laser application, blood levels of lactate and hemoglobin, BP, and HR will be measured in the first and last session. In addition to demographic, anthropometric, and hemodynamic variables, the penetrated energy will be quantified using a power meter, and information from orofacial pain and headache symptom questionnaires will be analyzed. The Monte Carlo simulation technique will be used to systematically study the relationship between the light penetration profile into the target tissues and the most relevant variables, namely BMI, tissue layer thicknesses, and skin phototype. Light transmittance, measured in vivo and simulated, will be compared to validate a personalized dosimetry model. The results of this study contribute to validating a Monte Carlo Simulation model to calculate the appropriate dosimetry for photobiomodulation therapies in the control of patients with Post-Covid-19 orofacial pain. Trial registration number: NCT06065969.

CLINICAL CASES OF SPITZOID NEOPLASMS

Spitz nevi account for about 2% of the total number of melanocytic skin neoplasms. There are benign Spitz nevi, atypical Spitz tumour, and malignant Spitz melanoma. These clinically similar lesions, usually represented by a flesh-coloured, pink or brownish-black spot or nodule, are often heavily vascularised, grow rapidly in size and change in structure, raising concerns about malignancy. Dynamic observations have revealed the possibility of long-term stabilisation and periods of regressive changes. Dermoscopy is used for early diagnosis due to the initially small size of nevi. When examining the magnified image of the tumour surface, the structure of the neoplasm is recognized. In the case of Spitz nevi, special patterns of “starburst” and “stardust” are identified, which allow to suspect the diagnosis and the period of involution, respectively. Pathohistologically, Spitz nevi are defined as melanocytic proliferations with large epithelioid or spindle-shaped melanocytes with large nuclei, vesicular chromatin and prominent nucleoli. However, the differentiation between different subtypes of spitzoid neoplasms remains a difficult issue. As of today, the review of H&amp;E-stained structures still prevails over immunohistochemical and molecular genetic diagnostic methods. Even nowadays, Spitz nevi still cause difficulties in clinical and morphological diagnosis and management approaches. The publication considers several interesting cases from personal clinical practice. Case 1: Patient A, a 24-year-old woman. She complained of a single rash on the outer surface of the right thigh, which gradually increased in size over the last year. On clinical examination, a small erythematous, partially pigmented, heterogeneous nodule was observed in this area. The demonstrated Spitz nevus is heterogeneous in structure. Being in the phase of active growth, it showed an asymmetrical “starburst” pattern formed by vascular elements in a linear arrangement, and white reticular lines or structureless zones. Case 2: Patient B, 34 years old. A full examination of the right popliteal fossa revealed a heterogeneous spot up to 4 mm in diameter, which caused concern. A case of Spitz nevus is represented by a globular pattern in the centre and a reticular pattern on the periphery, which is more common for lesions that have been on the skin for some time, but no longer show signs of active growth. Case 3: Patient C, a 25-year-old woman, skin phototype 2, with a family history of skin tumours in several previous generations. The examination revealed a heterogeneous nodule of suspicious morphology in the left scapula. Dermoscopically, the above-described lesion is represented by two zones of different structure. The central zone has the signs of radial markings formed by various pattern elements; the polychromatic zone has areas of negative pigment network, white lines, dots and globules. There was also an eccentrically located area with a radially oriented hyperchromatic pigment network and a clear border along the outer edge. Most Spitz nevi are independent lesions, but some of them can be associated with other skin neoplasms. This is likely to be the example in the above-mentioned case, so it was the nevus-associated Spitz melanoma. Spitz nevi are an urgent problem of modern medicine. The similarity of the clinical, dermoscopic and pathological picture to malignant skin neoplasms causes diagnostic difficulties. Visual variability requires considerable clinical experience of a specialist.

Validity of facial skin analysis pore detection: A comparative analysis.

Reliable, objective measures to assess facial characteristics would aid in the assessment of many dermatological treatments. Previous work utilized an iOS application-based artificial intelligence (AI) tool compared to the "gold standard" computer-based and a physician assessment on five skin metrics (British Journal of Dermatology, 2013, 169, 474). The AI tool had superior agreement for all skin metrics except pores and subsequently underwent an algorithm update for its pore detection system. This comparative analysis assessed the performance of the updated AI tool's pore scores across all Fitzpatrick skin phototypes to determine whether the AI tool more accurately represents a dermatologist's assessment of pores. Frontal facing photographs in uniform lighting conditions were taken of each participant. Percentile scores were generated by each of the four self-learning models of the updated AI tool. The pore percentile scores generated by the original and updated AI tool were used to rate "worse" pores among participant pairs. These ratings were compared to pore assessments performed by a "gold-standard" device and a board-certified dermatologist. Compared to the original pore detection tool and the computer-based program, models A and D had the highest concordance with the physician's pore assessments for Fitzpatrick skin phototypes III-IV and V-VI, respectively. The AI tool's pores detection update was successful in its ability to accurately detect pores on all Fitzpatrick skin types, improving on the performance of the AI prior to the update. Responsibly developed AI tools that can accurately and reliably detect skin metrics across diverse Fitzpatrick skin types can facilitate dermatologic evaluation, individualize treatment, and determine treatment response.

Subjective and objective assessment of color match of universal tinted sunscreens in Fitzpatrick skin phototypes I-VI.

Tinted sunscreens not only shield against UV rays but also provide protection against visible light, as opposed to traditional sunscreens. Universal tinted sunscreens are marketed to complement all skin tones. To assess color match and subject satisfaction for 7 universal tinted sunscreens across various price ranges in all Fitzpatrick skin phototypes (SPT). Products A-G were applied at concentrations of 1 and 2 mg/cm2 on the dorsal arms of 30 subjects spanning SPT I-VI. Photography, colorimetry, and subject and investigator surveys were utilized to determine color match. Using colorimetry analysis at the recommended 2 mg/cm2 concentration, two of seven products were identified as suitable matches for SPT I-II, while six out of seven were determined to be a good match for SPT III-IV. However, only one product was found to be a good match for SPT V-VI at the recommended concentration according to colorimetry results. Universal tinted sunscreens do not provide an adequate color match for all skin phototypes, especially for individuals with very fair or very dark skin tones.

An overlooked risk for skin health: Less availability and higher cost of sunscreen for people with melanated skin

BackgroundSunscreen with a skin protection factor (SPF) of 30 or greater is recommended to reduce the risk of skin cancer and improve skin health for all people regardless of skin tone. Traditional sunscreen that creates a white cast on the skin is incompatible with melanated skin. MethodsThe number of products on the shelf, SPF level, application, coloration, and cost were recorded at three beauty supply chain stores and three pharmacy, health, and wellness stores in or near Harlem in New York City in the Spring of 2023. The number of skin tones for tinted sunscreen was visually matched to the Fitzpatrick Skin Phototypes scale. ResultsA total of 385 sunscreen products were identified; 78.7 % were traditional white sunscreen, followed by sheer (15.3 %) and tinted (6.0 %) products. Beauty supply stores offered more tinted sunscreen options than did pharmacy, health, and wellness stores (n = 17,15.3 % vs. n = 6, 2.2 %, p < 0.001). Of the tinted sunscreen products, 19 brands offered only a single tone. Tinted sunscreen was significantly more expensive with an average cost of $24.59 [SD $14.71] per ounce vs. $6.85 [SD 8.66] for traditional, and $9.38 [SD 8.92] for sheer suncreen. ConclusionsSunscreen that is tinted or sheer and compatible with melanated skin is less available and more costly than traditional white sunscreen in beauty and pharmacy chain stores in NYC. Availability and affordability of sunscreen matching the spectrum of skin tones are essential for optimal sun protection and skin health.

52736 Assessment of Color Match of Universal Tinted Sunscreens in Fitzpatrick Skin Phototypes I-VI

52736 Assessment of Color Match of Universal Tinted Sunscreens in Fitzpatrick Skin Phototypes I-VI

54268 Assessment of picosecond laser safety and patient satisfaction for facial rejuvenationi in skin phototypes IV-VI

54268 Assessment of picosecond laser safety and patient satisfaction for facial rejuvenationi in skin phototypes IV-VI

Real-World Experience Using a Multi-Modality System using Intense Pulsed Light, Radiofrequency Microneedling, High-Intensity Focused Ultrasound, or Thermal Radiofrequency, 808, HIFU for Skin Rejuvenation Treatment.

Medical aesthetic procedures for facial rejuvenation with laser and energy-based devices (EBDs) are rapidly increasing. The following cases highlight real-life experience using a multi-modality system with various handpieces that combine intense pulsed light (IPL), laser hair removal (808 diode), high-intensity focused ultrasound (HIFU), radiofrequency microneedling (RFM), and thermal radiofrequency (RF) for antiaging and rejuvenation treatment. Laser and RFM treatments may improve skin conditions by inducing cutaneous changes that remodel the skin matrix. Six physicians who treat patients for skin rejuvenation reported on clinical cases from their practice using a multi-modality system with various handpieces. During the meeting, the advisors discussed 15 cases and agreed to select seven patients with different ages and skin phototypes receiving various treatments for photodamage of the face, neck, and décolleté. The advisors discussed why they selected the case, previous treatment, type of treatment, results, and clinical pearls. Sharing best practices in medical aesthetics using combination treatments on a single multi-modality energy-based device such as laser and MRF for facial, neck, and chest skin may support healthcare providers treating patients for skin rejuvenation to improve clinical outcomes.

In Vitro Anti-Photoaging Properties of Phylanthus urinaria L. Herb Extract

The overexposure to ultraviolet (UV) radiation from sunlight is related to photoaging of the skin and high risk of skin cancer. Sunscreen material and antioxidants are commonly used to protect skin from harmful UV. However, the application of synthetic compounds in sunscreen products is regulated to a limited amount because it can produce photosensitizers, inducing adverse reactions in the skin, and also harmful to the environment. Ethanol extract of Phyllanthus urinaria L. herb possesses a strong antioxidant activity similar to ascorbic acid, which makes it potential to substitute the synthetic compound in sunscreen products. Therefore, this research was conducted on the 70% ethanol extract of P. urinaria herb to analyze its in vitro anti-photoaging properties, i.e., antioxidant, protein antiglycation and antiinflammation, also to determine the Sun Protection Factor (SPF) and the quantitative composition of the metabolites. The extract exhibited a strong antioxidant activity IC50 of 3.01 mg/L, a higher moderate antiglycation activity IC50 of 216.67 mg/L, but low anti-inflammatory activity IC50 of 86.61mg/L. The presence of saponin, phenolic compounds, flavonoids, tannins, and methyl linoleates is suggested to contribute to the anti-photoaging properties. According to the anti-inflammatory assay, the extract may not inhibit signaling pathways that follow cytokine expression but possibly inhibit those that precede cytokine expression due to its antioxidant activity. An SPF value of 5.95 at 50 mg/L meets the recommended range for the skin phototypes of Southeast Asian, dark-skinned Asian, and African people. These results indicate that P. urinaria extract has potential as an anti-photoaging material for sunscreen products.Keywords: antiglycation, antiinflammation, antioxidation, Phyllanthus urinaria L., SPF.

Content of ascorbic acid in different skin phototypes in children with vitiligo

Aim. To evaluate the blood level of ascorbic acid in children with vitiligo according to skin phototype.Material and Methods. Blood ascorbic acid levels were analysed in children of different ages (6-15 years) with different types of vitiligo, depending on skin phototype. Patients were divided into two groups according to the degree and localisation of the vitiligo lesions: with non-segmental (n=116) and with segmental (n=134) vitiligo. The area of distribution of the dermatosis and its stage of development were calculated using the VIMAN and VIDA indices, respectively. Serum ascorbic acid levels were determined by liquid chromatography-mass spectrometry. Patients were classified by phototype according to T. Fitzpatrick’s classification.Results and discussion. Among the children with vitiligo studied, skin phototypes II, III and IV were identified, with a predominance of phototype III over the others. Their percentages differed in the two groups studied. In non-segmental vitiligo, there were more children with a light phototype and fewer with a dark phototype compared to the group of children with segmental vitiligo. Ascorbic acid levels were significantly reduced in children with vitiligo compared to a group of healthy children. The most pronounced decrease was observed in the group with non-segmental vitiligo in the 7-9 year age group. In both groups of patients, there was a tendency for ascorbic acid levels to decrease with age.Conclusion. The data obtained indicate that children with vitiligo have lower ascorbic acid levels than healthy children. The tendency to decrease increases with age, especially in patients with a dark phototype. This fact indicates the need to correct vitamin C levels in the body of children with vitiligo.

Platelet-Rich Plasma Injections in Periorbital Hyperpigmentation in Skin Phototypes III and IV: Strengthening the Assessment of Treatment Outcomes.

Periorbital hyperpigmentation (POH) is a therapeutic problem. Platelet-rich plasma (PRP) has been successfully used in some pigmentary disorders including POH. Proper evaluation of treatment in POH can be difficult. To assess the efficacy and safety of PRP injections for POH in skin phototypes III and IV by multiple clinical tools. A clinical trial included 30 patients with POH, skin phototypes III and IV. Three sessions of intradermal PRP injections were used in periorbital area every month. Treatment was assessed on different clinical levels 1 month after the last session by POH severity grading, blinded photographic assessment, and patient satisfaction. Adverse effects of PRP were evaluated. A significant improvement in POH was documented by disease severity grading, patient satisfaction, and to a lesser extent by photographic evaluation. Grade II-POH showed the best improvement. More than half of the cases were satisfied and very satisfied. Lower disease grades, constitutional POH, and epidermal pigmentation showed significant improvement. Side effects were mostly tolerated. The present results confirmed the beneficial role of PRP in improving POH. Multiple clinical tools are preferred for a more reliable assessment of treatment. Certain clinical types and grades of POH are suggested to respond more to PRP therapy.

Mutational Landscapes of Normal Skin and Their Potential Implications in the Development of Skin Cancer: A Comprehensive Narrative Review.

Recent evidence suggests that physiologically normal skin harbors pervasive mutant clones with cancer drivers. Normal skin has the highest burden of somatic mutations due to persistent ultraviolet exposure throughout life. The mutation burden exponentially increases with age and is further modified by skin site, sun-damage history, and skin phototype. Driver gene profiles in normal skin are similar to those in cutaneous squamous cell carcinoma where NOTCH family, FAT family, and TP53 are consistently reported, while other reported profiles include PPM1D, KMT2D, ASXL1, and RBM10. Normal skin seldom harbors canonical hotspot mutations with therapeutic relevance. The pathologic role of mutant clones with cancer drivers in normal skin is classically considered precursors for skin cancer; however, recent evidence also suggests their putative cancer-protective role. Copy number alterations and other structural variants are rare in normal skin with loss in 9q region encompassing NOTCH1 being the most common. Study methodologies should be carefully designed to obtain an adequate number of cells for sequencing, and a comparable number of cells and read depth across samples. In conclusion, this review provides mutational landscapes of normal skin and discusses their potential implications in the development of skin cancer, highlighting the role of driver genes in early malignant progression.

Hyaluronic Acid Filler VYC-25L for Jawline Restoration Yields High Satisfaction, Improved Jawline Measurements, and Sustained Effectiveness Across Skin Types, Age, and Gender for up to 12 Months.

A randomized study was previously reported to demonstrate the safety and efficacy of hyaluronic acid filler VYC-25L for restoring jawline definition. Evaluate patient-reported outcomes (PROs), objective changes in jawline profile, and safety and effectiveness measures by Fitzpatrick Skin Phototype (FST), gender, and age following VYC-25L treatment. Adults were randomized to receive VYC-25L (n=157) or no treatment (control; n=49) for 6 months. PROs were assessed by FACE-Q Satisfaction with Lower Face and Jawline, FACE-Q Appraisal of Lines: Marionette, and participant satisfaction with treatment questionnaires. Changes in jawline profile linear depth and volume were calculated using 3D digital image analysis. Responder rates, PROs, and injection site responses (ISRs) were assessed by FST, gender, and age. At month 6, >70% of treated participants responded "somewhat/very satisfied" to FACE-Q Satisfaction with Lower Face and Jawline questions, and ≥78% of treated participants responded "satisfied/definitely satisfied" with treatment overall. For participants treated in the marionette lines, the FACE-Q Appraisal of Lines: Marionette questionnaire mean score improved by 32.6 (baseline to month 6). Mean change in linear depth in the prejowl sulcus in the treatment vs control groups was 4.6 mm vs 2.5 mm, respectively, and for jawline volume was 6.0 cc and -2.6 cc, respectively, (baseline to month 6). Subanalyses showed similar outcomes by FST, gender, and age except for a numerically higher ISR incidence in females vs males. Treatment with VYC-25L to improve jawline definition yielded high patient satisfaction, objective improvements in jawline profile, and comparable effectiveness across various demographics.

Rosacea in East Asian populations: Clinical manifestations and pathophysiological perspectives for accurate diagnosis.

Rosacea is a chronic inflammatory disorder primarily affecting the facial skin, prominently involving the cheeks, nose, chin, forehead, and periorbital area. Cutaneous manifestations encompass persistent facial erythema, phymas, papules, pustules, telangiectasia, and flushing. The pathogenesis of rosacea is associated with various exacerbating or triggering factors, including microbial infestation, temperature fluctuations, sunlight exposure, physical exertion, emotional stress, consumption of hot beverages and spicy foods, and exposure to airborne pollen. These environmental factors interact with genetic predispositions in the development of rosacea. The roles of the lipophilic microbiome, ultraviolet radiation, nociceptive responses, and vascular alterations have been proposed as significant factors in the pathogenesis. These insights contribute to understanding the anatomical specificity of facial involvement and the progressive nature of rosacea. East Asian skin, predominantly classified as Fitzpatrick skin phototypes III to IV, is characterized by relatively diminished skin barrier function and increased sensitivity to irritants. Airborne pollen exposure may particularly act as a trigger in East Asian individuals, possibly mediated through toll-like receptors. The lack of specificity in objective clinical and histopathological findings leads to diagnostic challenges for individuals with colored skin, including East Asians, particularly when erythema is the sole objective manifestation. An alternative diagnostic scheme may thus be necessary. A diagnostic approach emphasizing vascular manifestations and nociceptive symptoms potentially holds promise for individuals with darker skin tones. More research focusing on potential variations in skin physiology across different racial groups is essential to establish more effective diagnostic schemes applicable to both dark and light skin colors.

Dermoscopic Features of Dermatitis Cruris Pustulosa et Atrophicans: A Retrospective Study from a Tertiary Care Center in South India.

Dermatitis cruris pustulosa et atrophicans (DCPA) is a chronic superficial folliculitis that can cause scarring alopecia if left untreated. Hardly any studies are there describing the dermoscopic features of DCPA. Dermoscopy can be a useful tool for diagnosing DCPA in addition to clinical and histopathological features and for differentiating other conditions like superficial folliculitis, folliculitis decalvans, and pseudofolliculitis. The aim of this retrospective study was to describe the dermoscopic features of 30 patients with DCPA at a tertiary care center in South India. A retrospective study of clinical and biopsy-proven cases of DCPA at a tertiary care center in South India. Thirty patients of DCPA of skin phototype IV or V were studied. Male preponderance of DCPA was noted in our study. Lower extremities 28 (93.3%) and upper extremities 2 (6.7%) were the common sites of involvement. The most common findings noted in dermoscopy were follicular-based pustules in 30 (100%) patients, follicular white structureless area in 16 (53.3%), perifollicular collarette of scales in 12 (40%), diffuse background dotted blood vessels in 12 (40%), and the absence of follicular orifices in 12 (40%). Other findings were yellow or hemorrhagic scales, perifollicular linear white lines, broken hair, and perifollicular dotted blood vessels. Pigmentary patterns observed were dark brown pigmentation, blue-grey globules, blue-grey dots, and accentuation of the pigmentary network. The limitations of the study were the retrospective nature of the study, the small sample size, and the lack of a comparison group. The predominant dermoscopic features observed in our patients were follicular-based pustules, follicular white structureless areas, perifollicular collarette of scales, diffuse background dotted blood vessels, and the absence of follicular orifices. Vascular and pigmentary patterns were less commonly noted.

Keratinocyte carcinomas in survivors of childhood cancer: A report from the childhood cancer survivor study

BackgroundChildhood cancer survivors (CCS) are at increased risk for keratinocyte carcinomas (KC) however, the long-term incidence of single and multiple KC is not well established. ObjectiveIdentify risk factors and quantify KC cumulative incidence and multiple-incidence burden in CCS. MethodsKC were identified among Childhood Cancer Survivor Study participants, a cohort of five-year cancer survivors diagnosed <21 years of age between 1970-1999 in North America. Cumulative incidence was estimated, and multivariable models assessed relative rates of KC associated with survivor and treatment characteristics. ResultsAmong 25,658 participants, 1,446 developed 5,363 KC (93.5% basal cell carcinoma, 6.7% squamous cell carcinoma; mean age 37.0 years (range 7.3-67.4), mean latency 25.7 years; 95.3% White and 88.4% with radiotherapy [RT]). Mean lesion count was 3.7 with 26.1% experiencing ≥4. RT imparted a 4.5-fold increase in the rate of any KC and 9.4-fold increase in the rate of ≥4 KC. Allogeneic and autologous hematopoietic cell transplant were associated with a 3.4- and 2.3-fold increased rate of KC, respectively. LimitationsParticipant self-reporting of some data including race without skin phototype and past medical history may have impacted analysis. ConclusionsThe burden of KC in CCS remains high, but predictable risk factors should guide screening