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Phosphor-signal transducers and activator of transcription 1 signaling in mucosal lichen planus developing from metastatic bladder cancer treated with pembrolizumab
Erika Tamabuchi, Taku Fujimura, Chunbing Lyu, Setsuya Aiba
doi : 10.1111/dth.14961
Dermatologic TherapyVolume 34, Issue 4 e14961
Efficacy of sonidegib for basal cell carcinoma in a patient affected by multiple infectious diseases
Luca Fania, Elena Dellambra, Gaia Moretta, Elisabetta Grilli, Christiana Zorika Di Rocco, Francesca Maria Morelli, Albina Rita Zappalà, Damiano Abeni, Roberto Morese
doi : 10.1111/dth.14969
Dermatologic TherapyVolume 34, Issue 4 e14969
Treatment of lymphomatoid papulosis resistant to methotrexate therapy with intralesional interferon-alpha-2a
Incilay Kalay Yildizhan, Bengü Nisa Akay, Merve Aygun, Aylin Okcu Heper
doi : 10.1111/dth.14971
Dermatologic TherapyVolume 34, Issue 4 e14971
Pityriasis rosea infection in a COVID-19 patient successfully treated with systemic steroid and antihistamine via telemedicine: Literature update of a possible prodromal symptom of an underlying SARS-CoV-2 infection
Giovanni Paolino, Matteo Riccardo Di Nicola, Carmen Cantisani, Santo Raffaele Mercuri
doi : 10.1111/dth.14972
Dermatologic TherapyVolume 34, Issue 4 e14972
A rare site of subcutaneous lipoma on the middle finger: Case report and analysis of affected sites in 126 cases at a single institution
Emi Inamura, Shinya Kitamura, Takuya Maeda, Teruki Yanagi
doi : 10.1111/dth.14973
Dermatologic TherapyVolume 34, Issue 4 e14973
Immunotherapy in transplanted patients: A special population that can no longer be ignored
Marco Rubatto, Martina Merli, Andrea Agostini, Gianluca Avallone, Luca Mastorino, Paolo Fava, Luigi Biancone, Maura Rossetti, Maria Teresa Fierro, Simone Ribero, Pietro Quaglino
doi : 10.1111/dth.14975
Dermatologic TherapyVolume 34, Issue 4 e14975
Development of pemphigus vulgaris during treatment with dipeptidyl peptidase-4 inhibitors: a case report
Kazumasa Oya, Masanao Fujii, Shijima Taguchi
doi : 10.1111/dth.14982
Dermatologic TherapyVolume 34, Issue 4 e14982
COVID-19-related chilblain-like lesions and idiopathic perniosis: Additional variables possibly influencing dermoscopic pattern
Enzo Errichetti MD
doi : 10.1111/dth.14985
Dermatologic TherapyVolume 34, Issue 4 e14985
Rosai-Dorfman disease presenting with nasal, nodal and multiple cutaneous involvements responding to a combination of systemic steroid and low-dose thalidomide therapy
Incilay Kalay Yildizhan, Hatice Sanli, Bengü Nisa Akay, Handan Merve Erol, I??nsu Kuzu, Ayça K?rm?z?, Güldane Cengiz Seval
doi : 10.1111/dth.14988
Dermatologic TherapyVolume 34, Issue 4 e14988
Low rate of scalp biopsy in systemic lupus erythematosus patients and the potential for misdiagnosis
Afsheen Sharifzadeh, Gideon P. Smith
doi : 10.1111/dth.14991
Dermatologic TherapyVolume 34, Issue 4 e14991
Successful treatment of angiolymphoid hyperplasia with eosinophilia with oral propranolol in two cases
Bahloul Emna, Ben Rejeb Mohamed, Khaoula Ben Youness, Ons Boudawara, Turki Hamida
doi : 10.1111/dth.14994
Dermatologic TherapyVolume 34, Issue 4 e14994
A novel use of intermittent low dose dabigatran for maintenance of remission in livedoid vasculopathy
Bandhala Rajan M, Abhishek Bhardwaj, Jyotsna Naresh Bharti, Akriti Agrawal
doi : 10.1111/dth.14997
Dermatologic TherapyVolume 34, Issue 4 e14997
Successful treatment of eruptive pyogenic granuloma with propranolol
Davide Fattore, Adriana Di Guida, Aikaterini Detoraki, Gaia De Fata Salvatores, Lucia Gallo, Gabriella Fabbrocini
doi : 10.1111/dth.14998
Dermatologic TherapyVolume 34, Issue 4 e14998
Local reactions to the second dose of the BNT162 COVID-19 vaccine
Antonella Tammaro, Ganiyat Adenike Ralitsa Adebanjo, Francesca Romana Parisella, Gabriella De Marco, Jordi Rello
doi : 10.1111/dth.15000
Dermatologic TherapyVolume 34, Issue 4 e15000
Severe hidradenitis suppurativa (acne inversa) associated with focal segmental glomerulosclerosis and gout partially responsive to canakinumab
Neslihan Akdogan, Basak Yalici-Armagan, Sibel Dogan, Rahmi Y?lmaz
doi : 10.1111/dth.15002
Dermatologic TherapyVolume 34, Issue 4 dth15002
A case of lichen amyloidosis associated with atopic dermatitis successfully treated with dupilumab: A case report and literature review
Koji Aoki, Manabu Ohyama, Yoshiko Mizukawa
doi : 10.1111/dth.15005
Dermatologic TherapyVolume 34, Issue 4 e15005
Vasculitis during certolizumab pegol and secukinumab treatment: Report of two cases
Ecem Bostan, Duygu Gulseren, Basak Yalici-Armagan, Sibel Dogan, Deniz Ates-Ozdemir, Ozay Gokoz, Umut Kalyoncu, Nilgün Atakan
doi : 10.1111/dth.15007
Dermatologic TherapyVolume 34, Issue 4 e15007
Are improvements in melasma severity correlated with improvements in quality of life? A systematic review
Adrian Michel Joseph Bailey, Brian Dorus, Heidi Oi-Yee Li, Nordau Kanigsberg
doi : 10.1111/dth.15011
Dermatologic TherapyVolume 34, Issue 4 e15011
Exacerbation of subacute cutaneous lupus erythematosus following vaccination with BNT162b2 mRNA vaccine
Dennis Niebel, Veronika Ralser-Isselstein, Kristel Jaschke, Christine Braegelmann, Thomas Bieber, Joerg Wenzel
doi : 10.1111/dth.15017
Dermatologic TherapyVolume 34, Issue 4 e15017
Split-thickness skin graft in one-stage procedure for severe axillary hidradenitis suppurativa
Karolina W?jcicka, Piotr K. Krajewski, Jacek C. Szepietowski
doi : 10.1111/dth.15019
Dermatologic TherapyVolume 34, Issue 4 e15019
Characteristics of granuloma annulare in reflectance confocal microscopy
Anna Pogorzelska-Antkowiak, Paola Corneli, Iris Zalaudek, Jacek C. Szepietowski, Marina Agozzino
doi : 10.1111/dth.15021
Dermatologic TherapyVolume 34, Issue 4 e15021
Efficacy of bleomycin as a treatment modality in pyogenic granuloma: a case series
Ananta Khurana, Sinu Rose Mathachan
doi : 10.1111/dth.15024
Dermatologic TherapyVolume 34, Issue 4 e15024
Does longer duration of corticosteroid treatment improve clearance in vulvar lichen sclerosus? Results from a single centre, comparative, open label study
Monica Corazza, Giulia Toni, Giorgia Valpiani, Chiara Morotti, Alessandro Borghi
doi : 10.1111/dth.14955
Dermatologic TherapyVolume 34, Issue 4 e14955
The factors influencing the unmet effects of alpha hydroxy acid peels on acne vulgaris: A single tertiary center experience
Jieying Tang, Jianmin Yang, Cuicui Zhang, Xuemei Zhang, Qiang Chen, Shihong Zhang, Lujia Chen, Chuan Wang, Weiwei Li
doi : 10.1111/dth.14956
Dermatologic TherapyVolume 34, Issue 4 e14956
Evaluation of relationship between antihypertensive drug usage and dermatoscopic features in patients with keratinizing skin cancer
Hatice Gamze Demirdag, Burcu Tugrul
doi : 10.1111/dth.14957
Dermatologic TherapyVolume 34, Issue 4 e14957
Thread lifting of the midface: A pilot study for quantitative evaluation
Alberto Diaspro, Gabriele Rossini
doi : 10.1111/dth.14958
Dermatologic TherapyVolume 34, Issue 4 e14958
Anti-pollution skincare: Research on effective ways to protect skin from particulate matter
Jongeun Lee, Se Jin Oh, Sewon Park, Ji-Hye Park, Jong Hee Lee
doi : 10.1111/dth.14960
Dermatologic TherapyVolume 34, Issue 4 e14960
A daily regimen of a ceramide-dominant moisturizing cream and cleanser restores the skin permeability barrier in adults with moderate eczema: A randomized trial
Fabrizio Spada, Ian P. Harrison, Tanya M. Barnes, Kerryn A. Greive, Daisy Daniels, Joshua P. Townley, Niyaz Mostafa, Andrew T. Fong, Philip L. Tong, Stephen Shumack
doi : 10.1111/dth.14970
Dermatologic TherapyVolume 34, Issue 4 e14970
The role of CD1a expression in the diagnosis of cutaneous leishmaniasis, its relationship with leishmania species and clinicopathological features
Yasemin Yuyucu Karabulut, Funda Ku? Bozkurt, ?mit Türsen, Gül Bayram, Gülhan ?rekeci Temel, Mehmet Emin Erdal
doi : 10.1111/dth.14977
Dermatologic TherapyVolume 34, Issue 4 e14977
Cutaneous leishmaniasis is caused by a flagellated protozoan transmitted by the bite of a female sandfly. The clinical and demographic details of this disease, predominantly affecting immunocompetent individuals, are recognized by the WHO as a Neglected Tropical Disease. We sought to determine the usability of CD1a immunohistochemical staining to detect amastigotes especially in cases where leishmaniasis is suspected but evident amastigotes could not observed. We also evaluated the relationship between CD1a expression and leishmania subtypes. A total of 84 cases diagnosed with leishmaniasis or suspected leishmania on histo-morphological evaluation of skin biopsies were included in the study. Amastigotes were easily detected in hematoxylin eosin in 18 of 84 cases. In 23 cases, amastigotes could not detect in hematoxylin eosin sections. The immunostains for CD1a are demonstrated amastigotes in 60 of 84 cases. However, a small number of amastigotes became visible by positive staining with CD1a in 43.4% of the cases in that amastigotes could not detected in hematoxylin eosin. A statistically significant correlation was found between amastigote amount in hematoxylin eosin and CD1a expression. In addition, a significant correlation was observed between CD1a expression, age and clinical pre-diagnosis of the cases. It was observed that amastigotes were easily detected in hematoxylin eosin in Leishmania Infantum / donovani positive cases in polymerase chain reaction (PCR), and at the same time, it was found that CD1a expression was significantly higher. Using histopathology examination with CD1a staining and/or PCR methods, a diagnosis of leishmaniasis can be established and early treatment initiated. This contributes to reduce transmission and prevalence.
Metabolic syndrome in patients with Alopecia Areata: A case-control study
Fahimeh Abdollahimajd, Nasim Niknezhad, Negin Bahreini, Shima Younespour, Nastaran Namazi
doi : 10.1111/dth.14979
Dermatologic TherapyVolume 34, Issue 4 e14979
The aim of this study was to evaluate metabolic syndrome prevalence in patients with Alopecia Areata compared to controls. Sixty eligible patients with Alopecia Areata and 60 healthy subjects frequency matched for age and sex attending to our referral dermatology clinics from 2015 to 2017 were enrolled. Prevalence of metabolic syndrome and its components were compared between the two groups. Metabolic syndrome was only seen in seven patients (11.67%) and four controls (6.67%) without a significant difference (P =?.34). The clinical presentations of AA included patch type (38.33%), ophiasis (6.67%), alopecia totalis (16.67%), and alopecia universalis (38.33%). Presence of metabolic syndrome was significantly associated with abdominal circumference (OR: 1.10, 95% CI for OR: 1.02to 1.19). Although there was no significant association between Alopecia Areata and metabolic syndrome, some components of metabolic syndrome were more prevalent in these patients. It may be concluded Alopecia Areata patients are at a higher risk of developing metabolic syndrome in the future. Further studies with larger sample sizes are needed.
Platelet-rich plasma versus carboxytherapy for the treatment of periocular hyperpigmentation; which approach is superior?
Ali Asilian, Akramsadat Amiri, Fatemeh Mokhtari, Gita Faghihi, Fariba Iraji, Samaneh Mozafarpoor
doi : 10.1111/dth.14980
Dermatologic TherapyVolume 34, Issue 4 e14980
Periorbital hyperpigmentation (POH) is a common aesthetic condition causing people referring to dermatology clinics. Although the therapeutic approach is steeply dependent to the etiology of POH, the gold standard approach of treatment is still a question. The current study is designed to compare the use of carboxytherapy versus platelet-rich plasma (PRP) for the treatment of POH. In the current clinical trial, number of 21 patients with POH underwent carboxytherapy in one side of the face and PRP therapy on the other side. SPSS software version 22 was used with independent T-test, Chi-square, and ANOVA for analytics. Carboxytherapy was performed by intradermal injection of 5 cc carbon-dioxide gas once weekly for 6?weeks. The PRP treatment was performed by intradermal injection of PRP in periorbital space using an insulin syringe every 2?weeks for three times. The periorbital darkness was assessed using visual analogue scale preoperatively and within 8?weeks postoperatively by the patients and the dermatologists. Automatic assessments of skin vascularity and pigmentation were assessed using a digital camera. The patients represented significant darkness improvement postoperatively for both of the approaches (p value: 0.84, p value: 0.87), while the comparison of the two groups revealed insignificant postoperative changes by dermatologists assessments (p value = 0.59, p value: 0.61), the patients' assessments (p value = 0.85), the digital camera skin vascularity and pigmentation assessments (p value?>?0.05). Conclusion: Although insignificant changes following both of the approaches were found, it may have occurred due to the technique, quality of material, or inadequate treatment sessions due to the type of Iranian skin; therefore, more evaluations considering particular entities such as vascularity for longer duration of follow-up and new design are strongly recommended.
Early time to recurrence predicts worse survival in patients with localized or regionally advanced cutaneous melanoma
Chengcai Liang, Wanming Hu, Jingjing Li, Xiaoshi Zhang, Zhiwei Zhou, Yao Liang
doi : 10.1111/dth.14981
Dermatologic TherapyVolume 34, Issue 4 e14981
To investigate the prognostic significance of time to recurrence (TTR) for overall survival (OS) and survival after recurrence (SAR) in patients with localized or regionally advanced cutaneous melanoma. A total of 731 cutaneous melanoma patients with an initial diagnosis of 8th American Joint Committee on Cancer (AJCC) clinical stage I-III were included in this study. The prognostic factors associated with OS and SAR were estimated through Kaplan-Meier and Cox regression analysis. Of the total cohort, 329 patients (45%) died, and 418 patients (57%) experienced recurrence. The median follow-up and TTR were 55.6 months and 9.6 months, respectively. A total of 141 patients (19%) experienced recurrence in <6 months, and 277 patients (38%) experienced recurrence in ?6 months. Patients with stage III and positive lymph node dissection (LND) were more common in the early TTR group than in the late TTR group. Both the OS and SAR rates at 5?years and 10?years in the early TTR group were significantly poorer than those in the late TTR group (P?<?.001 and P = .008, respectively). Furthermore, early TTR, along with truncal tumor, higher TNM stage and therapeutic variables (extended resection, LND and adjuvant therapy), were significant independent predictors of worse OS and SAR in multivariate analysis (all P?<?.05). Early TTR predicts worse survival and could be considered an independent prognostic factor for patients with localized or regionally advanced cutaneous melanoma. TTR should be evaluated in all patients with recurrence to guide post-recurrence risk stratification and follow-up schedules.
Low-dose isotretinoin versus minocycline in the treatment of rosacea
Avner Shemer, Aditya K. Gupta, Riad Kassem, Nechama Sharon, Emma M. Quinlan, Eran Galili
doi : 10.1111/dth.14986
Dermatologic TherapyVolume 34, Issue 4 e14986
Rosacea is a common inflammatory facial skin condition affecting the adult population. Its papulopustular subtype is mainly treated pharmacologically by topical and oral antibiotics. For severe or antibiotics-recalcitrant disease, daily low-dose isotretinoin has also been reported to be effective. However, no previous study has assessed the efficacy of once-weekly administered isotretinoin for papulopustular rosacea. For this purpose, a retrospective comparative study was conducted. For severe rosacea, 40?mg/week isotretinoin (24 patients) was administered. For mild to moderate rosacea, once-weekly 20?mg/week isotretinoin (28 patients) was compared with 100?mg/day minocycline (24 patients). Treatment courses lasted 4 to 7 months. Forty milligrams per week isotretinoin was highly effective for severe rosacea, achieving complete response (over 90% improvement) in 62.5% of patients and partial response (50%-90% improvement) in additional 29.2% of patients. Twenty milligrams per week isotretinoin and hundred milligrams per day minocycline showed comparable efficacy for mild to moderate rosacea (complete response of 10.7% vs 8.3% and partial response of 28.6% vs 33.3%, respectively). This study demonstrates that that the use of a weekly low-dose isotretinoin is an effective treatment for papulopustular rosacea, including among patients with severe disease.
Our experience with lipofilling in secondary rhinoplasty, into a new era
Raymond Challita, Ziad Sleiman, Nagham Bazzi, George Ghanime
doi : 10.1111/dth.14989
Dermatologic TherapyVolume 34, Issue 4 e14989
Rhinoplasty is a commonly performed cosmetic surgery. Clinicians are facing an increased demand on non-surgical procedures, therefore liquid rhinoplasty is gaining popularity. Given the characteristic of lipofilling to rejuvenate and improve skin texture, fat grafting can be used to reshape the nose in secondary rhinoplasty. Fat was injected in 27 patients with a mean age of 42?years. Volume of fat ranged from 1.5 to 4.5 cc with a mean of 2.2 cc. Patients were seen at 1 week, 3 months, 6 months, and 1 year. Patient satisfaction was measured using the Rhinoplasty Outcome Evaluation questionnaire and plastic surgeons' evaluation. After 1 year follow up, 20 patients were satisfied with the results at 1 year. The aesthetic outcome was noted as very good in 11 patients, good in 9 patients, and poor in 3 patients. Most of the patients had an improvement in skin texture with trophic effect on the skin. No complications were seen in our series According to this study, nasal lipofilling is a safe and efficacious filler in secondary rhinoplasty. However, more studies are needed to assess the indications and limitations of nose lipofilling.
Cutaneous squamous cell carcinoma of head and neck region: A single center analysis of 1296 tumors with clinical characteristics, comorbidities, treatment, and sun-protection behavior
Caroline Warnig, Uwe Wollina
doi : 10.1111/dth.14992
Dermatologic TherapyVolume 34, Issue 4 e14992
Cutaneous squamous cell carcinoma (SCC) is the second most common non-melanoma skin cancer among Caucasians. We analyzed our data on tumors been treated between 2006 and 2016 at the Skin Cancer Center of an academic teaching hospital. Thousand hundred and ninety-four patients with 1296 SCC have been identified including 804 males (67.3%) and 390 females (32.7%). The mean age among females was significantly higher with (83.9?±?7.9) years compared with males ([79.3?±?8.1] years; P?<?.001). The most common tumor localizations were outer ears (n = 227, 17.5%), scalp (216, 16.7%), and forehead (215, 16.6%). The majority of tumors was stage I. 31.9% of patients had previous SCC or Bowen's cancer, 29.1% had actinic keratoses. Major non-dermatological comorbidities were cardiovascular diseases and diabetes. SCC were treated by delayed Mohs surgery. First Mohs procedure resulted in R0 status in 83.9%. Most cases with R1 resection were located on nose and eyelids. For a subpopulation of patients (n = 105), a structured questionnaire study evaluated changes in sun protection behavior after skin cancer. After the confirmed diagnosis of a cutaneous SCC concerns about harm to the skin by intense sunlight was reported by 78.4% (76) of participants, with 92.0% among females versus 73.6% among males. Eighty percent of females and 76.8% of males wanted to care more about sun-protection in the future, spend less time 84.0% (females) and 72.5% (males) in the sun, and adapt their leisure activities for a better sun protection in 92.0% (females) and 81.9% (males). Secondary prevention in males needs improvement.
Effect of the varicella vaccination implementation on the development of herpes zoster in children and adolescents
Esma Inan Yuksel, Asude Kara Polat, Muge Gore Karaali, Ayse Esra Koku Aksu, Mehmet Salih Gurel
doi : 10.1111/dth.14995
Dermatologic TherapyVolume 34, Issue 4 e14995
Herpes zoster (HZ) is an infectious disease caused by latent varicella-zoster virus reactivation. There are conflicting reports on the varicella vaccine's effect on the incidence of HZ in children and adolescents. This study aimed to determine the impact of the single dose of varicella vaccination on HZ prevalence during childhood and adolescence. The study included children and adolescents aged <18?years who presented to the dermatology outpatient clinic between 2005 and 2019 and were diagnosed with HZ. Considering that the universal vaccination program started to be implemented in Turkey in 2013, non-vaccinated cases in the prevaccination period, vaccinated cases in the postvaccination period, and non-vaccinated patients in the postvaccination period were compared in terms of HZ prevalence and demographic features. After the initiation of the varicella vaccination program, the prevalence of HZ was found to decrease by 24.7% in all. The HZ prevalence was significantly reduced in vaccinated children, while the rate of decrease in non-vaccinated children was low (58.6% and 16.4%, respectively). The median age of the non-vaccinated cases in the postvaccination period (10 [min 0.5-max 17] years) was significantly higher compared to the other groups (p?<?0.001). The number of cases aged <2?years was the highest in the vaccinated group (p?<?0.001). Administration of a single dose of varicella vaccine was insufficient to decrease the prevalence of HZ <18?years of age. In the post-vaccination period, the frequency of HZ in unvaccinated cases increased in adolescence. In vaccinated children, HZ seems to develop at an earlier age.
Does the use of Dermojet affect the concentration of platelet-rich plasma? An in vitro experimental investigation
Ali G?kkaya, Metin G?rgü, Ertu?rul Karanfil, Burçin Acuner
doi : 10.1111/dth.14996
Dermatologic TherapyVolume 34, Issue 4 e14996
Needle-free injection systems with high jet pressure have been used for seven decades for drug or vaccine administration via intradermal, subcutaneous, and intramuscular routes. These systems are used for the application of mesotherapy drugs in plastic surgery and dermatology. Platelet-rich plasma (PRP) tissue regeneration is applied intradermally by a needle for different indications, such as wound healing and scar revision. To prevent complaints such as pain, erythema, and ecchymosis by patients during this application, PRP was applied using Dermojet, a jet injector system with a spring-loaded system. In this study, after measuring the average platelet count in PRP preparations obtained from 18 volunteers, a 2.5 cc PRP shot into an empty tube was performed with Dermojet. The mean platelet count was measured in a homogenized tube. The same procedures were performed for platelet-poor plasma (PPP). The platelet loss rates for PRP and PPP were compared. In addition, the amount of PRP in each shot of the Dermojet was calculated. When PRP and PPP were applied using the Dermojet, platelet loss was 8.41% and 8.33%, respectively. The difference in the number of platelets formed in PRP and PPP when applied with Dermojet was not statistically significant. PRP application with needle-free injection systems, such as Dermojet, may be an alternative because of patient comfort and the negligible platelet loss compared with the PRP application with the standard needle injection.
Fractional CO2 laser to improve noticeable scars after skin cancer surgery: An appraisal by the patients, laypersons, and experts
Nina Wyss, Nicole Graf, Juerg Hafner, Laurence Imhof
doi : 10.1111/dth.14999
Dermatologic TherapyVolume 34, Issue 4 e14999
Ablative fractionated carbon dioxide (fCO2) laser may be a useful tool to improve noticeable scars after skin cancer surgery. Therefore we evaluated 40 patients who have been treated with fCO2 laser for facial scars after skin cancer surgery. This retrospective study is based on blinded evaluation of pre- and postoperative photographs. Patients (n = 40), laypersons (n = 5) and experts (n = 5) evaluated the esthetics and the Vancouver scar scale as primary endpoints. Secondary endpoints included patient satisfaction and treatment safety. Patients, laypersons and experts consistently assessed a significant improvement of scar quality and appearance after fCO2 laser treatment, which was paralleled by high patient satisfaction. In conclusion, ablative fCO2 laser is effective in improving noticeable postsurgical scars. Patients are highly satisfied with post-laser results.
Itch reduction using immersive virtual reality—An experimental pilot study
Albert Baschong, Florian Spiess, Philippe C. Cattin, Alexander Navarini, Simon M. Mueller
doi : 10.1111/dth.15001
Dermatologic TherapyVolume 34, Issue 4 e15001
In a previous proof-of-concept study we have demonstrated that visual exposure to specific colors results in pruritic or antipruritic effects. To determine the effect of “antipruritic” colors when using immersive virtual reality (VR) and to assess whether psychometric values correlate with the response to the color exposure. In this cross-sectional interventional single-center study, itch patients were exposed to their subjective “antipruritic color” (defined by the Manchester Color Wheel) in a virtual monochromatic room for 10 min using a head-mounted display. Itch intensity rating (0–10 numerical rating scale [NRS]) was repeated at 1-min intervals. Additionally, dermatology life quality index, itch-related quality of life and the Hospital Anxiety and Depression Scale questionnaires were completed. Twenty-two patients (mean age 51.9?±?23?years, 13 females) participated in the study. Following color exposure for 10 min itch intensity was significantly reduced compared to baseline (exact Wilcoxon signed-rank test, mdn-NRS 4.5 vs 3.0; z = ?3.025, p = 0.001), confirmed by the area under the curve (z = ?3.118; p = 0.001). No significant correlation between itch reduction and questionnaire scores was found (Spearman's Rho for all questionnaires). Visual exposure to the “antipruritic color” using immersive VR resulted in a significant decrease in itch intensity. This aligns with previous findings on the influence of colors on itch perception. The response of the intervention appeared independent of psychometric values. Thus, color exposure using immersive VR is a promising, low-cost, rapidly-acting, easily-applicable, non-pharmacological experimental antipruritic method.
Tumor necrosis factor inhibitors are associated with a decreased risk of COVID-19-associated hospitalization in patients with psoriasis—A population-based cohort study
Khalaf Kridin, Yochai Schonmann, Giovanni Damiani, Avi Peretz, Erez Onn, Dana Tzur Bitan, Arnon D. Cohen
doi : 10.1111/dth.15003
Dermatologic TherapyVolume 34, Issue 4 e15003
The risk of coronavirus disease 2019 (COVID-19) and its complications among patients with psoriasis treated by tumor necrosis factor inhibitors (TNFis) remains to be decisively delineated. We aimed to assess the risk of COVID-19 infection, COVID-19-associated hospitalization, and mortality among Israeli patients with psoriasis treated by TNFi relative to other systemic agents. A population-based cohort study was conducted to compare psoriasis patients treated by TNFi (n =?1943), with those treated by methotrexate (n =?1929), ustekinumab (n =?348), and acitretin (n =?1892) regarding COVID-19 outcomes. Risk of investigated outcomes was assessed using uni- and multi-variate Cox regression analyses. The incidence rate of COVID-19, COVID-19-associated hospitalization, and mortality in the TNFi group was 35.8 (95% CI, 26.1-47.9), 0.8 (95% CI, 0.0-4.2), and 0.0 per 1000 person-years, respectively. Exposure to TNFi was associated with a comparable risk of COVID-19 infection [adjusted hazard ration (HR) for TNFi vs methotrexate: 1.07 (95% CI, 0.67-1.71); TNFi vs ustekinumab: 1.07 (95% CI, 0.48-2.40); TNFi vs acitretin: 0.98 (95% CI, 0.61-1.57)]. TNFi was associated with a decreased risk of COVID-19-associated hospitalization relative to methotrexate (adjusted HR, 0.10; 95% CI, 0.01-0.82) and ustekinumab (adjusted HR, 0.04; 95% CI, 0.00-0.64), but not to acitretin (adjusted HR, 1.00; 95% CI, 0.16-6.16). No significant difference in COVID-19-associated mortality was found between the four different groups. TNFi was associated with a decreased risk of admissions due to COVID-19. Our findings substantiate the continuation of TNFi treatment during the pandemic. TNFi may be positively considered in patients with moderate-to-severe psoriasis warranting systemic treatment during the pandemic.
Trichoscopy as a monitoring tool in assessing treatment response in 98 children with tinea capitis: A prospective clinical study
Pradeep Kumar, Deepika Pandhi, Sambit Nath Bhattacharya, Shukla Das
doi : 10.1111/dth.15010
Dermatologic TherapyVolume 34, Issue 4 e15010
Tinea capitis (TC) is the most common dermatophyte infection in children. Fungal culture the gold standard diagnostic method takes several weeks and has poor yields. Trichoscopy helps in rapid diagnosis and could work as a monitoring tool during antifungal therapy. Our main objective is to document the evolution of trichoscopic features with treatment and their correlation with clinical parameters in patients of TC. Forty-six and 52 children with clinically diagnosed TC that was confirmed by potassium hydroxide microscopy, received griseofulvin and terbinafine, respectively. Recruited children were subjected to clinical and trichoscopic assessment by calculation of CASS (clinical assessment severity score) and counting of TAHC (Total Altered hair count; negative and positive), respectively, at baseline and follow-up at 2, 4, and 6?weeks. McNemar, Wilcoxon singed ranked test and Spearman-rho correlation of various parameters was evaluated. Follow-up trichoscopy revealed significant (p?<?0.009) disappearance of negative TAHC like black dot (second week onward), corkscrew, horseshoe and zigzag hair at 4?weeks and short broken hair, erythema telangiectasia hemorrhage (ETH) resolved at 6?weeks. Positive TAHC (regrowing hair) shows significant increase at 6?weeks (p?<?0.001). CASS and negative TAHC showed significant difference at 4?weeks (p?<?0.001) by analyzing boxplot graph. Therefore, trichoscopic resolution occurred before the clinical cure. Terbinafine subjects showed a higher clinical cure rate at 4?weeks (p = 0.02) as compared to griseofulvin. To conclude, trichoscopy is a good monitoring tool that could document the disappearance of almost all dystrophic hair at 4 to 6?weeks and is a more sensitive tool than microscopic examination. Regrowing hair and perifollicular scaling are markers of recovery.
Hydroxychloroquine does not impair antibody response to 13-valent pneumococcal conjugate vaccine in patients with cutaneous lupus erythematosus—A pilot study
Karolina Pelka, Aleksandra Matyja-Bednarczyk, Anna Wojas-Pelc, Maciej Pastuszczak
doi : 10.1111/dth.15013
Dermatologic TherapyVolume 34, Issue 4 e15013
Pneumococcal pneumonia is an important cause of morbidity and mortality among patients with lupus erythematosus. Therefore, a vaccination against pneumococcal infections prior to the immunosuppressive therapy is strongly recommended in these patients. Antimalarials are the standard first-line systemic therapy for cutaneous lupus erythematosus (CLE). However, as many as 50% of CLE patients can be recalcitrant to this treatment and may require more intense immunosuppressive management such as for example, methotrexate, mycophenolate mofetil or azathioprine. The main aim of the current study was to assess the immunogenicity of the pneumococcal conjugate vaccine (PCV) in patients with CLE receiving hydroxychloroquine (HCQ) for at least 6?months prior to the study entry. Twenty patients with CLE but not systemic lupus erythematosus (SLE) who were receiving HCQ and five age- and sex-matched healthy volunteers were included in this study. All individuals were vaccinated with 13-valent PCV. Levels of anti-pneumococcal capsular polysaccharide (anti-PCP) IgM and IgG antibodies were measured before and 6?weeks after vaccination. Anti-PCP IgM and IgG levels increased significantly in both CLE and controls upon vaccination (p?<?0.0001 and p?<?0.05, respectively). Ninety-five percentage of CLE patients and 80% of healthy volunteers achieved at least 2-fold increase in levels of anti-PCP IgG upon vaccination. Vaccination was good tolerated in both groups. The CLE activity score before vaccination was not modified thereafter. Hydroxychloroquine does not impair immune response to PCV13. The time period when patients with CLE are receiving HCQ could be used for immunization before more intense immunosuppressive therapy would be initiated.
Impact of treatment delays on vitiligo during the COVID-19 pandemic: A retrospective study
Xinya Xu, Chengfeng Zhang, Min Jiang, Leihong Flora Xiang
doi : 10.1111/dth.15014
Dermatologic TherapyVolume 34, Issue 4 e15014
Due to the COVID-19 pandemic, routine treatments are delayed to some extent and their negative impacts have been widely reported. However, virtually nothing is known about vitiligo in the context of COVID-19. Therefore, we analyzed treatment delays and its impact on vitiligo, aiming to provide suggestions on vitiligo management within this special period. We performed a retrospective cohort study on 322 patients who visited our clinics at least 2 times from January to December 2020, and their medical records and photographs were reviewed. Patients were divided into normal (n = 155) and late group (n = 167) based on whether experienced treatment delays. As for the active cases, the late group showed higher progression rate than normal group (35 of 86 [40.7%] vs. 10 of 81 [12.3%]; p = 0.002). Moreover, we observed higher recurrence rate in delay group than those of normal group (26 of 81[32.1%] vs. 9 of 74 [12.2%]; p = 0.018) among stable cases. Further univariate and multivariate analysis determined treatment delays as the most important independent risk factor for disease progression and recurrence, and maintenance therapy (>2?years) as a protective factor against recurrence. This study, for the first time, revealed the independent adverse impact of treatment delays on the progression and recurrence of vitiligo and indicated the significance of continuous treatment for halting progression and long-term maintenance therapy for preventing recurrence for vitiligo, which should be highly valued in the management of vitiligo during the COVID-19 pandemic.
Mucocutaneous manifestations of patients with chronic kidney disease under hemodialysis: A cross-sectional study of 49 patients
Farzam Tajalli, Seyed-Mohamad-Sadegh Mirahmadi, Samaneh Mozafarpoor, Azadeh Goodarzi, Mitra Nasiri Partovi, Davood Lakestani
doi : 10.1111/dth.15015
Dermatologic TherapyVolume 34, Issue 4 e15015
Chronic kidney disease (CKD) is a common medical problem with well-known dermatologic manifestations, some of which highly disturb the patients' quality of life. This cross-sectional study was designed to identify the prevalence and type of cutaneous involvement in CKD patients. The skin manifestations of 49 patients with CKD undergoing hemodialysis at Akhavan Hospital in Kashan, Iran, were recorded over 2?months. Diabetes (35%) was the most common cause of chronic renal failure in the patients, and the most common skin manifestations were xerosis (95.9%), uremic pigmentation (89.8%), scleral discoloration (87.8%), dental discoloration (85.2% among the patients with natural teeth), dry mouth (65.3%), varicosity (61.2%), pruritus (57.1%), skin atrophy (49%), lentigo (46.9%), subungual hyperkeratosis (42.9%), half and half nail dystrophy (34.7%), and purpura (26.5%). Mucocutaneous involvement has a very high prevalence in CKD patients undergoing hemodialysis, and some of the cases are medically and cosmetically disturbing; therefore, with better knowledge about the type and prevalence of these involvements, the consequences can be better predicted and managed. Further studies are recommended to be conducted on the association between these signs and CKD grade, and clinical trials are also required for establishing the treatment options available for these signs and then assessing the patients' quality of life as a primary outcome measure.
Psychiatric morbidity, stress and quality of life among geriatric dermatology patients: Therapeutic considerations from an Indian perspective
Archana Anandakumar Geetha, Ettappurath N. Abdul Latheef, Sreekanth Sukumarakurup, Keerankulangara Devi, Mohammad Jafferany
doi : 10.1111/dth.15018
Dermatologic TherapyVolume 34, Issue 4 e15018
We aimed to determine the prevalence of psychiatric morbidities, stress and quality of life, the pattern of skin diseases and associated psychosocial factors in geriatric population. Patients aged 60?years and older were recruited. Demographics and dermatological history and findings were collected using a preset Proforma. Geriatric depression scale (GDS), hospital anxiety and depression scale (HADS), perceived stress scale (PSS), and dermatology life quality index (DLQI) were instituted in all the patients. A total of 310 patients were included in the study, 173 males and 137 females. Infectious diseases (39.6%), papulosquamous diseases (17.1%), and eczema (15.5%) were common disorders. 45.5% were depressed and 43.2% had anxiety (hospital anxiety and depression scale). 55.8% had depression (geriatric depression rating scale), 20.3% had high stress and 11% had extremely large effect on DLQI. Divorced/widowed patients experienced more depression (p?=?0.037) and had more impairment in quality of life (p?=?0.05). Patients living in three generation family experienced more impairment in quality of life (p?=?0.000). Our study demonstrated high prevalence of psychiatric morbidities in geriatric dermatology patients. It implies the need of special care with more attention to psychiatric co morbidities. The role of psychiatry-dermatology liaison clinic may benefit these patients.
Comparison of novel aluminium lactate versus aluminium chloride-based antiperspirant in excessive axillary perspiration: First prospective cohort study
Syrus Karsai, Christel Wei?, Constantin Lütgerath, Isabel Ott, J?rg Faulhaber
doi : 10.1111/dth.15020
Dermatologic TherapyVolume 34, Issue 4 e15020
Aluminium chloride-based antiperspirants are an effective topical therapeutic option for mild to moderate states of excessive perspiration. Its use is primarily limited by the occurrence of skin irritation, especially in sensitive skin types. The objective of this study was to compare the antiperspirant efficacy and tolerability of a novel antiperspirant with 12.5% aluminium lactate, and a 12.5% aluminium chloride-based antiperspirant. This cohort study was conducted as a two-sided self-assessment comparison between both preparations in healthy volunteers to generate selfcare-related data. Almost half of the participants stated that aluminium chloride was more efficacious than aluminium lactate; 22% stated aluminium lactate was more efficacious than aluminium chloride; 28% observed no difference in the efficacy of both preparations (p = 0.04). However, 88% described greater tolerability with aluminium lactate (p?<?0.0001). In this study, aluminium lactate showed significantly greater tolerability than aluminium chloride, although the latter tended to show slightly greater efficacy.
Teledermatology during the COVID-19 pandemic: Experience at a tertiary care centre in North India
Sanjeev Handa, Hitaishi Mehta, Anuradha Bishnoi, Keshavamurthy Vinay, Rahul Mahajan, Tarun Narang, Muthu Sendhil Kumaran, Dipankar De, Sunil Dogra, Davinder Parsad
doi : 10.1111/dth.15022
Dermatologic TherapyVolume 34, Issue 4 e15022
BACKGROUND:Teledermatology has evolved as a valuable option to outpatient visits during the current pandemic. We set up a smartphone-based hybrid model of teledermatology services providing direct care to patients at our center. To analyse patient and physician-experience and acceptability for teledermatology over a 6-month-period, along with clinicodemographic profile of patients.
The multi-target mechanism of Cyclosporin A in the treatment of vitiligo based on network pharmacology
Haojie Lu, Jinhui Xu, Bo Xie, Yebei Hu, Haixin Luo, Yi Chen, Xiuzu Song
doi : 10.1111/dth.15023
Dermatologic TherapyVolume 34, Issue 4 e15023
Network pharmacology is an emerging discipline that designs drugs based on systems biology theory and biological system network analysis. Here, we applied network pharmacology to analyze the multi-target mechanism of Cyclosporin A in the treatment of vitiligo First, we predicted the targets of Cyclosporin A. Second, we obtained the genes related to vitiligo from the database. Third, we constructed the PPI network of the mutual genes between Cyclosporin A and vitiligo and used gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) to analyze. Finally, we verified the prediction of potential targets through a docking study with Cyclosporin A. We found that there were 15 shared target genes between Cyclosporin A and vitiligo. We analyzed these 15 genes by Cytoscape and obtained a network diagram of 885 nodes. Through screening and molecular docking, PRKDC, CUL7, CUL1, HSPA8, HSPA4, and SIRT7 were the most likely multi-target mechanism of Cyclosporin A in the treatment of vitiligo. In our study, Cyclosporin A might not only affect the repair of DNA strands by targeting PRKDC, but also affected the innate and adaptive immune function of vitiligo patients by the targets of CUL1, CUL7, and HSP70. In addition, Cyclosporin A might promote the repigmentation of vitiligo by adjusting the expression of SIRT7.
Microdermabrasion assisted delivery of glycolic acid 70% peel for the treatment of melasma in dark-skinned patients
Amira A. Abdel-Motaleb, Radwa M. Bakr
doi : 10.1111/dth.15025
Dermatologic TherapyVolume 34, Issue 4 e15025
Melasma is a disfiguring dermatologic condition and its treatment is still considered a challenge. To evaluate the efficacy and safety of microdermabrasion (MDA) combined with glycolic acid 70% (GA70%) peel versus GA70% alone in treating melasma in dark-skinned patients. This study included 30 female patients (skin type IV and V) with melasma. After cleansing the face, 3 passes of MDA were done on one side of the face. Then, GA70% was applied to the whole face in 1–2 uniform passes. Melasma area and severity index (MASI), modified MASI and hemi-MASI scores were used to assess the outcome. A significant decline of the mean MASI, mMASI and both hemi-MASI scores following treatment (p value = 0.000 for each). Furthermore, the hemi-MASI score on the MDA/GA70% treated side showed significantly greater decrease than the hemi-MASI score on GA70% treated side (p value = 0.041). MDA enhanced the improvement of GA70% peel effectively and safely.
Long-term efficacy and safety of ustekinumab for moderate-to-severe psoriasis: A 9-year real-life experience from a tertiary referral center in Turkey
Goncagül Babuna Kobaner, Algün Polat Ekinci, Arma?an Kutlay
doi : 10.1111/dth.15042
Dermatologic TherapyVolume 34, Issue 4 e15042
There is a paucity of data on long-term (?5-year) outcomes of ustekinumab therapy for psoriasis in real-life clinical practice. This observational, retrospective study aimed to evaluate the long-term efficacy and safety profile of ustekinumab in 52 adult patients with moderate-to-severe chronic plaque psoriasis who were treated with ustekinumab for at least 28?weeks and a maximum of 105?months in our tertiary referral center in Turkey, between 2010 and 2019. Response to therapy was assessed using Psoriasis Area and Severity Index (PASI). Logistic regression analysis was performed to determine significant associations (p-value <0.05) with response to treatment. The PASI50, PASI75, PASI90, and PASI100 response rates were 97.8%, 88.9%, 53.3%, and 35.5%, respectively, at year 1 and 100%, 80.0%, 60.0%, and 40.0%, respectively, at year 5. Non-obesity was independently associated with PASI90 response at year 2 (p = 0.043), while biologic-naivety was independently associated with PASI90 responses at year 2 (p = 0.047) and year 3 (p = 0.021). An absolute PASI score of ?3 was achieved by 82.2% and 80.0% of the patients at year 1 and year 5, respectively. Nine patients received adjuvant therapy and nine underwent ustekinumab dose escalation. These strategies were effective for recapturing clinical response in most patients. Ustekinumab was generally well-tolerated with no dose-related and cumulative toxicity, or drug interaction over a mean of 33.5?±?21.1 months. The main reasons for discontinuation were secondary failure and loss to follow-up. Our 9-year real-life clinical experience demonstrates that ustekinumab is an efficacious and safe treatment option for long-term therapy of moderate-to-severe plaque psoriasis.
Association between surgical excision margins and outcomes in patients with dermatofibrosarcoma protuberans: A meta-analysis
Yiyin Chen, Guan Jiang
doi : 10.1111/dth.14954
Dermatologic TherapyVolume 34, Issue 4 e14954
Dermatofibrosarcoma protuberans (DFSP) is a tumor with low-grade malignancy and high recurrence rates. Wide local excision (WLE) is essential for DFSP, but its surgical excision margin is controversial. This study aimed to examine whether resection margin is associated with the prognosis of patients with DFSP by systematically reviewing related literature. Studies that evaluated the relationship between excision margins and outcomes after WLE were retrieved from the Cochrane Library, PubMed, Embase, and Web of Science databases. Relative risk (RR) estimates and 95% confidence intervals (CIs) were measured via a random-effect model to evaluate the subsequent outcomes: recurrence rate, mortality, and positive surgical margin rate. Sensitivity and subgroup analyses were simultaneously carried out. The meta-analysis of eight observational literatures demonstrated a significant positive correlation of ?3 cm margin with the recurrence rate (RR = 0.17, 95% CI 0.09-0.31) and the positive surgical margin rate (RR = 0.09, 95% CI 0.02-0.46). The same result was observed in the recurrence rate in all subgroups. The stability of the above outcomes was authenticated via sensitivity analyses. Our meta-analysis illustrated that excision with <3 cm surgical margin exhibited an increased risk of poor DFSP prognosis (high recurrence rate and increasing positive margin rate).
Comparison of guidelines for the use of Ustekinumab for psoriasis in the United States, Europe, and the United Kingdom: A critical appraisal and comprehensive review
Vipawee S. Chat, Shelley K. Uppal, Donovan G. Kearns, Jashin J. Wu
doi : 10.1111/dth.14974
Dermatologic TherapyVolume 34, Issue 4 e14974
The aim of this review is to compare and contrast evidence-based clinical practice guidelines from global dermatological organizations for the use of ustekinumab in psoriasis. Clinical practice guidelines from the American Academy of Dermatology, National Psoriasis Foundation, British Association of Dermatologists, and European S3 were reviewed and compared. Practice guidelines from the three dermatological organizations are similar with regards to treatment dosage and initiation but differ in their recommendations for baseline screening and interval laboratory monitoring, treatment in patients undergoing surgery or receiving live vaccines, and treatment contraindications. Ustekinumab is an effective and well-tolerated systemic treatment for patients with psoriasis and should be considered in the line of therapy that dermatologists discuss with their patients. Consideration should be given to evidence-based practice guidelines of global dermatology organizations to effectively guide treatment decisions in patients with psoriasis.
The effects of infliximab in treating idiopathic inflammatory myopathies: A review article
Yongpeng Ge, Sizhao Li, Fang Chen, Linrong He, Chunjia Li, Xin Lu, Guochun Wang
doi : 10.1111/dth.14976
Dermatologic TherapyVolume 34, Issue 4 e14976
Anti-TNF treatment may be useful for patients with idiopathic inflammatory myopathies (IIMs). The purpose of this study is to assess the efficacy of infliximab (IFX) in the management of IIMs. Two databases (ie, PubMed and China National Knowledge Infrastructure) were searched up to Nov 2020 for studies investigating skin lesions and muscular weakness in patients with IIMs treated with IFX. A total of 18 studies were included. One hundred and eighteen patients were identified, including 58 adult patients and 60 patients with juvenile dermatomyositis (JDM) treated with IFX. Among these patients, 110 (93%) patients with refractory cases. In addition to glucocorticoids, patients from 15/18 studies received immunosuppressant agents (ISAs) concomitantly with IFX, among which methotrexate (MTX) was most common. After treatment with IFX, skin lesions and muscle strength were improved in 67% of patients with DM and 75% of patients with JDM, respectively. Skin calcinosis was improved in 21/34 (62%) of patients with JDM. Only 55% (12/22) of patients with polymyositis exhibited improvements in muscle strength. Lastly, 40% (42/104) of patients reported adverse events. Current evidence appears to support the use of IFX in some patients with refractory IIMs, especially those with JDM. The most common adverse reaction was infection. Large, randomized-controlled studies should be carried out to confirm these findings.
Tetracyclines and photosensitive skin reactions: A narrative review
Giulia Odorici, Giuseppe Monfrecola, Vincenzo Bettoli
doi : 10.1111/dth.14978
Dermatologic TherapyVolume 34, Issue 4 e14978
Tetracyclines are a group of broad-spectrum antibiotics largely employed in infectious, dermatological and surgical fields. Some adverse events may occur during treatment, including photosensitivity reactions, which are divided in phototoxic or photoallergic. We performed a systematic search on Pubmed, Cochrane and Embase from database inception to August 9, 2020 aim to summarize all available papers on photosensitive reactions related to tetracyclines in all clinical settings where they are used on human being. On the basis of our inclusion criteria, we selected only randomized controlled trials, open comparative trials and prospective cohort studies performed on both volunteers and patients, moreover we included a pharmacovigilance register. Thirty-eight articles met inclusion criteria, describing photo-sensitive effects due to doxycycline, minocycline, tetracycline, lymecycline, sarecycline, demethylchlortetracycline, chlortetracycline and metacycline, across six diagnoses (acne, Lyme disease, Gulf Veteran Illness, adbominal aortic aneurysms, traveler's diarrhea and pterygium) and several volunteers who were deliberately exposed to natural or artificial light sources. Not all drugs belonging to tetracyclines class are available to date, moreover the studies included lacked a homogeneous design and most of them involved a scarce number of patients, including reactions induced in volunteers during photo-testing. Available data on incidence, severity and clinical relevance of tetracyclines-related photo-sensitive reactions are scarce, heterogeneous and weak. What we can extrapolate is that some tetracyclines are more often related to phototoxic skin reactions than others and some of those seem to have a very low risk of phototoxicity.
Recognition and treatment of devastating vasculopathic systemic disorders: Coronavirus disease 2019 and rickettsioses
Anugya Mittal, Marcus L. Elias, Robert A. Schwartz, Rajendra Kapila
doi : 10.1111/dth.14984
Dermatologic TherapyVolume 34, Issue 4 e14984
Cutaneous involvement can be an important sign of both COVID-19 and rickettsioses. Rickettsial infections may be first evident as an exanthem with eschars as a key finding. In contrast, eschars and necrotic lesions can be seen in critically ill COVID-19 patients. Both illnesses share a similar mechanism of infecting endothelial cells resulting in vasculopathy. Rickettsia parkeri and Rickettsia 364D are both characterized by eschars unlike Rickettsia rickettsii. Other eschar causing rickettsioses such as Rickettsia conorii, Rickettsia africae, and Orientia tsutsugamushi are commonly diagnosed in people from or having traveled through endemic areas. While there is no consensus on treatment for COVID-19, rickettsioses are treatable. Due to possibly serious consequences of delayed treatment, doxycycline should be administered given an eschar-presenting patient's travel history and sufficient suspicion of vector exposure. The proliferation of COVID-19 cases has rendered it critical to differentiate between the two, both of which may have overlapping vasculopathic cutaneous findings. We review these diseases, emphasizing the importance of cutaneous involvement, while also discussing possible therapeutic interventions.
The use of human acellular dermal matrices in advanced wound healing and surgical procedures: State of the art
Linda Tognetti, Elisa Pianigiani, Francesca Ierardi, Guido Lorenzini, Donato Casella, Flavio Giulio Liso, Andrea De Pascalis, Elisa Cinotti, Pietro Rubegni
doi : 10.1111/dth.14987
Dermatologic TherapyVolume 34, Issue 4 e14987
Wound closure after post-traumatic injuries and/or localized at peculiar body sites (head-and-neck, oral cavity, legs) are particularly challenging and can often be delayed due to local and systemic factors. In case of deep wounds and/or hard-to-heal wounds, grafting of dermal acellular matrices (ADM) is often needed. Though a great variety of synthetic and semisynthetic dermal and skin equivalents are available, viable human dermis, is still considered the most physiological alternative to replace the loss of autologous dermis, by acting as a physiological scaffold that add structural support to soft tissues. To date, human ADMs (hADMs) have been employed in the reconstruction of skin defects affecting almost all body sites, ranging from visceral sites to the skin and subcutaneous tissues. This review aims to investigate the use of hADM at different body sites and their peculiar advantages. A literature search was using the search terms “acellular dermal matrices”, “dermal regeneration”, “advances wound healing”, “human acellular dermal matrices surgery”. A total of 50 out of 150 papers was included. Based on the current body if evidence, hADMs appear to bring several advantages, such as: protection of deep structures (eg, tendons, bones, cartilage and nerves); stimulation of a functional new dermis (rather than a scar); reduction of wound closure time; control of pain and exudate. Finally, hADMs may represent the best treatment option for hard-to-heal wound not only in terms of efficacy and patient satisfaction bout also in terms of sanitary costs, especially across Europe, where hADMs cannot be commercialized as medical devices.
Does tocilizumab have a role in dermatology? A review of clinical applications, its adverse side effects and practical considerations
Dean Jeremy Choong, Ernest Tan
doi : 10.1111/dth.14990
Dermatologic TherapyVolume 34, Issue 4 e14990
Tocilizumab is a humanized monoclonal antibody to the interleukin-6 (IL-6) receptor which was first approved for use in refractory rheumatoid arthritis almost a decade ago. Since then, its use has expanded to a number of rheumatological and inflammatory conditions. In dermatology, off-label use of tocilizumab has been reported to be efficacious in morphoea, systemic sclerosis, psoriasis, atopic dermatitis, vitiligo, graft-versus-host disease, pyoderma gangrenosum, Behcet's disease, Schnitzler's syndrome, sarcoidosis, and cutaneous adverse reactions. That being said, the evidence demonstrating tocilizumab's efficacy in dermatology is predominantly low-level case-based evidence, and one must consider the potential for publication bias. In this review we will discuss the reported clinical applications of tocilizumab in dermatology, mechanisms of action, and the range of associated adverse effects (both cutaneous and non-cutaneous) that can occur. Additionally, we will discuss the role of tocilizumab in the management of COVID-19.
Androgenetic alopecia and COVID-19: A review of the hypothetical role of androgens
Hamideh Moravvej, Mohammad Reza Pourani, Moein Baghani, Fahimeh Abdollahimajd
doi : 10.1111/dth.15004
Dermatologic TherapyVolume 34, Issue 4 e15004
The coronavirus disease 2019 (COVID-19) has become the most emerging health issue globally. A prompt investigation regarding disease management and treatment is crucial for decreasing the burden of the disease. Many explorations and hypotheses have been posed, but the definite treatment has not been determined for COVID-19. Recent studies described a substantial prevalence of COVID-19 and also a higher rate of morbidity and mortality in men afflicted with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The gender-related discordance in COVID-19 infection may be due to hormonal differences, socioeconomic factors, genetic susceptibility, gender-related comorbidities, and habits like alcohol consumption. On the other hand, several studies proposed that androgens could improve the immune system and have a protective role in COVID-19, and decreased levels of androgens might be associated with unsatisfactory outcomes. In the field of dermatology, androgenetic alopecia (AGA) is correlated with a hyperandrogenic state and may be related to COVID-19 severity. Furthermore, recent research has assessed the plausible association of AGA and COVID-19. In this review, we investigate all evidence on AGA and its relationship with COVID-19, including the possible role of androgens in COVID-19 severity and outcomes as well as candidate androgen-related drugs for the treatment of COVID-19.
Topical beta-blockers in dermatologic therapy
Angela Filoni, Francesca Ambrogio, Aurora De Marco, Alessia Pacifico, Domenico Bonamonte
doi : 10.1111/dth.15016
Dermatologic TherapyVolume 34, Issue 4 e15016
An increasing use of beta-blockers in dermatology has been described over the last 10?years, despite the fact that their use in diseases other than infantile hemangiomas is off-label. This review discusses the emerging role of topical beta-blockers in the treatment of infantile hemangioma, but also pyogenic granuloma, Kaposi sarcoma, wounds and nail paronychia. Data in literature demonstrate that topical beta-blockers are a safe and valid therapeutic option in numerous cutaneous diseases. Side effects are mainly restricted to the application site. Further studies and randomized trials may contribute to reinforce the role of topical beta-blockers in the dermatological armamentarium.
The utility of dermal fibroblasts in treatment of skin disorders: A paradigm of recessive dystrophic epidermolysis bullosa
Forough Shams, Azam Rahimpour, Hassan Vahidnezhad, Simzar Hosseinzadeh, Hamideh Moravvej, Bahram Kazemi, Masoumeh Rajabibazl, Fahimeh Abdollahimajd, Jouni Uitto
doi : 10.1111/dth.15028
Dermatologic TherapyVolume 34, Issue 4 e15028
Dermal fibroblasts are the most accessible cells in the skin that have gained significant attention in cell therapy. Applying dermal fibroblasts' regenerative capacity can introduce new patterns to develop cell-based therapies to treat skin disorders. Dermal fibroblasts originate from mesenchymal cells and are located within the dermis. These cells are mainly responsible for synthesizing glycosaminoglycans, collagens, and components of extracellular matrix supporting skin's structural integrity. Preclinical studies suggested that allogeneic and autologous dermal fibroblasts provide widespread and beneficial applications for wound healing, burn ulcers, and inherited skin disorders. In this regard, generating induced pluripotent stem cells (iPSCs) from fibroblasts and gene-edited fibroblasts are promising approaches for treating skin disorders. Here, we aimed to review literature about ongoing and completed clinical trials that applied fibroblasts and bioengineered fibroblasts as therapeutic agents for various skin disorders. This review explores cell therapy protocols from the earliest phase of allogeneic and autologous fibroblasts development in different benches to translating them into bedside-level treatment for skin disorders, particularly recessive dystrophic epidermolysis bullosa.
“Azole menace”-An underappreciated trigger perpetuating the epidemic of antifungal therapeutic failure in cutaneous mycoses
Sidharth Sonthalia, Amarendra Pandey, Ruchika Mehndiratta, Mahima Agrawal, Shukla Das, Shrishti Shreshtha
doi : 10.1111/dth.14959
Dermatologic TherapyVolume 34, Issue 4 e14959
The South-Asian epidemic of anti-fungal therapeutic failures (AFTF) is on the rise. Although many demographic, environmental, and socioeconomic factors have been implicated in the genesis of this problem, two pharmacological issues warrant attention. While detailed discussions on the role of topical corticosteroid (TCS) in the changing landscape of the superficial mycotic infections in this region have been making headlines, another equally, rather more important pharmacological factor seems to have been undermined by the hype around TCS. The fastidious pharmacokinetic properties and related practical aspects of the triazole group of oral and topical antifungals, especially oral itraconazole seem to contribute significantly to the persistence of AFTF epidemic. In this paper, we shall discuss the broad aspects of the spectral precariousness of oral triazole antifungals with special emphasis to itraconazole, a concept known as the “azole menace” in the overall pathogenesis and tenacity of the AFTF epidemic.
Ixekizumab improves disease severity, clinical symptoms and quality of life in patients with genital psoriasis: A 24-week real-life experience
Gianluca Calianno, Maria Esposito, Rosaria Fidanza, Maria Palmieri, Maria Concetta Fargnoli
doi : 10.1111/dth.14993
Dermatologic TherapyVolume 34, Issue 4 e14993
Genital psoriasis (GenPs) has been traditionally considered a difficult to treat psoriasis area. Ixekizumab was the first biologic agent demonstrating efficacy and safety in a formal clinical trial on GenPs; however, real-life experiences are limited. To assess real-life effectiveness and safety of ixekizumab in the treatment of GenPs in a case series of patients with moderate-to-severe plaque psoriasis. Adult patients with moderate-to-severe plaque psoriasis involving the genital area received subcutaneous ixekizumab. Evaluation of disease severity, clinical symptoms, and quality of life was performed at baseline, after 4, 16, and 24?weeks of treatment. Assessment tools were: Static Physician's Global Assessment of Genitalia (sPGA-G), Psoriasis Area and Severity Index (PASI) score, Itch Numerical-Rating-Score (Itch-NRS), and Dermatology-Life-Quality-Index (DLQI). Adverse events were recorded. A total of 14 patients were treated with ixekizumab achieving consistent and significant reduction of disease and quality of life parameters, with a mean percentage reduction from baseline to week 24 of 91.4% for sPGA-G, 95.2% for PASI, 95.6% for Itch-NRS, and 93.7% for DLQI. Ixekizumab treatment was well tolerated. Ixekizumab significantly improved disease severity, itch, and quality of life with an acceptable safety profile in a real-life setting in adult patients affected by GenPs.
Basal cell carcinoma of the eyelid margin: Dermoscopic clues in a case series
Sabina Vaccari, Alessia Barisani, Costantino Schiavi, Carlotta Baraldi, Francesca Pepe, Matilde Roda, Annalisa Patrizi, Giulio Tosti
doi : 10.1111/dth.15006
Dermatologic TherapyVolume 34, Issue 4 e15006
Basal cell carcinoma (BCC) can sometimes affect the eyelids and in particular the eyelid margin, where it can often be misdiagnosed, mimicking other benign, more common diseases. Dermoscopy may provide additional diagnostic criteria for an earlier diagnosis of eyelid margin BCC, although the dermoscopic features of BCC affecting this anatomical site have seldom been reported. We highlight the peculiar presence of linear vessels perpendicular to the eyelid margin in BCCs of the eyelid margin. Our article represents the first report of these dermoscopic findings in a series of BCCs of the eyelid margin.
Study of autologous platelet-rich-plasma versus its combination with intense pulsed light in treatment of melasma
Shereen Adel, Amal Serri, Talal Abd El-Raheem
doi : 10.1111/dth.15008
Dermatologic TherapyVolume 34, Issue 4 e15008
Melasma is a common acquired hypermelanosis of variably successful therapies with frequent relapse. Platelet-rich-plasma (PRP) is a promising treatment in melasma, alone or combined with other treatments. We evaluated efficacy of autologous PRP in melasma treatment and the effect of combined intense pulsed light (IPL). Study included 20 Egyptian female melasma patients. PRP was injected in all melasma area and IPL was used on the right hemi-face. Melasma Area and Scoring Index (MASI) of melasma area, modified-MASI (mMASI) of PRP-IPL side and of PRP side significantly decreased after treatments (p-value?<?0.05). There was no statistically significant difference between both sides regarding mMASI score or patient and physician satisfaction (p-value?>?0.05). Our study provides the first comparison between PRP versus its combination with IPL in melasma treatment. We think the improvement of melasma with regression of melasma scores after PRP treatment is an important finding.
A case of orofacial granulomatosis evolving into Melkersson Rosenthal syndrome in a child treated with a steroid free regimen of Clofazimine and Minocycline
Soumya Sachdeva, Alok Raina, Kabir Sardana, Purnima Malhotra
doi : 10.1111/dth.15009
Dermatologic TherapyVolume 34, Issue 4 e15009
Orofacial granulomatosis (OFG) is a rare disorder with varied etiological, immunological and infectious mechanisms implicated and is believed to be a umbrella term which includes Melkersson Rosethal syndrome (MRS). We describe a 17?year old female who was diagnosed with OFG and was successfully treated with a combination of minocycline and clofazimine without oral steroids with significant improvement within 1 month of therapy.
A case of tripterygium glycosides-associated AGEP-like drug reaction combined with bullous pemphigoid
Ziwen Sun, Jianfeng Zheng, Ning Yu, Jia Chen, Yangfeng Ding, Na Liu
doi : 10.1111/dth.15012
Dermatologic TherapyVolume 34, Issue 4 e15012
Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous drug reaction. Bullous pemphigoid (BP) is an acquired autoimmune disease that might be associated with drugs. There is currently no report of tripterygium glycosides (TG)-induced AGEP-like lesions combined with BP. A 66-year-old male with a 20-year history of psoriasis was prescribed oral TG at 1 mg/kg, three times a day, due to aggravated psoriasis. Seven days later, erythemas, and blisters appeared. After another 3?days, there were two types of blisters: (1) numerous small tension blisters with a lot of neutrophils on the top similar to AGEP combined with BP; (2) a BP. After intravenous injection of methylprednisolone and gamma globulin, the lesions were controlled. This patient developed two types of lesions, including one similar to AGEP combined BP (AGEP-like) and a BP. It is a rare drug reaction induced by TG.
The invincible Professor Rajendra Kapila (1939–2021): A life to emulate
Prof. Robert A. Schwartz
doi : 10.1111/dth.15039
Dermatologic TherapyVolume 34, Issue 4 e15039
Safety and efficacy of parenteral glutathione as a promising skin lightening agent: A controlled assessor blinded pharmacohistologic and ultrastructural study in an animal model
doi : 10.1111/dth.15027
Dermatologic TherapyVolume 34, Issue 4 e15026
CORRIGENDUM to “Therapeutic potential of medicinal plants for the management of scabies”
doi : 10.1111/dth.15027
Dermatologic TherapyVolume 34, Issue 4 e15027
Retraction statement: Role of resolvin D1 in psoriasis before and after narrowband ultraviolet B phototherapy: A case–control study
doi : 10.1111/dth.15038
Dermatologic TherapyVolume 34, Issue 4 e15038
