Oral mucosal lesions in psoriatic patients based on disease severity and treatment approach

BACKGROUND

This observational case-control study was designed to investigate the frequency of oral lesions in psoriatic patients and to identify an association between mucosal involvement, the severity of the disease, and a form of treatment.

METHODS

One hundred twenty-seven patients diagnosed with psoriasis were enrolled in this study from November 2018 to September 2019. The oral mucosa evaluation was based on the clinical appearance, location, and morphology of the lesions. All patients completed a general medical history and a Dermatology Life Quality Index (DLQI) questionnaire. The severity of skin involvement was assessed using the Psoriasis Area and Severity Index (PASI) scale.

RESULTS

The most common oral lesions in patients with psoriasis were found to be fissured (FT), white coated (CT), and geographic tongue (GT). A significantly lower prevalence of GT was evident in the group managed with a new class of biological drugs and smokers. There appeared to be no association between the oral manifestation and the PASI score. FT appeared significantly more often in patients that experienced an extremely large effect of psoriasis on their quality of life as determined by the DLQI questionnaire and smokers. Only 25% of patients presented normal oral mucosa.

CONCLUSIONS

Tongue lesions seem to be associated with skin psoriasis regardless of the treatment. The severity of the disease, according to the PASI scale, does not influence mucosal involvement. The type of treatment may affect the prevalence of oral lesions. Further investigations are required to confirm the influence of biological therapies on mucosal improvement.

Deciphering the Association Between Psoriasis and Obesity: Current Evidence and Treatment Considerations

PURPOSE OF REVIEW

Obesity and psoriasis represent chronic inflammatory states that are interconnected in a vicious cycle, sharing also a degree of synergy. In this review, we aim to decipher the various lines of evidence supporting the bidirectional association between psoriasis and obesity highlighting their pathophysiologic connections as well as we attempt to strategize a therapeutic holistic approach for obese psoriatic patients.

RECENT FINDINGS

Recent meta-analyses have shown that (1) genetically higher BMI increased the odds of psoriasis occurrence; (2) obesity is associated with higher incidence and prevalence of psoriasis as well as psoriasis severity; (3) obesity is associated with lower efficacy to anti-TNF agents and may predict biologic treatment discontinuation; and (4) weight loss through diet and physical exercise may improve pre-existing psoriasis and prevent from de novo psoriasis. Methotrexate, acitretin, and cyclosporine could worsen hypertension, liver steatosis, and dyslipidemia. Since infliximab and ustekinumab are weight adjusted, they may be ideal drugs to treat obese psoriatic patients. IL-17 inhibitors are very effective independently from body weight; however, they tend to present better clearance rates in normal weight patients. There is a paucity on weight data regarding the efficacious IL-23 inhibitors. Apremilast may induce weight loss as an adverse effect presenting also some beneficial metabolic actions. Finally, simvastatin and some antidiabetic drugs could decrease psoriasis severity. More mechanistic, observational studies and well-conducted RCTs are necessary to decipher the enigmatic link between psoriasis and obesity, and to provide evidence-based specific guidelines for the screening and management of obese psoriatic patients.

A New 675 nm Laser Device in the Treatment of Melasma: Results of a Prospective Observational Study

Objective: This study evaluates the efficacy and safety of a new 675 nm laser source system on melasma. Background: Melasma is an acquired circumscribed hyperpigmented disorder that has a negative impact on patients' life quality. Different treatments are currently available. This study evaluates this new 675 nm laser source system, on melasma with the use of established parameters that guarantee minimum pain, the absence of side effects, and simplifying posttreatment management. Materials and methods: A total of 25 subjects (all women, 21-50 years old), with facial melasma and Fitzpatrick skin types I-III, were treated with three sessions of a new 675 nm laser system. Efficacy of treatment was evaluated using Melasma Severity Index (MSI) score before and 3 months after the last session. The appearance of side effects has also been monitored to evaluate safety. A preclinical study was executed to evaluate laser effectiveness on sheep skin. Results: All 25 subjects treated with the 675 nm laser had significant improvement in melasma according to MSI score (mean baseline MSI 26.4 ± 19.2; mean 3-month follow-up MSI 17.3 ± 15, p: 0.003). Histology in preclinical study showed selective damage of melanin-rich areas. No side effects have been observed except some minor erythematous reactions in two patients. Conclusions: Due to its high affinity with melanin, and its minimal interaction with the vascular component, novel 675 nm laser may be considered promising when treating benign pigmented lesions with a low risk of side effects and simple posttreatment management.

Phase I/Ib Study of Tenalisib (RP6530), a Dual PI3K δ/γ Inhibitor in Patients with Relapsed/Refractory T-Cell Lymphoma

Tenalisib (RP6530), a dual phosphoinositide 3-kinase δ/γ inhibitor was evaluated in a phase I/Ib study for maximum tolerated dose (MTD), pharmacokinetics, and efficacy in patients with relapsed/refractory peripheral and cutaneous T-Cell Lymphoma (TCL). Histologically confirmed (TCL) patients, with ≥1 prior therapy received Tenalisib orally in a 28-day cycle in doses of 200 to 800 mg twice daily (800 mg in fasting and fed state) in escalation phase (n = 19) and 800 mg twice daily (fasting) in expansion phase (n = 39). The most frequently reported treatment emergent adverse events (TEAE) and related TEAE were fatigue (45%) and transaminase elevations (33%), respectively. Most frequently reported related Grade ≥3 TEAE was transaminase elevation (21%). Two dose-limiting toxicities occurred in the 800 mg fed cohort; hence, 800 mg fasting dose was deemed MTD. Tenalisib was absorbed rapidly with a median half-life of 2.28 h. Overall response rate in 35 evaluable patients was 45.7% (3 complete response (CR); 13 partial response (PR)) and median duration of response was 4.9 months. Responding tumors showed a marked downregulation of CD30, IL-31 and IL-32α. With an acceptable safety and promising clinical activity, Tenalisib can be a potential therapeutic option for relapsed/refractory TCL. Currently, a phase I/II combination study with romidepsin is ongoing.

Role of Endoscopic Vacuum Therapy as a Treatment for Anastomosis Leak after Esophageal Cancer Surgery

Esophageal anastomotic leak is the most common and serious complication following esophagectomy. However, the standard treatment for anastomotic leaks remains unclear. Recently, endoscopic vacuum therapy has become an important non-surgical alternative treatment method for patients with esophageal anastomotic leak. This treatment involves the endoscopic placement of a sponge connected to a nasogastric tube into the defect cavity or lumen. Subsequently, continuous negative pressure is delivered to the cavity through the tube. Several studies have reported a treatment success rate of 80% to 100%. In this study, we review the mechanism of action, the method of performing the procedure, its safety and efficacy, and prognostic factors for failure of endoscopic vacuum therapy in the management of patients with anastomotic leak, and on this basis attempted to confirm the possibility of establishing a standardized treatment protocol using endoscopic vacuum therapy.

Metabolic Syndrome, Clusterin and Elafin in Patients with Psoriasis Vulgaris

Background: Psoriasis is a pathological condition characterized by immune system dysfunction and inflammation. Patients with psoriasis are more likely to develop a wide range of disorders associated with inflammation. Serum levels of various substances and their combinations have been associated with the presence of the disease (psoriasis) and have shown the potential to reflect its activity. The aim of the present study is to contribute to the elucidation of pathophysiological links between psoriasis, its pro-inflammatory comorbidity metabolic syndrome (MetS), and the expression of clusterin and elafin, which are reflected in the pathophysiological “portfolio” of both diseases. Material and methods: Clinical examinations (PASI score), ELISA (clusterin, elafin), and biochemical analyses (parameters of MetS) were performed. Results: We found that patients with psoriasis were more often afflicted by MetS, compared to the healthy controls. Clusterin and elafin levels were higher in the patients than in the controls but did not correlate to the severity of psoriasis. Conclusion: Our data suggest that patients with psoriasis are more susceptible to developing other systemic inflammatory diseases, such as MetS. The levels of clusterin and elafin, which are tightly linked to inflammation, were significantly increased in the patients, compared to the controls, but the presence of MetS in patients did not further increase these levels.

Near-infrared heating of skin to delineate non-melanoma skin cancer lesions: A pilot study

BACKGROUND

Surgical excision is a mainstay of treatment for non-melanoma skin cancer (NMSC); improving margin delineation can reduce the need for further monitoring/treatment. The objective of this pilot study was to determine if near-infrared radiation (NIR) application to skin causes visible changes in normal and NMSC skin, to help delineate margins.

MATERIALS/METHODS

Eleven biopsy-proven NMSC lesions were included. The skin was then heated under a 175W NIR heating bulb; margins were traced onto acetate film before and after heating. Lesions were then randomly assigned to excision based on pre- or post-heating margins. Composite images were generated by overlaying the heat and no-heat lesion contours. All specimens were sent for histopathology.

RESULTS

The range of closest margins in the control group was 2.0-3.0 mm with a median of 2.0 mm; the range in the intervention group was 4.0-9.0 mm with a median of 5.0 mm. Composite images showed larger heat contours when the initial lesion was larger. There was a statistically significant difference between the two groups. Overall, NIR light caused visible hyperaemia to skin, and more intense erythema to malignant skin lesions.

CONCLUSION

Near-infrared light may have use in an outpatient setting for skin cancer delineation, possibly reducing the rate of positive margins.

Gut-organ axis: a microbial outreach and networking

Human gut microbiota (GM) includes a complex and dynamic population of microorganisms that are crucial for well-being and survival of the organism. It has been reported as diverse and relatively stable with shared core microbiota, including Bacteroidetes and Firmicutes as the major dominants. They are the key regulators of body homeostasis, involving both intestinal and extra-intestinal effects by influencing many physiological functions such as metabolism, maintenance of barrier homeostasis, inflammation and hematopoiesis. Any alteration in GM community structures not only trigger gut disorders but also influence other organs and cause associated diseases. In recent past, the GM has been defined as a 'vital organ' with its involvement with other organs; thus, establishing a link or a bi- or multidirectional communication axis between the organs via neural, endocrine, immune, humoral and metabolic pathways. Alterations in GM have been linked to several diseases known to humans; although the exact interaction mechanism between the gut and the organs is yet to be defined. In this review, the bidirectional relationship between the gut and the vital human organs was envisaged and discussed under several headings. Furthermore, several disease symptoms were also revisited to redefine the communication network between the gut microbes and the associated organs.

Nicolau Syndrome, Masquerader of Postinjection Sciatic Nerve Injury: Case Report and Review of Literature

BACKGROUND

Sciatic nerve injury after inadvertent intramuscular gluteal injection is a well-described entity. We have presented a case of a rare and probably underdiagnosed pathological entity, Nicolau syndrome, which can be confused with injection palsy.

CASE DESCRIPTION

We report the case of a 13-year-old boy who had presented with foot drop and urinary and fecal incontinence after an intramuscular injection of benzathine penicillin in the left gluteal region. On examination, the patient had multiple ecchymoses over the left gluteal region and back of the thigh, mild swelling of the left lower limb, and left foot drop. Meticulous examination also revealed a subtle weakness of the opposite limb. Nerve conduction studies revealed axonopathy involving multiple bilateral lower limb nerves. These unusual neurological-dermatological signs and electrophysiological findings raised the concern for an alternative pathology, which was later diagnosed as Nicolau syndrome. The patient experienced clinical and electrophysiological recovery after a course of oral steroids and physiotherapy during the next few months.

CONCLUSIONS

Before diagnosing injection sciatic nerve injury, the possibility of medically treatable Nicolau syndrome should be considered. Neurosurgeons' familiarity with this pathology and a timely diagnosis is essential to plan appropriate treatment strategies.

Treatment of hard-to-heal leg ulcers with hyaluronic acid, sodium alginate and negative pressure wound therapy

OBJECTIVE

Hard-to-heal lower extremity ulcer is a common healthcare problem and can lead to a poor quality of life (QoL). Despite the advances in wound care, conventional therapies, such as necrotic tissue debridement, cleansing, treatment of infection and local treatment with dressing application are still considered the standard of care in patients with hard-to-heal leg ulcers. However, managing hard-to-heal ulcers that do not respond well to these methods has led to new treatment strategies. In this study, the effects of hyaluronic acid (HA) and sodium alginate (SA), combined with negative pressure wound therapy (NPWT), in patients with hard-to-heal leg ulcers are evaluated.

METHOD

Patients with hard-to-heal lower extremity ulcers were treated with HA-SA combined with NPWT (HA-SA-NWPT, n=11), or conventional therapy (n=14), between June 2014 and September 2015. Demographics, comorbidities, time to complete healing and change in wound area were recorded and compared.

RESULTS

A total of 25 patients took part. Complete healing was achieved in 63.6% (n=7) of the patients in the HA-SA with NPWT group, compared with 14.3% (n=2) of the patients in the conventional therapy group (p=0.017). The mean decrease in wound size was significantly higher in the HA-SA-NPWT group than in the conventional therapy group (73.8% versus 34.8%, respectively, p=0.029). Despite a shorter healing period in the HA-SA-NPWT group than in the conventional group, no statistically significant difference was found between groups for time to complete healing (37 days versus 55 days, respectively).

CONCLUSION

These results demonstrate that the combination of HA-SA-NPWT is a promising treatment for decreasing the healing time and increasing the success rate by their synergistic effect on wound healing in hard-to-heal lower extremity ulcers. However, further studies with a larger number of patients are needed to confirm the results.

Pilot study: immunohistochemistry expressions of vitamin D receptor associated with severity of disease in psoriasis patients

BACKGROUND

Psoriasis is a chronic inflammatory skin disorder characterized by keratinocyte hyperproliferation, differentiation abnormalities, and resistance to apoptosis. There are several factors that can affect psoriasis and vitamin D is one of the recently arisen. The role of vitamin D is mediated by vitamin D receptors (VDR) in target cells. VDR is a nuclear hormone that is involved in the antiproliferation and pro-differentiation pathways in keratinocytes. However, until now vitamin D/VDR signaling in psoriasis has not been fully understood.

METHODS

A cross-sectional study that involved 28 skin specimens from psoriasis patients to assess the immunohistochemistry expressions of VDR as well as their association with severity and duration of psoriasis. Statistical analyses were performed using Spearman's correlation coefficients, with P <0.05 was considered statistically significant.

RESULTS

In total, 28 specimens from psoriasis patients consisting of 60.7% women and 39.3% men, with mean age 41.28 ± 14.97 years, predominantly age group 46-55 years (25%), mean duration of disease 6.64 ± 4.26 years, and mean Psoriasis Area and Severity Index (PASI) score 19.23 ± 11.30. The immunohistochemistry expressions of VDR were predominantly strong (57.1%) and located in the basal layer (53.6%). There were a significant negative correlation between the expressions of VDR and PASI score (P <0.001, r = -0.719) and between the expressions of VDR and duration of disease in psoriasis (P = 0.020, r = -0.438).

CONCLUSION

VDR expressions and severity of psoriasis showed a strong significant negative correlation and also a moderate significant negative correlation between VDR expressions and duration of disease.

Spontaneous closure of an extensive postdebridement perineal wound in a newly diagnosed diabetic patient presenting with necrotizing fasciitis

Diabetes mellitus may present for the first time with necrotizing fasciitis. Early treatment of septic shock and immediate surgical debridement reduces mortality. A diverting loop colostomy prevents soiling of extensive postdebridement wound. Local wound care together with good glycemic and infection control leads to spontaneous wound closure.

The relationship between acne vulgaris and irritable bowel syndrome: A preliminary study

BACKGROUND

Irritable bowel syndrome (IBS) is a functional gastrointestinal disease characterized by chronic abdominal pain and changes in bowel movements without underlying organic pathology. Many skin diseases have been reported to be more common in individuals with functional bowel diseases.

AIMS

In this study, we aimed to investigate a possible relationship between acne vulgaris (AV) and IBS.

PATIENTS/METHODS

This prospective controlled study included patients with AV and healthy volunteers. All the subjects were evaluated in terms of the presence of IBS. The diagnosis of IBS was made based on the ROME IV diagnostic criteria. The clinical severity of AV was calculated using the global acne grading system (GAGS).

RESULTS

A total of 300 patients with acne vulgaris and 300 age and gender-matched healthy controls were included in the study. The majority of the patients were female (n = 175, 58.3%). The mean ages of the patients and controls were 20.22 ± 5.24 years and 20.49 ± 5.36 years, respectively. A total of 183 patients (61.0%) and 84 (28.0%) controls were diagnosed with IBS based on the Rome IV diagnostic criteria. The frequency of IBS was statistically significantly higher in the patient group than in the control group. (P = .001). There was also statistically significant relationship between the GAGS scores and IBS diagnosis (P = .001), abnormal stool form (P = .001), abdominal distention (P = .001), and feeling of incomplete evacuation (P = .001).

CONCLUSION

Our study showed that IBS is significantly more common in patients with AV than in healthy controls. Additionally, GAGS scores were higher in patients diagnosed with IBS. To the best of our knowledge, this is the first study focusing on the subject.

Lipid depletion enables permeation of Staphylococcus aureus bacteria through human stratum corneum

Atopic dermatitis (AD) is a chronic inflammatory disease that affects approximately 2-5% of adults worldwide. The pathogenesis of AD continues to be a well-debated point of conjecture, with numerous hypotheses having been proposed. AD conditions are associated with increased populations of Staphylococcus aureus and reduced skin lipids. In this study, we evaluate the ability of S. aureus to permeate across human stratum corneum (SC) exhibiting both normal and depleted lipid conditions consistent with AD. This permeation would enable bacteria to interact with underlying viable epidermal cells, which could serve as a trigger for inflammation and disease onset. Our results indicate that permeation of S. aureus through SC exhibiting normal lipid conditions is not statistically significant. However, bacteria can readily permeate through lipid depleted tissue over a 9-d period. These findings suggest that S. aureus may potentially act as the mechanistic cause, rather than merely the result of AD.

ABBREVIATIONS

AD: Atopic dermatitis; SC: Stratum Corneum; AMP: Antimicrobial peptide; DIW: Deionized water; PDMS: Polydimethylsiloxane; GFP: Green fluorescent protein; BHI: Brain heart infusion medium.

Clinical application of near infrared fiber optic spectroscopy for noninvasive bone assessment

Approaches for noninvasive bone quality assessment are of great clinical need, particularly in individuals that require close monitoring of disease progression. X-ray measurements are standard approaches to assess bone quality; however, they have several disadvantages. Here, a nonionizing approach for noninvasive assessment of the second metacarpal bone based on near infrared (NIR) spectroscopy was investigated. Transcutaneous bone signal detection was experimentally confirmed with cadaveric hand data, and Monte Carlo modeling further indicated that 50% of the measured signals arise from bone. Spectral data were collected via a NIR fiber optic from the bone of individuals with osteogenesis imperfecta, a disease marked by frequent bone fractures and fragility. Multiple significant correlations were found between spectral parameters related to water, protein and fat, and standard bone quality parameters obtained by X-ray measurements. The results from this preliminary study highlight the potential application of NIR spectroscopy for the noninvasive assessment of bone quality.

Releasing Burn-Induced Compartment Syndrome by Enzymatic Escharotomy-Debridement: A Case Study

Burn-induced compartment syndrome represents a serious and acute condition in deep circumferential burns of the extremities which, if left untreated, can cause severe complications. The surgical escharotomy that releases the high subdermal pressure is the therapeutic treatment of choice for burn-induced compartment syndrome. Guidelines for escharotomy indications and timing include pressure greater than 30 mm Hg and 6 Ps (Pain, Pallor, Paresthesia, Paralysis, Pulseless, and Poikilothermia). Nevertheless, despite the need for an early as possible pressure release, escharotomy is often delayed when a capable surgeon is not available, or if the indication is not completely clear to justify potential risks associated with surgical escharotomy. Early treatment of circumferential burns of the extremities with a Bromelain-based enzymatic agent NexoBrid® may represent a less traumatic and invasive procedure to reduce intra-compartmental pressure, replacing surgical escharotomy. This case study of 23 patients describes the variation of compartmental pressure in patients with circumferential burns of the extremities treated with NexoBrid® enzymatic escharotomy-debridement. All the patients were treated with NexoBrid® within 2 to 22 hours post-injury in our Burn Intensive Care Center. The excessive pressure recorded before treatment returned to normal below 30 mm Hg and an approximately 60% reduction of the compartmental pressure was observed in most cases within 1 hour from NXB application. On NexoBrid® removal after 4 hours complete debridement-escharotomy of the burns was achieved. Enzymatic escharotomy-debridement appears to be a useful and safe method to reduce postburn compartmental pressure. Additional randomized, well-controlled powered studies are needed to further support these results.

Therapeutic advances in wound healing

Wound healing is a complex physiological process that occurs in the human body involving the sequential activation of multiple cell types and signaling pathways in a coordinated manner. Chronic wounds and burns clearly decrease quality of life of the patients since they are associated with an increase in physical pain and socio-economical complications. Furthermore, incidence and prevalence of chronic wounds (unlike burns) have been increasing mainly due to population aging resulting in increased costs for national health systems. Thus, the development of new and more cost-effective technologies/therapies is not only of huge interest but also necessary to improve the long-term sustainability of national health systems. This review covers the current knowledge on recent technologies/therapies for skin regeneration, such as: wound dressings; skin substitutes; exogenous growth factor based therapy and systemic therapy; external tissue expanders; negative pressure; oxygen; shock wave, and photobiomodulation wound therapies. Associated benefits and risks as well as the clinical use and availability are all addressed for each therapy. Moreover, future trends in wound care including novel formulations using metallic nanoparticles and topical insulin are herein presented. These novel formulations have shown to be promising therapeutic options in the near future that may change the wound care paradigm.

Multistate analysis from cross-sectional and auxiliary samples

Epidemiological studies routinely involve cross-sectional sampling of a population comprised of individuals progressing through life history processes. We consider features of a cross-sectional sample in terms of the intensity functions of a progressive multistate disease process under stationarity assumptions. The limiting values of estimators for regression coefficients in naive logistic regression models are studied, and simulations confirm the key asymptotic results that are relevant in finite samples. We also consider the need for and the use of data from auxiliary samples, which enable one to fit the full multistate life history process. We conclude with an application to data from a national cross-sectional sample assessing marker effects on psoriatic arthritis among individuals with psoriasis.

Factors affecting postmusculoskeletal tumour surgery wound problem treatment with negative pressure wound therapy

The aim of the study is to investigate the risk factors identified in literature that have been associated with prolonged Negative Pressure Wound Therapy (NPWT). Our study included patients who developed local wound problems after bone or soft tissue sarcoma surgery with negative margin at our clinic between 2012 and 2018 and treated with NPWT. All patients were followed up of at least 6 months. Sex, albumin level, skin infiltration, type of wound problem, postoperative intensive care unit (ICU) requirement, and intraoperative blood loss were found to be influential factors on NPWT > 10 sessions. We conclude that treatment may be prolonged and the necessary precautions need to be taken in patients with an impaired preoperative nutritional condition, with intraoperative high amount of blood loss, and with long postoperative stays in the ICU as well as if the underlying cause for wound problem is an infection.

A Prospective, Multicenter, Single-Arm Clinical Trial for Treatment of Complex Diabetic Foot Ulcers with Deep Exposure Using Acellular Dermal Matrix

OBJECTIVE

This prospective, multicenter study evaluated the efficacy and safety of an acellular dermal matrix allograft, DermACELL (D-ADM; LifeNet Health, Virginia Beach, Virginia), in the treatment of large, complex diabetic foot ulcers (DFUs) that probed to tendon or bone.

METHODS

Inclusion criteria were Wagner grade 3 or 4 DFUs between 4 weeks and 1 year in duration. All participants received one application of D-ADM at baseline and could receive one additional application if wound healing arrested. Ulcers were assessed weekly for 16 weeks using a laser measuring device.

RESULTS

Sixty-one participants were enrolled, with an average wound area of 29.0 cm²; 59 of these ulcers showed exposed bone. The entire per-protocol population (n = 47) achieved 100% granulation. The mean time to 100% granulation was 4.0 weeks with an average of 1.2 applications of D-ADM. Mean percent wound area reduction was 80.3% at 16 weeks. Those DFUs 15 cm² or smaller were substantially more likely to close than DFUs larger than 29 cm² (P = .0008) over a 16-week duration. No complications were associated with the use of the studied matrix.

CONCLUSIONS

The D-ADM demonstrated the ability to rapidly reduce the size of large, complex DFUs with exposed bone. Some wounds did not completely heal by 16 weeks; however, the significant reduction in size suggests that these large, complex wounds may heal if given more time.

Coupled blue and red light-emitting diodes therapy efficacy in patients with rosacea: two case reports

Background

Rosacea is a common inflammatory skin condition affecting approximately 5% of the world population. Therapeutic approaches to rosacea are focused on symptom suppression by means of anti-inflammatory agents. More recently, photodynamic therapy, especially light-emitting diodes, has been introduced as a valid alternative to conventional therapy.

Case presentation

In the present work, we reported the efficacy and safety of light-emitting diodes therapy combining blue (480 nm) and red (650 nm) light for the treatment of two patients with papulopustular rosacea: a 22-year-old Caucasian woman and a 68-year-old Caucasian man.

Conclusions

This kind of treatment could represent an effective, safer, and well-tolerated approach for the treatment of such conditions.

The relationship between stress and vitiligo: Evaluating perceived stress and electronic medical record data

Vitiligo is a T-cell mediated skin disorder characterized by progressive loss of skin color. In individuals genetically predisposed to the disease, various triggers contribute to the initiation of vitiligo. Precipitating factors can stress the skin, leading to T-cell activation and recruitment. Though hereditary factors are implicated in the pathogenesis of vitiligo, it is unknown whether precipitating, stressful events play a role in vitiligo. To understand this, we utilized a validated perceived stress scale (PSS) to measure this parameter in vitiligo patients compared to persons without vitiligo. Additionally, we probed a clinical database, using a knowledge linking software called ROCKET, to gauge stress-related conditions in the vitiligo patient population. From a pool of patients in an existing database, a hundred individuals with vitiligo and twenty-five age- and sex-matched comparison group of individuals without vitiligo completed an online survey to quantify their levels of perceived stress. In parallel, patients described specifics of their disease condition, including the affected body sites, the extent, duration and activity of their vitiligo. Perceived stress was significantly higher among vitiligo individuals compared to those without vitiligo. ROCKET analyses suggested signs of metabolic-related disease (i.e., ‘stress’) preceding vitiligo development. No correlation was found between perceived stress and the stage or the extent of disease, suggesting that elevated stress may not be a consequence of pigment loss alone. The data provide further support for stress as a precipitating factor in vitiligo development.

Far infrared radiation induces changes in gut microbiota and activates GPCRs in mice

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Transient exposure of FIR induced compositional and temporal changes in gut microbiota of mice.

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FIR exposure stimulated growth of the gut beneficial bacteria.

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FIR exposure promoted growth of the gut SCFAs-producing bacteria.

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FIR treatment upregulated the expressions of the SCFAs-sensing G-protein coupled receptors in the intestinal mucous of the mice.

Far infrared radiation (FIR) has been widely used to treat chronic diseases and symptoms; however, the underlying mechanism remains unclear. As gut microbiota (GM) markedly impact the host’s physiology, making GM a potential target for the therapeutic evaluation of FIR. C57BL/6J mice were exposed to five times of 2 min-FIR exposure on the abdomen, with a two-hour interval of each exposure within one day. Fecal samples were collected on day one and day 25 after the FIR/control treatment, and the extracted fecal DNAs were evaluated using ERIC-PCR and 16S amplicon sequencing. Host’s G-protein coupled receptors (GPCR) were analyzed using qRT-PCR. FIR induced immediate changes in the GM composition. A prompt and significant (p < 0.05) reduction in the abundance of phylum Deferribacteres (comprised of several pathogens) was observed in the FIR-irradiated mice compared to the control group. Contrarily, FIR exposure induced beneficial genera such as Alistipes, Barnesiella, and Prevotella. The gut of FIR-irradiated mice was predominated by short-chain fatty acids (SCFAs) producers. Also, FIR stimulated the expression of SCFAs-sensing receptors, GPCR 41, 43, and 109 in the gut epithelial barrier. These findings provide the first-hand evidence in which the beneficial effects of FIR radiation might be partially through the modulation of GM.

Blue light-triggered optogenetic system for treating uveal melanoma

Uveal melanoma is the most common intraocular primary malignancy in adults and has been considered a fatal disease for decades. Optogenetics is an emerging technique that can control the activation of signaling components via irradiation with visible light. The clinical translation of optogenetics has been limited because of the need for surgical implantation of electrodes and relatively shallow tissue penetration. As visible light easily penetrates the eyes, we hypothesized that an optogenetics approach can be an effective treatment of uveal melanoma without surgery. In this study, we evaluated the feasibility of this strategy by using a genetically encoded optogenetic system based on reversible blue light-induced binding pairs between Fas-CIB1-EGFP and CRY2-mCherry-FADD. Subretinal injection of B16 cells was performed to create a uveal melanoma model. Plasmids pairs were co-transfected into B16 cells. We found that blue light irradiation dynamically controlled the translocation of FADD to Fas on the plasma membrane and induced the apoptosis of B16 cells transfected with the optogenetic nanosystem in vitro. Moreover, the blue light-controlled optogenetic nanosystem suppressed the growth of uveal melanoma in vivo by inducing apoptosis. These results suggest that light-controlled optogenetic therapy can be used as a potential novel therapeutic strategy for uveal melanoma.

Down syndrome, severe psoriasis, and increased risk for cardiovascular events

Down syndrome is a genetic disorder known to cause many complications with lifelong effects. Patients with Down syndrome are known to produce excess interferon gamma, a major culprit of psoriasis formation and severity. Both conditions increase patient risk for major cardiovascular events; however, a potential association between Down syndrome and severe psoriasis has not been well studied. This article discusses a patient with Down syndrome and worsening plaque psoriasis who died of an acute myocardial infarction.

A challenging case of pigmented Bowen's disease and differential diagnosis of pagetoid pigmented skin lesions

Differentiation of pagetoid cutaneous neoplasms can be very challenging on hematoxylin and eosin-stained sections.

We report a singular case of pigmented pagetoid Bowen’s disease showing transitional features between extramammary Paget’s disease and in situ squamous cell carcinoma.

Pathological Relationship between Intestinal Flora and Osteoarthritis and Intervention Mechanism of Chinese Medicine

Chinese medicine (CM) has a good clinical effect on osteoarthritis (OA), but the mechanism is not very clear. Evidence-based medicine researches have shown that intestinal flora plays a role in the pathogenesis and succession of OA. Intestinal flora affects the efficacy of CM, and CM can affect the balance of intestinal flora. This paper focuses on the relationship between intestinal flora, intestinal microenvironment, brain-gut axis, metabolic immunity and OA, and preliminarily expound the significance of intestinal flora in the pathogenesis of OA and the mechanism of CM intervention. The above discussion will be of great significance in the prevention and treatment of OA by CM from the perspective of intestinal flora.

Experimental and investigational drugs for the treatment of alpha-1 antitrypsin deficiency

Introduction: Alpha-1 antitrypsin deficiency (AATD) is most often associated with chronic lung disease, early onset emphysema, and liver disease. The standard of care in lung disease due to AATD is alpha-1 antitrypsin augmentation but there are several new and emerging treatment options under investigation for both lung and liver manifestations. Areas covered: We review therapeutic approaches to lung and liver disease in alpha-1 antitrypsin deficiency (AATD) and the agents in clinical development according to their mode of action. The focus is on products in clinical trials, but data from pre-clinical studies are described where relevant, particularly where progression to trials appears likely. Expert opinion: Clinical trials directed at lung and liver disease separately are now taking place. Multimodality treatment may be the future, but this could be limited by treatment costs. The next 5-10 years may reveal new guidance on when to use therapeutics for slowing disease progression with personalized treatment regimes coming to the forefront.

Social Status May Interfere in the Prognosis of Frontal Fibrosing Alopecia in Female Patients: An Observational Study

Introduction

Frontal fibrosing alopecia (FFA) is a cicatricial alopecia whose incidence has greatly increased worldwide over the last years. The main purpose of the study was to investigate the possible association of the social status of FFA patients with the prognosis of the disease.

Methods

A total of 100 female patients with FFA, monitored at Andreas Sygros Hospital, Athens, Greece, during the last 3 years, were recruited in this observational study. The age of the women ranged from 29 to 92 years with a mean age of 61.2 years (SD = 10.3); 97% of them were Greek, with skin type II and III.

Results

In total, 46% of the patients were intermediate graduates, and 42% had received tertiary education; 82% were married and 21% had 1 child. The duration of the disease ranged from 0.5 to 20 years with a mean duration of 5.2 years. In 53% of the women, the frontal hairline recession was <1 cm, in 26% it was 1-2 cm, and in 15% it was 3-4.99 cm. Overall, 55.6% of patients were professionals, 26% were technicians and associate professionals, 23% were office workers, 9% were service and sales workers, and 13% were at elementary occupations. The severity of the disease was higher in lower-educated patients, who belong to the category of unskilled or with elementary occupation.

Conclusions

Women with high educational level and social status are more likely to be diagnosed earlier, resulting in sufficient therapeutic response.

Trends and targets in antiviral phototherapy

Photodynamic therapy (PDT) is a well-established treatment option in the treatment of certain cancerous and pre-cancerous lesions. Though best-known for its application in tumor therapy, historically the photodynamic effect was first demonstrated against bacteria at the beginning of the 20^th century. Today, in light of spreading antibiotic resistance and the rise of new infections, this photodynamic inactivation (PDI) of microbes, such as bacteria, fungi, and viruses, is gaining considerable attention. This review focuses on the PDI of viruses as an alternative treatment in antiviral therapy, but also as a means of viral decontamination, covering mainly the literature of the last decade. The PDI of viruses shares the general action mechanism of photodynamic applications: the irradiation of a dye with light and the subsequent generation of reactive oxygen species (ROS) which are the effective phototoxic agents damaging virus targets by reacting with viral nucleic acids, lipids and proteins. Interestingly, a light-independent antiviral activity has also been found for some of these dyes. This review covers the compound classes employed in the PDI of viruses and their various areas of use. In the medical area, currently two fields stand out in which the PDI of viruses has found broader application: the purification of blood products and the treatment of human papilloma virus manifestations. However, the PDI of viruses has also found interest in such diverse areas as water and surface decontamination, and biosafety.

Evaluating and reducing xerosis in competitive swimmers: an in vitro study and randomized controlled clinical trial

INTRODUCTION

Xerosis is a common problem with significant sequelae in competitive swimmers, and it results from transepidermal water loss. This study evaluates moisture barriers for reducing xerosis in competitive swimmers.

METHODS

An artificial skin model was used to evaluate five products. Models were measured for changes in thickness and weight over 7 days. The optimal barrier was tested in a randomized controlled trial (RCT) of 20 swimmers. Skin moisture content was serially measured. Skin micrographs were scored in a blinded fashion.

RESULTS

The moisture barrier #1 treated skin model at day 7 maintained a mean thickness of 7.08 mm versus 2.38 mm for control (p = .0001). The mean weights of group 1 treated and control groups at day 7 were 40.1 and 8.65 g (p = .03). In the RCT, the group treated with moisture barrier #1 and the controls exhibited low moisture content and moderate xerosis scores at baseline. At week 3, moisture measurements for treated and control groups were 28.6% and 18.2% (p = .003). The mean xerosis scores for the treated and control groups were 8.5 and 12.9 (p = .0008).

CONCLUSIONS

Artificial skin preservation varied for five commercially available moisture barriers. Moisture barrier application improved moisture content and reduced xerosis in competitive swimmers.

Filaggrin and atopic march

There is an increasing number of experimental, genetic and clinical evidence of atopic dermatitis expression as a pre-condition for later development of other atopic diseases such as asthma, food allergy and allergic rhinitis. Atopic dermatitis is a heterogeneous, recurrent childhood disease, also present in the adult age. It is increasingly attributed to systemic features and is characterized by immunological and skin barrier integrity and function dysregulation. To maintain the protective function of the skin barrier, in particular the maintenance of pH, hydration and antimicrobial functions, the filaggrin, among others, plays a significant role. Filaggrin is a multifunctional, histidine-rich, insoluble protein. The lack of filaggrin is associated with various cutaneous (e.g. ichthyosis vulgaris, allergic contact dermatitis) and non-cutaneous (e.g. diabetes, inflammatory conditions of the gastrointestinal tract) diseases and may be a result of genetic, immunological factors combined with environmental factors. In this review we summarised (emphasized) recent findings in understanding the role of filaggrin in atopic dermatitis and other diseases, participants in the atopic march.

The Prevalence of Sensitive Skin

Sensitive skin has been described as unpleasant sensory responses to stimuli that should not provoke such sensations. Objectively measurable signs of irritation are not always present in individuals with sensitive skin, however, subjective sensory effects such as, itching, burning, stinging, tightness, and dryness, are consistently present. Given the subjective nature of the phenomenon known as sensitive skin, surveys have been a popular approach to evaluating the prevalence of this condition among the general population, and a number of them have been conducted worldwide. Overall, ~60–70% of women and 50–60% of men report having some degree of sensitive skin. However, there are differences between populations in various geographies, and perceptions of sensitive skin at specific anatomic sites. This article is a review of survey data on the prevalence of self-declared sensitive skin in various geographies, among different gender and age groups, and at various anatomic sites. In addition, we review the factors that may contribute to sensitive skin, and the physiological characteristics associated with this condition, including impaired barrier function and heightened neural reactions.

Role of endoscopic vacuum therapy in the management of gastrointestinal transmural defects

A gastrointestinal (GI) transmural defect is defined as total rupture of the GI wall, and these defects can be divided into three categories: perforations, leaks, and fistulas. Surgical management of these defects is usually challenging and may be associated with high morbidity and mortality rates. Recently, several novel endoscopic techniques have been developed, and endoscopy has become a first-line approach for therapy of these conditions. The use of endoscopic vacuum therapy (EVT) is increasing with favorable results. This technique involves endoscopic placement of a sponge connected to a nasogastric tube into the defect cavity or lumen. This promotes healing via five mechanisms, including macrodeformation, microdeformation, changes in perfusion, exudate control, and bacterial clearance, which is similar to the mechanisms in which skin wounds are treated with commonly employed wound vacuums. EVT can be used in the upper GI tract, small bowel, biliopancreatic regions, and lower GI tract, with variable success rates and a satisfactory safety profile. In this article, we review and discuss the mechanism of action, materials, techniques, efficacy, and safety of EVT in the management of patients with GI transmural defects.

Sensitive Skin in the Genital Area

When evaluating sensitive skin, it is common to focus on the face. However, it is becoming increasingly clear that individuals can have different perceptions about the degree of skin sensitivity at distinct anatomic sites. Structural variations in the skin of different body sites can contribute to differences in barrier function, which may contribute to differences in skin sensitivity. Potential triggering factors for skin sensitivity would be expected to vary by body site. For example, the face is exposed to all ambient environmental conditions in the course of daily life, and to several products (e.g., cosmetics for women) and practices (e.g., shaving for men) that may lead to adverse sensations associated with sensitive skin. In contrast, the skin of the genital area is protected from ambient environmental conditions. However, the genital area can be exposed to conditions of higher temperature, different habits and practices and moisture due to the semi-occlusive environment. For some individuals, additional challenges such as incontinence can provide triggering factors for skin sensitivity that effect only the genital area. This article reviews data on the perception of sensitive skin of the genital area, differences based on gender, age, racial differences, and the effects of incontinence on skin sensitivity. The effects of menopause are also considered with regards to sensitive skin perceptions and to emerging differences in biomolecular and physical measures of the urogenital skin.

Negative pressure wound therapy use in diabetic foot syndrome-from mechanisms of action to clinical practice

BACKGROUND

Diabetes and its complications constitute a rising medical challenge. Special attention should be given to diabetic foot syndrome (DFS) due to its high rate of associated amputation and mortality. Negative pressure wound therapy (NPWT) is a frequently used supportive modality in a diabetic foot with ulcerations (DFUs).

DESIGN

Here, we reviewed the current knowledge concerning the tissue and molecular mechanisms of NPWT action with an emphasis on diabetes research followed by a summary of clinical DFU studies and practice guidelines.

RESULTS

Negative pressure wound therapy action results in two types of tissue deformations-macrodeformation, such as wound contraction, and microdeformation occurring at microscopic level. Both of them stimulate a wound healing cascade including tissue granulation promotion, vessel proliferation, neoangiogenesis, epithelialization and excess extracellular fluid removal. On the molecular level, NPWT results in an alteration towards more pro-angiogenic and anti-inflammatory conditions. It increases expression of several key growth factors, including vascular endothelial growth factor and fibroblast growth factor 2, while expression of inflammatory cytokinesis reduced. The NPWT application also alters the presence and function of matrix metalloproteinases. Clinical studies in DFU patients showed a superiority of NPWT over standard therapy in terms of efficacy outcomes, primarily wound healing and amputation rate, without a rise in adverse events. International guidelines point to NPWT as an important adjuvant therapy in DFU whose use is expected to increase.

CONCLUSIONS

This current knowledge improves our understanding of NPWT action and its tailoring for application in diabetic patients. It may inform the development of new treatments for DFU.