Solar Elastosis Research Articles

Extrafacial melasma over forearms.

Sir, Melasma is a common hypermelanoses affecting the female gender. The etiology of melasma has not been clearly identified. Factors associated with melasma include exposure to ultraviolet light, pregnancy, oral contraceptives, hormone replacement therapy, thyroid autoimmunity, cosmetic ingredients, and phototoxic drugs.[1] The commonest site affected by melasma is the face and has been distinguished into three clinical patterns, namely, centrofacial, malar, and mandibular. Extrafacial melasma is a rare entity and has been very rarely reported in the literature. Extrafacial melasma should be distinguished from acquired brachial cutaneous dyschromatosis (ABCD).[2] A 55-year-old woman presented with brownish pigmentation of her both forearms for past six years. She reported that initially few brown hyperpigmented asymptomatic spots appeared on her right forearm and similar pigmented spots started appearing on the other forearm too. She denied any history of inflammatory dermatoses prior to appearance of her skin problem. The patient was postmenopausal since three years. She reported that the pigmentation became more prominent on sun exposure. She denied the intake of oral contraceptive pills or hormone replacement therapy. There was no history suggestive of thyroid dysfunction. She did not give history of receiving any photosensitizing drugs. Cutaneous examination showed a large, brown irregular patch on her right forearm and a similar developing lesion on her other forearm. The patches comprised of multiple coalescing hyperpigmented macules with irregular borders with intervening areas showing normal skin. She also had malar type of facial melasma [Figure 1]. We made a provisional diagnosis of extrafacial melasma and ABCD. Potassium hydroxide mount from the patches failed to show any fungal elements, which ruled out pityriasis versicolor. Wood's lamp examination showed accentuation of pigmentation suggestive of epidermal pigmentation. Skin biopsy from the lesion showed epidermal thinning and increased melanization of basal layer [Figure 2]. Histology showed minimal epidermal atrophy and mild solar elastosis in the form of elastic fiber degeneration. No evidence of amyloid material was seen on special stains, which ruled out frictional amyloid deposition. On a review of the literature, we were able to rule out acquired brachial cutaneous dyschromatosis as there were no hypopigmented atrophic macules. On correlation, we made a diagnosis of extrafacial melasma involving dorsa of both forearms.Figure 1: Patient having malar type of melasma and brownish pigmentation on dorsa of both forearmsFigure 2: H and E stained section of biopsy showing epidermal thinning and increased melanization of basal layers (×20)Extrafacial melasma is an uncommon variant of melasma and has been very rarely reported in the literature. Extrafacial melasma shares similar clinical features as that of facial melasma with brownish hyperpigmented spots with irregular borders. Although facial and extrafacial melasma share some clinical features, they differ in incidence. Melasma occurs predominantly in the age group of 20–40 years with a mean age of 33 years and is rarely observed in menopausal females.[3] Extrafacial melasma is known to affect menopausal women in the fifth decade of life.[4] A close differential for extrafacial melasma affecting forearm is ABCD. ABCD is characterized by dyschromatosis (hyperpigmented and hypopigmented macules) and face is never involved, whereas extrafacial melasma lacks hypopigmented atrophic macules. ABCD has a strong causal association with antihypertensive drugs particularly angiotensin converting enzyme inhibitors.[2] A striking observation in cases of ABCD is poikiloderma of the neck (Civatte), which may be incidental in cases of extrafacial melasma. Histologically, extrafacial melasma resembles facial melasma with increased pigmentation of basal layer and epidermal atrophy. Both the entities show signs of chronic actinic damage on histology Skin biopsy in our patient showed epidermal thinning, which can be a sign of chronic actinic damage. Treatment of extrafacial melasma can be challenging with frequent relapses. Depigmenting drugs, retinoids, and sunscreen are the mainstay of therapy for extrafacial melasma.[56] It is premature to comment whether extrafacial melasma responds to depigmenting therapy akin to typical facial melasma. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Histopathologic Distinguishing Features Between Lupus and Lichenoid Keratosis on the Face.

Background:The occurrence of lichenoid keratosis (LK) on the face is not well characterized, and the histopathologic distinction between LK and lupus erythematosus (LE) occurring on the face is often indeterminate. The authors aimed to describe differences between LE and LK occurring on the face by hematoxylin and eosin alone.Methods:Cases of LK and LE were obtained using computer-driven queries. Clinical correlation was obtained for each lupus case. Other diagnoses were excluded for the LK cases. Hematoxylin and eosin–stained sections were reviewed.Results:Forty-five cases of LK and 30 cases of LE occurring on the face were identified. Shared features included follicular involvement, epidermal atrophy, pigment incontinence, paucity of eosinophils, and basket-weave orthokeratosis. Major differences between LK and LE, respectively, included perivascular inflammation (11%, 90%), high Civatte bodies (44%, 7%), solar elastosis (84%, 33%), a predominate pattern of cell-poor vacuolar interface dermatitis (7%, 73%), compact follicular plugging (11%, 50%), hemorrhage (22%, 70%), mucin (0%, 77%), hypergranulosis (44%, 17%), and edema (7%, 60%). A predominate pattern of band-like lichenoid interface was seen more commonly in LK as compared with LE (93% vs. 27%).Conclusions:The authors established the occurrence of LK on the face and identified features to help distinguish LK from LE. Follicular involvement, basket-weave orthokeratosis, pigment incontinence, paucity of eosinophils, and epidermal atrophy were not reliable distinguishing features. Perivascular inflammation, cell-poor vacuolar interface, compact follicular plugging, mucin, hemorrhage, and edema favored LE. High Civatte bodies, band-like lichenoid interface, and solar elastosis favored LK.

Squamous Cell Carcinoma: Clinical and Pathological Features and Associated Risk Factors in an Observational Study of 118 Patients

Background and objectiveIn the latest edition of its cancer staging manual, the American Joint Committee on Cancer (AJCC) revised the criteria for staging squamous cell carcinoma (SCC) by introducing high-risk tumor features to define tumor stage (T) and help to identify tumors with a higher risk of metastasis. The aim of this study was to investigate the characteristics associated with SCC meeting the high-risk criteria defined by the AJCC for T2 lesions. Patients and methodWe performed a case-case observational study in which patients with SCC were included over a period of 18 months. We collected clinical, anthropometric, and tumor data, and analyzed these using PASW Statistics (SPSS) version 18. ResultsOne-hundred eighteen patients, the majority of whom were men, were included. Mean age was 77 years. Over 70% of the tumors were located in the head region and a majority of tumors measured 2cm or less. The prevalence of SCC T2 was 61.9%. The risk factors significantly associated with SCC T2 were an age of over 85 years (odds ratio [OR], 4.48), location in the head and neck region (OR, 3.38), presence of solar elastosis in the peritumoral tissue (OR, 2.08), a higher tumor growth rate (>1.5mm·wk−1; OR, 5.73), and higher cumulative exposure to smoking (>20pack-years, OR, 3.63). ConclusionsAdvanced age, location in the head and neck region, presence of solar elastosis, high tumor growth rate, and high cumulative smoking exposure were all significantly associated with the presence of SCC T2.

TERT promoter mutations in periocular carcinomas: implications of ultraviolet light in pathogenesis

Background/aimsUltraviolet light-signature mutations in the telomerase reverse transcriptase (TERT) gene promoter have been identified in cutaneous melanomas, basal cell carcinomas (BCCs), and squamous cell carcinomas (SCCs). Whether these mutations also...

CD4, IL-17, and COX-2 Are Associated With Subclinical Inflammation in Malar Melasma

The pathogenesis of melasma, a common, photo-induced hyperpigmentary disorder, is not clearly understood. Significant factors linked to melasma are ultraviolet radiation exposure and genetic predisposition. Histological analysis has demonstrated that melasma is caused by a network of cellular interactions among melanocytes, keratinocytes, mast cells, fibroblasts, and dermal vasculature exhibits, features similar to chronic sun damage. Dermal inflammation caused by ultraviolet radiation might play an important role in the hyperpigmentation and reactivation of melasma lesions through the production of melanogenic cytokines and growth factors. Because the role of inflammation in this disorder is unknown, we used histochemistry, immunohistochemistry, and quantitative real-time polymerase chain reaction to evaluate melasma lesions from healthy female patients (n = 20) with malar melasma. Lesional skin without specific solar exposure or photoprotection measures within the previous 4 weeks was compared with nonlesional skin. The increased lymphocytic infiltrate in lesional skin was mainly composed of CD4 T cells, mast cells, and macrophages. Levels of the cytokine interleukin (IL)-17 and the proinflammatory mediator cyclooxygenase (COX)-2 were significantly elevated in affected skin compared with healthy skin. In addition, the Melasma Activity and Severity Index score, fraction of solar elastosis, and epidermal melanin were positively associated with COX-2 expression. There was no statistically significant difference in IL-1α, IL-1β, R-IL1, IL-6, IL-8, vascular endothelial growth factor, and tumor necrosis factor alpha expression levels. Together, these data indicated that melasma under unchallenged conditions is characterized by chronic inflammatory cells and mediators, which may explain its recurrent nature.

Carcinoma epidermoide cutáneo: definición de sus características clínico-patológicas y factores de riesgo asociados en un estudio observacional de 118 pacientes

Background and objectiveIn the latest edition of its cancer staging manual, the American Joint Committee on Cancer (AJCC) revised the criteria for staging squamous cell carcinoma (SCC) by introducing high-risk tumor features to define tumor stage (T) and help to identify tumors with a higher risk of metastasis. The aim of this study was to investigate the characteristics associated with SCC meeting the high-risk criteria defined by the AJCC for T2 lesions. Patients and methodWe performed a case-case observational study in which patients with SCC were included over a period of 18 months. We collected clinical, anthropometric, and tumor data, and analyzed these using PASW Statistics (SPSS) version 18. ResultsOne-hundred eighteen patients, the majority of whom were men, were included. Mean age was 77 years. Over 70% of the tumors were located in the head region and a majority of tumors measured 2cm or less. The prevalence of SCC T2 was 61.9%. The risk factors significantly associated with SCC T2 were an age of over 85 years (odds ratio [OR], 4.48), location in the head and neck region (OR, 3.38), presence of solar elastosis in the peritumoral tissue (OR, 2.08), a higher tumor growth rate (>1.5mm·wk−1; OR, 5.73), and higher cumulative exposure to smoking (>20pack-years, OR, 3.63). ConclusionsAdvanced age, location in the head and neck region, presence of solar elastosis, high tumor growth rate, and high cumulative smoking exposure were all significantly associated with the presence of SCC T2.

Clinical, Histologic, and Molecular Analysis of Differences Between Erythematotelangiectatic Rosacea and Telangiectatic Photoaging.

Facial erythema and telangiectasia are commonly associated with the erythematotelangiectatic subtype of rosacea (ETR). It is important for clinicians to recognize that these findings can also be associated with a subtype of photoaging, which we term telangiectatic photoaging (TP). To demonstrate that ETR and TP are distinct dermatologic disorders. A case-control observational study comparing clinical, histologic, and gene expression features of 26 participants with ETR, 20 with TP, and 11 age- and sex-matched controls in the Program for Clinical Research in Dermatology at University of Michigan. Findings of clinical history and examination, light and electron microscopy, immunohistochemical analyses, and real-time quantitative reverse-transcriptase polymerase chain reaction gene expression. Transient erythema was greater in the ETR group (38% graded moderate to severe) than in the TP (0%; P < .001) and control groups (0%; P = .002). Nontransient erythema was also greater in the ETR group (50% graded moderate to severe) than in the TP (25%; P = .03) and control groups (0%; P < .001). Participants with ETR tended to have erythema and telangiectasia primarily on the central face (79%), whereas those with TP tended to have more lateral involvement (57%; P < .001). Those with ETR had significantly less clinical evidence of photodamage (0% graded 6-8 on a photonumeric scale) than those with TP (40% graded 6-8; P = .01). Histologically, there was less evidence of photodamage in ETR than in TP, which had wispy collagen and solar elastosis surrounding blood vessels. Immunohistologic analysis demonstrated greater geometric mean immunostained area by mast cell tryptase staining in ETR samples (0.018%) than in TP (0.004%; P = .01) or control samples (0.001%; P < .001) but no increase in mast cell number, indicative of greater mast cell degranulation. Gene expression of matrix metalloproteinase-3 was 4-fold greater in ETR samples than in TP samples (P = .004) and 5-fold higher than in control samples (P = .004). Gene expression of the neuropeptides calcitonin gene-related peptide (CGRP-α) and substance P was significantly increased in ETR compared with TP (9-fold [P < .001] and 5-fold [P = .002], respectively) and control samples (10-fold [P < .001] and 28-fold [P < .001], respectively). Telangiectatic photoaging is characterized by less transient and nontransient erythema, a more lateral distribution of erythema and telangiectasia, less neurogenic mast cell activation, and less MMP-mediated matrix remodeling than ETR. These data demonstrate that TP is a distinct clinical entity from ETR that can be distinguished on the basis of clinical, histologic, and gene expression findings.

Clinical characteristics associated with BRAF, NRAS and KIT mutations in Japanese melanoma patients

BackgroundThe importance of the genetic background of melanoma cells to the individual susceptibility to treatment has become apparent. In Caucasians, BRAF mutations are frequently detected in lesions on the skin of younger patients compared to NRAS and KIT mutations. However, clinical and pathological characteristics associated with BRAF, NRAS and KIT mutations have not been fully evaluated in East Asians. ObjectiveTo clarify clinical and pathological characteristics associated with BRAF, NRAS and KIT mutations in Japanese melanoma patients. MethodsClinical data were retrospectively collected from 11 hospitals in Japan. BRAF, NRAS and KIT mutations were evaluated with polymerase chain reaction and Sanger sequencing. The relationships between these gene mutations and pathological and clinical findings were analyzed. ResultsThe number of cases examined was 171 (primary: 135, metastases: 11, paired: 25), and all were Japanese patients. The detection rates of BRAF, NRAS and KIT mutations were 30.4%, 12.3% and 12.9%, respectively. Compared with the wild type, the presence of BRAF mutations was significantly associated with younger age (median, 50.0 years vs. 70.0 years, p<0.001). BRAF mutation was frequently detected in the lesions of the scalp (80%; 4/5), trunk (72.0%; 18/25), extremities (56.7%; 17/30) and neck (44.4%; 4/9), and the least prevalent were the face (22.2%; 2/9), nail (12.5%; 3/24), palm or sole (8.9%; 4/45) and mucosa (0%). NRAS mutations were prevalent in the face (33.3%) and palm or sole (20.0%), and the median age of these patients was 70.5 years. A KIT mutation was observed in the nail apparatus (25%), palm or sole (15.6%) and mucosa (18.2%). The median age of the patients with a KIT mutation was 63.0 years. Heterogeneity of mutations between primary and metastatic lesions was detected in six of 25 cases (24%). Solar elastosis was identified in 12 of 71 cases (15.3%), among which four cases harbored BRAFV600E (2 cases), BRAFV600K, NRASQ61K or NRASQ61L, respectively. ConclusionSome clinical characteristics associated with BRAF, NRAS and KIT mutations were observed in Japanese patients, and we observed both similarities to and differences from those of Caucasians. Our findings could provide useful information in efforts to clarify the tumor genesis of malignant melanomas.

Combined cutaneous tumors with a melanoma component: A clinical, histologic, and molecular study

The histogenesis and clinical behavior of combined cutaneous tumors (CCTs) in which the mesenchymal component consists of melanoma remain unclear. We sought to characterize the clinical, histologic, and molecular findings in CCTs with an epithelial and a melanoma component. We retrospectively reviewed the records from 2 institutions for CCTs. Fluorescence in situ hybridization was performed to assess chromosomal copy number alterations in both components. Sixteen CCTs were included. The most common subtype was the squamomelanocytic tumor (11), followed by the basomelanocytic tumor (3) and the trichoblastomelanoma (2). CCTs were more common in men (87%), on the head and neck (57%), and had extensive solar elastosis (81%). The median follow-up was 25 months (range, 8-167 months). One case had an adverse outcome. Fluorescence in situ hybridization revealed chromosomal alterations in approximately 55% of the cases. Five cases showed chromosomal gains only in the melanocytic component. One case showed 11q13 gains in both the epithelial and melanocytic components. Our study is retrospective and the sample is small. The low incidence of adverse outcomes suggests that CCT may be more indolent than noncombined tumors. 11q13 amplification in both components supports the theory of dual differentiation from a common progenitor cell.

Intradermal nevi with atypical nuclei in the elderly: The senescent nevus

Benign melanocytic nevi removed from elderly patients may demonstrate focal areas with nuclear atypia. We sought to determine the prevalence of these nevi and their clinical and histologic features. Intradermal nevi from patients older than 60years were evaluated for areas of focal nuclear atypia and analyzed for 9 histologic characteristics. The patients' sex, biopsy sites, and clinical diagnoses were also tabulated. A statistical analysis of the 2 groups was undertaken. In all, 197 specimens from 157 patients were found. Twenty exhibited nuclear atypia (senescent nevi) and 177 did not (benign nevi). Significant differences were found for suggested clinical diagnosis, epithelioid-appearing melanocytes, the number of mast cells, evidence of solar elastosis, the number of intranuclear pseudoinclusions, and the presence of abnormally staining connective tissue. This is a single-site, retrospective analysis involving a modest number of specimens. In addition, only a single age group was evaluated and only intradermal nevi were examined. The presence of focal nuclear atypia in benign melanocytic nevi in the elderly is not a rare finding. As these features are likely a result of the age of the lesion and possibly of long-standing ultraviolet light exposure, the term "senescent" nevus is suggested.

Elastin Modification by 4-Hydroxynonenal in Hairless Mice Exposed to UV-A. Role in Photoaging and Actinic Elastosis

Chronic exposure to ultraviolet (UV) radiation causes oxidative stress, which is involved in photoaging and actinic elastosis. UV and reactive oxygen species generate lipid peroxidation products, including the α, β-unsaturated carbonyl compounds such as acrolein or 4-hydroxynonenal (4-HNE). These aldehydes can modify proteins of the extracellular matrix, but their role in the pathogenesis of photoaging is not clarified. The aim of this study was to investigate whether these aldehydes contribute to alter elastin metabolism and whether topical carbonyl scavengers delay UV-induced skin photoaging. Hairless mice (4-6-week old) daily exposed to UV-A (20 J cm(-2) per day, up to 600 J cm(-2)) exhibited the typical features of photoaging, associated with a significant increase in 4-HNE- and acrolein-adduct content, and elastotic material deposition. Immunofluorescence studies showed the accumulation of 4-HNE adducts on elastin in the dermis of UV-A-exposed mice. This was mimicked in vitro by incubating orcein-elastin with 4-HNE or acrolein, which altered its digestion by leukocyte-elastase, a feature possibly involved in the accumulation of elastotic material. A daily topical application of carnosine completely reversed the development of photoaging alterations and 4-HNE-adduct formation on elastin. These data emphasize the role of 4-HNE and acrolein in the mechanism of photoaging, and the preventive effect of carbonyl scavengers.

New finding that might explain why the skin wrinkles more on various parts of the face.

The mechanism of formation of facial wrinkles has not been fully clarified due to the existence of many distinct influential factors. To clarify the relationship between facial wrinkles and structures in the skin, especially sebaceous glands, image analysis was performed on the forehead and lateral canthus regions of cadaveric skin specimens; 58 male and female donated cadavers (age range at death 20s - 90 s) were included in the study. Specimens were obtained from forehead and lateral canthus region after measuring wrinkle depth. Then tissue slices were prepared to observe the sebaceous gland and its density was measured and analyzed in relation to wrinkle depth, retinacula cutis density, dermal thickness, and solar elastosis degree. A correlation was found between sebaceous gland density and wrinkle depth in forehead specimens with a lower retinacula cutis density. Wrinkles were shallower in specimens with a higher sebaceous gland density. However, no such correlation was found in lateral canthus wrinkles, presumably due to the lack of sebaceous glands in that region. In addition, specimens with a higher sebaceous gland density tended to have a thicker dermis and/or less solar elastosis. Sebaceous gland density seems to be one of the multiple factors that prevent wrinkle deepening, and that is why wrinkles are deeper in the lateral canthus area than in the forehead. Functional studies will elucidate the mechanism of wrinkle formation in the future.

Identification of human papillomavirus in pterygium.

The purpose of this study was to evaluate the involvement of human papillomavirus in the pathogenesis of primary and recurrent pterygium in northern Israel. A retrospective study examined 100 randomly chosen pterygium specimens with solar elastosis, from 100 patients who underwent pterygium surgery during 2012-2013 at the Emek Medical Center. All the specimens were analysed for evidence of human papillomavirus infection by immunohistochemistry. Human papillomavirus was not detected in any of the 100 pterygia samples by immunohistochemistry. These used samples were taken from 100 patients with mean age of 51.5 years and a primary: recurrent ratio of 8.09:1. We conclude from our study that human papillomavirus infection does not appear to be an important pathogenic factor of pterygium in Israel.

Benefits of plasma rich in growth factors (PRGF) in skin photodamage: clinical response and histological assessment.

Skin ageing is characterized by small and fine wrinkles, roughness, laxity, and pigmentation as a result of epidermal thinning, collagen degradation, dermal atrophy, and fewer fibroblasts. Plasma rich in growth factors (PRGF) is an autologous plasma preparation enriched in proteins obtained from patient's own blood aimed at accelerating tissue repair and regeneration. To evaluate the benefits of PRGF in skin photodamage, 10 healthy volunteers were treated with three consecutive intradermal injections of PRGF in the facial area. Clinical outcomes and histological analysis were performed. A statistically significant increase in the epidermis and papillary dermis thickness was seen after PRGF treatment (p < 0.001). Skin thickening was observed in all patients studied, being more intense in the group of patients with photodamage (p < 0.001). After PRGF treatment, a reduction of the average area fraction of solar elastosis was observed in patients with clinical and histological signs of skin photodamage (p < 0.05).No changeswere observed in the number of CD31, XIIIa factor, cKit, CD10, nor p53-positive cells. The improvement score after PRGF use was 0.75 (9/12) for the group of patients with signs of skin photodamage. Intradermal PRGF infiltration appears to be an effective treatment for the photodamaged skin.

Unusual Limbal Lesion in Neurofibromatosis Type 1

To describe an unusual limbal lesion clinically resembling pterygium in a young patient with neurofibromatosis type 1. Clinical case report with a review of the literature. The lesion was excised, and histopathology was performed. Histopathology disclosed conjunctival mucosa with expansion of the substantia propria by dense and loose collagenous tissue, small nerves, and thin-walled blood vessels. No skin or skin appendages were seen, although a small amount of mature adipose was present. Focally, spindle cells with wavy nuclei were seen scattered within the collagenous areas and were positive on S100 immunohistochemistry. Mast cells were readily identifiable. There was no evidence of actinic elastosis, dysplasia, or malignancy. These histopathological features most resemble heterotopia with some features of neurofibroma. We report an unusual limbal lesion in a patient with neurofibromatosis type 1. Histopathological features resemble a heterotopia with some neurofibroma features. We suggest that all lesions excised from patients with neurofibromatosis, no matter how characteristic in appearance, be sent for histopathological confirmation of diagnosis.

Squamous cell carcinoma in a psoriasis patient after multiple courses of phototherapy

The authors present a clinical case study of squamous cell carcinoma in a psoriasis patient after 24 courses of phototherapy (22 courses of PUVA therapy and two courses of mid-wavelength ultraviolet therapy (311 nm)). The malignant neoplasm developed against the background of signs of a chronic photodamage of the skin: lentigo, actinic elastosis, diffuse hyperpigmentation, spotty skin pigmentation.

Polypodium leucotomos: a potential new photoprotective agent.

As the understanding of the immune system pathways, cytokine balances, and cellular interactions continues to expand, so must the potential applications of therapies that can impact the process of diseases instead of just controlling their symptoms. In the case of Polypodium leucotomos extract, which is derived from a tropical fern of the Polypodiaceae family, the future potential of applications in dermatology and beyond will be better understood as its incorporation into daily routines gives rise to the development of new regimens. Clinicians may position this agent as an option for daily maintenance, accept its use in combinations, or use it as a template for further development of oral supplementation that may evolve into a true immunomodulator. The antioxidant activity of P. leucotomos extract is primarily driven by caffeic acid and ferulic acid, resulting in the control of cutaneous responses to ultraviolet-induced erythema, in the interception of inflammatory mechanisms, and the promotion of other cytotoxic responses. Histologically, the impact of P. leucotomos extract induces an effect on the overall reduction of angiogenesis, photocarcinogenesis, and solar elastosis, while on the cellular level there are improvements in cell membrane integrity and elastin expression. Future applications for P. leucotomos extract could include the potential for photoprotective effects, and subsequent research efforts should focus on determining the optimal dosage regimen, duration of action, and utility of combinations with sunscreens, among other outcomes. Recently published data have also demonstrated how the antioxidant effects of oral P. leucotomos extract can delay tumor development in mice models, suggesting there might be a protective role that could be described with further clinical research. In addition, it is important to recognize the distinction between photoprotection and chemoprevention, in that there has yet to be any in vivo or controlled clinical trial data in human subjects that show a role for P. leucotomos extract in the prevention of carcinogenesis.

Actinic granuloma arising from the pulsed dye laser-treated skin in a patient with capillary malformation.

Dear Editor: Actinic granuloma is a rare inflammatory skin disorder that presents in chronically sun-damaged skin with flesh-colored to erythematous papules that coalesce to form centrifugally enlarging annular patterns1. However, its pathogenesis remains to be elusive. It is thought that ultraviolet radiation, heat, viral diseases or other unknown factors transform the antigenicity of elastic fibers and induce cellular immune reactions1,2. A 49-year-old Korean woman had reddish patches on the right side of her face from birth. She was diagnosed with capillary malformation about 20 years ago. She has treated the skin lesion with a pulsed dye laser (PDL) and fractional laser >10 times with 7 years. However, her skin lesion has not completely disappeared. On examination, the reddish patch had an uneven surface and firm texture (Fig. 1). These changes in the skin occurred 2 years ago. Histopathologically, there were some telangiectatic vessels and granulomatous inflammation in the superficial and mid-dermis (Fig. 2A). The dermis showed histiocytes with numerous giant cells, and some of them contained elastotic material, which was consistent with actinic granuloma (Fig. 2B, C). Because of previous repeated laser therapy, we presumed that these granulomatous reactions resulted from the laser therapy-induced actinic and/or heat damage. First, she was treated with oral methylprednisolone (8 mg; Methylon; Kunwha, Seoul, Korea) for 4 months and topical desonide (0.05%; Desowen Lotion; Galderma Pharma SA, Lausanne, Switzerland) for 1 year. However, this treatment resulted in no response. Then she was treated with oral isotretinoin (10 mg; Roaccutane; Roche, Basel, Switzerland) for 4 months, but she also had a minimal response. Fig. 1 (A) Ill-demarcated reddish patch with an (B) uneven surface and firm texture on the right side of the face (white arrow: the biopsy site). Fig. 2 (A) Some telangiectatic vessels and granulomatous inflammation in the superficial and mid-dermis (H&E, ×40). (B) The granuloma is comprised of numerous giant cells (H&E, ×200). (C) Some giant cells are contained in the ... Actinic granuloma typically affects exposed, weather-beaten skin in patients who are at least aged >30 years. Predilection sites are the neck, face, chest, and arms. O'Brien3 considered actinic granuloma to be a phenomenon of repair within damaged connective tissue. A biopsy specimen shows three distinct zones in the dermis. At the periphery within normal skin, actinic elastosis is prominent. The annulus shows a histiocytic and giant cell inflammatory reaction in the papillary and mid-dermal region. The giant cells may contain intracytoplasmic degenerated elastic fibers, or they may surround the foci of elastosis. A center, relatively elastin-free zone is present within the annulus3,4. The differential diagnosis includes granuloma annulare and necrobiosis lipoidica. The absence of dermal mucin and the presence of larger, more numerous giant cells help to distinguish actinic granuloma from granuloma annulare. The presence of elastophagocytosis, degenerated collagen, and sclerosis aid in distinguishing actinic granuloma from necrobiosis lipoidica. The treatment of actinic granuloma has been disappointing. Most reports have cited poor response to topical steroids with a single report of a response to isotretinoin5. In our current report, the patient was previously treated with PDL and fractional laser therapy >10 times. She was a housewife living in an urban area. We thought that the actinic granuloma resulted from the repeated laser therapy-induced heat and/or actinic damage. And, the damage may have destroyed the elastic fiber, which triggers an inflammatory response that causes granulomas. We describe an unusual case of actinic granuloma arising from the laser therapy treated skin.

Effect of ultraviolet radiation, smoking and nutrition on hair.

Similar to the rest of the skin, the hair is exposed to noxious environmental factors. While ultraviolet radiation (UVR) and smoking are well appreciated as major factors contributing to the extrinsic aging of the skin, their effects on the condition of hair have only lately attracted the attention of the medical community. Terrestrial solar UVR ranges from approximately 290 to 400 nm; UV-B (290-315 nm) reaches only the upper dermis, while the penetration of UV-A (315-400 nm) into the dermis increases with wavelength. The two most important chronic effects of UVR on the skin and bald scalp are photocarcinogenesis and solar elastosis; however, the effects of UVR on hair have largely been ignored. As a consequence of increased leisure time and a growing popularity of outdoor activities and holidays in the sun, the awareness of sun protection of the skin has become important and should also apply to the hair. Besides being the single-most preventable cause of significant cardiovascular and pulmonary morbidity and an important cause of death, the association of tobacco smoking with various adverse effects on the skin and hair has also been recognized. Increasing public awareness of the association between smoking and hair loss seems to offer a good opportunity for the prevention or cessation of smoking, since the appearance of hair plays an important role in the overall physical appearance and self-perception of people. Finally, the quantity and quality of hair are closely related to the nutritional state of an individual. Normal supply, uptake, and transport of proteins, calories, trace elements, and vitamins are of fundamental importance in tissues with high biosynthetic activity, such as the hair follicle. In instances of protein and calorie malnutrition as well as essential amino acid, trace element, and vitamin deficiencies, hair growth and pigmentation may be impaired. Ultimately, important commercial interest lies in the question of whether increasing the content of an already adequate diet with specific amino acids, vitamins and/or trace elements may further promote hair growth. Unless the hair is impaired due to nutritional deficiency, there is only so much that nutrients can do to increase the size of individual hairs because hair thickness is largely genetic. Nevertheless, there are external factors that influence hair health to such a degree that micronutrients could boost hair that is suffering from these problems.

O′Brien actinic granuloma: A case report and brief review of literature

O’Brien first described the actinic granuloma in 1975, as an infrequent granulomatous disorder occurring in sun-exposed skin, with a slow but often self-limited course. Ever since its initial description, the actinic physiopathogenic hypothesis has been debated by many authors. We report a 60-year-old female rural worker that presented with a 14 × 7 cm annular lesion with erythematous elevated borders and an atrophic center on the right calf. The lesion was evolving for 2 years, and histopathology confirmed actinic granuloma. She started acitretin with halting of disease progression after 6 months of therapy. Our case can also be associated to actinic damage, despite its unusual location, therefore highlighting the role of solar elastosis in the development of O’Brien actinic granuloma.