Skin Spots Research Articles

LUPUS ERYTHEMATOSUS DIAGNOSED THROUGH ORAL MANIFESTATIONS

Systemic lupus erythematosus is a classic example of an immunologically mediated condition, which involves several systems, with a variety of cutaneous and oral manifestations. It's a disease that is hard to diagnose, as it often presents in a nonspecific way, with periods of remission or inactivity of the disease. The final diagnosis depends on clinical, microscopic, and serologic associations. A male patient, 17 years of age, was referred to the stomatology clinic with a complaint of multiple lesions in the oral cavity. Extraoral clinical examination revealed hyperpigmented skin spots on the face, and intraoral examination revealed multiple ulcerated lesions, symptomatic, throughout the oral cavity, with an evolution time of approximately 13 years. An incisional biopsy was performed with a diagnosis of lupus erythematosus, along with laboratory exams including antinuclear antibody, anti–double strand deoxyribonucleic acid antibodies, and anti-Smith antibodies, which aided in the diagnosis. The patient was referred to the dermatologist for treatment and is being followed up currently.

Frequency of circulating subpopulations of T-regulatory cells in patients with hidradenitis suppurativa.

Decreased number of T-regulatory cells (Tregs) and/or their loss of function potentially lead to uncontrolled immune-mediated inflammatory responses. There are only few data available on Tregs in hidradenitis suppurativa (HS) - a disease in which it has been suggested that host immune factors and an overactive immune system of the follicular epithelium play a pathogenetic role. To analyse frequencies of Tregs subpopulations in blood of HS patients in comparison with a healthy control group. Blood samples obtained from HS patients and healthy controls were evaluated by flow cytometry and enzyme-linked immunosorbent assay. The frequency of natural Tregs among CD4+ T lymphocytes were significantly reduced in the HS group compared to the healthy controls. The proportion of activated Tregs, non-suppressive Tregs and proliferating Tregs showed no significant difference when compared to controls. Regarding Tregs frequencies, there was no significant difference between the three Hurley stages. Serum concentrations of IL-10, TGF-ß1 and IL-17A did not show significant differences between the HS and control group. The reduction of natural Tregs observed in blood of HS patients could be the result of Tregs homing to sites of inflammatory hot spots in HS skin. Further studies are justified evaluating the role of circulating Tregs during the evolution of HS lesions and as a biomarker for treatment response.

Café au Lait Macules and Associated Genetic Syndromes.

Café au lait macules (CALMs) are a common, isolated dermatologic finding in the general population. But when do these irregularly shaped, jagged-edged, flat, hyperpigmented birthmarks suggest something that may warrant referral? Most pediatric providers are familiar with the association of CALMs and neurofibromatosis type 1. There are, however, other genetic conditions associated with these seemingly benign skin spots. This article provides an overview of CALMs, followed by a summary of several conditions associated with CALMs ranging from the most common (neurofibromatosis type 1) to rare, ring chromosome syndromes. It reviews the associated gene(s), pattern of inheritance, incidence, presenting symptoms, diagnosis, and management for these genetic conditions.

Application of regression model combined with computer technology in the construction of early warning model of sepsis infection in children

This paper uses computer technology combined with regression model to analyze the risk factors of children with sepsis, determine the relevant factors and establish a corresponding early warning model of sepsis, and then verify the clinical application value of the regression model. The paper collected severe infections and sepsis in children who came to our hospital from 2014 to 2018, including 129 patients with infection and 86 patients with sepsis. The general conditions, clinical symptoms, laboratory tests and other factors were used. Analysis, to identify the risk of infection development into sepsis, and use Logistic regression model combined with computer technology to construct an early warning model of sepsis. The experimental results show that early warning of sepsis is closely related to skin spots, platelets, procalcitonin, creatinine and international normalized ratio. The experiment demonstrates that the early warning model has higher sensitivity and specificity, and has higher accuracy for predicting whether infection develops into sepsis in advance, and has certain clinical value.

Non-invasive Production of Multi-Compartmental Biodegradable Polymer Microneedles for Controlled Intradermal Drug Release of Labile Molecules.

Transdermal drug delivery represents an appealing alternative to conventional drug administration systems. In fact, due to their high patient compliance, the development of dissolvable and biodegradable polymer microneedles has recently attracted great attention. Although stamp-based procedures guarantee high tip resolution and reproducibility, they have long processing times, low levels of system engineering, are a source of possible contaminants, and thermo-sensitive drugs cannot be used in conjunction with them. In this work, a novel stamp-based microneedle fabrication method is proposed. It provides a rapid room-temperature production of multi-compartmental biodegradable polymeric microneedles for controlled intradermal drug release. Solvent casting was carried out for only a few minutes and produced a short dissolvable tip made of polyvinylpyrrolidone (PVP). The rest of the stamp was then filled with degradable poly(lactide-co-glycolide) (PLGA) microparticles (μPs) quickly compacted with a vapor-assisted plasticization. The outcome was an array of microneedles with tunable release. The ability of the resulting microneedles to indent was assessed using pig cadaver skin. Controlled intradermal delivery was demonstrated by loading both the tip and the body of the microneedles with model therapeutics; POXA1b laccase from Pleurotus ostreatus is a commercial enzyme used for the whitening of skin spots. The action and indentation of the enzyme-loaded microneedle action were assessed in an in vitro skin model and this highlighted their ability to control the kinetic release of the encapsulated compound.

High-density thermal sensitivity maps of the human body

‘Personal comfort systems’ and thermally active clothing are able to warm and cool individual building occupants by transferring heat directly to and from their body surfaces. Such systems would ideally target local body surfaces with high temperature sensitivities. Such sensitivities have not been quantified in detail before. Here we report local thermal sensations and sensitivities for 318 local skin spots distributed over one side of the body, measured on a large number of subjects. Skin temperature changes were induced with a thermal probe 14 mm in diameter, and subjective thermal sensations were surveyed after 10 s. Our neutral base temperature was 31 °C and the spot stimulus was ±5 °C. Cool and warm sensitivities are seen to vary widely by body part. The foot, lower leg and upper chest are much less sensitive than average; in comparison, the cheek, neck back, and seat area are 2–3 times as sensitive to both cooling and warming stimuli. Every body part exhibits stronger sensitivity to cooling (1.3–1.6 times stronger) than to warming. Inter-personal differences and regional variance within body parts were observed to be 2–3 times greater than potential sex differences. These high-density thermal sensitivity maps with appended dataset provide the most comprehensive distributions of cold and warm sensitivity across the human body.

Growth hormone-Insulin-like growth factor 1 axis hyperactivity on bone fibrous dysplasia in McCune-Albright Syndrome

McCune Albright syndrome (MAS) is a rare disorder caused by somatic gain-of-function mutations of the GNAS gene [1]. This gene encodes the α-subunit of the Gs protein and its mutations are responsible for persistent stimulation of adenylyl cyclase and dysregulated production of cyclic AMP leading to persistent overactivity in the target tissues. The extent of the disease is determined by the proliferation, migration and survival of the cell in which the mutation spontaneously occurs during embryonic development. Therefore, patients with GNAS mutations show a wide range of phenotypes, differing in the degree of severity and the age at onset of the disease. The disease is characterized by a variable association of café-au-lait skin spots, hyperfunctioning endocrinopathies and skeletal lesions with fibrous dysplasia involving one (monostotic) or multiple (polyostotic) bones.

Development of topical drug delivery system with Sphaeranthus indicus flower extract and its investigation on skin as a cosmeceutical product.

Cosmetics are the products used to beautify the skin. Emulsion is a fine dispersion of two or more immiscible liquids. Sphaeranthus indicus is claimed to be used for skin beautification in folk medicine. Multiple emulsion was formulated containing the extract of S indicus flowers. This research study indicates that extract of S indicus flowers contains sufficient amount of polyphenols and also possess good antioxidant activity with mushroom tyrosinase inhibition activity. Further, stable multiple emulsion was developed and stability testing was performed for 180days by keeping the multiple emulsion at 8°C±1, 25°C±1, 40°C±1, and 40°C±1 with 75%±1 RH. Parameters checked were color change, phase distribution, viscosity, droplet size and size distribution, pH determination, and electrical conductivity. Sun protection factor (SPF) was determined which also showed promising results. Skin testing on human volunteers was done for 3months after biosafety profiling of the most stable multiple emulsion. This also showed remarkable effects. Skin erythema, melanin, and sebum were reduced. Skin hydration and elasticity were increased. There was also reduction in the number of skin large and small skin pores. Skin spot area was also reduced by the use of multiple emulsion loaded with S indicus flower extract. ANOVA test showed that all the effects produced on skin were significant, ie, P≤.05. A stable multiple emulsion was developed which produced significant cosmetic effects on human skin.

Rapid Characterization of the Genetic Loci Controlling Commodity Traits of Chinese Hami Melon (Cucumis melo var. Saccharinensis Naud.) through Multiplexed Shotgun Genotyping

The genetic architecture and the genetic loci controlling commodity traits in this Hami melon have not been characterized. Multiplexed shotgun genotyping (MSG) was used to genotype an F2 population of 370 Chinese Hami melon progeny. A total of 47,609 single nucleotide polymorphism (SNP) markers were obtained after strict filtering. Thebins were used to construct a genetic linkage map with a total length of 1572.954 cM. Quantitative trait locus (QTL) analysis revealed that fruit color was controlled by one major gene about 2 Mb region on chr09, while exocarp color (EC) was controlled by one major gene about 1.9 Mb on chr04, and skin spotting was controlled by two dominant genes, one in the same region of chr04as the EC QTL and the other in the 1031.05 kb region on chr02. Two major QTLs on chr03 and chr05 were related pleiotropically to several quantitative fruit traits, namely, edge sugar content (ES), center sugar content (CS), fruit weight (FW), and fruit length (FL). A further QTL on chr09 also influenced ES, while five other QTLs affected FL. This study was the first to conduct genetic architecture analysis and QTL mapping in Chinese Hami melon with high-density markers and a large target population.

When WAS Gene Diagnosis Is Needed: Seeking Clues Through Comparison Between Patients With Wiskott-Aldrich Syndrome and Idiopathic Thrombocytopenic Purpura.

Background: Wiskott-Aldrich syndrome (WAS) is a rare and severe X-linked disorder with variable clinical phenotypes correlating with the type of mutations in the WAS gene. The syndrome is difficult to differentiate from idiopathic thrombocytopenic purpura (ITP) before genetic diagnosis. We retrospectively reviewed patients suspected to have WAS who were referred to our hospital from 2004 to 2016 and compared the clinical features and laboratory examination of genetically confirmed WAS patients and of patients diagnosed with ITP in order to seek some clues to distinguish WAS and ITP before genetic diagnosis.Methods: Seventy-eight children suspected to have WAS from 78 unrelated families were enrolled in this study. The clinical data and laboratory examination of children were reviewed in the present study. The distribution of lymphocyte subsets from peripheral blood was examined by how cytometry. WASP mutations were identified by direct sequencing of PCR-amplified genomic DNA.Results: Forty-two patients were finally diagnosed with WAS genetically. The median onset age of these patients was 1 month (range: 1 day−10 months). The median diagnosis lag was 4.6 months (range: 0 months−9.42 years). Fifteen patients (35.71%) had positive family histories. More than half of the patients (n = 23, 54.76%) had diarrhea. Twenty-three (54.76%) had pneumonia, 7 with severe symptoms. Major bleeding events included skin spots or petechiae (n = 27, 64.29%), per-rectal bleeding (n = 21, 50.00%), epistaxis (n = 7, 16.67%) and intracranial bleeding (n = 2, 4.76%). Twenty-nine patients (69.05%) had eczema, and one patient had a drug allergy. Three patients had autoimmune diseases, among whom 2 had autoimmune hemolytic anemia and one had autoimmune hemolytic anemia and IgA nephropathy. A total of 42 mutations in WASP were identified, including 19 novel mutations. Eight patients received hematopoietic stem cell transplantation (HSCT) and all survived. Compared with the 30 patients diagnosed with ITP, the WAS patients had higher EOS counts and elevated IgE level, increased NK cell numbers but fewer CD8+T lymphocytes.Conclusion: The WAS gene diagnosis should be considered in all males with ITP-like features, especially for patients with a very early onset age, decreased MPV (<6.5 fl), higher EOS counts and elevated IgE level, increased NK cell number, diminished CD8+T lymphocyte count.

Use of heavy metals resistant bacteria—a strategy for arsenic bioremediation

A large number of industries release their untreated wastes in the environment causing an increase in the concentration of toxic pollutants including heavy metal ions in ground and drinking water which is above the WHO limit. The presence of toxic pollutants in the industrial wastes pollutes our environment. Arsenic (As) is a ubiquitous toxic metalloid. Its amount varies in different parts on the earth, and its concentration is increasing in our environment day by day both by natural and anthropogenic activities. It is found in two forms; one is arsenate (As5+) and other is arsenite (As3+) and the latter is more toxic due to high mobility across the cell membrane. The long-term use of arsenic-containing water causes arsenicosis. High arsenic consumption, revealed by skin harms, color change, and spots on hands and feet, may cause skin cancer and affect lungs and kidneys. Hypertension, a state of high blood pressure, and lack of insulin which causes diabetes and many other disorders which relate to reproduction are the consequences of arsenic contamination. Several methods have been employed to decontaminate arsenic pollution, but the bioremediation by using biomass of bacteria, algae, fungi, and yeasts is the most compromising approach and has gained much attention from researchers in the last few decades. The microbial detoxification of arsenic can be achieved by reduction, oxidation, and methylation. High bioremediation potential and feasibility of the process make bacteria an impending foundation for green chemistry to exterminate arsenic in the environment.

Embryonic and fetal development of the red brocket deer (Mazama americana)

The red brocket deer (Mazama americana), a medium-sized Neotropical ungulate, is one of the most hunted mammals in the Amazon. This study analyzes the intrauterine development in the red brocket deer through the description of the external and internal morphology in one embryo and 38 fetuses collected from animals hunted for subsistence in the Amazon. The chronological order of occurrence of external characteristics in relation to the total dorsal length (TDL) was: differentiated genitalia, limbs and eyelid buds (TDL = 3.9 cm), fusioned eyelids, outer ear and hooves (TDL ≥ 9.5 cm), skin (TDL ≥ 20.4 cm), tactile pelage and nasal pigmentation (TDL ≥ 21.5 cm), covering pelage and skin spots (TDL ≥ 31.3 cm), and teeth eruption and opened eyelids (TDL ≥ 34.2 cm). The formula of fetal age was ∛W = 0.072 (t – 42), with a high linear relationship between TDL and gestational age. Multiple linear and non-linear regressions showed strong positive associations between biometric measures and absolute visceral weights with TDL. The relative weight of the tubular gastrointestinal organs, spleen and thymus increased during the fetal development; in contrast, the liver and kidneys’ relative weight diminished during the fetal development. Advanced fetuses (≥44.0 cm TDL) had lower proportion of liver and larger tubular gastrointestinal organs within the visceral weight than adults. The chronology of appearance of the main events of the fetal development suggests that the red brocket deer adopt some precocial features, such as the early development of the sensorial function, including the early development of eyelids, outer ear and tactile pelage, the early development of the covering pelage which acts in thermoregulation and the early teeth eruption which allows the early foraging. Nevertheless, the precocial level of the red brocket deer is apparently lower than other species more frequently predated by large felids, such as peccaries and the paca.

MON-247 Clinical Characterization of Female Peripheral Precocious Puberty Due to McCune-Albright Syndrome

Background: McCune-Albright syndrome (MAS) is a rare and sporadic disease caused by a post-zygotic mutation in GNAS1 gene. It is characterized by the classical triad of polyostotic fibrous dysplasia, café-au-lait skin spots and peripheral precocious puberty (PPP). However, clinical presentation of MAS is highly variable depending on mosaic tissue distribution of mutant-bearing cells. Due to the low prevalence of MAS, detailed data of clinical and laboratory presentation are scarce. Aim: To describe the clinical and hormonal features of PPP due to MAS from a single tertiary center. Patients and Methods: The medical records of girls with PPP due to MAS diagnosed and treated from 1990 and 2018 were systematically revised. We analyzed initial clinical presentation, Tanner stage, gonadotropins and estradiol levels, and pelvic ultrasound findings of a MAS cohort. Results: From a total of 37 patients (35 girls and 2 boys) with clinical diagnosis of MAS, 14 (37.8%) female patients presented PPP. The first clinical manifestation was thelarche in 12/14 (85.7%), followed by vaginal bleeding in 7/14 (50%), and pubarche in 5/14 (35.7%). The mean height (SDS) was 109 ± 35 cm (SDS: 1.3 ± 1.6). All girls had Tanner-staging ≥ B2 (ranging from B2-B4) and 8/14 (57.1%) had pubarche. Fibrous bone dysplasia was detected in 9/14 (64.2%) by bone scintigraphy and café-au-lait skin spots were found in 10/14 (71.4%) of these girls. Menarche occurred at mean age of 3.75 ± 2 yr (2 - 7.2 yr). Mean basal LH and FSH were 0.36 ± 0.24 IU/L and 1.27± 1.0 IU/L, respectively. Estradiol levels ranged from < 13 to 783 pg/mL (mean 96.8 pg/mL). Basal estradiol levels were at prepubertal range in 8/14 (57%) on several occasions. All girls underwent a GnRH-analogue stimulated test showing a prepubertal LH response (2.9 ± 2.1 IU/L); 2 patients showed completely suppressed basal and stimulated gonadotropin levels. Uni- or bilateral ovarian cysts were identified in 9/14 patients (64.2%) being bilateral in 50% of them. Mean ovarian volumes were 2.63 ± 1.4 cm³ for right and 2.05 ± 1.9 cm³ for left ovarian, with mean cyst volumes ranging from 2.7 to 45 cm3. Other endocrine hyperfunctions were not identified in this MAS cohort. Conclusion: PPP in girls with MAS has a heterogeneous clinical presentation. It was characterized by menarche at very early age as a first sign associated with variable values of estradiol levels (pre- and pubertal) and ovarian sizes. Pediatric endocrinologists must be aware of atypical clinical and laboratory presentation of PPP due to MAS.

The efficacy and safety of fractional erbium yag laser combined with topical amniotic membrane stem cell (AMSC) metabolite product for facial rejuvenation: A controlled, split-face study

Skin aging is a complex biological process, and it growing fast in number. Fractionated laser has been considered as the gold standard for skin rejuvenation. Stem cell-based therapy also becoming a promising new approach for treating this condition. To investigate the effect of fractional erbium laser and topical amniotic membrane stem cell (AMSC)-metabolite product (MP) on skin aging. A total of 9 female participants, were included in controlled split-face study. The participant’s face was randomly allocated to AMSC-MP or saline, immediately after fractional laser procedure. All participants received 3 sessions of treatment with 4-weeks intervals. An evaluation was done using pre- and post- treatment photographs and skin analyzer, Janus. Laser-assisted transdermal delivery drug using topical AMSC-MP give a better improvement on skin pore and spot UV compared with the control group. The wrinkle and skin tone showed different results maybe because of multifactorial factors influence. No serious adverse events were found. This study suggest that fractional erbium YAG laser treatment combined with topical AMSC–MP is effective and safe for facial rejuvenation in Asian patients.

The morphology, size and density of the touch dome in human hairy skin by scanning electron microscopy.

The touch domes of mammalian hairy skin are mechanoreceptors characterized by the accumulation of Merkel cell-neurite complexes at the epidermal base. In this study, we examined the shape, size, and density of the touch dome of human skin of the forearm and the abdomen through scanning electron microscopy (SEM). Human skin samples were obtained from donated bodies, as well as a patient who underwent biopsy. Skin pieces were treated with a KOH-collagenase method for the separation of the epidermis from the dermis. The basal surface of the separated epidermis was then observed using SEM. The touch dome was clearly determined as a concave area bordered by a thick epidermal ridge, where neural components accumulated. The touch dome was rather independent from hair follicles, although they were sometimes located beside the touch dome. The average size and density of the touch dome were 0.06 mm2 and 3.82 cm2 in the forearm, and 0.10 mm2 and 1.30 cm2 in the abdomen, respectively. Our results suggested that the regional difference in size and density of the touch dome might be related to the sensation's sensitivity as touch spots in human hairy skin.

Neonatal McCune-Albright Syndrome: A Unique Syndromic Profile With an Unfavorable Outcome.

ABSTRACTSomatic gain‐of‐function mutations of GNAS cause a spectrum of clinical phenotypes, ranging from McCune‐Albright syndrome (MAS) to isolated disease of bone, endocrine glands, and more rarely, other organs. In MAS, a syndrome classically characterized by polyostotic fibrous dysplasia (FD), café‐au‐lait (CAL) skin spots, and precocious puberty, the heterogenity of organ involvement, age of onset, and clinical severity of the disease are thought to reflect the variable size and the random distribution of the mutated cell clone arising from the postzygotic mutation. We report a case of neonatal MAS with hypercortisolism and cholestatic hepatobiliary dysfunction in which bone changes indirectly emanating from the disease genotype, and distinct from FD, led to a fatal outcome. Pulmonary embolism of marrow and bone fragments secondary to rib fractures was the immediate cause of death. Ribs, and all other skeletal segments, were free of changes of typical FD and fractures appeared to be the result of a mild‐to‐moderate degree of osteopenia. The mutated allele was abundant in the adrenal glands and liver, but not in skin, muscle, and fractured ribs, where it could only be demonstrated using a much more sensitive PNA hybridization probe‐based FRET (Förster resonance energy transfer) technique. Histologically, bilateral adrenal hyperplasia and cholestatic disease matched the abundant disease genotype in the adrenals and liver. Based on this case and other sporadic reports, it appears that gain‐of‐function mutations of GNAS underlie a unique syndromic profile in neonates characterized by CAL skin spots, hypercortisolism, hyperthyroidism, hepatic and cardiac dysfunction, and an absence (or latency) of FD, often with a lethal outcome. Taken together, our and previous cases highlight the phenotypic severity and the diagnostic and therapeutic challenges of MAS in neonates. Furthermore, our case specifically points out how secondary bone changes, unrelated to the direct impact of the mutation, may contribute to the unfavorable outcome of very early‐onset MAS. © 2018 The Authors JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

Formulation and evaluation of skin whitening cosmetic body lotion by using a combination of crocus sativus and psidium guajava leaves extracts

Skin whitening body lotions are the cosmetics products which work on human skin by reducing a pigment called melanin in the skin. It also lightens naturally dark skin and dark spots. It is giving a moisturizing effect to the skin as a natural cosmetics body lotion. This study was aimed on a reduction of skin melanin by tyrosine inhibitory with plant extracts by formulating a stable whitening body lotion containing the plant extracts of Psidium guajava L. leaves and also the extract of Crocus sativus (Saffron). Two plants were extracted in a different way; the method of extraction for Crocus sativus was reflux method and for Psidium guajava leaves was maceration method. The phytochemical screening and tyrosinase inhibition activity of extracts were evaluated. The various types of lotion namely F1 to F5 were formulated by incorporating different concentrations of extracts and evaluated for different parameters. The findings of tyrosinase inhibitory study exhibited that the IC50 value of tyrosine inhibitory of combined extract of Psidium guajava and Crocus sativus was lower compared to Crocus sativus extract. The formulation F3 with the mixture 0.5 g of Crocus sativus and 0.5 g of Psidium guajava leaves showed the best results among several formulations. The result which obtained from formulation F3 was compatible to pass all the evaluation tests. As a conclusion, the mixture of Psidium guajava and Crocus sativus extract possesses a strong tyrosine inhibition activity, and it was formulated as a stable whitening natural body lotion, and it can be safely used on the skin.

A Meta-Analysis of Intraepidermal Nerve Fibre Density in Healthy and Neuropathic Subjects: A Proposed Guidance Model

Background: Skin spot biopsy is the gold standard for diagnosis of small fibre neuropathy. Here we systematically approached intraepidermal nerve fibre density (IENFD) with the aim of precisely estimating its value in healthy and neuropathic subjects. The present findings will serve as a guidance model for further use of IENFD, as an indicator of neuropathy predisposition. We also investigated how IENFD was influenced by age, gender, and neuropathy. Methods: We conducted a systematic search of PubMed, Web of Science, and ScienceDirect to identify clinical studies published during the last twenty years (1997-2017), which investigated IENFD in healthy and neuropathic adult population. Data were retrieved from longitudinal cohort studies including 5-188 healthy adult subjects and 6-40 neuropathic adult patients. We used meta-analysis techniques including multilevel meta-regression. Findings: In the healthy population, the estimated (95% CI) IENFD values (in fibres/mm) were 21.4 (19.9, 22.9) in the thigh, 17*7 (15.3, 20.1) in the forearm, 12*9 (11.8, 14.0) in the distal leg, 11*3 (6.1, 16.5) in the fingers, and 6*5 (4.4, 8.6) in the toes. The corresponding estimates in the neuropathic population were 17*2 (15.2, 19.2) in the thigh, 6*3 (2.3, 10.2) in the forearm, 5*1 (3.8, 6.4) in the distal leg, and 2*0 (0.0, 5.7) in the toes. In the healthy population, IENFD decreased with ageing, by 1*4 fibres/mm every 5 years (p<0.001). We detected gender dimorphism in IENFD, with females showing higher IENFD values in the distal leg (13*6-10*5 fibres/mm) compared to males (9*3-7*2 fibres/mm). Interpretation: The present meta-analysis results highlighted the IENFD alterations in neurodegenerative disease, suggesting that IENFD may be a reliable prognostic marker for the timely diagnosis of neuropathy. Funding Statement: The authors state: was no funding source for this study. Declaration of Interests: There is no conflict of interest.

Skin and Wound Map From 23,453 Nursing Home Resident Records: Relative Prevalence Study

Related ArticleThis is a corrected version. See correction statement in: http://derma.jmir.org/2018/2/e12495/

Knowledge and practices of primary care providers on skin cancer and skin self-examination.

To determine the knowledge and practices related to skin cancer and skin self-examination of primary care providers. This cross-sectional descriptive study was conducted in Turkey. The study was carried out in primary health centers such as family health centers, community health centers, early cancer detection centers and family planning centers in 2016-2017. Participants' socio-demographic characteristics, their knowledge and practices related to skin cancer, skin cancer risk factors and skin self-examination were determined. The study population included 94 primary care providers. The symptoms of which the participants were most aware were changes in the color of moles or skin spots (95.71%), and of which participants were the least aware was the itching of a mole (71.43%). Among participants, the most recognized risk factor was having fair skin (97.14%), whereas the least known was the presence of birthmarks (24.29%). The mean scores the participants obtained from the questionnaire were as follows: 5.39±1.61 for skin cancer risk factors and 10.47±2.73 for skin cancer symptoms. Of the participants, 14.29% received training on skin self-examination, 38.57% knew how to perform skin self-examination, and 67.14% did not perform skin self-examination. Of the participants, 61.7% did not perform skin self-examination because they did not know what to look for. Of the participants, 85.71% did not have continuing education/workshop about skin self-examination after graduation. Although the primary care providers' knowledge of skin cancer symptoms was adequate, their knowledge of skin cancer risk factors was not sufficient. Primary care providers' knowledge of skin self-examination was good, but they did not perform skin self-examination adequately.